06/03/20 Apple AMPS 281 +5 360 - Inconsistent Results

Previous post: http://www.felinediabetes.com/FDMB/...1-higher-dose-yielding-higher-numbers.227918/

We're on a real rollercoaster ride. Having held the 2.25 for 18 cycles, we expected a consistent decline, but we are getting the opposite. We don't know what to do. We know for a fact food isn't affecting the numbers - we feed the other rescues hard food in a locked room.
If there is an admin around to take a look at his numbers and give us some advice, that would be greatly appreciated.

-Avery

 

I'm confused. From your signature, you're following TR. That being the case, you evaluate the dose after 3 days/6 cycles if the nadirs are primarily over 200 and hold the dose for 5 days/10 cycles if nadirs are under 200. Apple's nadirs look to be mostly over 200. If you've been holding the dose for 18 cycles, I'm not sure why you were doing so.

Right now, you're seeing a bounce. Apple bounced off of the greens on 6/1. It can take roughly 3 days for a bounce to clear.

 

So what do you suggest we do, raise the dosage another .25 after 3 days?

 

Because of the unfortunate "reset" in dose, Apple has developed some glucose toxicity. That means you'll have to increase possible further to break through that. Typically we hold doses that show some green for 10 cycles total. Go ahead and increase now. The only issue with a bounce is that you don't want to increase on the same cycle as the bounce is breaking.

 

Wendy said exactly what I would have suggested.

 

Just to clarify, the reset was a bad idea? We'll increase his dosage this evening...how soon should we get back to you to see how that is working?

 

Yes, there was no reason to reset. You have been doing a good job testing, increasing in safe amounts and with enough data to know how low the dose was taking Apple, so he was not overdose. All it accomplished was 5 weeks without any greens. There is also a danger with resetting, and that is the possibility of ketones developing. I have seen more than a couple cats get very sick by following some bad advice to reset.

As for checking in, give in six cycles if you don't see any greens, 10 if you do, unless he goes low and earns a reduction of course. Good luck with the new dose.

 

Is this a dangerous situation and can it be overcome with increased dosage?

 

As long as you are testing regularly for ketones, and they've been negative, you are fine. And yes, increasing insulin is how you get over glucose toxicty.

 

The term, "glucose toxicity" sounds awful. All it means is that your cat is treating those higher numbers as her new "normal."

 

[QUOTE="As for checking in, give in six cycles if you don't see any greens, 10 if you do, unless he goes low and earns a reduction of course. Good luck with the new dose.[/QUOTE]
He did end up getting greens in the 70s, but my grandmother gave him gravy to "keep the numbers" in that range. Was this a good decision?

-Avery

 

70's are safe. I personally would have gone with a couple tsps of regular low carb food to help keep Apple surfing. Extra carbs after nadir, when the insulin is naturally starting to wear off, can reduce duration and cause numbers to shoot up at the end of the cycle.

 

O.k. so what would you consider Apple's nadir? The greens occurred at +4,5,6,7. Next time no extra carbs. Thanks for the reply

 

And just to clarify at what number would you give extra carbs so he doesn't slip into a danger zone?

 

The nadir can vary by cycle, though some cats are consistent - mine wasn't. I would give extra carbs if below 50 on the human meter.

 

Definitely a startling #, but if that's the norm we'll let it go down next time.

 

If you take a look at Apple's string of greens last night, till this morning, it didn't shoot up. I tested him every 40 minutes and slept in between. I couldn't stay awake to watch him so I did give him a measuring tsp of FF gravy at each interval. We won't give him a shot this morning if he's still in the 90's. Is he up for a reduction? Thanks

 

I'm not sure why you didn't shoot this morning. 90's is perfectly safe to shoot, especially for someone with as much data as you have. I guess you will get to sleep today. And no reduction, he has to go below 50 to earn one.

It was a lovely cycle last night.

 

+4 at 376, now I wish I would've shot. I imagine there will be horrendous numbers today and bouncing for days and Apple ends up the guinea pig. It wasn't sleeping today, it was fear of a sign or the largest increase he's ever had resulting in a hypo, it's my fault for just not going with it. Thanks for the response, I'm disappointed, but can't change what has been done no matter how much I wish it different.

 

Think of it as a learning experience. Tonight is another cycle.

 

Thank you for reading my rant...and for the reply that didn't include anything alarming