? What am I doing wrong???

Hi. Frankie was reaching good numbers on. 2.75 dose twice a day, he just couldn't stop bouncing. I asked for advice and was told to fatten the dose which I did. I then increased up to 3 units after 6 cycles. Since I fattened the dose, he has been showing me really high numbers, including the first black this year. What can I do to help Frankie get into better numbers? Is there such a thing as a failed increase? Should I go back to 2.75 units? I feel so bad for my boy right now. He is acting fine and his usual self, so it's not making him feel too bad, but I'm at a loss right now.

 

Any changes to food? Any potential health issues going on....teeth, UTI, URI?

I'm not sure why he popped up to black on 2.75u. Did you retest? I do think today he's seeing some New Dose Wonkiness. I wouldn't take the dose back down. I'd give him six cycles to settle into 3u and see what he does.

 

No health issues at all, anti jinx. I did retest that black number twice and both times came out higher. The food is the same, so that's why I'm stumped.

 

Thanks for answering.

Here's the only thing I see that stands out to me. On the p.m. Cycle of 2/18, you got a 167 at PMPS and he was clearing a bounce. No rechecks that night. I'm thinking he might have gone lower on you, bounced, and the black was the high before the break....except he got a dose increase and NDW.

When he's clearing a bounce and you get a blue PMPS, you should check him again at some point and see how low he is going.

 

I always have my alarm set to retest, when I don't test, it's because I've slept right through, not intentionally. I shoot at a about 7am and pm, and as he very rarely reacts until at least +4, that means I try to retest at +5 which means midnight. If I wake up like now at 2am I will not sleep again until about 8pm tonight when I drop off watching TV and that is where I usually stay until morning, or if I do wake, them that is when I go to bed.

 

Rotten luck that he seems to like to do his diving at night. Paws crossed that this new dose will settle down and give you some better numbers.

 

yikes, that is rough - the length of time you're awake after getting up to test him.

I agree with Marje about the dose - I'd just hang onto this 3.0u for a few more cycles and see what he can do with it.

 

previous post
I think he went low after the blue PMPS on 02/18
As discussed in your previous post, along with the increase in dose strategically managing the curve with food may also be needed to avoid the lows that are triggering the high spikes.

 

I have been managing the curve with food since I was told that the other day and giving him small meals when he goes lowish, and it seems that is what spikes him too as he has huge food spikes. It seems I can only feed him the maximum 5 hours after injection, otherwise he shoots up.

 

Can you point out an example?

 

On 04/11/2015, at PMPS he was 1.7, so I did not shoot, just gave him his usual low carb food and 35 minutes later he was up to 7.7, although 2 hours after that he was starting his bounce. I do not usually put on the spreadsheet when I feed, but I know that he doesn't need high carb food to prevent him going hypo, normal low carb worls just fine. Also on 25/09/2015, he went from 7.9 at PMPS to 11.6 in an hour.

 

Or on 31/12/2015, he went from 11.1 at PMPS to 25.1 in an hour.

 

Well that sheds some light on things.
Firstly none of these are examples of food spikes.

this was s bounce from the 36 you caught at AM+5 that day.

this was a bounce from the 45 at AM+7 that day. (He may have been lower in the hours previous).

That bounce from the PMBG (AM+12) of 31 was well on its way before the meal hit his bloodstream.

while having the full history is invaluable,when actively treating and trying to make decisions sound dosing you want to focus on the previous 2 week period. what came before is pretty much ancient history.

I've got to run for now but will be back later with thoughts about possible strategies to get Frankie off the roller coaster.
Hang in there!

 

My $0.02-
For starters to get the ball rolling in the right direction I recommend you hold this dose, get in as much random testing as possible, and watch carefully for a signal that a reduction may be in order (anything under 68 for AT meter). If he needs a reduction you will likely see it within the next couple cycles.

At your earliest opportunity do either a 12 hour curve, testing every 2 hours or and 18 hour curve testing every 3 hours. This will help clarify Frankies onset, nadir and duration and build a picture of the current Frankie (v.2016)

Can you tell us what his normal feeding schedule is (amounts, timing and carb content)? Also, what is your availability to monitor day to day?
This info will help folks here to best help you and Frankie get back on track.

Also please check regularly for the presence of ketones in his urine, something all caregivers should do, particularly during periods of BG instability.

What do you think?

I'm out the door again but will be back later.
Hang in there and hang in here,

 

I can't monitor during the day as I am at work. I leave straight after morning shot and return just before evening shot. I have sitters come in at +4 so that is all I can get during the week. Weekends are usually manic, trying to catch up on what I miss doing in the week. He gets 4 pouches of Felix chunks a day. Usually at PS times obviously and +4 in the morning and any point before +5 in the evening. The carb content is 9.3%. There is no dry food in the house, and the only other food is Felix Senior which is 7.2% but he stays continually high on that. That is for my other diabetic. Frankie does not usually hold reductions well, but I will go back to once under the limit and I will reduce. Should I do a curve if he is on a bounce or wait until he isn't? That is the bit that confuses me. I will try Sunday to get the curve. I check for ketones, Frankie has never had any.

 

I encourage you to follow the link below which will take you to an informational 'sticky' post on working full time and TR. There you will find all sorts of tips and strategies to help you collect the data you need to make informed decisions.
http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/

Interesting that the lower carb food keeps him high. Could you point out an example on the ss where the 7.2% kept him continually high?

Since he is a long term diabetic you have the option of waiting for him to dip into the 58-68 range (AT) 3 times on separate days before reducing. I would go the standard route first (one dip under 68 AT) and if you see he does not hold the reduction you can try the alternate method. The 3 times under 68 on separate days method does require careful monitoring for safety. You want to make sure he does not go much lower than 68.

Do a curve whenever you have the opportunity. You want to capture as much data as possible - the good the bad and the ugly
glad you are monitoring for ketones !

Stay close to us here. We can help you navigate the ins and outs.

 

Hi Sue, no insight from me but just interested to know what meds you give Frankie for his cardiomyopathy and neuropathy, as Crystal also has cardiomyopathy and has now just been diagnosed with neuropathy.

I hope you manage to get some answers, good that Sandy is on the case.

 

You've gotten some great advice from Sandy! Hang in there, Sue!

 

@julie & punkin (ga) I'm trying, but these high numbers are hanging around since his dose increase when normally the bounces would clear in the second cycle (recently at least, on 2.75 units)
@suki & crystal Frankie has Zobaline for his neuropathy and takes half a 25 mg tablet a day of Atenolol for his Cardiomyopathy. It's a human beta blocker. but has kept his Cardiomyopathy in control (and even disappeared) for 7 years now. He was on the syrup to start with but once diagnosed diabetic, he had to swap as the syrup is too sugary.
@Sandy and Black Kitty I am trying to follow that link, that is why I get the pet sitters in to test. They used to come in later at +6 but that is after Frankie's onset at +4, so wasn't really helping. I do not have an info on the lower carb food affecting his numbers. I haven't had him on that food for at least 8 months, and I don't really keep info on food given as now it is always the same brand just different flavours. I also can't come home at lunch time, as I work an hour and a half away from home, on public transport. That's on a good day!!!

 

This should be interesting. At +4 he is 9.1 (164). He's eaten his normal meal at this time, plus a bit more to try and slow or control the drop with food. Paws crossed he's not too high at PMPS.

 

Hi there

Frankie may have an earlier onset

Being that your weekday schedule doesn't have any wiggle room you might consider getting a timed feeder. It could provide a mini meal between +4 and when you return from work and /or a+2 mini meal in the event you discover Frankie has been having an earlier onset. It was a lifesaver for us. Especially on the overnights.

Regarding the PM cycles, can you manage a nightly +2 along with a test before you go to bed?

 

I think he was clearing his bounce this morning as he had a pink preshot. With 5 other cats including another diabetic, I could never be sure that the food was going to who it was intended to!! But I will keep it in mind as a possibility, depending on how he goes onset wise. I will get a +2 tonight and then whenever I wake up (hopefully with the alarm!!) but I stopped doing the +2's as he was normally still having a food spike, but I'm prepared to try anything right now.

 

Well, at PMPS he was 13.3 (239) and at +2 he is 20.9 (376). Any thoughts @Sandy and Black Kitty ?

 

My $0.02 regarding the +2:

He hit a low after AM+4 that his defense system is reacting to and a bounce is in progress
or a bounce is in progress because his defense system perceived the drop from AMPS to AM+4 as potentially dangerous

Do what you can for tests -- any or all of the following will help fill in the picture.
If you have not yet turned in for the night see if you can grab a before bed test.
if you can, grab a late cycle test (+10 or +11)
if you make a trip to the loo during the night grab a test.

I just noticed that on
02/10/PM+6 you caught a 59 (AT) and held the dose (2.75u)
Also on 01/23/PM+6 you caught a 65 (AT) and held the dose (2.75u)
And on 01/24/PM+5 you caught a 45 (AT) and held the dose (2.75u)
I'm wondering why







.

 

I really don't understand why he's bouncing on hitting a 9!!! He's used to so much lower and his bounces were clearing a lot quicker too. I held the dose as he does not do reductions well, so I was going for 3 below 68 on 3 consecutive days as per advice on here, but the third one never came. I got a +4 of 22.3. I'm calling it quits for tonight. At least I can get some sleep. Thanks for your help so far. Let's see what tomorrow brings.

 

I didn't realize that you have 5 kitties!

Fast drops can also trigger a bounce. How fast and how deep is an ECID thing. It could be that going from 385 to 164 in 4 hours was too quick a drop for him.

I suspect he went lower. All his lowest readings (2016) are +5 or later.

 

6 including Frankie!! I only wanted 2 (Frankie and Teddy) The other 4 found me, two were strays (Fluffy and Po), the other diabetic (Romulus) I found asleep on a bed one summer. The only time he left was to go and fetch his sister (Remus) and then they never returned wherever they came from!!

AMPS and Frankie is 18.6 (335)

 

There is another half to that rule. On the human BG meter, we say 3 drops below 50 or one below 40 earns the reduction. On the AlphaTrak, I'm not quite sure what the equivalent is to 40 however.

 

Well, 40 = 2.2, so I'm guessing on AlphaTrak it would be about 2.5-3

 

Sue

Just for your own information. These are a couple of readings in that range using my AT vs FS Lite same drop blood comparisons:

AT 3.1 FS Lite 2.2
AT 3.1 FS Lite 2.1
AT 3.6 FS Lite 2.5

 

Thanks. I will probably use 3 as an immediate reduction figure, seeing as 3 is the lower end of the normal scale, and 3.7 for the 3 times reduction figure.