8/10 Mačka AMPS 530, +3 427, PMPS 501, +3 496

http://www.felinediabetes.com/FDMB/...277-2-410-5-244-pmps-481.217922/#post-2421747

It was too good to be true... Macka is back to his old blacks n reds (and grumpiness too).

Do I give this dose another chance or should I increase? Is he bouncing right, now even from yellows you think? On the 8/08 night, he could have been in the blues though.

Recently I changed his food to Wellness (4% carb pâté) instead of FF (1-3%), would it make a noticeable difference in the BG? I haven't seen blues since I started it.
Also, he usually breaks the bounce on the 9-11th cycle... I wonder if I should wait until then to make a safe decision on dosage.

I have to go to work today (but can get a +6), it looks like he'll be safe, right?

I wish a great day to you all, here in Oregon it looks like autumn already and raining. At least we can breathe again! Macka is in the garden smelling the flowers, braving the high BG

 

You’ve got lots of room to increase! The lowest Macka has been on his dose was 212. If you were doing TR, you would get to increase tonight to 2.25 u. SLGS says to hold the dose, of course.

 

How do we explain the blues that happened on lower doses?

 

Excuse the looong post...

This is something I would love to understand more deeply too, why does a dose pull numbers down one day, then not the next and then why is a higher dose not even getting him to blues!!! It is such a mind-bender. Glucose toxicity, insulin resistance, absorption... these are all things that I know about in the abstract although I am certainly not qualified to talk about them with any specificity... as you know!

But I think in practice--and what I've seen with Figaro lately--is that looking back at the whole history can be a red herring. I think it's part of why dosing is so tough, why diabetes as a whole is so frustrating, and why we benefit from collecting data constantly.

It is very hard for me to ignore Fig's older BG numbers when considering an increase. A couple weeks ago I was so worried about increasing above 1u and I ended up wasting several days (even beyond the SLGS guidelines) where he was simply not getting enough insulin. Even though it seems logical that if a certain dose would take Figaro into greens, a higher dose would take him lower... I don't think that logic actually holds. I don't really understand why that is, so I say to myself that, you know... things change! Especially cats. And I of course consider the opinions of experienced people here.

Looking at spreadsheets (as I know you do) can be so helpful, because you can see how even in well-regulated cats, dosing can go up, and down, up up up down down or up up up, etc etc. It would be lovely to see an up-up-up-down-down-down-OTJ trajectory but I don't think that is common. Many cats that have better numbers than our boys seem to need increases from time to time (like @Sue and Luci today ).

Also, it helps me to remember that a .25u increase is quite small. And at 2u, an increase to 2.25u is an increase of just 12.5%!

Lastly... as Crista said, on SLGS you would continue to hold the dose for a full week. Then you can be confident in the increase if you don't see evidence you don't need to increase after all.
Are you thinking about switching to TR? No pressure! Just wondering because you are asking about an increase already

 

I don't want to add to your confusion so I'll just say that in my experience with Luci - if you'll look at her SS - her dosing needs have rolled up and down the dosing ladder - and I try to keep up with her needs. I don't know if there is a scientific explanation for it - perhaps some of the other members may know - but I was told that regulating diabetes in cats is difficult - and you need to be sensitive to their blood glucose levels that for a variety of reasons can go up and down...as she needs more...she gets more...at some point we'll reach the sweet spot - where she'd getting enough - and then her pancreas kicks in and makes a contribution and her BG numbers will drop significantly - I have to be super-diligent during those times to check her often enough to catch those really low numbers - and after three 'below 50' events, she earns a reduction.

Because Luci has typically been difficult to keep in those lower numbers after a reduction I try to make sure she's eating really well and I test her frequently when she's low - in hopes of holding her above that 50 threshold. Simply going under that and she will lose what might be an effective dose - and that's why I try my best to keep her above 50 (away fro the sharks) so I can avoid the reduction for as long as possible.

And then after a while..when she drops further and further down the dosing ladder... for whatever reason...she turns around and heads the other way - like she's been doing lately - persistently higher numbers - hence the increases - every 6 cycles since we're following TR. I'm giving her the nudge she needs to get back to those greens - she may need a lot of repeated increases to nudge her back...and as you can see we've been at this for quite a while...not as long as some, but longer than many...and it is necessary to keep her well and healthy - to do for her what her body can't - for whatever reason - by giving her the insulin twice a day...

After a while, this will make more sense...they just need what they need - just like humans - diabetics need to monitor their sugars and often change their doses to adjust to their blood glucose numbers.

I hope this helps

 

Thank you @Figaro's Liz and @Sue and Luci for sharing your thoughts. I guess cats needs do change from a week to another. It just makes the whole process even scarier because of the fluctuations.

I am not sure I'm ready for TR, althought thinking about it every day. Next Monday would be a good day to increase and monitor.
However, when seeing Macka's numbers today, I'm pretty sure he's bouncing from blues I missed, two days ago.
Whatever these reds are, they're ugly, and frustrate me, and Macka is so tired of being high all the time. So, yes, TR, maybe very soon

 

Definitely it is scary at times.. but you aren't alone you have your data!! And us, of course

 

Another flat bouncing cycle tonight...! PM +3 496

 

You can always try TR and go back to SLGS. It is frustrating that the blood glucose is unpredictable even when all the variables remain the same. This is what doctors and vets have to deal with, I suppose. My vet just shakes her head and says, “feline diabetes is notoriously difficult to treat” which reminds me that patience is an important ingredient.

I’ve read on the site that cats do even out over time and many get flatter curves. I’ve also read that some cats never regulate and we just have to learn to do our best and not get too upset over it.

 

Hi Penelope!
How are you!
I hope you are managing to get more sleep than you were and that things are generally better.
You do sound much better I think!
I would also like to encourage you to try TR. The longer Macka stays in high numbers the harder it is to get out of them.
Initially you won't find much difference at all between TR and SLGS....except you will be increasing every three days instead of 7 days. The other main difference is the number at which you decrease the dose, but you don't have to worry about that at the moment. You are certainly testing enough for TR so that doesn't need to change.
Just take one day at a time with it.
You can always swap back any time you feel it is not working for Macka.

 

Good morning!

I do sleep a little more, but not full nights! I can't help waking up 1-2 times every night to check on him and make sure he's not dropping, which obviously does not happen at all at the moment. I am still not confident with the data that I have and he still surprises me with his curves.

I think I will try TR tomorrow morning and increase to 2.25. How many times do you recommend I should test when on TR? Also, what are the red flags that would suggest an upcoming hypo (blues too early on?)? How fast does blood sugar drop? What I mean is, can it go from 200s to lime greens in an hour? Or should I be concerned only if he gets into the blues? Because as of today, I freak out even when I see yellows. The reason is, he can go from 600s to 300s in two hours and dip quickly.

Are we sure that his AMPS and PMPS will get lower with an increase? It doesn't look like it right now. They were actually looking better when he was at 1 unit, which I don't understand :/

Wild nights coming ahead!

 

http://www.tillydiabetes.net/en_6_protocol2.htm
Here’s the protocol. All cats are different, and then just when you get used to them, they change! Lots of spreadsheets show cats’ progression into lower numbers. You can see there are lots of moments when they take two steps forward and one step back.
Good luck!

 

Thank you @Margie and Jackson.

I also called the Animal dental clinic in Lake Oswego twice, to inquire about giving a dental to a diabetic cat (I was told they were the best in town) and they do not call me back with the Doctor's reply. I am a little frustrated. Do you know any other (more serious) dental clinic in Portland?

 

You're already testing enough Like @Bron and Sheba (GA) said, you probably won't notice too much of a difference except that you get to increase sooner rather than later.

I remember someone talking about this in one of my posts but I can't recall exactly what was said. But that that will happen because they're so high and bouncing. It's not ideal but it happens and especially on bounce clearing cycles. I know @Wendy&Neko aims for not dropping more than 50 points an hour but I think that's more important when numbers are flatter and lower.

My main concern with Ming when he goes from high 300s to 80, is the bounce that will follow afterwards. It's why I try to feed him at onset to slow that down.