Very late nadir

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Charliemeow

Charliemeow

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I did a curve yesterday and found charlie's nadir was at his pmps. Does this mean something?

Amps:427, 4u
+2: 382
+4: 355 (food at +5)
+6: 325
+8: 345 (food at +9)
skipped +10 since he had risen between the +6 and +8 tests.
pmps: 298, 4u

Any thoughts? Ever seen this before? Thanks!! I cross-posted in pzi, too.
 
How much does Charlie weigh? (or would he weigh when healthy)

Edited to add: If he's eating a lot relative to his actual needs, perhaps it takes longer to clear any excess, so the nadir might come later.

Are you feeding only on a schedule?

Edited to add: I've observed some folks intentionally feeding on a specific schedule in order to manage the curve
 
14 lbs.- his ideal weight for his size. He is fed 1/2 can of 9 lives 5 times a day on a schedule because he is a Hoover. He may or may not be acro. He has some of the common symptoms: snoring, was overweight until he went on a diet, slight heart murmur, big, male, over 9 years old. He has not been tested for it yet. Good teeth, no infections.
 
OK a late nadir has absolutely nothing to do with feeding or the weight of an animal, not sure how someone would think those details would factor into the picture.

My Oliver is a very late nadir, and I know this for a fact because I have data on his BG all along his cycles.
A spreadsheet with only ps testing doesn't help to determine a cat's nadir.
You can look at his ss to see how his numbers curve. When a person does curves and tests at different points on cycles, the cat's nadir can be found and a late nadir at ps is much different from a regular mid cycle nadir.

If I get a 150 for Oliver at ps, I'll shoot. If I get a 150 for Shadoe at ps, I will not shoot.
I know from my gathered data that Oliver will likely begin to rise until +3 or 4 or later and he will be at his lowest much closer to ps, which is the reason why I like to get his +10 or 11 - when I get his ps and it's lower than his +11, he is still dropping and I may wait and test again in 15min if I want to see him start to rise.

I don't bother getting any +10 numbers for Shadoe because I know she's rising. Save a strip.

All of this info was learned by testing mid cycle. Their nadirs are what they are and not based on weight or food. My cats eat the same foods and both could afford to lose a bit of poundage.

Oliver's nadir has always been late, ever since he was adopted last March and he arrived skin and bones.

You may want to consider having him tested in the future for insulin resistance because he's got some of the signs. I don't know about other acros, but there are a few with late nadirs.

Now, I am using Levemir for my cats, but both were on Lantus before. I can't really comment on curves for PZI as I had thought that Lantus/Lev were longer lasting insulins.

Some cats have double dips so maybe that's what you saw on this last curve?
Maybe try to get a couple more curves - I usually do on weekends - and compare to see if they all look to be lower just before ps.
 
Claudia --

I'm responding here to your PM. As I mentioned in my note, I'm not a PZI user so please consider my thoughts in light of that limitation.

One factor you may not be considering -- the nadir is not a fixed point. It can move from cycle to cycle or day to day. There are certainly days where you have a mid-cycle nadir. Other days, you are seeing a nadir that is later in the cycle. Gayle's Oliver is one of those kitties who typically has a late nadir. It can be hard to wrap your head around what that looks like. Essentially, move the numbers on your SS 6 hours in one direction. What that means is that the higher numbers are around the middle of the cycle and the low points are at shot time. For insulins such as PZI where you adjust the dose based on pre-shot values, this is probably more than a little bit confusing when it comes to deciding on a dose. If you start to see a consistent pattern of late nadir, I'd ask for some PZI users to lend a hand. (Dosing with Lantus and Levemir may be approached very different in this situation.)

I also agree with Gayle that getting some spot checks in during the PM cycle will give you more information about not only where the nadir is but where some of the high pre-shot numbers are possibly coming from. Many cats experience lower numbers during the PM cycle. It's possible that Charlie is experiencing lower numbers at night and bounces into the pinks or higher at AMPS. If you are basing your dose on that bounce, you may be giving more insulin than is really necessary which could then set up another bounce. Even if all you get is a before bed test, that may give you some insight into whether the PM cycle looks very much the same as the AM.

From my Lantus-brain, the shifting of doses from 6.0 to 3.0 to 4.5 to 3.0 will yield wonky numbers. I honestly don't know if this is the case with PZI.
 
i would say that pzi does not give a 'double dip' and that charlie has a sputtering pancrease that has only recently been brought back to life and is sputtering on it's own schedule. cludia this is again, sorry, a time for a lot of testing as you never really know when mr. p will show itself. often a pancrease will sputter after food...sometimes after a romp...and sometimes, just becuase.
no matter the insulin used this would be the case.
it is sometimes, often, the beginning of the healing process.
 
Odd cycles like that have happened to me - they are frustrating. You can try to capture that happening again in future cycles and see if it is more an aberration or something consistent.

Late nadirs with PZI are usually interpreted as sign of perhaps too much insulin that cycle. But I'm not saying that you should back off n your dose - just that's the first thing that pops into my head when I hear "late nadir."

Also this might be a sign of the pancreas just trying to do some work after the +9 big meal and a fairly flat curve the rest of the day? You can read what Sue wrote about the P test at the end here:
viewtopic.php?p=328315#p328315
So actually feeding can affect BG values and on day with fairly flat curve - who knows the extra influence of the relative larger meals Charlie is getting [out of necessity - Charlie is a hoover kitty]? And I think weight has been an issue with Charlie in the past. BJ is right to ask about feeding - unfortunately AFAIK this cat has to have it's feeding limited.

I agree with Sienne that the nadir is not something fixed - especially with ProZinc in my experience.

It looks like you are tying your hand at some consistent dosing so I think it is just one of those things you kind of tough out or just write up to confused_cat . And as long as the nadir is not something too low then I think you are fine. If you were doing some sort of variable/scale dosing then this would be a more frustrating ending to a cycle. But with the consistent dosing you are doing then you just hope to capture some of that drop this cycle for the next.
 
Thanks everyone for your thoughts. After Xmas I'll get another curve. I tested +2 this evening before his bedtime meal and it was pmps:354, +2:384. I'm a very light sleeper, so it's very hard for me to get back to sleep after those midnight tests. And I desperately need my sleep!! Maybe tomorrow night I can get a later test since we'll be up late getting ready for Santa. I hope Lori is right about a sputtering p. Although if he's acro, then that's a given. Maybe it was just a crazy cycle like gator suggested. I guess it'll just take more testing.

Thanks again!!! Charlie and I really appreciate your help!!
 
I will crosspost my response in PZI as well. I don't see a sputtering pancreas. I do see a couple startling signs:

Odd drops and resistance building.

What I see is possible IAA. Here's a SS for you to look at and see if you see familiarity. This cat is on Lantus so keep in mind the action of the insulin is going to be different from PZI, but you can see in the early days where there was not enough insulin, and as the dose started to get higher, the odd drops started. http://spreadsheets.google.com/pub?key= ... utput=html

The reason I say possible IAA and am not (at this time) focusing solely on acro is the odd drops. IAA is known for that. You get the insulin to the point that it finally overwhelms the resistance, and either reduce or hold, and the IAA picks up strength again. If this turns out to be IAA, you will need to be very aggressive. The good news is, if it's IAA, it's a temporary condition, as long as you are consistently aggressive. If it's acro, you will need to be "cautiously aggressive" which means give lots of insulin to overwhelm THAT resistance, but also avoid green cycles. Read the sticky that Patti posted about high dose conditions to familiarize yourself with the difference between the two. Not all acro's are very high dose, so it's possible, but I feel if Charlie was an acro... or I should say.. to feel more inclined to push that acro test.. we wouldn't have seen that drop on the 9th. I do think you need those tests, but I am also keenly aware this is a terrible time of year to be budgeting, and that finances may not be available for it. I do also think you need a change in insulin. No one need suggest I am attacking PZI users because I am a former PZI user myself. I just think PZI is doing no good for Charlie or you right now.
 
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