What am I doing wrong? (Hercules thread 3)

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Hercule's mum

Hercule's mum

Member Since 2020
previous thread: https://www.felinediabetes.com/FDMB/threads/hercules-new-bouncing-thread.234490/#post-2631286

@Critter Mom
@Elizabeth and Bertie
@Deb & Wink
@JanetNJ

Why does his Bg just does not behave in a precicatble/expectable way. I keep thinking there must be something to do with his food pattern, or food type? Does anyone have a suggestion?

His BG rarely decreases much in the first 4 hours. Despite increasing his dose a lot in the last month, we just barely touch blues or greens. He continues to bounce a lot (does it ever stop)? and he keep getting these low values pre-shot? why?

I have been recording timing and amount of food, but in summary I aim to do 150 g per cycle, divide in 3 portios (PS, +2 and +4). I assumed that was what we were suppose to do, to match when insulin is peaking. But the BG seems to mostly follow his food, and not the as much the expected insulin work, if you see what I mean?
 
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I'm awfully sorry but I can't suggest anything. I've never used Prozinc and I really don't understand how it works to even be able to hazard a guess. :(

I hope you get some helpful replies soon.


Mogs
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Hi Sienne - I thought I was using the SLGS approach? But if you spot some wrong interpretation of my application, I'll be grateful for some advice. Perhaps it looks like a sliding scale because I am using U100 and end up changing by 0.2 instead of 0.25?

Mogs - I saw on another thread that your fur baby giving you some worries.... Hope she feels better soon!
 
Today's low pre-shot looks like it was from him clearing a bounce. That green yesterday set it off. Technically he earned a reduction from that 76 (4.2).
You're increasing in .10 increments (I imagine due to you using U-40 needles?) and sometimes you're holding the dose for a long time (you kept that .70 for almost ten days) and other times quickly that (.90 for only two day).

I think it'd be helpful to look over the sticky Sienne linked you to - SLGS has you increasing every 7 days, MPM every 3. Either method will help you to keep from holding the dose too long (and encouraging glucose toxicity) and having you wait long enough to give the dose a chance to work. Some cats need a few days for the dose to adjust well for them.

It also looks like Herc nadirs a little on the late side; I don't think you're doing anything wrong with feeding, and I mean you're seeing a few blues and greens, so you're doing something right! But a lot of times bouncy cats do just need time to not be so bouncy ... other times they really just need to switch to a depot which keeps the BG low and flat, with little bouncing. I think you'd be pleased with switching to Lantus, but I think that goes for most cats in general.
 
Thanks panic. I have been wondering if he would do better in a different insulin. If the pandemic ever gets sorted, I would be away from home the whole day. I thought I read somewhere that depot enzymes are not so good for owners that stay away for very long?

I see that it looks I stay too long sometimes, and it is due to the lack of confidence plus the bouncing.... In retrospect I probably stayed on 0.7 for too long. After 7 days I got paranoid that perhaps the insulin has lost its potency (was getting a bit over 2 months), so I started using a new one and took a few days to convince myself that it was really the dose.
It seems like every time I change the dose there is a "response", with lower BG numbers; but that usually disappears after a few days. I am having trouble separating the response to the new dose, from the bouncing....

I wasn't sure what to do with that 4.2 yesterday.... we have been stuck on only yellow and pinks for days as you noticed, and the day I changed to a 1Unit and hit green, I worried about immediatly reducing again back to the rut....

I will read some more about depot insulins, but do you reckon I should reduce the dose from tomorrow morning?

Many thanks for the help!
 
The depot insulin (specifically Lantus, not sure if Levemir is as picky but I imagine so) craves consistency. It likes the same dose AM and PM and it likes to be as exact to 12 hrs apart as possible. There is a 15 minute window you'd want to stick to (so if you do shots at 10, try to stay between 9:45 and 10:15, no more no less) OR 30 minutes early/late every 24 hrs. The reason for this is the way the depot works, if you give earlier than that it's like giving more than full dose; if less, it's like reducing the dose. One cycle affects another. If you're good about the 15 minute window though there's not really anything to be concerned about. Some people here work 12 hr shifts and use Lantus. Lantus brings down the numbers and keeps them there. A cat can't really bounce if the numbers aren't moving much. :p

One thing someone told me, when I was also concerned about bouncing vs waiting for the dose to work ... they said if the numbers go up and then back down (to say yellows or pinks) and stay there, the dose isn't high enough. Reds and blacks are usually the bouncing numbers. If you're sitting in pinks and yellows you're usually just not giving enough juice.

As for the reduction tomorrow - that is up to which protocol you want to follow. SLGS = 7 day wait, reductions below 90. MPM = 3 day wait, reductions below 50. You're testing enough for MPM and I don't believe you're feeding dry so if you want to move a little faster and give Herc a chance to hang in better numbers longer, you might want to consider MPM. You could also "modify" one a bit ... say you'd be fine doing MPM but are not comfortable letting him drop under 50 ... you could make your own reduction number at say, 70, or 80.
 
Thanks Elizabeth! Super helpful. I will officially switch to MPM protocol. I dont want to jinx myself, but I think I can handle low numbers better these days, so a 50 threshold should be ok....

However, can I ask? Intuitively it seems like a bright green number somewhere close to a nadir, makes sense to interpret as "dose is too high, reducing BG too much". But if it is at an oddball point, for example at AMPS, should i take it to have the same meaning? specially when his numbers are all over the place?

most of the time I would say his nadir is around +6, but then there are these weid cycles, where Bg doesn't come down until +10 or +12. That is why I tought it was more due to the food than the action of insulin.... but perhaps prozinc is acting differently on him?
 
Sometimes Prozinc lasts longer than 12 hours. I had it happen to me once, got a 42 at AMPS. Scared the daylights out of me haha! I was basically just told that it happens sometimes, though I can't say I have reasoning behind it. Maybe @Deb & Wink could shed some light on it?

Food would be burning up the insulin though, not encouraging BG to stay low. I would go ahead and add another meal or two in there to steer the drop a little more. Might help!
 
A bright green BG number, those "neon green" colors on the SS, can happen anytime during the cycle. That would be a BG < 2.7 mmol/L on a human meter (<3.8 mmol/L on a pet meter) or <68 pet meter mg/dL, <50 human meter).

They always mean you need to pay attention, and bring the BG levels back up to a safer level with some food.
The tree green BG levels are where you want to see your cat. It gives the pancreas a rest, and allows it to heal and perhaps start producing more insulin on it's own.

Why does the occasional nadir happen at +10 or +11? No idea really. Because your cat is being a cat.
 
Thanks @Panic and @Deb & Wink . I hear what you are saying... but something is weird.... low values right before shots seem to be happening too often, don't you think?
Look at today's cycle. There seemed to have been an actual nadir at about +6, and then back down again.... PMPS was 11.1 and because I am so tired, I decide to stall and check again before shooting, because I couldn't handle another PJ party.... 45 minutes later BG got lower: 10.5... Decided to give half a dose, but I am truly confused :confused:
 
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Some cats get a "double dip". By that I mean they have a nadir at around +5 to +7, and then another nadir later in the 12 hour dosing cycle sometimes.

Is Hercules eating differently these days? At what times does he eat?
Different foods?

p.s. SS is missing dates for the last few rows of data.
 
He has been eating the same brand of wet cat (Feringa) food since transition after diagnosis. 3 different flavours, but I haven't see any relationship between meat type and BG behaviour. They are all less than 3% carb.
I have been changing his schedule around a bit, initially he was fed after every test as his treat. Then I gave him food a bit late in the cycle if I panicked with lower values. The last week or so, I started being as rigid as I can with his food schedule, to try and sort it out what is goin on. So with few exceptions he has been fed at shooting time, +2 and +4.

I filled in the dates! thanks!
 
So... today it was looking good, but it seems he went for a big bounce towards the end of the day?

I am attempting to follow the MPM method, so can i double check I'm doing this right? It has been 5 days since he has gone on a dose of 1U. However 2 of these days I felt unable to give the full dose. Using the 8 cycles, I would says his nadir is between a 100 and 200 (no consistent greens...), so I should increase to 1.2 (U100 syringes make 0.25 increaes difficult)?
 
Hercules can definitely have some HUGE bounces! Case in point, 13/09/20 ( or 9/13/20 for us US folks). He went from the greens all the way up to black BG ranges in 5 hours.

You've certainly given the Prozinc SLGS method plenty of time to see what it dose for Hercs. So yes, give MPM a try.

You don't have to wait so long to change the dose, 10 cycles, that you did.

The decision point (also called the shoot/no-shoot BG) pre-shot BG for Prozinc is 8.3 mmol/L (150 mg/dL).
That is your "stop and think" BG number. It's where you pause and consider your next step, stall and retest without food in 20 minutes, reduced dose (token dose) or skip the shot entirely.

Your reduction point with MPM is lower, 2.7 mmol/L (50 mg/dL) but you don't have to get there all at once. You can take smaller incremental reduction points. I'm listing these in mg/dL format. For instance, drop from 90 to 80 to 70 to 60, as you gather more data and understand better how Hercules reacts to a particular dose.

Yes, it's difficult to measure smaller dose changes. The key is to be as consistent as you can. Trying to draw up the same amount in the syringe each time, weather that is a U100 syringe or a U40 syringe. Calipers can help. There is a thread on using calipers in the Health Links/FAQS forum.
 
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