? 4/8 Hugo AMPS = 518. +6 = 303. PMPS 167. +2 = 389

Previous thread

He curved down to 300s last night and then we woke up to this. We're going up to 2.5 units tonight if there's no marked improvement, in line with the TR protocol. I don't think 2 units is enough.

If we give him too little for too long, cant he become resistant to it?

 

When possible, please advise.

@Wendy&Neko
@Bron and Sheba (GA)

 

Inceasing to 2.5 units is too much. Per TR, with nadirs under 200 (and you saw under 100), the increase is by 0.25 units. So 2.25 units would be the new dose.

There something called glucose toxicity, which means a cat gets used to high numbers after a period of time. However, Hugo is not stuck in high numbers, he has been seeing blues and greens. Which are the reason you are seeing the high numbers now due to the bounce. Bounces last up to six cycles, which isn't long enough for glucose toxicity to happen.

 

Nadirs under 100? When?

 

AMPS of April 6th - just look back two days. Nadirs are not always at the same time of the cycle. They are the lowest point of the cycle, whenever that happens. Nadirs are often later when they are breaking bounces, like he did the night of the 5th. A good question to ask when looking at increases is "how low can this dose take my cat".

 

I'm sorry, I'm very frustrated. I really don't understand these bounces. All I see are days and days of reds and now a black. This seems like more than a bounce, no?

 

Bounces are rather complicated, and each cat is different. My cat's worst bounce numbers were always three cycles after the low, most cat's show worse numbers earlier. And sometimes cats will do what we call a "high before the low", where they go up high before coming down and breaking the bounce. The good news is that Hugo should be getting over his bounce today or tomorrow the latest.

 

+6 = 303. Ketones were 0.4

 

I was just reading the Remarks on the spreadsheet (a good place for the latest ketones result), and I noticed you weren't sure about last night's shot. Did you feel liquid on his fur or smell Lantus? That would be another reason for a high number this AM.

 

I didn't. But his fur is so thick that sometimes I get really unsure if I got it or not, especially when he starts to get mad. But he went down in numbers to the 300s after, so I'm pretty sure I got it.

 

Hi Elle, I agree with Wendy that your next increase in dose should be up by 0.25 units to 2.25 units.
Lantus dosing is based on the lowest number the insulin takes the cat (nadir) and the lowest point can be anywhere in the cycle.. even the Preshot BG.

When giving the insulin, are you parting the fur so you can see where you give the shot? Also are you letting him eat something he likes as you shoot to distract him?

Hang in there. Great news ketones are still negative!

 

We do part the fur, of course. Hugo does not tolerate anyone touching him which he's eating.

 

Also, how do you draw up .25 on a shot? We have syringes with 1/2 unit markings.

 

Good question.
The 2.25 mark is half way between the 2 unit mark and the 2.5 unit mark. As long as you are drawing up the same amount each time, if you are off by a fraction, that is OK, as there is no mark for you to draw the insulin to.
I always found a magnifying glass useful with those doses.

 

PMPS 167.

Do we hold at 2 units or go up? I still want to go up but I dont want to send him bouncing again.

@Wendy&Neko
@Bron and Sheba (GA)

 

We held at 2 units. He tends to go low in the evening, and I didn't want to push it. We'll reevaluate tomorrow morning with what we get tonight.

 

Sorry I didn’t see this earlier. I think you made a good decision holding the dose as he’s coming off the bounce.
I’d give him some low carb snack at +1 and +2 when you test so that he doesn’t drop too much or too fast and bounce again.

 

How much would you give as a snack?

 

A couple of teaspoons

 

And I want like regular food low carb not no carb like a piece of chicken?

 

Patience is rewarded. Yes, regular LC.

 

Ok. But now I'm getting what looks like trace on the ketone strips. I'll try to get another ketone blood test tonight if I can.

 

You could probably increase by 0.25 units tomorrow morning, provided be doesn't go low tonight. Doing an increase on a cycle they are breaking the bounce can cause some downward momentum, so tonight might not have been a great time to increase.

 

+2 = 389. Ketones at 0.7. I am so sure I got his shot in. I dont know what's happening. I'm going to give him anything he will eat.

We're going up to 2.25 tomorrow.

 

He could be bouncing again. I’d feed him more food if the blood ketone level is creeping up a bit.

 

How could he still be bouncing? This is heartbreaking. I don't know why he's not eating. I dont know why his bg is so high. We've never had a problem with ketones until this past week.

I got him to eat about 1/4 can of food with a little water mixed in. I dont know what the use of testing his bg tonight would be.

Could he need a higher carb food? With more insulin?

 

No need to test anymore tonight. You will increase tomorrow and see if that helps.

Any chance there is an infection or inflammation going on? His teeth look OK?

 

Not according to his blood tests. His teeth look fine to me.