? 5/21 Tuxie AMPS 538 +2-448 +3-324 +5.5-207; +7-155; +9- 281 One step forward 2 steps back

[Tuxedo Mom]

ALPHA TRAK 2 PET METER

Yesterday:

http://www.felinediabetes.com/FDMB/...326-pmps-409-coming-down-and-going-up.138143/

Increased dose by .25 units this morning. It seems that everytime it looks like Tuxie is starting to get to better numbers or reaches a point where he actually gets a reduction, he shoots back up and goes into the yucky numbers. Some of it may be bouncing, but with the amount of monitoring I do, I don't see him hitting low numbers that would cause that on an on-going basis. I really don't think he is getting proper duration with the Levemir. His vet has suggested trying a different insulin. Lantus did not work well when he first started on insulin and I would be worried about the sting it can give with the higher doses. Getting so frustrated after 6 months with no real progress toward getting his glucose into a controlled range. These high numbers HAVE to be playing havoc with his body.

Any suggestion for a different insulin to try. I am in Canada.

 

[tiffmaxee]

He got to green on this dose and then too low. Hopefully this time it wont happen until he has time at this dose. Max is known to not hold reductions so I know how frustrating it is. When he starts to approach green I'd feed a little mc perhaps to see if you can keep him surfing and not dropping too low. Good luck. No advice on insulin.

 

[Wendy&Neko]

I find that I get better duration if the dose is high enough to get a lot of green. A phrase used here in the past was BIPO (big insulin poop out). It's usually caused by too low a dose. Of course it looks like it's hard to find a dose where Tuxie will spend time in normal numbers and not earn reductions.

Elise's suggestion about feeding when he gets green is a good one. If you look at the Where Can I Find post, at the bottom of the list is one called "Feeding the Curve, Tashie", Jill makes some good suggestions about food. The basic idea is to feed a little bit of higher carb food to try to prevent those reduction and hopefully get Tuxie to level out and spend more time in green - thereby reducing those darned bounces. When they drop fast, they bounce more. And when they drop fast, they sometimes get reductions due to the downward momentum that they wouldn't get in a more gentle curve. Another option, some kitties benefit from increasing the carbs in their food to a higher low carb, maybe 8%. Of course, trying food changes means experimenting and it can take a while to see the effects of those changes.

 

[Tuxedo Mom]

Thanks for the replies. Since I am using an AT meter a nice low blue would sit just fine with me. But I would really like to avoid the high AM and PM preshot numbers. I feed him a little bit of his regular home-made 3% food (or salmon, chicken, beef) after each test, so he gets a lot of "snack meals" rather than larger meals. If I see him dropping a lot then I will give a bit of 8%, if he drops too fast then either the 18% or 30% depending on how fast or how low he goes.

I wonder if I should feed MC food when it looks like he is going to drop into the blues...like today where he decided to surprise me. Almost 400 drop from AMPS to +7 reading! As you can see I test pretty often so I am not usually caught off guard with sudden drops. The only time it could happen is in the 5 hours after his last night test and morning test.....when I actually sleep I would rather have a flat yellow for a bit to get his body used to it and then get more aggressive about going into the blues. Does that make sense??

 

[Meya14]

I'm using levemir as well, and I noticed with Max that if I hold the dose for a couple cycles after the "earned" reduction it helps to keep the numbers in the green. If he goes into the 40s then I reduce at the next dose, if he is 50-60 then I hold a little bit until his numbers look a little better. Instead of reducing at the first numbers you see in this range, you can wait until 3 times it drops to 50-60.

I don't think you are having a duration problem. Levemir has a hard time beating down those high numbers, so often there is a "breakthrough" dose that you hold for a little bit and then end up reducing. I think what you are seeing is glucose toxicity and it takes a little time in the greens to break this cycle. Its clear that his body is using the insulin as his curves are not flat. I would not change insulin at this point, as you would have to start from scratch and that for sure would not help the glucose toxicity, as well as puts him at risk for complications (dehydration, DKA)

Of course, monitor BS levels closely.

Also, what is your feeding schedule like?

Edit: Above numbers are for human meters, adjust accordingly since you are AT. Just FYI, when I was using alphatrak, I was having accuracy problems with this meter's readings. They were way off the allowed % on the same drop of blood. This meter doesn't have to meet the same FDA requirements as human meters so that concerned me.

 

[tiffmaxee]

For Max flat cycles lead to active cycles. I was able to get him better controlled using the mc at low blue. I would try to keep tuxedo from earning reductions and it will take experimenting to figure out what that means for him. The more Max got used to being in blue and green, the lower the carb percent he needed to keep him surfing. I would rush for higher carbs when I saw the low 50's (human meter ). Max is very carb sensitive.

 

[Meya14]

I also did the same thing when my Max was just starting to break the high numbers, we fed wet food at shot time, and a handful of dry food in the middle of the day to keep him flatter. Gradually reduced both the insulin and the dry food once he was more stable.

 

[Tuxedo Mom]

I'm using levemir as well, and I noticed with Max that if I hold the dose for a couple cycles after the "earned" reduction it helps to keep the numbers in the green. If he goes into the 40s then I reduce at the next dose, if he is 50-60 then I hold a little bit until his numbers look a little better. Instead of reducing at the first numbers you see in this range, you can wait until 3 times it drops to 50-60.

I don't think you are having a duration problem. Levemir has a hard time beating down those high numbers, so often there is a "breakthrough" dose that you hold for a little bit and then end up reducing. I think what you are seeing is glucose toxicity and it takes a little time in the greens to break this cycle. Its clear that his body is using the insulin as his curves are not flat. I would not change insulin at this point, as you would have to start from scratch and that for sure would not help the glucose toxicity, as well as puts him at risk for complications (dehydration, DKA)

Of course, monitor BS levels closely.

Also, what is your feeding schedule like?

Edit: Above numbers are for human meters, adjust accordingly since you are AT. Just FYI, when I was using alphatrak, I was having accuracy problems with this meter's readings. They were way off the allowed % on the same drop of blood. This meter doesn't have to meet the same FDA requirements as human meters so that concerned me.

I still wonder about duration, since Levemir duration in humans can vary quite a bit. That is why some people have to use split dose with Levemir and others have to use 2X daily like our kitties do. When Tuxie started 6 months ago he basically stayed in the red and black zone, so he has improved since then. It is just frustrating to see okay numbers (for him) and then spike up in many of his preshots., especially when my (over) testing does not show any extremely low numbers that could cause a bounce.

Tuxie is on a series of mini.meals. He is a vacuum cleaner when it comes to food. I basically give him 8 mini-meals based around test times. I only give a teeny bit when it is close to the 2 hours before shot time. Snacks consist of chicken, roast, salmon, bone broth etc..all home cooked.

I actually did a comparison between the AT2 and Freestyle Lite meters...both made by the same company. The differences in readings were consistently around 35% lower on the FS meter. I can use the FS lite strips in my AT2 meter and the readings are accurate, since I compared a LOT of tests before I ran out of AT strips. I think at this point I am just so used to dealing with AT readings that I prefer to use the AT rather than the FS. It is hard enough for me to "rethink" my mmol/l to mg/l when reading the literature here.

And yes I test...A LOT !! Thank goodness Tuxie is food motivated. He views his tests as a "pre-feed"

 

[Tuxedo Mom]

For Max flat cycles lead to active cycles. I was able to get him better controlled using the mc at low blue. I would try to keep tuxedo from earning reductions and it will take experimenting to figure out what that means for him. The more Max got used to being in blue and green, the lower the carb percent he needed to keep him surfing. I would rush for higher carbs when I saw the low 50's (human meter ). Max is very carb sensitive.

When Tuxie hit the greens a few times and I used HC 38%, it really didn't push his numbers up very far. Unfortunately when Tuxie decides to have an active cycle his nadir will come later than his "normal" +6-+8, so I am never really sure what he is going to do. One of the low greens (on AT) he hit was at +10 when his numbers are usually rising. All I know, is that I cant count on Tuxie being consistent.

 

[Tuxedo Mom]

I also did the same thing when my Max was just starting to break the high numbers, we fed wet food at shot time, and a handful of dry food in the middle of the day to keep him flatter. Gradually reduced both the insulin and the dry food once he was more stable.

Tuxie has never eaten dry food. His sister was a dry food fanatic and was really hard to transition to home-made food, but Tuxie always ate wet. I could leave a bowl of dry out and he would be "starving" and never touch it.

 

[Meya14]

The other thing that you could consider doing is adding a tiny bit of R to help beat down the PS highs. Of course, you'll probably have to reduce the lev, and I don't know if you can get R where you are at. This would require strict monitoring.

There are some HC wet foods, I believe the science diet foods are all very high carb for wet foods.

 

[tiffmaxee]

I don't use lev mostly because of the late nadirs which often hit as late as pre-shot. I'd like the freedom of not needing to test as much if that happened with Max but not having to be up in the wee hours of the morning. So if his nadir is late that should mean a surf or gradual rise up after that. Of course ECID.

 

[Tuxedo Mom]

The other thing that you could consider doing is adding a tiny bit of R to help beat down the PS highs. Of course, you'll probably have to reduce the lev, and I don't know if you can get R where you are at. This would require strict monitoring.

There are some HC wet foods, I believe the science diet foods are all very high carb for wet foods.

That is something that I have considered. In Canada we don't need prescriptions for insulin, but I am still very nervous about attempting that, even though I do monitor a lot.

I have some Friskie indoor with gravy that is 32%. Most of the time I will try MC 18% if he seems to be falling too fast. Of course sometimes he just does a big drop out of the blue, even though his earlier numbers don't predict it.

 

[Tuxedo Mom]

I don't use lev mostly because of the late nadirs which often hit as late as pre-shot. I'd like the freedom of not needing to test as much if that happened with Max but not having to be up in the wee hours of the morning. So if his nadir is late that should mean a surf or gradual rise up after that. Of course ECID.

Up until recently Tuxie's nadir was between +6 to +8. That is what I had always counted on. His AM test and shot is at 4AM so by 10AM I felt pretty confident about where he was heading. Tuxie however has decided to mix things up a bit and do later nadirs from time to time..just to keep me guessing

 

[Wendy&Neko]

As far as Neko is concerned, the nadir is the low point of any given cycle, not something to become predictable. On Levemir, she's done it anywhere from +5 to +15 that I've spotted.

Another kitties SS you might want to look at is Sheba. She is on Levemir, higher dose, on a raw food diet, and loves the drops and bounces. Bron has been working hard to feed when she drops and just recently switched from adding HC canned, to adding a drop of honey to raw. Bron does a great job commenting on the SS when she feeds and adds honey. Take a look at the progress she's made in the last week. And this is on a human glucometer. When I refer to Tuxie in green, I mean the AlphaTrak equivalent.

 

[Meya14]

Once Max gets those wonderful low numbers to shoot on, I have no nadir, as the insulin last well into next shot time. This is why I love levemir. Max's BS is flat in fact, his BS hardly budges from 70-80 even if he gets into the dry food. It just takes a while to get there with lev.

 

[Tuxedo Mom]

Another kitties SS you might want to look at is Sheba.

Thanks for pointing this out. It is very interesting to see a spreadsheet that looks similar to Tuxie's with the highs and lows. If I didn't know better I would have thought this was Tuxie's sheet ...except for the last bit where the numbers have stabilized much better. And it even has the world mmol/l Very interesting reading!!!

 

[Tuxedo Mom]

Once Max gets those wonderful low numbers to shoot on, I have no nadir, as the insulin last well into next shot time. This is why I love levemir. Max's BS is flat in fact, his BS hardly budges from 70-80 even if he gets into the dry food. It just takes a while to get there with lev.

That is exactly what I would like to see...a nice flat cycle with numbers in a nice safe range.

 

[julie & punkin (ga)]

One of the things that seems to be typical is that the lovely flat cycle only happens when the dose gets high enough that the cat is completely in normal numbers. I've heard many people comment that they'd like their cat to be consistently in blue numbers (human glucometer), but only once or twice have I seen a cat in flat blue - Purrdy is one of them.

Those lovely flat cycles (human meters) only seem to happen in green numbers.

In Tuxie's case, I think you're seeing higher numbers because he hasn't spent long enough at a large enough insulin dose. If he were mine, I would try to keep him at 5.5u for several days by giving him carbs to prevent him from going under 68AT. In other words, don't allow a dose reduction. Doing that (which is also described in the post that Wendy linked for you about feeding the curve) can provide enough insulin to bring down those higher numbers around preshot time and the overall cycle can flatten out. As long as it is fairly easy to keep him over 68, it's ok to do this. If you get to the point where you're having to do a lot of carbing to keep him over, then it's probably time to take a dose reduction.

You can also go to the option that Meya mentioned - decide you want to let him go below 68 three times before reducing the dose, but at the point he drops under the third time, you really need to reduce by the full 0.25u.

A third option that some people use is to only shave the dose if the cat goes under 68AT. Rather than taking the full 0.25u reduction each time the cat goes under, just shave it a tiny bit.

The concern with doing these methods is that you don't want to mix and match them. In other words, don't decide you want to let him go under 68 three times and then only shave the dose after the third time.

I don't think there's anything wrong with the lev and I suspect you'd see the same thing on another insulin. It's about the dose, in my opinion.

His ss only goes back to March and I don't see on there (unless I'm missing it) if he has had a dental. Sometimes cats that need dentals have strongly zig-zag patterns in their cycles. Sometimes cats on uber-low carb diets also have zig-zag patterns in their spreadsheets.

 

[Tuxedo Mom]

One of the things that seems to be typical is that the lovely flat cycle only happens when the dose gets high enough that the cat is completely in normal numbers. I've heard many people comment that they'd like their cat to be consistently in blue numbers (human glucometer), but only once or twice have I seen a cat in flat blue - Purrdy is one of them.

Those lovely flat cycles (human meters) only seem to happen in green numbers.

In Tuxie's case, I think you're seeing higher numbers because he hasn't spent long enough at a large enough insulin dose. If he were mine, I would try to keep him at 5.5u for several days by giving him carbs to prevent him from going under 68AT. In other words, don't allow a dose reduction. Doing that (which is also described in the post that Wendy linked for you about feeding the curve) can provide enough insulin to bring down those higher numbers around preshot time and the overall cycle can flatten out. As long as it is fairly easy to keep him over 68, it's ok to do this. If you get to the point where you're having to do a lot of carbing to keep him over, then it's probably time to take a dose reduction.

You can also go to the option that Meya mentioned - decide you want to let him go below 68 three times before reducing the dose, but at the point he drops under the third time, you really need to reduce by the full 0.25u.

A third option that some people use is to only shave the dose if the cat goes under 68AT. Rather than taking the full 0.25u reduction each time the cat goes under, just shave it a tiny bit.

The concern with doing these methods is that you don't want to mix and match them. In other words, don't decide you want to let him go under 68 three times and then only shave the dose after the third time.

I don't think there's anything wrong with the lev and I suspect you'd see the same thing on another insulin. It's about the dose, in my opinion.

His ss only goes back to March and I don't see on there (unless I'm missing it) if he has had a dental. Sometimes cats that need dentals have strongly zig-zag patterns in their cycles. Sometimes cats on uber-low carb diets also have zig-zag patterns in their spreadsheets.

Thanks for the detailed information. Tuxie had a dental and extractions about 1 1/2 months ago..he has been testing for IAA, Cushings and Acro. He does have a high fPLI, but has never shown ANY of the symptoms of pancreatitis. This test was not done fasting so I don't know how much that changes the results. In spite of his high numbers (anti-jinx) he has never had ketones. He does have organomegaly....enlarged pancreas, adrenal and liver according to x-ray and ultra-sound. I have not rechecked since January to see if this is getting worse. Maybe something I will look into in the near future.

I will definitely hold his dose and increase if it does not start to level out. I am not looking at remission (wishful thinking) only at trying to stay in healthy numbers. Maybe I will try giving MC food when he starts dropping too fast. My whole goal is to keep him in "happy numbers" where the least amount of organ damage is being done. At this point if I could keep his numbers more level even if they weren't my target goal, I would be happy. I still feel that the big swings up and down are as bad as staying in high numbers. If it is going to take higher doses and feeding the drops then I will definitely do that approach.