09/16 Ivana AMPS=250, +12.5=335, shot at +13.25, +2=385, +6=292, +11.5=274, PMPS=328, +2=290, +3=266

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Tara & Ivana (GA)

Tara & Ivana (GA)

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Yesterday's drama-filled post

For those following along from Ivana's first hypo incident last night, you'll be pleased to know all is well this morning and she's still letting me go near her ears and even purring.

I don't know what to do for this shot though, so will hold off until I get advise please. There was a suggestion to drop back to 1u, does that sound ok? I'll be home to monitor her all day today.

Thanks FDers!
 
I agree with Sienne's suggestion to drop the dose to 1.0U. Those 20's are very scary and you weren't at 1.5 u very long. If you find over time that she isn't holding the reduction, then you can increase back to 1.25U. Best to be safe. Be aware that due to the depot, you could still see some action the next few cycles. Or she may well bounce.
 
I'm so scared to give her anything! But I just tested again 30mins later to see if she's going up or down and she was 18.6. Just waiting for her to have some breakfast then will give 1.0u. How often do you think I need to test her this cycle?
 
Given that she's up to 335 now, I'm voting for the bounce scenario. I'd get a +2 to confirm, and if she's still going up, give her a break until PMPS. Hopefully getting a little insulin in her will ease the bounce some.
 
How much food should they eat before a shot? I think she ate more than normal last night with the carb food (and I forgot to remove her regular food so that got eaten through the night too) so she might not be as hungry as usual. She's nibbled at breakfast, but not eaten a substantial amount yet as she's a grazer. Is it safe to shoot 1.0 now?
 
Morning Bron. Yes she is still alive and kicking! I, on the other hand, feel like death warmed up after getting to bed at around 1.15am, up to test at 3am, then up again at 5.45am for the AMPS. Looking forward to a snooze today!
 
I'm not surprised you feel a bit seedy this morning
I found it hard to get to sleep last night....I think it was all the adrenalin still running around in the system.
So I am feeling a bit the same.....
 
I just read yesterday's condo. You, your DH, and Bron did really well. Congrats on the reduction although I'm sure you would have liked to earned earned with less drama!
 
Thanks :-) How great are the people on this board?! Couldn't have got through it alone. Never want that much drama again - are you listening Ivana?
 
Still going up at +2 of 385/21.4. I'm going to give her a rest from tests for a while, will try again at nadir which I think is around +7.
 
I'm just now getting online. I agree with the others that going to 1.0u is a fine decision for this point. It may end up not being enough, because it is a sizable reduction - so you'll want to watch and see what you get when the inevitable bounce that's starting now clears. My thought on going to 1.0u is that you had only just increased to 1.5u, so I'd blame at least some of the low numbers last night on the 1.25u dose, which is why I support the suggestion to drop to 1.0u initially. That and the fact that 20 is very low, and you had to work for quite a while to get her up over 50 and keep her there.

You did an awesome job handling things last night! So glad you had help from several folks! That is the beauty of FDMB - even halfway around the world someone can lend a hand when you need it.

When you have a bounce it overrides the normal lantus cycle - so I wouldn't worry about nadir today. I'd just grab one test mid-cycle and another at preshot until the bounce begins to clear. After hitting the 20's it's bound to be a "nice" bounce, lol. You know bounces can last up to 3 days, so she may be high for a while - or she may clear it sooner. No way to know for certain.

Did you translate all those numbers from last night into the US side of the ss? Thanks so much for doing that!!! It made it so easy to see exactly what was going on.

I hope you get some sleep today!

Just fyi - the quickest way to get dosing help from the many people who are willing to help is always going to be to put "DOSE HELP" in your subject line. It's totally fine to tag people, but there may have been folks who could've helped you who didn't know you needed it because they weren't tagged. Just an idea for the future. I really encourage people to use the subject line extensively. It's such a huge help.
 
Thanks for the detailed reply Julie. I'll just grab a mid-cycle then and not worry about nadir. As well as PMPS and +2 as usual. And will be prepared for strange numbers for a few days.
Yes I calculated the US numbers as I know that's what most people would look at.
Good tip about adding "Dose Help" to the subject line. I was way to stressed to even think of doing something like that! I could have also added the little 911 icon too I guess.




Now that I've had time to think about everything that happened, I've definitely learnt some lessons from the experience:
- That I should have done another test after the PMPS as it was lower than the +10, and not just assume that it's the Lantus dip (or whatever it's called, which I've seen in a sticky here about a dip right at the end of the cycle).
- That if I'm doing lots of testing during the AM cycle for a curve or whatever, to limit treats to ensure she's still hungry at dinner time and eats enough.
- That if there is a big drop like there was between PMPS and +2, not to wait 15mins to test again, but to give carb food/honey immediately.
- That I need to ensure my honey hasn't crystalised, or keep Karo instead (I was too stressed to even think that I could just take off the squeezy lid and scoop the honey out).
- That the FDMB crew are awesome.
And the most important thing I've learnt... - That just when you think you're getting the hang of things, diabetes likes to shake things up :-)

But I'm not going to dwell on the should'ves, I'm just going to learn from them. If there's anything else that I might have done differently, please let me know - I don't mind being told I've made a mistake so that I don't do it again next time. Although hopefully there isn't a next time!
 
My thinking (and I could certainly be wrong) - well, let me try to explain.

She'd had multiple cycles at 1.25u, but you had just increased her to 1.5u. It takes a few cycles for the depot to "grow" to equalize with the new larger dose. So while it *could* be the 1.5u that pushed her over the edge, it's just my gut feeling that for her to get into the 20's on one shot of 1.5u, that she would've dipped at least below 50 on the 1.25u if she'd gotten it last night instead of the 1.5u.

In other words, there is some immediate response from a newly increased dose, but there is also some delayed response because of the depot. You don't typically see the full effects of a dose increase when you give the first shot of an increase. The size of a depot is relative to the size of the dose, and the reason we hold a dose for several cycles after an increase is to allow the depot to re-equalize to the NEW larger dose. Then you can see what that dose can really do.

It's perfectly possible that the 1.5u is responsible for the lows, but I am skeptical that just 1 shot of the 1.5u would've sent her in the 20's unless the 1.25u also would have sent her into low numbers. That's why I agreed with Sienne's suggestion to decrease to 1.0u.

I'm not a vet, but that's what I'm thinking. The depot is a big player in using Lantus & Levemir - I didn't really understand its full ramifications when I began. You might want to look at the sticky that explains the depot to get a more full understanding of it. I especially like the link that's called "Lantus and Levemir, what's the difference?" because they really explain how the insulins work in the body.

Let me know if that doesn't make sense. Perhaps others will chime in as well.
 
Another possibility - absorption varies from one shot to another by as much as 50%. We've had more than one cat that seems to go low after getting subq fluids, which would raise the question about dehydration perhaps inhibiting the insulin's absorption. There have been conversations on here before about links between dehydration and blood sugar levels. Perhaps for some reason, Ivana was less dehydrated last night and the insulin absorbed better than normal. Or perhaps it absorbed better because the moon was full, or who knows.

In any case, you'll want to watch and see what she gets to when she clears the bounce, because ideally it's going to be a safe green number. If it's not, then you may have to increase the dose again to 1.25u and try it all again. Adjusting the dose is just part of the dance.
 
See if this helps you "visualize" the depot:

Think of the depot like a funnel .....as you pour into the top, it doesn't overflow because it's dribbling out the bottom....but if you pour too much or too fast, it will flow over the top...that's an "over-full depot"...as it spills over the top, it's adding to the "liquid" that's already been dribbling out the bottom

It's possible that at 1.25, the funnel was perfect but when you went to 1.5, it was just enough to cause the funnel to overflow
 
Thanks Chris. I wish I could see how full the funnel is, that would make it much easier! I will do more reading tomorrow once I've recovered from no sleep last night.

In other news, as yesterday was Ivana's curve day, I've sent her ss link to our vet along with the original article about TR and have said we want to start Ivana on that protocol and asked her thoughts. Hopefully we''ll have the vets support too.
 
Wow Tara, I've just read your previous post, that was certainly a trial by fire, but you did amazing, great that you had Bron and Julia on hand to keep you sane. I hope you don't ever get a repeat performance from Ivana but if you do, you have learned such a lot and it will be easier. Well done to you and your DH for coping so brilliantly. Hope you manage to catch up on some much needed sleep.
 
She's not eating her dinner (she is a grazer though, but didn't want to eat what we just served) - should we still give her the shot? Might she be feeling awful from her hypo last night still?

ETA: Looks like she was just a bit fussy - she opted for option 2 on the dinner menu :-) Not that she usually gets a choice!
 
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Hi Tara, I missed your first couple of days in the forum as I wasn't online much. I'm one of the other Aussies on here, so I'm likely to be awake at similar times to you.

I read last night's condo this morning. The first time you get hit with numbers like that is really scary, but it looks like you guys did well. @Bron and Sheba is amazing. She was a great support for me when I started here a couple of months ago.

It's great that you have your vet's support, it makes life so much easier. My vet and I don't see eye to eye on everything, and she was worried about me getting advice online, but we've managed to work something out.

It looks like Ivana is on a bounce after last night's shenanigans, so hopefully you can catch up on some sleep tonight without worrying about her. :)

About the depot, if the funnel image doesn't work for you, think of it like a rainwater tank. It can take a few cycles to fill it up, and as long as Ivana keeps using the insulin, it probably won't overflow. It also contains enough to keep influencing her numbers for a few days after you reduce a dose (like getting less rain but there's still water in the tank). Then something happens - higher dose, less food, ready to reduce the dose, random being a cat and therefore unpredictable, and you get the scary numbers from too much insulin (the tank overflows because you've had a storm, or you haven't used as much water for some reason).
But you should definitely read the sticky note about the depot to make sure you have it clear. In fact, read as many of the stickies as you can without your brain exploding. ;) You won't take everything in at first, but it will give you a good overview. Then you can go back and read specific stickies when you need information about something in particular.
 
Hi Carolyn, nice to meet you and Martian - what a handsome boy. I can see in your signature that he is on 0.1u - how the heck do you measure that? We're having enough trouble doing 0.25 unit measurements!

I never want a repeat of last night, but I guess now we've got our first hypo over and done with, we'll know what to do next time. Although hopefully there won't be a next time...

I'm still worrying tonight though, because her +2 was lower than her PMPS, so I'm going to stay up for a bit longer to get a +3 just to make sure she's not being tricky. And then I shall sleep very well tonight I think, got a lot of zed's to catch up on!

I read every sticky when I first joined, and I admit most of it went over my head. I find I have to keep going back to re-read stuff, or sometimes forget I even read it in the first place. I've got a lot of them printed out too, which is helpful.
 
There's something in one of the notes somewhere about measuring 0.1U. Basically, squeeze the plunger in as far as you can, insert the syringe into the vial and release the plunger; it should suck in a few drops of insulin. My problem then is making sure Martian sits still for his shot so I can make sure every last little drop goes in.

You had particularly scary hypo numbers. The lowest Martian has gone (so far) is 2.4. As part of TR you do need to let Ivana drop below 2.8 occasionally, to earn her reductions. But hopefully you can keep her from going too low, too soon. Keep testing, build up your data, and sooner than you believe possible you will get a feel for Ivana's patterns, when and how much you should feed her, and you'll get more confident in managing her.

And always remember: she is a cat, and cats like to be unpredictable. Even the most experienced people on here receive feline surprises on a regular basis. So never think you did something wrong. You love your girl, and you are doing the best you can to look after her.
 
Thanks Anne!

Carolyn you're right, I know we didn't do anything wrong, but there are definitely things I would do better next time. That said, onwards and upwards! We're still working out Ivana's patterns but that's just a time thing. Hopefully that won't stop us from doing TR in the meantime.
 
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