Discussion in 'Feline Health - (The Main Forum)' started by Squalliesmom, Aug 7, 2015.
From looking back, if Lucy posted right after AM shot, about 30 minutes past +12
I'm 25-35 minutes behind schedule
I'd go 2 units. high amps could be a bounce for unseen low last night.
Trying to get food in him now so we don't get any farther behind!
He's getting some carbs tonight, he won't eat the Tiki Cat so he's having FF Pate.
I would vote "no" on 4 units. I am thinking that both this morning's 442 and tonight's 383 are somewhat inflated by bouncing both cycles. (I don't necessarily thing that the 442 this morning was due to 2 units not being enough, in other words). Last night, he dropped over 100 points by +3. He might have dropped lower later on.
All that said, I'm thinking 2 or 2.5 might make sense tonight?
Four units dropped from 442 to 75 in 4 hours.
That's 367 mg over 4 hours and roughly 91.75 mg/dL per unit. That won't be consistent shot to shot.
Starting at 383 mg/dL, you might give no more than 3 units, possibly get down around 100-ish mg/dL and have a bit of cushion above 50 mg/dL.
And I like Carl's idea of 2 to 2.5 units, so you can sleep!
I like 2 units also. 2.5 might be okay, but it is overnight and he is most likely to be safe with two units and you can both get a break. I agree the amps could have been a bounce and he could have been lower 30 minutes ago.
If you get a couple cycles that are higher and flat, then start moving back up, 0.5 at a time.
Okay, 2 units it is. I'm so thankful to you all for your knowledge and advice!
Little stinker knows he's got me over a barrel when it comes to food. He refuses to eat the lovely Tiki Cat, which even I think looks delicious, lol, and makes me bribe him with treats to eat more than a few nibbles of the FF. I finally got him to eat maybe a tbsp-full so I'll let him have a few minutes and then give him his 2 units.
The FF you are feeding. What flavor is it? Is it a "classic" style?
Lucy, as a former Vetsulin (Caninsulin) user and looking at his sheet, I'd be inclined to stick with 2 units. I think 3 will just make him dip lower and won't improve your AM or PMPS numbers - those higher readings are likely just Vetsulin not lasting past 8 hours. If he were mine, I'd shoot 2.
Whoops, you already said you would do that - darn second page didn't load.
Hope Squallie is going to eat more for you!
You may have already tried all the tricks. I found adding warm water to the pates and making them more "gravy like" helped my kitty. Sometimes the chunk texture is what they don't like.
Luna's a big fan of my patented 'Pate Soup' since she had ketones and needed more water.
This was a huge help for Genghis. I think between the warmer temp (more aromatic as well?) and the liquid consistency, she eats the FF way better than she did when I just smushed the contents for her.
Okay, he just got his 2 units at 9:30, so he's an hour behind from this morning, shot then was at 8:30. I will keep monitoring him.
I do that sometimes, but he had a tendency to lick up all the tasty water and leave this weird, mushy paste behind.
He is not above a hunger strike if he doesn't get the food he wants. Which is all the stuff he's not supposed to have.
Lucy, Genghis does that sometimes, too! This grainy, blech left on the plate... yuck. Sometimes I have whizzed her food in the Magic Bullet .... shhh, don't tell my boyfriend because I make smoothies for him in it, too....
Hard to resist that face! Stay strong!!
We play "appetizers." I give him an "appetizer", a treat, and he eats a mouthful or two of food. On a good night I can get a whole bowl of food in him with just one or two "appetizers", other nights I 'm lucky to get him to eat at all. Tonight was one of the latter.
That is just too funny!!!
I agree with Sue and Rhonda. If Squallie was mine, I would give no more than 2 units and stick with that dose for several cycles unless it becomes clear that he's going too low on 2 units and then I'd move back to one. I found when Radar was on Vetsulin that he needed a few cycles sometimes for his little body to adjust to a particular dose. I hope this is helpful.
He gets the classic pate', the lowest carb ones. His favorites are the ocean whitefish and the salmon. I can't believe he won't eat the Tiki Cat, my other guys LOVE it, and it actually does look like people food.
Sadly, Squallie just isn't a big fan of canned food, in any brand or variety, although he did used to like the Friskies breakfasts with the eggs and all the lovely, high carb sauce!
That is plenty low as far as carbs go. All of the "classics" are low carb, so no problem if that what he'll eat, let him eat it.
While I agree that 2 units is a good choice, I have to disagree with your take on the higher readings. Nothing on Squallie's spreadsheet indicates that the Vetsulin only lasts 8 hours. In some cases, it looks like he doesn't even reach nadir until +6 or +7. I think he's just one of those ECID cats, and he gets long duration on an insulin that isn't supposed to give him long duration. Some cycles it looks like he even goes beyond 12 hours on a dose.
Please help me understand - as clearly I have not interpreted what I have seen as a duration issue correctly - How should the higher AM and PMPS numbers be viewed?
Read my post about Pretty Foots in ICU twice in 2 weeks 7 days total bad URI . Couldn't get his regulated on Vetsumln , or Lantus. Home since 8/3 giving Nov0lin R intramuscular every 4 hours.
I view them more as potential bounces from numbers that were low in the middle of the cycle. Given how much he has dropped during the cycles where Lucy caught the scary green numbers during the middle of a cycle, I think it is safer to assume that they are happening during the cycles when she hasn't been able to "see them happen".
Yesterday, he dropped from 370 to 70 on 4 units. And Lucy had to carb him up to stop him from going lower, indicating that he wasn't at nadir (timing-wise) when she saw that 70. Last night, she gave him 2 units. Isn't it reasonable to believe that he again dropped down into green numbers when his PMPS was 100 points lower than his AMPS was? If he did drop to 70 or lower, then this morning could be due to that happening. I don't believe it was because the 2 units just didn't last long enough.
If I believed that, then I'd believe her vet's advice that Squallie needs three shots a day instead of two. And I see absolutely no data on the spreadsheet that supports that way of thinking.
In my mind, advising he needs shots closer than 12 hours apart puts him at risk, and is irresponsible advice.
Can you give a link to that thread? I'm interested that you are giving IM shots, but this thread is probably not the place to discuss it. Interested because my cat got IM shots for 10 weeks, and other than in one other case that was short-term, I haven't seen any other kitty who was dosed that way (until you just mentioned it).
Duration issues will be seen if the high number happens well before the next shot time when there isn't anything else going on.
The day of the 419 at +9, for example, was a bounce from the day's low of 22 and being carbed to get the numbers up. If it had happened without going low any time in the prior 3 days, we might think there was a duration issue.
@Carl & Polly & Bob (GA) here is the link.
Thank you for the detailed reply, Carl. I'm sure glad you were here to catch that on my post and correct my thinking. I have puzzled over Genghis' sheet for only a little over a month - clearly there is an art to it that comes from experience. Essentially, to my untrained eye, all I saw was lower numbers bookended by higher ones. This is great info.
Thanks, @BJM for your explanation also!
You're welcome! I wasn't around much when you were using caninsulin so if you posted about the high numbers, I missed it. I hope things are going better with Lantus, but I can't be of much help with that.
I actually used compounded PZI which is also supposed to be an 8-10 hour duration, and a lot of times it was. But I still shot every 12 hours or so, and never went as far as shooting TID.
If you look at Luna's SS she bounces all over the place. Every time there's a low under 100 she flies up over 400. She's on Lantus, but same principle.
A good way to check for duration is to test towards the last half of the cycle to see when the glucose starts rising and how fast it happens.
@Carl & Polly & Bob (GA) (and small thread hijack, sorry Lucy!) I understand you were out with the turtles and I loved all the photos (not just of the turtles). You have a gift! Genghis is doing wonderfully on Lantus - she has been pretty much under 250 since I started and I shot my first "green" tonight - if my data is any good (and the planets align) it won't be a long night...
I read up on the Caninsulin when I was using it and one site's "fix" for a cat's metabolism and duration issues was to suggest TID dosing.
If the peak time is less than five hours, a longer-acting insulin is given, or the current insulin is given more frequently, generally three times a day.
If the peak time is five to eight hours, the current insulin is continued on a twice-daily schedule.
If the peak time is greater than eight hours, the current insulin is continued, but is given once daily.
I never really bought into the TID or SID -- Genghis would peak at +4 through +10 - she just never seemed predictable (learning that nothing about FD ever is!) so I made the switch to Lantus.
Thanks again for the clarification - not sure I'll ever have a proper "eye" for reading the spreadsheets - this is an amazing place for help and information.
I feel so stupid but I just don't understand bounces, or bounces vs duration. I don't know how to look at a spreadsheet and see a bounce rather than just a lack of insulin, or longer/shorter durations. :-(
But when I checked him at +5 hrs last night it seemed to me that his #s were rising again?
Did you add that 201 recently? I don't recall seeing it last time I looked at the SS.
I am going to look for an old thread in PZI that Dr. Lisa participated in to see if I can help explain the whole "bounce" concept. It might not happen until tomorrow night though. I guess it comes from looking at thousands of spreadsheets, but for me (and for lots of others), differentiating between a bounce and short duration isn't impossible. Just takes practice. And I am far from being always right!
edit to add - and Lucy, DON'T ever feel "stupid". You've only been at this for a couple of months. And feline diabetes is anything but easy to understand and deal with! You're doing great so far!
Yes, I was looking over his spreadsheet because I knew I remembered thinking his BG was coming back up, so I compared it to my meter's memory and saw that I hadn't entered that 201. Sorry if I screwed something up. I try to keep it all up to date but it's been so crazy here the past few days and I'm so short on sleep that I'm surprised I haven't missed more than that!
I just tested him at +2 hrs and his BG was 312, I'll check him again in a couple of hours.
I monitored Squallie through the night and didn't see any of the incredibly steep drops he seems to show in the mornings. AMPS today he is back up to 421 and I don't know whether to give him 4 units, or maybe a little less? Anybody have any suggestions?
I went ahead and made an executive decision: I gave Squallie 2.5 units (really closer to 2, my syringes don't have markings for .5 units so I had to estimate). I figured higher BG numbers are safer than numbers that are too low and, since he has been showing such a huge drop shortly after his morning shot, I thought it would be best to err on the side of caution. I hope I made the right decision.
I like your decision, Lucy. Glad you didn't go with 4. I'd rather see you slowly work your way up, if needed.
Thanks. That's what I figured, too. Until I have a better grasp of what's going on with him, I think it's better to go with less and increase the dose if needed after I see where he's headed, BG number-wise. That sharp drop he's been experiencing for the past several days must be hard on him, I imagine, I wish I could get his numbers down a little more gently, if you know what I mean.
I second this wholeheartedly.
Squallie's BG at +2 hrs was 271; I know that's still fairly high but so far glad to not see that sharp plunge ha's been having the last few days! I hope it continues as a nice, slow downward slope!
Getting data at the lower dose may help you to identify bounces better if at some stage you might need to ease the dose upwards.
How is the food change going, Lucy? What percentage low carb wet to kibble is Squallie getting now?
Here's my probably terrible explanation at a bounce. These #'s are from Luna's SS the last few days. On the top column where there's a 115 as the low at +10 she hit 319 at +9 during the PM cycle (off to the right of the SS). This is a bounce.
You see it again in the middle column where her AMPS was 275. At +7 she started dipping towards 57, her low of the day. She instantly sky rockets to 424 at PMPS, and stayed red all night. You will notice too that Luna takes about 24 hours to clear a bounce, when she goes below blue/green #'s, she immediately goes red/pink for about 12 hours, and slowly back to yellow by about +18, and then by +24 she's back into low #'s.
If you look at Squallie's SS, try and notice any patterns like this. I personally would not be worried about duration and would just try and train your eye looking for the 'bounces'.
He gets about 1/2 - 3/4 cup of dry Evo (8% carbs) throughout the day, he really just nibbles at it when he gets hungry (very frequently those times coincide exactly with drops in his BG), and he gets 1/2 can of FF low carb pate or Tiki Cat no-carb wet food for breakfast and again for dinner. It doesn't sound like he eats very much but I have trouble getting him to eat just that small amount because he isn't thrilled with any of these foods. He is chubby and has even gained weight since his last vet visit last week; he weighs 14 lbs. We are managing to keep all carbs below the 10% mark, even if he doesn't like it, lol.
Okay, I kind of think maybe I see what you're talking about. I don't know that I would have identified it as a bounce, though. Let me see if I can put it in words and you can tell me if I'm on the right track - When a kitty hits a very low point in a cycle the body starts trying to compensate and the numbers climb higher than they would, had that low not occurred. Is that a bounce? I still don't know that I wouldn't just have viewed it as just a low point that started to come up higher as the insulin reached the end of the cycle - except that it seems out of line with other average high numbers.
Thanks for the food info, Lucy. I wasn't sure if the kibbles you're feeding were low or high carb.
That may well be due to the insulin helping Squallie to make better use of his nutrients? Some diabetic cats are underweight at Dx, and start regaining weight when they start insulin therapy.
Squallie was pretty chunky when he was diagnosed, too. He hasn't been even close to underweight in years, if ever, lol. Until recently, he'd never met a cat food or treat that he didn't like!
It's great that you've noticed this correlation. Saoirse used to start asking for food when the Caninsulin started to really kick in (onset). I used to use it as a signal to start monitoring her more closely. I also recorded the time of onset in her spreadsheet notes. As the Caninsulin became progressively too potent for her I noticed that she got her 'appetite uptick' earlier and earlier after the injection was given (e.g. moving from +2 back to +1.5 and eventually to +1 after the injection) and her nadirs started coming earlier followed by a rise in BG as her system started to compensate for the Caninsulin threatening to take her BG levels too low. (She also started showing similar behaviours and BG responses toward the end of her treatment with Lantus.)
Squallie' s appetite uptick seemed pretty consistent at around +2 until I started the transition to the new, low carb food. He doesn't come looking for it now because he doesn't like it, and he's discovered that I'm not going to give him the junk food that he loves so much. But that's also about the same time he started having these hypo episodes, just after we finished the transition onto the new diet.
That is very valuable information, Lucy. Food, feeding habits and insulin dose are all so intertwined. Recording and sharing information like this can help enormously in working out a safe treatment plan for Squallie.
I really think that's why his BG started going so low when he was still getting 7 units of insulin; that was okay when he was eating all the high carb food but once his system adjusted to a much lower-carb diet the 7 units became deadly over-kill.
Yes that's basically a bounce. The liver effectively gets used to being at high numbers. When you introduce a sufficient amount of insulin to make the #'s drop drastically to (healthier) levels, the liver reacts by releasing stored glucose as a kind of 'defense' mechanism, thus the system gets flooded with glucose and BG level's effectively skyrocket. On 8/5 Squallie had quite a bounce from his 22 at +4 to 419 at +9, though that was probably food influenced as well. On 8/4 your PMPS was 524, I can almost guarantee you had a low # that day somewhere in the cycle, probably around 50-75. It's a little tougher to tell with vetsulin I think, but hopefully you get the idea. Low # followed by super high # = typically a bounce.
Okay, that makes sense. Thank you for explaining it. So much to learn with a diabetic cat!
Erm ... it's the liver that releases the stored glucose (glycogenolysis). It also metabolizes other non-carbohydrate nutrients to produce glucose (gluconeogenesis).
EDITED TO ADD:
Here comes the science bit:
How Glucose Regulation Works - and How it Stops Working
Can't beat a bit of light bedtime reading.
Just tested Squallie at +8 and his BG was 357. I think maybe the 2 units this morning wasn't enough? Or maybe it IS a duration issue and he does need a shot 3x daily, just lower than 4 units TID?
Liver, pancreas, it's all the same thing (thanks for correction - I fixed it ).
Lucy: please, please be guided by Carl and Sue. I really don't think TID dosing is right for Squallie.
Regulation is a marathon; not a sprint. It takes time to first find a good dose that will keep Squallie in better - SAFE - numbers for a good part of the day. As his treatment progresses all that time spent in lower numbers will allow his pancreas to rest and, hopefully, heal enough to not need insulin some day.
You cannot rush the body to accept lower numbers. Squallie's body's current idea of 'normal' is to run at high blood glucose levels. When it sees numbers lower than it's used to, it thinks, "Yikes! I'm gonna run out of energy! MORE GLUCOSE!!!"
It's not possible to 'force' the body into good numbers. Squallie's body needs to relearn what it feels like to be in healthier numbers. It needs to recognise that safe lower numbers are OK so that the liver will stop overreacting and producing bounces. It needs to go through 'rehab'. He'll first get used to the yellows, then the blues, and then the greens. We stock patience pants here for a reason!
Liver schmiver. LOL!
I'm sure I've had a few doctors who didn't know the difference.
I think you're safe to drop the "3x a day" thing from your vocab for now unless someone says otherwise. With a little patience I think you'll find a good dose that keeps Squallie safe and not too low.
I bow to your greater knowledge, Mogs! I wasn't really suggesting it was a good idea to go to TID dosing, just throwing it out there to get opinions. He hasn't had any sharp drops today, thankfully, but he has stayed in higher numbers, overall. Thank you for reminding me to put on my patience pants, I need that every once in a while .
I just tested him at +10 and it read 343. When I test his BG I've been basing my +times on when I administered his shot, not on the time I do the pre-shot test. Is this right, or should I switch it the other way around?
I know you want this fixed fast, Lucy. It may be that 2 units isn't enough, but I would give it three full cycles before you increase. He has been bouncing all over and gone from 7U to 4 to 2. He dropped at least 50% today.
And if he is still in higher ranges tomorrow morning, then I would increase to 2.5 and hold that dose three cycles.
My thinking is to give his body time to adjust to all these changes, get a picture of how he does on 2 units and then raise 0.5 units at a time, if needed.
We all do, Lucy. We all do!
That's absolutely spot on, Lucy. The clock starts running from the time of the injection.
That makes good sense to me. I want it fixed, yes, but not to Squallie's detriment, that would kind of negate the whole reason we're doing this in the first place.
You're doing it right. It's + from when the shot was given.
And letting him settle for a little while at a safe dose might mean Squallie won't feel so crummy.
Thanks! That question has been rattling around in the back of my mind - what's left of it, lol - for a while, I just keep forgetting to ask. Glad I got it right!
I wanted to increase Luna every time I saw her #'s not going below 300 when I started lol.
He actually purred a little for me this evening, something he doesn't do much of these days. He slept all day today, only got up once or twice earlier in the day. I know I'm exhausted from lack of sleep and stress, so I know it's got to be even worse for him!
Lol. Glad he's purring again. You guys will figure it all out soon (ok maybe not ALL out)! It's not easy!
446 PMPS, gave him 2 units, hopefully we'll both get to sleep through the night tonight!
Lucy (and anyone else who feels like reading it).
Many moons ago I posted this in the PZI forum. It might help you understand bounces, and what goes on inside the body of a diabetic cat. Plus you may find it entertaining if nothing else.
Informative and entertaining, both!
Squallie's AMPS was only 363 this morning, yay! He ate a great breakfast, too, he even ate some of the Tiki Cat chicken that he's been turning his nose up at, lol. I gave him 2units, and will monitor.
Sounds good, Lucy. Often it takes several cycles for the new dose to really affect their levels.
How about starting a new thread? Once it gets to two pages, it is harder for people to follow.
Separate names with a comma.