23/4 Alice AMPS 527, Bouncing again?!

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Hi all,
Its proving a tricky thing to get Alice anywhere near stable. Thanks for the encouragement that this isn't unusual. Her BG at +6 in the night was 180 so I was encouraged but unfortunately she is back up to 527 this morning at AMPS! She was actually sick (just fluid & little fur) hopefully not significant. She is thirsty again so I'm pretty sure her BG is now above 527 as it was followed by food. I wonder if the 180 to her was a reason to bounce (any blues?
I did does her with a little more than 1 unit this morning.

You were right I think Julie (& Pumpkin) about watching the night, although she was ok I'm guessing that tonight will be different as increased dose this morning & maybe 'bounce' is settling? I do hope shes ok tonight as tomorrow I have my annual 'Personal Development Review' first thing!

Chris (& China) many thanks for the pics of syringe dosing! I have put the link in Alice's diabetic folder! I have spent quite a while this morning with turmeric coloured water, your pics and her old syringe practicing! This is how I looked cat(2)_steam ! I had my torch, magnifying glass & husband helping! I really cannot see that .25. I understand where it is on the syringe but cant tell if I've got it. I kept looking at the position of the plunger versus the black line on the syringe. I find it impossible!! I even wore two pairs of reading glasses!! Maybe practice maketh perfect. Marje mentioned calipers - I wonder if I would manage better that way? :?: BTW what is a 'fat zero' :?:

Well today has started & I'm still in my Jim Jam's (nightclothes!).
Thanks for your interestx
BTW I forgot to say my vet rang and said to give 1.25 units if BG over 18/324 or 1 unit if under that. For the daytime I'll give it a go but for now at night I daren't go over the 1 unit until I see she is steadier. After all, that's exactly what I did when she had the low at night - I will give it a go though nailbite_smile I'm having to overuse this icon! :lol:
Juliex

I forgot to say my vet rang and said to give 1.25 units if BG over 18/324 or 1 unit if under that.

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It sounds like your vet is used to the other non depot insulins where dosing is varied depending upon the pre shot test. The depot insulins (Lantus and Levemir) work best when the dose is as consistant as possible every 12 hours.
Alice probably went lower than she is used to last night and that is why you are seeing a bounce this morning.
The bounce could last 2 or 3 days, but hopefully you'll see it clearing before that.
I would stick with the 1.00 dose, or if you prefer the fat one unit dose (1.20?), but the same dose amount every shot for at least 6 cycles (3 days) unless she goes below 50. The changing of doses each shot causes wonky numbers.

The board is so slow this morning :? . I hope this Reply works.

Re: 23/4 Alice AMPS 527, Bouncing again ?!

Thanks Dyana,
So even 10 is too low for Alice! I have to admit to :cry: right now! I am so discouraged. It seems impossible! I am trying to take best advice & there is so much good advice and help & yet still I'm failing to get it right. Finding the 504 +4 after the shot seems like she is getting worse not better. I thought at least from the AMPS of 527 that she would go down somewhat further than that.

My vet does use Lantus & she discussed Alice yesterday with an 'expert' who said she needed to be more 'aggressive' with Alice. She had advised increase to 1.25 if over 360 (20) & stick at 1 unit if under that in the morning but after going on a course during the day & speaking to the feline 'expert', rang me back in evening with revised idea of if over 324 (18) give the 1.25. My gut feeling is stick at 1 unit until I see a drop and then slowly increase - or maybe give 1.25 'ish in morning and 1 in evening - but there again, that's what I did when we had the close shave with the hypo. Truth is, I'm really unsure. People have been great here and I really appreciate all the kindness & compassion everyone has had. I'd love to see some progress! Its worrying me seeing her with such high figures for so long.

Sorry to off load following your post (therapy for me!).
Juliex

Julie,

Lantus needs consistent dosing, so we don't increase/decrease based on pre-shot numbers. Dosing is always based on the nadir, and the 1 unit dose got Alice into greens just Sunday night.

Then she bounced and it looks like she was just clearing it last night (and I agree, probably went lower than the 180 that you caught), but also had a pretty good drop from PMPS to +3...138 points in 3 hours is a quick drop and also probably contributed to this mornings bounce.

I wouldn't have increased her this morning for 2 reasons. She looks like she was clearing the previous bounce and then bounced again (and we don't increase while they're bouncing) and the fact that the 1 unit dose had taken her very close (and possibly under) a reduction number just Sunday night.

I know your vet is more familiar with Canisulin, which IS based on the pre-shot numbers, and you just switched to Lantus about a week ago. Please give the protocol a chance. It's still very early yet and Alice has already shown some better results than she had on the Canisulin.

I know it's hard not to listen to your vet, but in this case, it's really true that the people here are probably a lot more knowledgeable than your vet is when it comes to using Lantus.

Please check Alice for ketones if at all possible today. We always worry when they're in those higher numbers more than when they're lower.

And offload all you want! If anyone understands the frustration of dealing with this disease, it's us!!

Hope Alice comes on back down soon!

Re: 23/4 Alice AMPS 527, Bouncing again ?!

Juliana said:

...So even 10 is too low for Alice! I have to admit to :cry: right now! Sorry to off load...(therapy for me!).
Juliex

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I agree it looks like a bounce from those blues again.
But just because Alice is bouncing now doesn't mean it'll stay that way, Julie. Really.
Her body is having to 're-learn' what is normal. And she may just suddenly 'get it', and stop bouncing...

As Chris said, do check for ketones if at all possible today. Anything more than 'trace' is a reason for a vet visit ASAP.

And re measuring doses, are you putting the light behind the syringe (backlighting)? (That's the only way I can see Bert's small doses, but even then it makes my eyes hurt sometimes @-) .)

I know it must be discouraging for you at the moment. But chin up, sweetie. It's still early days and there's every chance that things will get a lot better soon.

Good luck with the review tomorrow! (C'mon Alice, let your mum have some good sleep tonight... I-) )

Eliz

Hi guys .. no dosing advice from me but just want to say I understand your frustration and if you need any place to vent, this is it! We've all been there and understand .. just hang in there, you're doing great!

Thanks folks!

I will keep it steady with the dose - not sure how I will explain to vet. I have to drop off the BGs to her on Sunday for her to 'adjust' again! She even rang me from home to see how Alice was! She is actually a really conscientious work-a-holic and loves cats (not my original vet). She goes on every single training course & study day she can & rarely has a day off. She said she couldn't care less about the 'Cascade' rules here in the UK regarding using Caninsulin first. She admits she used to use it years ago but wont now as she does what is best for the cat. So you see, it is hard to go against someone who is working hard to help. I think you are right though, she does go by the pre-shot rather than the nadir. She says we have 4months to try and get Alice into remission and a month had already gone when she took over. She thinks that the pancreatitis is causing the instability. I'm not sure what her feelings are about 'bouncing' but its pretty obvious to me. Right from day 1 her BG went up as her insulin went up in the Hospital.

Anyway, better go and encourage her to take some more food - she was so hungry for 2 or 3 hours before the PMPS - now I'm having to take it to her! Any bets on tonights numbers?

Thanks again for all the encouragement - this was not such a happy day, so thanksxx

BTW I did check for ketones - none at all thankfully.

Hi Julie!

I will join the chorus that says changing the dose too often will result in wonky crazy numbers. Your goal is flat, healthy numbers and you can't get flat numbers with the dose changing too often. You want to hold a dose long enough to see what it does. Take a peek at the spreadsheet for Davidson, who is currently on an OTJ trial to see what I mean by flat numbers. His blood sugar went flat a couple of months ago and that enabled his pancreas to heal and for it to begin producing insulin again on its own.

You're going to want to put on your mental math hat as long as you're using the Alpha Trak meter - it runs about 30-40% higher than the human meters that are figures in the "general guidelines" on the yellow starred sticky "Tight Regulation Protocol."

My best suggestion for your vet is for you to download the pdf on the TR Protocol page that is about 5 paragraphs down from the top of the page. The title of the pdf is "Management of Diabetic Cats Using Long-Lasting Insulins." Give a copy of it to your vet and read it yourself as well. It spells out exactly when to hold a dose, when to increase and when to decrease, based upon the BGs you are getting. I would link it for you, but it's not possible to link the PDF. Just go to the TR Protocol page just above everyone's posts, download that PDF and print it off. If you can't find it, say so and i'll try to link you partway.

As hard as it is, you want to hold the dose through bounces, too. Sometimes when a bounce clears, it happens very quickly. Different cats are different on this, and it can vary from one time to the next in a cat. If you have the experience, however, of a bounce clearing fast, like from 500 to 50 in a few hours (which does happen) and you have increased the dose in the meantime, you can end up with a situation that can be scary and hard to handle. I only had it happen once with punkin, but i felt like he cleared a bounce like a freight train running down a hill and I had a hard time keeping his numbers out of hypoglycemic range. I gave him carbs every 15 minutes for more than an hour, if i remember correctly, and he kept skating at 40ish. I couldn't get him to rise higher. That's why it is critical to not increase doses based upon bounce numbers. The bounces pass.

The numbers that are most important are the low numbers in between the bouncing. We focus on those! Alice had 70's on Saturday night, which is right around 50 on a human meter - and SUPER! That's just perfect!

As Alice gets used to the normal numbers, her bouncing will lessen and then it will stop. Your job is to be patient and keep showing her green numbers so her body gets used to it. The longer we can keep her in those numbers, the faster that will happen. What you can do when you see her under 120 AT, is give her about 2 teaspoons of low carb canned food. Often that will help a cat "surf" green numbers.

Your vet's comment about you having 4 months is semi-true, but not absolute. The best chances for remission, according to that PDF protocol, are in the first 4 months after diagnosis. But we have experienced here cats going off even after 2 years. The important thing is to get there safely, and you can't hurry it by increasing the dose too much. Following the guidelines in the protocol is the safest strategy!

I'd also agree that Alice is very new to this! You're making progress and that's what's important. Be encouraged! :YMHUG:

Thanks Julie,
I'm getting the message - keep it steady! So back to the 1 unit twice a day? I still think the 1 unit at night though is a little too much. Is it possible to do 1 unit am & .75 pm & keep it steady at that to see what happens? There again, it may have been the very slightly increased am dose that is affecting her pm? :?

I will definitely look at the PDF - trying to get to bed at mo as nearly 1am but will tomorrow thanks. Will have to test her again at 0.45 though as already in blue! I kind of knew she would do this. Nights are definitely lower for some reason.

Bye for now
Juliex

you want the same dose morning and evening. i think you're ok with the 1.0u for now - you're looking for a blood sugar of less than 68 on the Alpha Trak before you want to reduce her dose. It's just the way it works best - that is, if you're wanting to work towards remission for her. Are you? I was assuming that's your goal, because most people want their kitty to become diet-controlled, but if it's not your goal then perhaps letting her go higher is ok.

Take a peek at this post on Counting Cycles.

You might be interested in reading how Lantus works here and how the depot works here. If you understand the mechanism, holding the dose til it settles and having the same dose morning and evening makes more sense.

Many, many cats go lower at night. There is something called a Dawn Phenomenon that increases the morning blood sugar and is probably a factor in why the night cycles are typically lower. People and cats both experience this.

hehe i just thought you'd like a little light reading for your pleasure tomorrow! :lol:

Juliana said:

..I still think the 1 unit at night though is a little too much. Is it possible to do 1 unit am & .75 pm & keep it steady at that to see what happens?

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Hi Julie,

If you are concerned that the 1 unit may be too much, but want to keep the dose consistent am and pm, how about trying the .75 am and pm...? In a few days you may get an idea of whether that is going to be sufficient or not, and could easily then up the dose if need be, at your own pace.

I know it's hard to decide what to do when our vets tell us one thing, and internet forum folks are saying something else (and not always agreeing). But Alice is your cat and you are her care-giver. It is important that you are comfortable with the amount of insulin you're giving.

Eliz