? Yum's preshots are increasing but her nadir is about the same: should I decrease her dose

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by MJW, Aug 10, 2017.

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  1. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Could the increasing preshots be bounces?
    Her nadir of 98 is on an AlphaTrak. Maybe I am keeping her too low. If I switched from TR to SLGS, I would be decreasing her dose.
    Could a lower dose flatten her out?
    I tried increasing the dose on 7/23 to 3---that dropped her nadir further but didn't decrease her preshots---so I went back to 2.75f.
    I don't know why her preshots are increasing lately, maybe because I am so obsessed with them.
    I am tempted to try 2.50f to see what happens. Or maybe just 2.75.
    We have a vet visit on Monday.
     
  2. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
    No dosing advise..

    Could it be stomach acid in the AM causing the higher AMPS? How long have you been using the current insulin? Any recent changes? Diet, new food, meds, supplements?
     
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  3. Wendy&Neko

    Wendy&Neko Well-Known Member

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    On SLGS, you lower the dose if they go below 90, not 98. Her SS is pretty sparse in the PM+5 to +11 time frame. I might try to get random spot checks then. Her higher AMPS could be bouncing from lows overnight.
     
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  4. MJW

    MJW Well-Known Member

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    I got the automatic feeder last week to prevent the stomach acid in the AM. She hasn't vomited fluid since I started that. The feeder is a change though. At first 1 AM feedings seemed to help, but then they didn't.
    I've had this Lantus vial open since June 3, less than 3 months.
     
  5. MJW

    MJW Well-Known Member

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    Judging from comparisons that I've seen, I think a 90 on a human meter is about 135 on an AlphaTrak. So I am keeping her morning nadir very low.
    I have been trying to get more sleep, so I am guilty of slacking off on the evening tests. I need to do a curve. I know my vet will want to see one next week.
    But I have NEVER seen her go low in the evening/overnight.
    And now her PMPS is also above "normal".
     
  6. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Do you have the feeder set so it turns with no food 2 hours before AMPS? I actually put 3-4 freeze dry in the last turn slot, they don't affect BG levels and it isn't cruel (turns with no food :()
     
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  7. MJW

    MJW Well-Known Member

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    Ha! I failed to train her to respond to the sound of the dish turn. So the feeder opens to a dish with about 4 FD treats at 11:30 AM. At 1:30 AM it rotates to a dish with 1 FD treat. That's it. (That's my current strategy; I've tried many. It's possible that she now responds to the sound of the turn. I haven't tried it during the day when I can watch.)
    I've read cats can turn FD treats into glucose. Maybe chicken more than salmon, something about the fat content.
    Yum has had some wet bowel movements. Although she has enjoyed canned salmon and sardines as treats for years, I cut back on those the past few days in case they were disagreeing with her. They are good sources of omega fatty acids, which fight inflammation. I gave her a few salmon treats again today and just now she had mild diarrhea. I will have to experiment more to determine if she has developed a problem with fish.

    Bottom line: I want to flatten out her curve.
    (1) Noah had such a flat curve on Primal Freeze Dried, I tried that. Yum doesn't like it very much, so it is still a side dish and FF Classic pates remain the main course.
    (2) I tried the automatic feeder at night. Late night feedings seemed to help at first but now they don't.
    (3) I could feed her MC around 10 AM to ward off her 11 AM nadir.
    (4) Or I might just try reducing her dose by .125 units.
     
  8. Wendy&Neko

    Wendy&Neko Well-Known Member

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    I didn't mean to test every night, but maybe try the trick of drinking a big glass of water before bed and testing her when the inevitable happens. Hard to say she never goes low at night if you aren't retesting then. If she's not going low, then maybe she needs a slight increase. I never found reducing the dose to work.
     
  9. Susan G & Jimmy G

    Susan G & Jimmy G Member

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    I like the water idea...def going to try it!
     
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  10. MJW

    MJW Well-Known Member

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    I am still all geeked out smitten with silent vibration wakeup alarms on apple watches, fitbits, etc
     
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  11. MélanieW

    MélanieW Member

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    Did you try food with a bit more carbs? Noah didn't do as well with only the turkey (around 3%) and had better number when I mixed turkey and chicken and salmon (around 6%)?
     
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  12. MJW

    MJW Well-Known Member

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    Ah. You are still monitoring the forum! :) Thanks for the input. (And I finally noticed the emoji bar.)
    I've only been doing the primal turkey so far. Just now (AMPS+4) I gave her a medium carb FF gravy snack to raise her morning nadir. I'll see if this flattens her curve. I do have a bag of the primal chicken and salmon in the pantry. I put it away when I noticed the high carb content. I will get it back out.

    Yum is my little science experiment.

    I cut out her bedtime snack last night and, even with some freeze-dried zero carb snacks in the middle of the night (from the automatic feeder), she threw up a dab of fluid with a few strands of fur at PMPS+11. Probably acid stomach. At least that is a cause/effect I can understand and predict.

    My goal is flattening her curve. I will try higher carbs and then I will try lowering her dose.
    An AlphaTrak number in the 90's is like a human meter number in the 60's. I might be keeping her nadir too low for too long w/o earning reductions.

    Do cats go into remission on SLGS? If so, at what rate compared to TR? I will probably post a thread with that question once this thread dies out.
     
  13. MélanieW

    MélanieW Member

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    Yes, I'm back on the computer after my three weeks of vacation (last day today). I needed a break from the computer and from FD, but I missed the people here and wanted to check in on everyone.

    Getting the AMPS to go down is really about finding out what works best for your cat. With Noah, I was lucky and giving him small meals in the feeder during the night did the trick. I had tried feeding before bed and in the morning, but he was free fed all his life and him not having access to his food was stressing him out and raising his BG levels. Also, if Yum is throwing up that might explain the higher numbers. Noah's BG levels go up when he throws up. Thankfully, it doesn't happen too often (but every once in a while he wants to go outside to eat grass and 5 minutes later I get to pick up the massive amount of vomit. EVERY. SINGLE. TIME).

    I'm hoping the food does the trick and you can flatten the curve! ;)
     
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  14. MJW

    MJW Well-Known Member

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    Well, the FF MC this morning raised her nadir slightly, but it didn't stop the upward trend on her PMPS (now AlphaTrak 191).
    Now the PMPS is almost as big a problem as the AMPS.
    I will skip the FF MC tomorrow and see if her nadir is still in the 90's.
    She has been gaining weight recently, maybe an ounce a week. That could well be what is causing the problem.
    She is also used to being a free feeder. Changing that is complicated with 3 cats. I have been trying to avoid using the auto feeder for all her meals.
     
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  15. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    @MJW

    Actually, I think there is too much concern about the AMPS by most members :p It's one thing if the kitty is on 0.1u and all green except the AMPS. That's when we try feeding at +8/+9 so we can see if the pancreas is working. If it is, the numbers will come down 3-4 hours after eating which would be AMPS.

    For a cat on 2.75u, this isn't going to work. The AMPS is always the last number to consistently come down as a cat comes down the dosing scale. Dawn phenomenon, which occurs from a surge of hormones in the early morning hours, is often the reason why the AMPS is higher.

    The other thing that could be at play is she is losing duration; that's what it looks like to me.

    It's also important to realize there is not a specific and consistent difference between the AT and a human meter. If you look at my Gracie's SS, I have a tab comparing the values.

    What I believe is an important take home is there is no consistency between the two types of meters. And certainly, the readings between my AT and my human meter would likely vary greatly if we ran my AT against your human meter.

    Try not to think in terms of what an AT number would be on a human meter because it is speculation and it's easy to get into a "comfort level" that doesn't and shouldn't exist.

    I agree with Wendy. I wouldn't reduce Yum's dose. I also think if she's not dropping at night later in the cycle, she could use a tweak upwards on the dose.
     
    Last edited: Aug 13, 2017
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  16. MJW

    MJW Well-Known Member

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    I was frustrated anew this week because her AMPS and PMPS were BOTH ramping way up with no comparable change in her morning nadir.
    We could certainly say she is losing "duration". That describes it perfectly.

    I agree with you and Wendy that a dose decrease would be a mistake. I tried raising her nadir with food and there was no improvement---these aren't bounces.
    However, I'm not sure I want to increase her dose. We'll see.
    I tried 9 cycles of an increase to 3 units on 7/23. It decreased her nadir but it did not seem to help her preshots, so I dropped back to 2.75f units.

    Of course the preshots have worsened since then. I've noticed that she is gaining weight, maybe an ounce a week. She has taken to going upstairs and eating the civvies' daytime food. Yesterday I started trying to control her portion amounts more carefully. Her water consumption has also dropped 25% this week, which is odd. Probably it is because she is spending less time outside in the heat and more time inside raiding the upstairs food dish or asking me for tummy rubs. Maybe she has some body pain issues. I don't know. I am giving her freeze dried treats in the middle of the night to stop her from throwing up fluid in the morning (success). We'll do blood work tomorrow.

    If I were to switch to SLGS, there is no way I would use an AlphaTrak 90 for my cutoff BG. On a human meter, 90 is 57% of the way to the max of the normal 50-120 range. On an AlphaTrak, 90 is just 17% of the way to the max of the normal 72-175 range. 90 is quite aggressive on an AlphaTrak. I do use your comparison chart when I think about these issues, along with the spreadsheets of others who post both human and AlphaTrak numbers. I will discuss safe long term nadirs with my vet tomorrow.

    Thanks for the feedback.
     
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