What is NDW?

I've searched everywhere, all I get is pages and pages of people saying maybe the cat has NDW. My cat has been over 600 since yesterday afternoon. Also, what is R? I have a second meter which I will try in an hour. Other than looking unhappy and drinking a little more water she seems okay. At least it helps to see that other people have this happen.

 

Hi Karin,

NDW = new dose wonkiness. Sometimes when a kitty starts a new, increased dose, their BG numbers go higher at first. Then they settle into the new dose. Not sure why
R is an insulin that is usually not used in cats. It will bring blood glucose numbers down very quickly, and possibly dangerously low. Some members use it, but only after a lot of discussion, and only now and then.

Welcome to you and Jesse

 

Do you think an increase of .25 (or .3) could cause NDW? I'm trying a little more tight regulation with Jesse since I would like to see her numbers go down. She has some renal failure but the vet thought it would resolve when her BG got under control. I just sat there this morning staring at that HI on the meter, feeling terribly discouraged and worried.

 

It looks to me like she could have gotten some lower numbers than she is used to on the night of the 17th and is bouncing from it.
Do you test at night time?

 

I am not experienced enough to give dosing advice, but would you be able to get a PM +5 or around that time to see if Jesse could be dropping then? A lot of kitties drop lowest at night, and some BG numbers would help anyone looking at Jesse's SS.

 

That's what I was thinking, too, that she must be dropping low at night and then bouncing. But this seems to be a holding pattern. I should try testing at night, but so far I haven't been able to wake myself up. I am a super heavy sleeper.

 

So am I. I sleep through alarms quite often, but I keep trying .

 

When I went to town last week I planned to buy an alarm clock but forgot. Probably because I hate alarm clocks. I live a lifestyle where I never need one -- until now that is. I clearly need to get some nighttime numbers once this mess clears up. I just checked with my back up Relion -- not much lower.

 

I never used to use alarm clocks. I could actually program my brain to wake up at a certain time. If I wanted to get up early at 4:00am, I would just tell myself that as I went to bed, and it would work.
Since I've had a diabetic cat, I have used various alarm clocks. Mostly I use my cell phone now, but if it is too far away from me, I don't hear it or put the noise into a dream and don't wake up. You can also get a loud alarm clock and put it next to the far wall, where you have to get up out of bed to shut it off (another words not pressing the snooze button in your sleep ;-) ).
Do you have time before you go to bed to get a +2 test in the evening cycle?
The +2 test will often tell if you need to get up again later in the middle of the night to test.

 

I'm sort of embarrassed to say that I go to bed when the sun goes down which is only about an hour or a bit more after she gets her dose. From the little information so far her nadir during the day seems to be late, like +9. I will have to adjust and find a way to test her once in awhile at night.

... and I will attempt to get a +2 tonight.

 

Me too. I like to go to sleep real early and get up real early. So, I never get to watch those T.V. shows that start at 9:00pm, and I don't even know why they start some movies at 10:00pm, because IF I can force myself to stay up until 10:00pm within minutes I am out like a light :lol:

I think I heard that human sleep patterns are 4 hours long. Maybe if you go to sleep around PMPS or soon after and set an alarm for about 4 hours later, you could get a +5 or so once in a while. Also, drinking a large glass of water before bed, might help too ;-)

 

I just found this post:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012

Someone should make this a sticky, it explains NDW and bounces clearly.

 

I was about to link that post on NDW for you.

One thought regarding your PM tests, would it work if you were to move Jesse's shot time earlier so you could then get a PM test or two?

If you are wanting to get Jesse more tightly regulated, I'd encourage you to read over the Tight Regulation Protocol sticky. Once you're able to get at least one test during the evening cycle, the TR approach may be a good option. One aspect of the protocol is how long you hold the doses. Typically, a dose is held for 3 - 5 days (6 - 10 cycles) depending on where the nadir falls. What you may also be running into with Jesse is that you were holding the 1.0u dose for overly long. If the nadirs were where you want them and if you're concerned about keeping Jesse's BG values below renal threshold, then you may have needed to increase the dose sooner. Having the PM tests would help you to know if that was the case.

With the TR protocol, you're encouraged to get at least 4 tests per day -- your 2 pre-shot tests and at least one additional spot check during both the AM and PM cycles.

 

No need to be embarrassed by that! Right now Cobb gets his shot at 8pm. I have to force myself to stay up to get a +2. Whenever I go back to work that shot time will likely change to earlier, which might be helpful since it seems whenever Cobb does decide to bottom out it is around 2-4am...you know, when the board is nearly empty and I'm exhausted!

 

I kept the dose at 1U for longer because the relaxed folks suggested to wait a few more days after I chickened out and skipped one dose because she was low on 1/12 - I was afraid she might go lower. Due to the one low amps they thought that the 1 unit may be working so I should hold it a little longer to see. Later when I looked back I realized she had been lower before and I gave the shot with no problems.

It is confusing since her curve is in reverse most of the time at least during the day. I read in one post that this can be because the dose is too high! I couldn't imagine lowering her dose more.

This is why I decided to do a more tight regulation since with her already compromised kidney function I didn't want to keep her in high numbers.

If she is lower at night do you adjust according to that nadir or the higher day values?

 

Hi Karen and extra sweet Jesse!!

On the Relaxed forum, they do suggest holding the same dose for 7 days unless they drop below 80. That's why they had suggested you start counting cycles again from the skipped shot on 1/12.

It works kind of the same here on TR...IF you skip a dose or do a BCS shot (big chicken s***), the cycle count starts over, but we don't hold the dose for so long. The minimum here is 3 days (6 cycles) unless they drop below 50, or in some cases (like high flat numbers or ketones) we suggest a faster course, but those are done on an individual basis.

With Jesse, yes, it's important for you to get at least some tests at night. As much as we might not like it, sleep deprivation is part of this dance. Hopefully with a new alarm clock, you'll have better luck, but when you can, please do try to get at least a +2 on the PM cycle. If there's a big drop between the Pre-shot number and the +2, it's a good sign that it's really important to do more tests later in the cycle. Do you have anyone else at home with you that might be able to wake you?

In answer to your question, not really. We take into consideration both the AM nadir and the PM nadir, but as long as Jesse doesn't drop below 50, we just keep going forward and increasing every 6-14 cycles (depending on the numbers)

Good luck, and I hope you're able to find a way to get those tests in at night. It will help so much to have a clearer picture of where Jesse is going during that PM cycle to see if he's bouncing, or needs more juice!