? Is this how a "Honeymoon" typically starts?

Abby was diagnosed diabetic 2 months ago. Over the past couple of weeks she has had some surprisingly low pre-shot BG's, especially in the last few days. From what I have read, cats who have been switched over to a low carb canned food diet & blood sugar has begun to be controlled with insulin shots, glucose toxicitycease to attack newly generated tissue, and many cats are able to regenerate some of the damaged pancreatic beta cells and slowly resume insulin production.
Could this be happening with Abby? It almost appears that close to her next scheduled shot when the previous shot is wearing off, her body is releasing her own insulin & giving her better BG's than she would normally get at nadir with insulin shots. It doesn't seem to last too long but in the meantime, I have to test & test again while withholding food. Finally, I have to feed her because I don't want to starve her in the meantime, then test again in 2 hours. Sometimes, I still get a BG that is too low to shoot. This is becoming problematic as it's throwing her schedule way off. When her BG does rise enough to give her a shot, it's much later than her usual time & it's a guessing game how much to give her. I don't want to skip the shot but at the same time give her some insulin, not too much to put her in the danger zone but enough so that she doesn't go too high for when she is due for her next shot.
I have been searching the forums looking for some guidelines on how to deal with this but so far haven't been able to find anything. Except, that once a cat has been OTJ for 2 weeks, they are classed as on a honeymoon.
So far, if her body is starting to produce insulin again, it seems to be just on & off. With this happening, I have to test her more often than I did before because I never know when I'll have to give her the next shot & if I do, what dosage to give her.
I'm happy to see this happening but it's perplexing at the same time. Is this the way it normally happens when a cat may be on the road to going on a "Honeymoon?"
@Merlin , if you are available please look at Abby's SS & let me know what you think or anyone else who may have some words of wisdom.
Thanks,
Louise

 

Her morning pre-shots are red and pink and she's bouncing all over the place. She's not regulated yet and she's bouncing considerably! I'm no expert.. they will chime in soon..but honeymoons come after regulation. Then you can start lowering the dose. The low numbers are good to see She's definitely making progress.

I would ask some of the advanced members on tips for controlling the bounces you're seeing. You want more of a straight line than peaking and crashing.... steady blues or even yellows would be better to get regulation happening.

 

Found this in the ProZinc forum sticky:

http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

If one preshot is above 200 and shootable, and one preshot is too low to shoot, it probably means the dose is a little too high and lasting more than the usual 12 hours. Try reducing by at least .25 to see if you get two shootable preshot numbers (ideal) rather than one that is too high and one that is too low to shoot (not ideal)

I would definitely ask for some dosing advice from the ProZinc folks to stabilize the numbers and get you on the way to a honeymoon, hopefully!

 

@Kiara I have been trying to follow a sliding scale set up for me by one of our experts, Cindi. I haven't been following it exactly as I find some of the dose recommendations are too high. @Merlin , can you comment on this & suggest what I can do? The sliding scale dosages you have recommended seem too strong for Abby.

 

I agree with Kiara - while the greens and blues are great to see, it looks like there is some bouncing going on which may indicate that the dose is a bit too high. Or it could be from the inconsistent shot times. If the pre-shot is too low, the recommendation is to wait 20 minutes and try again, but that doesn't need to go on for hours. If it's still too low after waiting, I think people usually skip the shot instead of getting off schedule. Then post and see if it's time for a shot reduction. Giving the shot a couple of hours late can not only mess up your schedule, but could lead to the numbers being a bit wonky like this. I know there is a feline diabetes website that recommends chasing the numbers and shooting at any time, but I think the protocol here tends to be stick to your schedule and go for consistency - aiming for a steadier approach to getting OTJ instead of a reactionary one. Looking at your sliding scale, it looks pretty consistent with what I've seen other people shooting, but if Abby's pancreas is waking up, it may need to be adjusted down a bit so you can get two shootable numbers each day.

 

I was wondering if this was happening. It's just hitting on the right dosage. I hate to miss a dose, as the end of the next cycle, she is too high again.

 

Hey Louise, I have been looking at your ss this morning. definitely think we can do some tweaking. It does look like Abby is responding a little more to the insulin here lately. There are a few numbers where we can reduce and that is in the 300 range. Hopefully by reducing some doses will eliminate some of the bouncing. Also it appears that Abby is holding on to the insulin a little longer than normal too. So just curious, have you taken a look at your scale and determine any changes that you would make based on the numbers that you are getting? What numbers/doses would you suggest?

So in looking at the recent data, here are some suggestions.

180-205 1.25
206-224 1.50
225-274-1.75
275-325 2.00
326-430 2.25
431 plus 2.50

This scale is a suggestion, so please take a look at your ss and check to see if these are the changes that you would make based on previous data. If you want to change any of it, that is fine too. I do think that you may not see Abby get as low as nadirs, but we will see and will just have to change it as you continue.

If you do not get a nice low nadir, then make a note of it next time and try increasing by 0.25. If it is too low, reduce by 0.25. If some of these changes, are producing higher pre-shot numbers and higher nadirs, go ahead and make a note and change the dose for the next time.

To give you an example, this is how I would change a scale.

Example: Abby's AMPS is 260 and you dose 1.75. The +5 test is 165 and PMPS is 320. The next time you close to a 260, you shoot again 1.75 (now you are seeing if Abby gets similar cycle). This time, Abby gets 145 at +6 and PMPS is 290. The next time you get a similar or close number for pre-shot, you can increase by 0.25 i.e. 2.00. Then you move your scale from:
225-274-1.75
275-325 2.00

to:
225-259 1.75
260-325 2.00

I always like to test the number twice with the same dose before I change the scale. However, when my scale was new, I do remember that I had to change it quite a bit.

I hope this helps.

Just about to send this and just saw your last post. I am no means an expert on this so I don't know if his pancreas is sputtering or not. I am thinking that as you get comfortable, that you may be wanting to test out a dose for a lower number. For example, I know Robin (AT user) shoots lower numbers and I (human meter) do too. The lowest that I shot is 140 in which I give 0.20. So it is just something you have to try and see how Abby would respond. You can give small doses like 0.25 and see how Abby responds but will definitely need to monitor.

 

@Merlin , thanks for your reply. I just have to absorb all you said, convert your #'s to metric so I can get a handle on what you mean.

So, do you mean, give Abby a "mini" dose when she is in the blue range at pre-shot or halfway through her cycle when her #'s start to rise?

 

Yes I was talking about the pre-shot. So if you got a 178, you could try 0.25 or 0.50. I tested a 0.20 when I got a number under 200 rather than no shot just to see how he would do. You have already shot 187 (1.50u) on 11/20 and you got a decent +3 of 151. I have never given a dose or mini-dose half way through a cycle.

 

Thank you Cindi, I will try that. Good thing I now have U-100 syringes. I would never be able to measure small doses like that with the U-40's.

 

You're doing great, Louise Nice low numbers today, Abby!!! <3