20/4 Alice AMPS 427, Low last 24 hours - why?!

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Julie and Alice

Julie and Alice

Member Since 2014
viewtopic.php?f=9&t=117505

Hi All!

What happened in the night?! Its a mystery to me! Her BGs plummeted and at +4.5 hours. She stayed in her bed and didn't ask for food but ate well when I took it to her! I had a night on the tiles but Alice was fine apart from a few complaints about being woken for ear pricks! This morning she had eaten the food I left out for her which has probably influenced her AMPS. As she started lower yesterday before her increase to 1.25 units I chickened out of keeping the increase. I don't want to risk a hypo and I'm not up to another night like last @-) I wondered where that icon could be used - now I know! I did stay up until 04.30am & was happy to see BG 247. I still left a little food out & access to my room.

When she left hospital after the DKA a vet stated that I was in for a 'bumpy ride'! This is proving difficult. This morning she is good! Dashed into the house after visiting the garden & then ran at top speed up the stairs - a first!

Concerning her recent DKA, I have heard its important to control her BG quickly. Is this to prevent another DKA? If so then if I am testing for ketones (she's had none at all since), would that mean theres no problem there?

Can last night's low BGs be explained at all? I'm sure if I hadn't tested her at the low point and given her food she would have dropped much further to dangerously low. She ate a lot and still it didn't go up much the next couple hours at all. :?:

Thanks to for all your help and advice - especially Julie & Pumpkin last night (I watched your video while sitting it out - fabulous - I love both your kitties! Pumpkin is sooo affectionate & patient! (Worth a look everyone!) :smile:

Bye for now
Julianax
 
Hi Juliana,

I'm not an experienced dose advisor, but I wanted to stop in and give you some reassurance! Alice's numbers looked great last night.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.
Click to expand...

(You're still using an Alpha Trak, is that correct? According to the chart we use here, any number between 80 and 160 is a great number for that meter!)

As Alice becomes more regulated on insulin, you will hopefully see a lot of those lower pre-shot numbers. It's scary to shoot those lower numbers, but the experienced users will be here to help guide you through the process. (They really are wonderful people!) Just remember - we want to see those good numbers. That means Alice is responding to the insulin, and her pancreas can begin to heal in those lower numbers!

I would encourage you - when you get a chance to catch your breath - to take a look at some other kitties' spreadsheets. It sometimes helps to see how other kitties "surf" blue and green numbers.

I'll leave your questions about DKA to the more experienced users. (Fortunately, we've been extremely blessed not to have to deal with it.)

You're doing a great job with Alice. I know it's scary, but it does get easier!
Shelly
 
Nice numbers last night. I know they are scary at first, but they are the healing numbers we want to see.
I only quickly scanned your condo from yesterday, but I agree with Julie that keeping her on the 1.25 dose may give her some more of those nice numbers.
 
FWIW, right now you may consider these numbers "low." In a few weeks, you won't. It's amazing how we begin to crave normal range numbers and wonder why our kitties aren't spending more/all of their time in that range.

Probably the best rationale I can give you for Alice's numbers are that the insulin depot has formed and you're seeing better regulation on Lantus than you were seeing on Caninsulin. Caninsulin is a shorter acting insulin than Lantus and it looks like you were seeing a lowering of numbers by nadir and then by your next shot time, numbers were back up. Lantus has a longer duration and there is overlap between the doses. Once the depot has formed, you can see the obvious benefits of the way the insulin works.

It looks like you may be seeing a bounce this morning. Alice's liver and pancreas aren't used to spending that much time in normal range numbers. As a result, they "panicked" and released a stored form of glucose and counterregulatory hormones which caused the numbers to spike back up. The more time Alice spends in normal range numbers, the less this will happen. These kinds of bounces can last for roughly 72 hrs.
 
Hi again, Juliana.

I came across the information below that Chris (and China) wrote in one of Mom-Mom's posts. I know Mom-Mom's circumstances are different than yours, but maybe some of the information will be helpful to you!

Shelly

Ketones are produced when the body starts to break down fat to use as fuel. This occurs when there is too little insulin for the amount of glucose in the body....the body is supposed to use glucose for energy, but without enough insulin, the glucose stays in the bloodstream instead of "feeding" the cells, so the body finds a way to "feed" itself.

As fat continues to be used, ketones continue to rise and can result in a condition called Diabetic Ketoacidosis, or DKA. DKA is very serious and very expensive to treat (and not always successfully), so it's best to catch ketones early, when it's still possible to flush them from the body and get them under control.

The recipe for DKA is "too little insulin+infection/inflammation+not enough food"...with Mom-mom's bad tooth/teeth, infection/inflammation are quite possible which adds to my concern. Her high numbers are another risk factor.

It's important to test ALL diabetics for ketones, but it's especially important when they're in those high numbers like she's been lately.

If she starts to look or act sick, it's vital that you get a ketone test in immediately (other than routine testing)...if she has more than a trace, she will need to go to a vet that can monitor 24 hours.

DKA is deadly, so we want to try to prevent it or at least catch it early when it's more likely to be treatable.
Click to expand...
 
Hi Juliana! I haven't had the pleasure of meeting you and sweet Alice yet so wanted to stop in and say hi and welcome to LL :-D

Looks like Alice is adjusting beautifully to the Lantus. I agree with the others, that it looks like her depot has filled and she is working the juice more effectively now. The AMPS today is most likely a bounce from those shockingly beautiful blues from yesterday, and to be expected. Some kitties clear a bounce rather quickly (within the cycle) while others can take several cycles to clear it. As for sticking to 1u or going to the 1.25u, it looks like you have been working with Julie on that and I think you are getting a lot of great info there. I too think that you saw some great and safe action on that dose, but the fact that Alice has gotten a 1u dose again for the last two cycles and is currently in a bounce, you may want to stick with the 1u for another cycle or so.
As for the ketones, you most definitely want to check everyday, and as often as you can when she is in those higher numbers. As Shelly mentioned , anything above a trace reading and you need to call your vet.

You really are doing a fabulous job. Before long, you will find those scary and unsettling feelings fading :-D
 
I won't add to the already great explanations. I'm glad Alice saw some better numbers.

th_HaveaPurrfectEasterCatBasket.gif
 
Thanks everyone. Very reassuring! I hadn't considered that the numbers were ok! Lots to learn still. I don't think I could have left her though at the low point, I wasnt able to predict what would happen next. Was I right to feed her then or should I have left it & let her go lower?

Yes, I'm still using the AlphaTrack2 monitor.

My hubby has just done the ear prick and it is '7' (126) (3+)- says he thinks its a night job for me again! He's off to bed now! Now .... what should I do now? Feed her or not? She did eat well but may take more if I offer it. Seems she got over her bounce quickly! She seems to have dropped quickly. I'm wondering if 1 unit is too much?

I did have a look as you mentioned at a couple of other SS & it was inspirational, especially the 'OTJ'!

Thanks for info re ketones too.
Unfortunately right now in the middle of writing this it is happening again that I have to watch for low numbers nailbite_smile nailbite_smile . Can you predict how low this could go or when I should test again as its only 3+ hours since the shot. Thankfully I'm not at work tomorrow!

Just a thought, do people use different doses of Lantus, eg less pm than am?

Thanks, Julianax
 
Hi Juliana! Lantus generally works better when 2 equal doses are given 12 hours apart. Generally you wouldn't want to reduce unless you see a number below 80 on the Alphatrak.

Boy, Alice sure cleared that bounce quickly! That's great news. :-D

How often does Alice eat? She seems like she likes to dive at the beginning of her cycles. Sometimes even a quick steep dive can set off a bounce! What some people have found is that it helps to split up meals so that their cat gets a mini-meal at shot time, +1, +2, +3. This can help the cat not dive quite as fast.

You're doing great! Hang in there. All this time in good numbers is great for Alice and while missing sleep seems bad now, it will be worth it if we can get Alice off the juice! :YMHUG:
 
Dropping fast now at 4.6 (82.8)from 7 (126) in 30 minutes! Is this to be expected?
Juliana
Ps I cant seem to enter it on her SS as its +3.5 hours
 
Hi Juliana,

You'll get more eyes if you go back up to your first post and edit to add the 911 up there. This does sometimes happen. I think Marje was on a little bit ago. I'll PM her and see if she can stop by.
 
Ok, I'd test again and see if she's gone below 80. If she does, we'll need to give her a bit of high carb food or some syrup mixed with her regular food. You don't want to give to much, just a bit so she stays hungry. Then test again in about 20 minutes. Ok?

ETA: Marje to the rescue! Thank you! I'm still not great with the low numbers dance...It's way harder when it's someone else's cat!
 
Do you have some HC gravy or even some syrup? If you have HC gravy, I'd give her a tbsp of the gravy only and recheck in 30 minutes. If you do not have HC gravy, please give her a couple tsp of her regular food and a drop or two of syrup. Not big drops. Please test her in 30 and post.

You can take the 911 down. She's ok.... :-D
 
Good job. So disregard my above post and do what you did again with the HC but remember you don't want her to get too full so if there is just gravy, give her that, ok? Retest in 30 after you have given her more gravy. If you didn't have gravy, then feed her a tsp or two of the HC food.

You did perfect!

Edited to add (eta): I'll fix her SS.
 
Just given two teaspoons previous HC food, no gravy so gave two drops glucogel. Thanks for advice & updating SS.
She's happy to eat and wanting more. Shall I make her wait until next blood test & then give lower carb Hill Diabetic food?
 
You want to be careful about giving her too many carbs. The HC you gave her that slowed her down from 82.8 to 75.6 worked well. So let me be sure I understand. You did that again and gave her glucogel, too? If so, then retest her 30 mins after she ate and we'll decide at that time what she gets, ok?

Julie...also...you don't need the 911 any longer. Normally, as soon as someone starts to help you and you have fed the kitty, then we take it down.

Here's a quick recap:

PMPS: 338 NUMBERS ARE WITH ALPHA TRAK
+3: 126
+3.5: 83 fed 20 grams HC
+4: 76 fed 2 tsp HC/2 drops glucogel
 
Computer crashed, working from iPhone. Bg now 4.9 (88.2). Is that enough in view of had glycogen & food. Now +4.5 hours. I'll try remove 911.
 
Great job!

Now I'd give her just a tsp of her regular LC food and retest in 30 minutes. If she's staying up at that point, we will give her some time.

HC food and I'm also assuming the glucogel wears off in about two hours so we will want to stay on top of numbers until we see she's going to stay up, ok?

See you in 30.
 
Hi Marje,

Now 5.7 (102.6). Phew! In my panic I thought you said 2 tspns LC food. She took one reluctantly & I added tiny bit of cooked lamb to the other as she stopped eating. LC food isn't her favourite unless hungry. She didn't have much Glucogel previously at all - 2 drops. I naively expected her to shoot up to 30 (540) or something! I guess she could still drop? How often should I test now? She's now at +5.5 hours. It seems she's quite sensitive to the Lantus. I suspect that much of her high BGs with the Caninsulin was due to the quick drops & her reaction with bounces. Do you think we will be able to get her regulated eventually? :roll:

Hope you are ok here, sorry to take your time - its your Easter Day too! Many thanks Marje!
Juliex
 
Great!!! Well done, you!!! And Alice, of course.

If you can get a test in at +6.5 or +7, that would be fine. That way we can just be sure she is still on the way up. She could still drop but she's more likely to go up because she hasn't spent much time in low numbers. However, the lantus may really have started to work for her now.

On the getting her regulated, yes. Tightly regulated? I have no idea. But also keep in mind that even regulated cats can bounce a bit (like my girl).

You aren't taking up my time.....hubby is working and I'm doing chores. You are welcome.

Also....please check back here before you shoot again. I want to talk to a few other members about whether we should reduce the dose.
 
Ok, thanks Marje,
I keep forgetting I did the shot at 19.45pm - so I'll test again in 15 mins which will be +6.5.
You are kind, thanks, I appreciate it. Beginning to relax here, a little! Thanks to to all your helpers. I'll post result in 15 mins which will be an hour since last.
Juliex
 
Marje is the greatest, isn't she? :-D :-D Personally, I think she might be a little addicted to FD. :lol: :lol: It's a bit like roulette, you never know what a particular kitty will do. Many kitties respond well to Lantus and get regulated and go OTJ. Paws crossed for Alice to do that. Others are like Gracie and Zener and never seem to settle in to tight regulation, although their health is good for a long time. It's an incredibly challenging disease and everyone here is amazing for the care they give their kitties.
Liz
 
I agree Liz! Its great that folks give their time & knowledge so freely to us, complete strangers until entering Lantus Land :-D

So Marje - I'm guessing you're there...! BG now 8.9 (160.2) at +6.6. Further relief! Should I test in another hour? I will check out here like you said before the morning shot too.

Juliex
(am I allowed to use my name now & not username or will that confuse folk?!)
 
Julie

So sorry...I could not get on the board. I know the other Julie was also trying. Not sure what was going on. So I hope you were able to figure out that as long as she's coming up and you're past that 2 or so hour window where the HC wears off and they come back down, that you can lay off the testing and just grab one before bedtime.

On the dose tomorrow, let's hold it for now. Does that sound ok for you? So shoot the 1u dose again the next cycle. The TR protocol we use states that when an Alpha Trak user gets an 80, it's a reduction. However, there is some new info out about the difference between the AT numbers and human glucometers which would, in effect, lower the reduction number to about 68. Alice was close to 80 and well above 68 so let's just hold 1u until she really earns a reduction.

Hope you had a nice easter and get some rest.

And thanks, Liz. You are pretty darn special too, my friend.
 
Hi Marje,
Yes, I couldn't get back on either! I eventually thought your server was down, I only managed to get on now via your links on Facebook.
For your interest now I guess, the numbers went +6.5 (8.9/160), +8.5 (13.5/243), +9.5 (28.8/518.4).

So stick to one unit!

Well - I've got two hours left now to get my head down before starting over again` @-)

Thanks again,
Juliex
 
Julie...yes, it's fine for you to use your real name! It would be extra helpful if you'd add it to your signature line too!

LL is a big family and we wouldn't want to keep calling you "Alice's caretaker"!

You should print out the link Sienne posted for you on how to handle low numbers and keep it somewhere you can always find it. On the refrigerator or in a "hypo kit" (where you'd also want to keep some "gravy lovers" foods, and at least an extra box of strips) is another good place. You always want to keep an extra box of strips someplace separate because it seems like when you need them the most is when you'll run low on them! (Like at 4am when Alice's blood glucose is under 80)

The cost of the strips for the Alphatrak may be a real good reason to consider using another meter too!

The board has been down for several hours, so it's important you have those guidelines in case nobody can get on to help you!

Good job keeping Alice safe today!! We all freak out when we first start to see lower numbers, so don't worry about feeding too much, or too soon! Everybody does it!
 
Chris & China said:
The cost of the strips for the Alphatrak may be a real good reason to consider using another meter too!
Click to expand...
Hi Julie,

I can send you a One Touch Ultra meter to use as a back up meter if you'd like (and tub of strips to get you started)? It doesn't have the 'bells and whistles' that the Alphatrak has but is a good reliable meter. (And ongoingly you can often get OTU strips for around £13 for a box of 50 on Ebay). PM me your address if you'd like me to pop one in the post.

Looks like Miss Alice is still keeping you from dreamland (how on earth are you managing with so little sleep, sweetie???) It must be encouraging though to see her experience better blood glucose numbers.
(Don't let today's bounce phase you. It's just par for the course... :roll: Is a dose reduction needed after last night...?)

Eliz
 
Marje and Gracie said:
...On the dose tomorrow, let's hold it for now. Does that sound ok for you? So shoot the 1u dose again the next cycle. The TR protocol we use states that when an Alpha Trak user gets an 80, it's a reduction. However, there is some new info out about the difference between the AT numbers and human glucometers which would, in effect, lower the reduction number to about 68. Alice was close to 80 and well above 68
Click to expand...

Hi, may I just ask a question for clarification?
(I am NOT a Lantus user but am following Julie/Alice's case).

Re dose reduction, although Alice did not drop below 80 (or 68) it seems to me that she could well have done that given that the 83 was at +3.5 and she had dropped 43 points in the previous half hour. If she'd continued to drop at that rate (and hadn't had food/syrup intervention) could she not have dropped below the threshold at which a dose reduction is earned..?
confused_cat

Do please bear with me, I'm just a li'l ol' Hypurin PZI user who's trying to understand more about Lantus dosing.

Thanks,

Eliz
 
Elizabeth, I hope I can help answer your question

While yes, if she hadn't intervened, it's possible the BG would have continued to drop, the protocol says that we wait until we actually catch it when it goes below 80 (or 68)

We really want them to "Earn" those reductions, so we wait until we catch that low number. Taking the reduction when it's "close" (or when we THINK it might have gone too low) leaves too many questions to be sure the reduction was warranted.

Julie is still very new to using Lantus and also new to seeing lower numbers and (as most of us did when we were in her shoes), grabbed the high carb food a little too soon so we'll never know for sure what might have happened.

Also, dropping 43 points in a half hour can be totally normal for some cats...until we have more data on how Alice responds to the Lantus, it's another question we can't answer.

I hope I've helped a little. Marje is usually on later in the day (or earlier in the night as it were) so hopefully she'll chime in later too!
 
Chris & China said:
..Also, dropping 43 points in a half hour can be totally normal for some cats...
Click to expand...

Oh, yes indeed, Chris. My own cat can drop at this speed (and faster).
But given that Alice was already down to 83 a further drop of 43 points would have taken her BG too low (ie 40 on an Alphatrak meter).
I agree that we don't know what actually would have happened: Maybe the drop would have slowed down. Maybe not.

Thanks for taking the time to explain some aspects of the Protocol to me. I appreciate it. Though I do confess to some puzzlement over there being no scope for extrapolating data in a situation such as this. (I think I'd probably make a very poor Lantus user... ;-) )

Eliz
 
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