? 15 Oct | Girlie | AMPS 653; +4=HI; PMPS 662; +2=664; +4=502 Confused re: dose increase, TR, bounces

Condo: http://www.felinediabetes.com/FDMB/...s-194-2-263-pmps-544-2-571-what-to-do.185385/

Cycle 8 @ 0.25 and I'm concerned as she's back in high blacks again. The lowest I've seen so far is 194 @AMPS yesterday (before the enema at home). It looks to me like she might need a dose increase, or does that one blue number at her AMPS and some yellows yesterday mean that I should still hold this for a little while longer to see if this is a new bounce to high black numbers in reaction to the enema yesterday?

This is her 9th cycle on really high numbers (mostly black). I don't want to hold this dose at such high black numbers on TR, but I'm starting to confuse myself about TR and dose increases, and how to determine whether this is a really long bounce that I should wait out, a second bounce, or...? Any help would be appreciated!

Checking daily for ketones; all negative so far.

 

Was reading another post and came across this link re: Myths debunked, so now I'm even more confused and wondering whether I should have already increased Girlie's dose:

"For example:

Phase 2: Increasing the dose

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl. (emphasis mine).
What this says is:

Nadirs under 200: hold doses for 5-7 days. Why? Day 1 & 2 - may see higher numbers due to "New Dose Wonkiness," Day 3 - this would probably be the day to see a lower nadir, if there is going to be one, Day 4-6 could be bouncing. If good numbers don't return, increase the dose. Use your own data to determine how long to wait before deciding the good numbers won't be returning.

Nadirs over 200: who cares if there is bouncing, cat needs more insulin, increase after 2-3 days."


I know I confused things somewhat after the vet visit on 10 Oct by giving her two 0.10 BCS reductions (mea culpa!), but she was already at 504 for her PMPS before I gave the 0.1, so she was already climbing the high numbers ladder...and then determinedly clinging to the top until yesterday's AMPS blue 194. I just can't think straight...I am so confused!

 

Further on, at post #17, I just read this (so I'm more uncertain now than ever...):

"One other note:

Every high number is not a bounce! Numbers go down, numbers go up. Often I see people comment that their cat is bouncing, when really they are just seeing the natural rise at the end of the cycle or a food spike. Other times I see people whose cats are stuck (really stuck) in a high pattern who think it's a bounce. If your cat has been in pretty good numbers for a while, then suddenly loses regulation, don't hold the dose, get the regulation back! If they are used to good numbers, it is much, much easier to get the good numbers back if you do it quickly."

 

Hey there! Looking at the SS, she needs an increase. Her lowest number is 83 and that was 10 cycles ago. She has seen blues before so we need to get her back into green numbers. So, if she were my kitty, I would take her back up to .75 the next cycle and monitor like you have been doing. After they see a green number and bounce upwards, you only want to give it 3 days or 6 cycles to let the bounce clear so you know whether to hold the dose, or to increase.

The protocol is a bit confusing as written........ but, I would increase the next cycle unless she pops you another green this cycle then hold.

 

Unless girlie surprises you and hits green, I would take the dose back up.

Since she dropped below300, i wouñdtake her up by 0.25u to 0.5u
@Bobbie And Bubba

 

Oh yes! Thanks Gill, typo! Yes, take her back to .50 unit.

ETA: I am tired and signing off after this boo- boo.

 

Night night.

 

Night Night Gill, glad you had my back.

 

I wasn't checking up on you you posted just as I was going to post, tbh I wondered if I'd missed something, it's 1am here, I should be asleep too.

 

A+4 = HI, so yeah, she's going up to 0.5 tonight; I wish I had put her up to 0.5 this morning, but I wasn't sure if I should still wear the patience pants.

This is what I find so confusing. She hit her first high black number @PMPS on 10 October. Could the two 0.1 doses have drained the depot enough to account for her continuing spike up to and hold at high numbers? I'm just trying to understand this so that the next time this happens, I feel comfortable knowing whether I should wait the bounces out or not.

Things are always easier in hindsight, I know, but in the future, if I see the numbers I saw from 10 - 13 Oct again, I wonder whether it would be good to increase even if it is a bounce. I'm a bit stuck now, of course, because I'll increase tonight, but I can't monitor closely for the next few days - I can only monitor up to +2 tomorrow, for example - so this is going to be tricky if she decides to dive.

I wish I had more of a clear understanding of when patience pants are needed and when to increase even if it is through a bounce, especially if you can monitor closely following the increase.

In that other sticky, where Libby and Lucy wrote "Nadirs over 200: who cares if there is bouncing, cat needs more insulin, increase after 2-3 days:": is there a time when this wouldn't be good to follow?

 

Thanks so much, Gill, and @Bobbie And Bubba

Just out of curiosity, do you think I should have increased this morning when I saw how high her AMPS was this morning and that she'd gone back to high blacks last night?

 

Hard to say. She is so sensitive. With Gizmo it would take him 8 cycles to see the full benefit of an increase but I can't see that type of pattern with Girlie and then there is the injection and poo issue and you drained the depot with the short shot. I think I would have given it another cycle too. Try and be patient as hard as that is.

 

Thanks, Lizzie. She seemed to really hit her stride and comfort level with the blue and greens (mostly blues) for 11 days, and then the bottom fell out.

Everything seemed to come together after the vet visit and all of the tests there, and then the constipation. She's no longer constipated, though, and still climbing the ladder... It's hard figuring this all out and understanding what influences what: did she need a dose increase? Could the vet visit and blood/urine tests there have caused that high and long a bounce (or not bounce but need for dose increase)? Same with the constipation? And could the depot have drained that quickly after just two cycles?

There is so much I don't know and don't feel confident acting on because I don't know it!

And then there's the added stress of this week coming up, where close monitoring will be sporadic, at best, and that not til later in the week...sigh...sigh...

Sometimes it's hard to have a diabetic cat! I'm trying to decide whether I can be away from her for 10 days at the end of December, with her having to stay at the vet's, or whether I should make it 9, instead: one less day with mom, but one less day for Girlie to have to be at the vet's. Because flying from Australia to the US takes 24 hours, if I'm away for 9 days, I have effectively five days to visit - weird, I know. Sigh again... It's just one of those hard days for us, I think...

 

And then there is the cat factor . I would just follow the protocol as close as you are comfortable with given this:

There are too many variables (as is often the case), some (most?) that you can't control. You are doing the best you can. Don't beat yourself up. How is Girlie feeling?

 

Sorry for complaining, and thanks for understanding! Girlie is ok; she isn't very happy when she's in high numbers, especially the really high black numbers, unfortunately. I hope the dose increase will help her turn things around, though.

 

Didn't take it a complaining - just concern, which is understandable.

Tine to work the juice Girlie

 

Thanks, Christie. She has a couple of hours to go until the PM shot, then we'll see!

 

Is flying your mom to Australia to see you an option?

Sorry for your hard day.

 

No, she's 82 and has Alzheimer's and can't go anywhere unattended; she's been in assisted living for a year now.

Thanks so much for your kind thoughts!

 

Solid high black all day: increased dose to 0.5 in PM

AMPS: 653
+2= 682
+4= HI
+9= 650
PMPS 662

 

I've just been re-reading Tilly's Diabetes Homepage (which I believe is Dr Roomp of Roomp and Rand Management of Diabetic Cats is that right?). She mentions giving 500 mg of taurine/day as a supplement. Is this something that others are doing, and if so, what brand/what form/how?

Thanks!

 

PM+2 = 664 after dose increase to 0.5

Here's hoping she doesn't stay too much longer in those high numbers.

 

Ate entire can of FF Savoury Salmon by +4, probably because she's dropped 162 points in the last two hours.
@Gill & George I've been adding extra water to her and my civvie Max's food - found the right amount and they're both eating it all up, so thanks for that suggestion!

PMPS 662
Dose increase to 0.5
PM+2 = 664
PM+4 = 502

 

Sorry you're frustrated. I hope Girlie comes down for you. As far as your trip as long as you have confidence in your vet she'll be fine. She may not like it all that much but she'll be safe. Our kitties are very resilient and a stay at the vets isn't that horrible. I'm sure the vet techs will give Girlie scritches and attention.