Where to go with a bouncy kitty?

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Elizabeth B

Elizabeth B

Member Since 2017
As you can see from Hamilton's log, he has been steadily decreasing his lantus dose since changing over to a wet diet. His little pancreas is jumping back into the game. However, I'm getting some interesting reads where he'll have two or three good days at the new dose and then will see two days of a high preshot numbers and a big drop in glucose around +4.

I've read conflicting advice where one theory is to hold the dose and another theory is to reduce. I've been reducing, but let's be honest. I'm winging it here! I'm interested to hear some of your thoughts on his numbers.

Thank you!
 

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Are you doing SLGS? I think 90 on a human meter is about 135 on an alpha trak. Reductions/increases are based on the nadirs.
 
We did start with SLGS. We went over a month with a bad lantus pen, so we kept increasing the dose and getting nowhere. Finally, we switched to a new vial and his numbers went crazy. By some Christmas miracle we never dealt with hypo.

Ever since, we've been steadily decreasing his dose. I've been using 90 as my cutoff for nadir, but it finally hit me...what if that isn't for an AlphaTrak and I'm flirting with disaster!?

I made another post, but maybe it helps to repost it here. I find these guidelines everywhere but don't know if that is for a human glucometer or an AlphaTrak.

  • Not treated
    • blood glucose typically above 300 mg/dl, poor clinical signs
  • Treated but not regulated
    • often above 300 and rarely near 100, poor clinical signs
  • Regulated
    • generally below 300 with glucose nadir near 100, good clinical signs, no hypoglycemia
  • Well regulated
    • generally below 200-250 and often near 100, no hypoglycemia
  • Tightly regulated
    • generally below 150 and usually in the 60-120 range, no hypoglycemia, still receiving insulin
  • Normalized
    • 60-120 except perhaps directly after meals -- usually not receiving insulin
 
I think those are human meter readings. They say for human meters 120 is the top normal BG. For alpha track the normal range is about 72 to 175. Hamilton is doing well. When was he diagnosed and when did you start Lantus? (You should have a profile with this info.)
 
Ok. I added a signature and tried to use the information you used as I'm sure there is a guideline about that somewhere. I just can't find it. I'm not sure if you mean that by profile or not. We started lantus immediately, but like I said before, we had a bad pen. We started the new vial on 7/27 along with wet food and that is when I started the spreadsheet recommended by this board.
 
I don't usually give advice to newbies, but my Yum is an alpha trak cat. According to the SLGS protocol: you could do a .25 dose reduction since Hamilton has gone under AT2 135, which is my interpretation of 90. (I might get flamed for that.) 68 is the AT2 TR trigger for a reduction. Your .5 dose reduction is bigger than the recommended .25 increment. Since Lantus is a "depot" insulin, you might not yet be seeing the full impact of your dose reduction. Since it was a big reduction, since his numbers are great (mostly normal range), and since you are doing a lot of testing, you might wait at least a day to let the depot drain and to see the full effect of the new dose. However, you have been taking huge reductions with no bad results---so what do I know? Why did you go from 4 to 2.5? Because of the 98?

You are testing a lot. Why are you on SLGS instead of TR? Risk averse? That's okay.

You've read all the stickies at the top of the web page, right?
 
I've read the stickies about ten times over! I also have a tendency to overthink things a bit. I think I've got a little PTSD after the whole overdosing due to the bad lantus pen. So, risk averse is certainly a factor.

I've done pretty big reductions because I really felt his dose was entirely too high, so I wanted to reduce fast enough to let him level out, but still avoid unnecessary hyperglycemia. It's also a bit of know thy cat and what I felt his behavior indicated. This is why I'd say I'm somewhere between SLGS and tight regulation. I'm just making sure I have the skill set to pursue it. I'm scared to make a mistake.

I like your advice to hold for a day or so and see what his readings do. I have a hard time figuring out what's a bounce and what's a weird day and what to do with the data I collect! I do feel lucky that he's fairly consistent.
 
The best suggestion I can give you is to pick a dosing method. The "all over the place" method is really hard for you and even harder for us because we end up having to second guess what you're doing.

A couple of thoughts...
Hamilton isn't bouncing all that much. I'm not sure how long it's been since Hamilton was diagnosed. If it was at the end of July, an even more extreme range than what you're seeing is completely normal. Even after the drop to 98, you didn't see much of a spike in numbers. What you are seeing are very flat cycles.

Reducing the dose when you think there's bouncing going on doesn't work. We've seen lots of caregivers who have been told about Somogyi rebound. There has been published documentation that is very clear that Somogyi doesn't occur in cats that are on long-acting insulin (and there precious little research that indicate it exists in either humans or cats on any other type of insulin). In cats whose dose has been reduced, there is little if any improvement gained by reducing the dose.

Most of the higher numbers you're seeing are at pre-shot times. This makes complete sense. Those values are occurring at the end of the cycle when the insulin is wearing off. You'd expect higher numbers. Your then seeing lots of blue throughout the rest of the cycle. Ideally, you want the overall level of the cycle to come down so that initially, you have blues at pre-shot and more green throughout and ultimately, entirely green cycles.

 
Any chance you could put the spreadsheet link in your signature. The instructionon creating a spreadsheet, tell you how to put the link in your signature. That'll make it easier for people to open and look at the data and to help you.
MJW said:
According to the SLGS protocol: you could do a .25 dose reduction since Hamilton has gone under AT2 135, which is my interpretation of 90.
Click to expand...
The SLGS guidelines say to reduce if your kitty gets below 90. It does not say 135 on your AT. Unless you have tested your AT against a human meter and know that 90 human meter is 135 on your AT, it's better to just use 90. Individual meters read differently, though still within 20% of each other.

As Sienne says, if you pick either TR or SLGS, it makes life much easier. Then you'll know when to increase and when to decrease.
 
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