1/21/20 Apple AMPS 77 +6 417 +9 428 - Help!

Previous post: http://www.felinediabetes.com/FDMB/...76-numbers-going-back-up.224481/#post-2511669

Apple didn't get a shot this morning due to the very low number. Is it normal for numbers to be this high afterwards? We're really at a loss because the numbers haven't been this high in a long time.

-Avery

 

Just my thoughts....hopefully someone else will be along shortly to give their thoughts/advice.
There's no overnight data beyond PMPS from last night's cycle. It's hard to say what happened w/o the data. Her AMPS this morning was 77...so did she go lower than 77 during PMPS. Or was that 77 a "double dip"(second nadir). She could be bouncing with a combination of the depot depleting(from the N/S this morning) giving you the #s you're seeing now. Just my thoughts. I'll put it out there...I'm usually wrong

Eta: Ooops...huge mistake...Apple is a boy. My apologies. I should've said him instead of her.

 

Right, I noted on the comments in the spreadsheet we were running out of strips, so this is all we have. We're focused on today's numbers.
Thanks for replying

 

To me, those numbers just show how important the insulin is to Apple. I know the low AMPS would give you pause, but I would expect the numbers to rise a lot. Maybe not that much (hoping the depot would help some), but it's not too surprising
Now I bet you are ready to give the PM shot!

 

We're almost counting the minutes for that PM shot, especially after the +9. We also wanted to make sure that not shooting at a 77 was correct, everything you've read flies out of your head and you just hope it's right

 

I make sure to double check numbers that seem off pattern too. I got a (87) this morning on a small blood sample and a (286) with a large sample when I rechecked it. I don't know much about the relion meter but mine in a little picky about nice, round blood samples.
Hope Apple does well with her PM shot !

 

What you're seeing is a bounce. You have no idea how low numbers went during yesterday's PM cycle. Given the speed of the rise today, I suspect Apple went fairly low and the numbers rocketed up. Combine the rapidly rising numbers with a skipped shot and, well, you see the results.

One thing I'd urge you to start thinking about. With TR, the goal is to "shoot low to stay low." You've been using TR since October so you're not really new at this. It's time you started to consider how low you're comfortable shooting. Ideally, you will work your way down to shooting any number above 50. It looks like you've shot as low as 114. What is the next lowest number you'd be comfortable shooting?

 

Well that's the question. For me it depends on his numbers following up to the preshot, for instance if he was giving us higher numbers, then lowered to 100 for a preshot, I'd shoot, but if he was lower beforehand I wouldn't. What is the rule of thumb, or is it relative to the cat?

Another thing to note, we didn't know what we were doing for a long time. We haven't *really* been following TR for that long and people's advice and our experience has changed the way we deal with his numbers.

-Avery

 

First another question -- is your name Avery or Caren?

For me, if the numbers prior to pre-shot were, for example, 200 and then dropped to 150, I would likely stall and see if numbers continued to drop or if they were heading up within the next 30 min. If you're still feeling like a novice, shooting a dropping number can lead to an "exciting" time of lots of testing and lots of HC. This isn't always the case and I've shot lots of dropping numbers but I had a LOT of data. (I'm a little confused by your description so if you were saying the same thing about not shooting a dropping number, my apologies.)

I think you've done well with lowering your shot threshold. You've shot in the low 100s which is great. I just urge people to keep their experience and observations about how their kitty has responded to shooting progressively lower numbers in mind so you're prepared for the next low number.

 

This is Caren's grandson, Avery. I do the testing and give the shots. We both answer these questions, but when I do I sign off with my name.
I apologize, I did write that backwards and was trying to say what you said here. How much of a jump within that 30 min threshold would be enough to reevaluate shooting?

-Avery

 

Thank you! I was so confused by the names!!

I wish there was a hard and fast rule regarding when to shoot. In some cases, it's helpful to test in 15 min and if numbers haven't come up enough, stall for another 15 min, and then decide. A lot depends on your comfort level as to how low you're willing to shoot (hence my earlier comments), how fast numbers are rising, if someone will be home to monitor, etc. To gauge if numbers are rising, you would want the tests to be more than the 20% difference that is attributable to meter variance. The other factor is what does your test data tell you. Looking at the days when you shot a 114 and a 120, Apple had lovely cycles. There's no guarantee that every cycle will look like those and numbers won't drop, but it does give you a sense of how Apple responds to your shooting lower numbers.

 

Okay, will keep that in mind for next time. There are so many variables that it's impossible to know exactly what to do, so we appreciate all of your advice. And another thing that we've wondered is when to increase the dose under these circumstances? We've held it for 15 cycles at this point. I guess it will depend on tonight's/tomorrow's numbers at least, but this seems like a very long time to hold it. We get greens and then it spirals out of control...

-Avery

 

With TR, you evaluate the dose every 3 days/6 cycles. If nadirs are largely below 200, you hold the dose for 5 days/10 cycles. If Apple's numbers are not in norm range (50 - 120), you want to give serious consideration to increasing the dose. In part, you evaluate the increase based on how low a given dose drops the numbers.

At the moment, Apple is clearing a bounce. I would hold off on increasing the dose until the bounce has cleared.

 

We thought so, but as always need reassurance. Is the bounce cleared when he picks up a couple of greens again?

 

Either back to greens or roughly in the numbers you were seeing prior to the skipped shot.

 

Thank you for the clarification and thank you for all the time you've spent discussing Apple with us today, it is greatly appreciated.