4/4 Gracie 40 AMPS No Shot Given

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=10953 Saturday


Good Morning and Happy Easter All!

This morning is a strange 40. We got a loverly 139 at bed time last night, after starving all day... We had some foamy vomit again about 4:30 this morning even with the midnight snack...) And we start the day with this basement number, rechecked both ears.

Gave her her regular food, which she slurped up like a hoover vacuum cleaner. No shot given. I will recheck in another hour. (shaking head) If this is "Bouncing", you can keep it! I thought things were going so well yesterday.

Hope everyone has good luck at the Easter Egg Hunt. Lots of Blues & Greens.

 

Happy Easter and hope Gracie has a good day I would be having a heart attack if I saw a 40 with Do Lou right now but then I cannot get him down out of pink

 

Good thinking this morning. A 40 is not a shootable number. However, there was the possibility of stalling (i.e., not feeding and re-testing in 15 min. intervals to see if Gracie's numbers are coming up). For future reference, there are three options when you have a low pre-shot number:

• Do not feed and stall for 15 min. then re-test. Repeat this until numbers are surfing in a shootable range or are rising.
• Shoot a reduced, big chicken sh*t (BCS) dose.
• Skip the shot.

Each of these options has an effect on the shed and/or your schedule and these issues need to be factored in.

I'm wondering if you need to find a dose that you can shoot consistently? I'm checking to see if we can get a few others to take a look at Gracie's SS and offer some input. I think one of the reasons Gracie's numbers are jumping around is you don't have a consistent dose (so you get wonky numbers and have to adjust the dose).

 

Hi,
I'm just going to echo what Sienne said and put in an even stronger pitch for consistency. If you think about it, Gracie hasn't been on Lantus very long, and there are a lot of different doses in her history! Since Lantus is a medication that works best at a regular and consistent dose, every time you skip a shot or give 1/3 the dose or something like that, you throw things off for a while. That's not to say those decisions are always avoidable, but to the extent you can avoid them, you should aim to do that and work within a plan.

I know when I first started, I had to read and reread all the stickies in this forum. Maybe refreshing yourself would help you feel more confident and also know when to come here for advice about dose changes? A lot of people here can really help with that with the goal of hitting on the right pattern for Gracie.

 

In looking at SS I think you can rule out 1.5u as Gracie's dose for now.
1.5u has been leaving you with days of having to shoot a reduced dose and skipped shots. That would indicate a reduction should be considered.

I see you started out with 1u and on 3/25 game plan went to 1.5u. As you probably already know, with a SS like Gracie's, we like to raise in 0.25u increments.

As a cat gets better, a dose that wasn't necessarily working a few weeks ago, could work beautifully now. We tend to think past history on the SS means "well, I already tried that and it didn't work." Not the case -- we have to stay open-minded and listen to what the cat is saying each day.

You might consider trying the 1u again. Tonight may not be the time to reduce to 1u -- Gracie may bounce to the moon from the 40. If she does you might shoot 1.25u tonight -- totally depends on what she does today. If the 1u doesn't do the trick then you can go to 1.25u -- IMO, I think the 1u will do nicely for Gracie -- it will help even things out which feels much better to a cat's body.

I think you will be delightfully surprised once you can shoot a consistent dose.

 

hi michelle. ditto to what d has said. finding a dose you can shoot consistently will give gracie better coverage than having her too low for you to shoot comfortably.
what do you think about d's plan?

 

I agree with the others, reducing to 1 unit sounds like a good plan that should leave you with numbers you're comfortable shooting a consistent dose.

 

Phew! There's a PS number that makes hometesting an easy sell!

Have to agree with the others.. I notice in your SS that a specialist recommended the 1.5U increase.. I'm sure they have the best at heart.. but there was some significant action a few days before hand on 1U (78 PS!!).. probably because you cut out the high carb munchies (which is effectively a dose increase by itself because Gracies insulin needs go down).

 

Gracie :shock:
Good luck with the consistent dose & shots.. just what Lantus needs to work.. I bet you will be seeing wonderful #s soon :mrgreen:

 

Hey All-

Thanks for the encouragement.

Had been thinking of going back to the 1 unit and have decided on that. She did bounce into the pinks later in the afternoon but came back down to yellow PMPS. She actually spent most of the day out in the living room watching the birds outside and interacting with DBF and the other Heathens. I gave her the 1 unit and she has only dropped 20 points in 2 hours. I will check again before bed and try to see if I can catch the nadir.

As some of you have pointed out, she hasn't been on Lantus for long-She was only diagnosed on March 10, and I'm sure there is a breaking in period for us humans too... I understand that consistancy is key, but it is difficult to be dosing consistantly with her numbers all over the place. In the begining, I would try to prevent a Hypoglycemic episode before it even thought about starting, now I am letting it ride a bit longer. The other issue is that she was showing signs of hypoglycemia (disorientation, discoordination, confusion) the evening she tested 88 at + 3. At the 40 this morning, she was fine. Just very, very hungry.

I know a few human diabetics-some Type I and some Type 2. They all tell me to relax; that management is a lifelong art form and that even after a lifetime (for some) of testing and treating, they still manage to make a mistake once in a while.

So, I will continue to remind myself to breathe, accept the numbers thrown at Gracie and deal with them to the best of our ability.

Just to confirm...

With the Lantus, the shot is based on the pre-meal/pre-shot number and the nadir, right? So you shoot the PS number in anticipation of achieving a specific window in the nadir? So a PS # of 190-270 and/or avereage nadir of 90-180, you would shoot the regular amount with no change. If the pre-shot number range is 190-270 and the nadir averages between 54-72, keep the same dose (no change) and if the next pre-shot is 190, reduce the dose by .5?

Do I have this right?

Thanks-

 

Well..... Not really.

The issue of whether to raise or lower a dose is based solely upon the nadir. We get pre-shot tests for the purpose of safety. The pre-shot value does not dictate the decision over whether to change the regular dose. A BG value of less than 50 earns a dose reduction in a newly diagnosed cat. I'm not sure where you have found the ranges for PS values and their relationship to nadir. If you haven't looked at it already, this is the Tight Regulation Protocol that we use for dosing guidelines.

You're right in that whatever the AMPS/PMPS is not the number you are shooting. You are shooting the nadir value. The difficulty is that you neither the PS or the nadir is completely predictable. You need to have done data collection in order to know how Gracie, or any cat for that matter, responds to Lantus to know what is a safe number to shoot, when the onset of Lantus is, where the nadir is likely to be (because it's not a fixed point), and when the effect of the insulin is waning. Some cats are prone to steep drops and big bounces; others seem to routinely have relatively flat curves.

Just to give an example. You were absolutely right to not give a shot with Gracie having an AMPS of 40. You don't yet have the data when it comes to shooting low numbers. On the other hand, if you look at Jake's condo (Bo and Jake) from today, Bo shot an AMPS of 30. Jake is a long term diabetic and Bo has tons of data. (I don't know that I would be comfortable shooting that low of a number.)

In looking at your SS notes from today, you probably didn't need to feed HC at +3. There was no insulin on board and no danger of numbers dropping. What it does look like is that Gracie's numbers were pretty darn good for going 24 hours without insulin. I also wouldn't worry about bounces. This is very normal for this stage in the process. It's simply Gracie's liver responding to what it thinks are low numbers. Her body isn't used to having numbers in the normal range so the liver dumps stored glucose into the bloodstream in response. As Gracie gets used to being in lower numbers the bouncing should subside.

I hope I haven't completely confused you!