Whoops - starting out AMPS at 67; how to proceed??

Slept in ths morning, so Tonka is already an hour behind schedule. He's coming down from yesterday's rebound and is down to 3.7 (67). I just fed him part of his regular low carb food (1/2 can of the DM pate) but I'm putting off injecting him just yet.

At least I have the option of staying home today - I was supposed to head out for a few hours in the afternoon, but that can be put off if necesssary.

Should I give him his usual 2.25 units Lantus? SHould I give him some higher carb god to go with his low?

 

Just an update: Tonka is not acting terribly famished, so he's not feeling too low yet. He only ate half the food I put out for him.

 

Just tested him at half hour since his first test: now up to 5.1 (92), so I'm giving him his does (reduced it to 2.0 units, though, since I was toying with doing that anyway) and added a bit of higher carb wet food to his breakfast, which he is suddenly interested in eating. Hopefully that won't be overkill, but I don't want him to drop into the true lows this soon after injection.

And just a note on the late injection: I know that the 12 hour consistency is advised, but Tonka has frequently been injected a bit late or early, depending on schedules and who's given him his shots (our cat sitter probably gets him 10 hours apart during the day, with a 14 hour gap overnight, because of her schedule... the vet had said that this should be fine, as long as the difference isn't much more than that. And I can stall his evening shot by half an hour tonight to transition him back to his 7 am shot tomorrow morning).

Since he's in a healthy range right now, but could still be coming down from rebound (the increase now could be due to a food spike), how often would you suggest testing him?

 

A couple of thoughts...

Whenever you aren't sure if it's safe to shoot, don't feed your kitty! If you feed, chances are that next numbers you see will be influenced by food. So the rule of thumb is to not feed unless your cat in in the 40s or lower.

You have several options if you are concerned about the pre-shot number:

• Stall. Retest in 15 - 20 min and see if the numbers are rising. Once they are more than the 20% you can attribute to meter variance, shoot.
• Shoot a reduced dose (also known as a big chicken sh*t or BCS dose). This is what you did today.
• Skip

All of these options have an effect on the depot with the reduced dose and skipped shot having the largest effect. Stalling can make a mess out of your schedule, though, so none of the options is perfect. You also want to try to avoid stalling AND reducing the dose. Stalling by more than an hour has a similar effect as reducing the dose so the depot takes a double hit. I'd suggest you take a look at the sticky that reviews Shooting and Handling Low Numbers which provides more detail.

 

Thanks for the link. I have read that one (and the other stickies on the board), and I understand the theory - just not brave enough to put it into practice on my own, apparently

 

Practice on a piece of fruit (ex an apple), then on yourself (on your arm), first, to get a feel for it.

 

Oh, not re. the testing or injecting: I have more than enough experience with the physical process. Not brave enough to shoot lower numbers just yet, apparently. So much for my chance to see what he did on his own at that level when I injected him. I was just worrying that he was still coming down from a rebound this time. (Excuses excuses, right?)

 

And he's back down to 3.6 (65) now (at +1.5), so I think it's probably safe to assume that he was still coming down from his rebound this morning.

 

I went through it again, but I'm still not sure what I should do when he's coming down from a rebound. I know that in this case I should have waited to feed him to be sure he was still falling, but I figured it was a safe assumption and from his +1.5 reading, that does appear to have been the case.

The sticky says that if the cat does not spike with food, or if they are still falling, to be "more conservative", but I'm not clear on what that would mean. I get that if he was rising, then injecting his normal dose at his normal time would have been an ideal thing (especially since I can watch him today), but I'm not so clear on what to do when they're still falling. Help?

 

Jordi it can be really confusing. The first time or two that a person gets a preshot that they're uncomfortable with, we encourage them to post and ask for guidance, which you did. You're correct that Tonka was clearing a bounce, and sometimes that can cause a lot of momentum. Actually now (hindsight is always so very clear!) we can see that he's surfing along in green numbers - which is fabulous! The longer he spends in green numbers, the more his body will accept it as normal and hopefully, his bouncing will lessen.

Once a cat's given you a green preshot, it's very likely to happen again. At some point you want to bite the bullet and shoot the full dose into everything that's over 50, as long as he's eating normally, ie, not sick, you're around to monitor and you have plenty of supplies. Here's a post that Libby wrote a while ago about shooting a dropping number: Look for post #6 in that thread.

I also wrote an explanation of the difference between shooting a high number and shooting a low number here. Look for post #16 in that thread. Shooting high numbers and low numbers are two completely different experiences, although when a bounce is clearing like you've got today, that can sometimes send a cat right into low numbers. It's hard to say - but as long as you're home to monitor you'll be able to pull him up if you need to. Sometimes the first couple of times a person shoots low, ie, the full dose into 50-120 normal numbers, the cat will drop lower, but typically after you've done it a couple of times the cat will flatten out. Typically. Take a look at the spreadsheets I linked on that last post and notice when the amps goes green and the person shoots the regular dose into - then track across that row and see what happens to the BGs that day.

For now, I'd check Tonka every hour or two, doling out a couple of teaspoons of regular food each time as the day goes on to help him surf in green. This is GREAT!

 

by the way, since he didn't earn a reduction from the 2.25u, typically you would return to 2.25u tonight as his regular dose, just counting this morning as a one time reduced dose because of his normal preshot.

Back to your first question - should you have given him high carb to shoot him? we wouldn't normally give HC in order to inflate the preshot number to make it safe to shoot. HC wears off in an hour or so, and if you were to inflate the preshot with HC, then you could end up with low numbers fairly quickly. Most of the time you can safely shoot everything over 50 once you are data-ready to do so, feeding your normal low carb food.

If you're going to be gone at some point in the cycle and want to leave out HC, that's perfectly fine. Funny how a kitty's appy often improves when the gravy is available, isn't it?! just like people and their sweets . . . .

 

Thanks much for the clarification.

My biggest problem with shooting low is that, normally, I am not around during the day to monitor him (in fact, I was supposed to head out for a few hours this afternoon, but I can cancel that if he's not coming up by the time I'm supposed to leave - unfortunately, it'd be right about the time he's mid-nadir on a normal day, so my afternoon out is probably off unless he starts to climb up a bit). Today is a very rare chance to inject at the lower numbers and see where he'd be without my interfering until it was truly necessary, and I've blown it.

Either way though, I'm definitely not "data ready" to shoot low on any day that I can't be there, since I have still not seen what this critter does with anything but a higher pre-shot reading. And even today's close to low number was not a "normal" one, since he is coming down from a rebound: I don't know if I could even use that as an indication that I should reduce him or not, even if he did hit the less than 40 levels today without my interference. Which is why I'm reluctant to keep offering him more food when he's not dropping significantly right now. But if I've already messed up the data, I guess I might as well do so and prevent him from getting so low that he does rebound, eh?

He hasn't even finished off the food that was put out this morning though, which was less than usual since I hadn't injected him yet. He did slurp up the higher carb (all together, he probably got more than his usual carb count this morning, as a result of mixing in some higher carb wet, but I doubt it would even work out to significantly much more than he usually gets when he eats more of his (and Teeger's) breakfast. Probably more like I'd fed him a 8-10% carb food rather than the 3-4% he usually gets.

If I bring it up to him (he's mid-snooze upstairs in the sun right now... his "snoozes" typically last about 8 hours during the day ...) he'd probably eat a bit more. Should I do that?

 

You haven't screwed up anything. don't worry about that. The one thing with FD - you almost always get another opportunity to try something. This time you're getting to see what happens when you stalled for a while til he came up a bit, then you shot almost the entire dose in. That's good to know. That's part of becoming data ready. But I totally agree - shooting low isn't for trying out when you're not going to be able to monitor. You want to do it the first couple of times when you can monitor what's happening and learn.

Have you tested him again since the 58? I'd probably give him an hour after that and retest. He's coasting along fairly nicely, but that isn't very far above 50, so he may very well drop below 50 today.

 

Was just going to do that when I saw your post. He's up to 4.1 (74) at +4. That could just be meter variance, but it looks like he's probably rising, or at least not falling. This is usually when he starts to nadir, so I'll check him again in an hour. If he's rising then, do you figure that I'd be safe to run out? Maybe leave some extra food (which he will no doubt eat post-snooze, whether or not he needs it), just to be safe?

 

I tend to trust the numbers and not worry too much about meter variance. I think you're safe to run out - I'd just leave him some food now and go ahead and go.

Nice day for him!

 

Hopefully this isn't the beginning of yet another rebound. Like I said, +4 is usually when he's falling, not rising, and I haven't fed him (anything but a couple zero carb freeze dried meat treats at test times) since his a.m. injection

 

When you stall, the last dose is wearing off. Typically most cats begin showing effects of the current shot a couple of hours after they get the shot. So you may be seeing him rise because there was less overlap between the end of last night's shot and the onset of this morning's shot.

But he's also had a nice long run of green today and last night, and his body isn't that used to it yet. So he might very well bounce.

Hindsight will tell us if it's a bounce or just the effects of the stall+reduced dose. Then you just add that to the bits of info for your decision-making for next time.

 

It still floors me that there is that much of an effect from the depot, especially since Lantus seems to be in and out of cats' systems faster than it tends to be in humans (where it's supposed to be a 24 hour, peakless wonder - but in reality, not so much). My own Lantus injections (like person, like cat in this house) are first thing in the morning (whatever time I get up - can be as early as 5 a.m. during fieldwork season, and used to be much later on weekends, prior to the days of having to get up early for Tonka) and then not again until somewhere between 9 and 10:30 at night. I also take a much smaller dose at night than in the morning. This has never made a noticeable difference in me with day to day variation in time and the daily variation in amount, but then again, I also take bolus shots of a very fast acting insulin to deal with food intake and any blood sugar spikes, so maybe I'm just not noticing it because I found a good balance to compensate with years ago... Dealing with nothing but a depot insulin in my cat has been very challenging to me: I see a low or high and I want to fix it immediately with more or less insulin. If I wasn't away from home half the time in the snow free season, I seriously think I'd be better off asking my vet about putting Tonka on a shorter acting insulin that is more flexible, but being home so little, that would probably be an even bigger risk for him.

 

And up to 88 by +5. Yay - I'm comfortable leaving him at that, although I am going to put out a foodsickle of med carb food in case he needs it in an hour or two (when he'd normally be at peak nadir)

 

And at 9.1 (166) at +9. Hopefully he doesn't rise much farther (he usually drops a touch at +10 if he hasn't spread his eating out to that late in the cycle, which has happened, and isn't rebounding), and I can finally inject him with confidence at his full dose and see where he goes from something closer to normal

Thanks for the advice and support

(and the foodsickle was thawed but uneaten, so it got removed)

 

What a great day for Tonka! And wonderful that you were around to watch part of it.

It's interesting hearing a human perspective on Lantus. Neko has a high dose condition, and at one point she was getting more insulin per day than a friend of mine who is probably ten times her weight. Do you find that Lantus stings on injection?

 

That is interesting. Punkin had acromegaly and I did use both Lantus as the basal insulin and Humulin R as a bolus to try to help manage his blood sugar. Mostly that's used for cats with high dose conditions or after people have really given a good effort at following the TR protocol and the CG wants to try something more. Tonka's doing pretty well - i doubt it would be needed in his situation at this point.

You probably have to relearn everything to make the switch to managing his diabetes, i suppose.

 

I'm a relatively low dose diabetic myself, so it amazes me how much some of these poor cats need to function. I can't say that I've noticed it stinging any more than the needle itself does. But I don't refrigerate my own insulin after I've opened it, so that might make a difference too.

 

It definitely requires a different way of thinking about how to control his diabetes. And more "un-learning" certain methods of control.

He's feeling quite perky tonight - even running about on his poor wobbly legs chasing after imaginary prey