9/26 Jack AMPS 390 (After 7 days of AMBG Too-Low-To-Shoot)

Most Recent Condo (9/21)

Yoshi here. So it's been about 5 to 6 weeks since Jack's diagnosis - and the learning curve has been steep. My first interaction with this board was on Tuesday (09/21), and it was quite overwhelming to have my eyes opened to this supportive online world that Jose jumped into 9 days before me.

I understand the importance of posting daily now, and Jose and I will do our best - however, it's quite a huge schedule adjustment and new routine that we haven't smoothed out yet - so bare with our inconsistencies and know we are trying
(I don't know how y'all do it! I try to remind myself this is good practice for when we have kids )

Where's the Reset Button :?: Jack's SS, is making my head spin. It hasn't helped that the vet that knows Jack the best is on vacation until sometime in October. I believe the most important issue on Jack's chart right now is that before this morning - Jack had not received an AMS for a full week! So, on one hand - I'm really happy that his numbers were high enough this morning to dose him - but on the other hand, there was a only a very small dip in his insulin on the PM curve. The smallest curve he's ever had I think. I can think of two reasons for last night's PM curve: * It was a partial fur-shot and/or * Jack's shed finally ran out after several days, and we now are seeing the true effects of the 1.75u dose.

While our vet is not reachable for the next few weeks, the director of the vet hospital we go to gave us the following advice:
* He wants us to skip a dose if Jack's numbers are less than 150 AM/PMPS.
* If Jack's morning numbers do not start getting closer to 100 than 50 - He wants us to bring Jack in for a fructose 2-week average test and a urine test
* He also said there's a chance that Jack would level out better if we switched insulin.
* The vet is on the same page with us regarding how to treat Jack, except for one important point: He doesn't want Jack's numbers going below 100 - ever. His philosophy is that it's more important to simply stabilize the cat at a 'safe level' rather than tight regulation (which Jose and I want to aim for as that's y'alls philosophy).

My biggest frustration is that we unfortunately have had too many variables changing too fast:
* We've been lowering the dosage at a steady pace (by the time we joined this forum mid-September, we got stuck adjusting from a high dosage to a lower dosage. We didn't realize pre-FD that our vets goal of maintaining a glucose level consistently above 150 wasn't going to help Jack go into remission, but in fact keep him insulin dependent. I know we would want to be doing exactly the opposite (slowly raising his dosage) ideally, and that was hopefully what we would have been able to do when we started with 1.75 BID - but a new complication arose when Jack's morning levels were dipping so low this past week.
* Switched testing meter brands on 09/19. The True2Go Walgreen meter was costing $70 for 100 test strips. ReliOn was 1/2 the price and recommended by y'all. So it was almost a no-brainer besides the fact that the two meters were sometimes giving wildly different numbers (more than 200 mg/dL apart), so I did a comparison of the two brands to find out exactly how they were different. Turns out that low numbers on both meters reported within 10% to 22% of each other consistently, and the higher the numbers got, the farther apart the meters reported them> You can view this recorded comparison on Jack's SS Chart, by clicking on the worksheet called "Test Strips". As the low numbers are the most important ones to not be misread, it seemed like an okay switch to make. But since the ReliOn consistently reports higher numbers - Jack's chart 'appears' to have a spike in higher numbers starting on 09/19.
* Also on 09/19 - Jack got over a cold he had for a few days. (Maybe that effected his levels, too?)
* From July through August, Jack was eating various dry foods including most recently the LC prescription M/D dry food until mid-September when we switched back to the LC Raw food diet Jack was originally on before we got Sawyer in July.


Nitty-Gritty

1. What is the correct shorthand for 4 hours 45 minutes after the PM shot? Is it: +4:45 PMPS ?
2. Is there any online retailer (besides Walmart) that sells the ReliOn test strips?
Is it okay to make the following changes on the Spreadsheet?
A. Weight is an important factor to consider, so I added a weight column before the remarks on the spreadsheet.
B. As +11 is important for AMPS, I moved it from the end/right side of the chart to the beginning/left side of the chart.
C. Wouldn't it be helpful to indicate when Jack's getting food not just in the remarks of the chart, but in the actual curve? I thought it would be nice to designate this by changing the color of the text during the hour Jack was fed from black to gray. (For example, +9 PMPS on 09/24)

Today's Schedule
I'm leaving right now for 2 hours (and back between +3 and +4 AMPS) then out the door again. Jose will be in and out all day.

1. What is the correct shorthand for 4 hours 45 minutes after the PM shot? Is it: +4:45 PMPS ?
Yes. If you are trying to reflect that in your ss, you can put the exact time in the notes column, or just round up to the +5 column.

2. Is there any online retailer (besides Walmart) that sells the ReliOn test strips?
No. Those are Walmart's proprietary brand. I used to buy 4-5 containers at once. Others use a different meter and buy the strips online.

not an advisor...but wanted to say good to see you and good luck!

celi & binks

Yoshi said:

While our vet is not reachable for the next few weeks, the director of the vet hospital we go to gave us the following advice:
* He wants us to skip a dose if Jack's numbers are less than 150 AM/PMPS.
* If Jack's morning numbers do not start getting closer to 100 than 50 - He wants us to bring Jack in for a fructose 2-week average test and a urine test
* He also said there's a chance that Jack would level out better if we switched insulin.
* The vet is on the same page with us regarding how to treat Jack, except for one important point: He doesn't want Jack's numbers going below 100 - ever. His philosophy is that it's more important to simply stabilize the cat at a 'safe level' rather than tight regulation (which Jose and I want to aim for as that's y'alls philosophy).

Click to expand...

I would take a look at the sticky on becoming data ready regarding shooting low. I shoot low. I shoot way lower than 150. In fact, I've shot a hundred points lower than that BUT, I have a great deal of data and experience in managing low numbers. There are better alternatives than skipping a dose. I don't think the issue is shooting low, though. I honestly think you need to reduce Jack's dose to a point where you can start shooting twice a day (BID). By skipping the AM dose, you are seeing big surges into high numbers by the evening dose. Lantus is a BID insulin when used with cats. It's not a surprise you are seeing big swings on Jack's SS if he get's too much at one time and then none 12 hours later. It won't matter what insulin Jack is on if he's getting too much at one time. In fact, on some of the shorter acting types of insulin, your risk for hypoglycemia will increase considerably since those types of insulin have a harsher onset. I would probably lower Jack's dose to 1.25u or even start over at 1.0u and from there, bring Jack's dose up as you need to following the guidelines in the tight regulation protocol. The switch to a LC diet has had an impact on Jack's numbers and it's no surprise that he needs less insulin. I'd like for you to get some additional input from others regarding dose.

If you test consistently, the way you are doing, a fructosamine test is a waste of money. You have far more "real time" data than a fructosamine test will ever yield. Once my vet saw how I was testing, the topic of a fructosamine test never came up again. Most vets are not used to having people who will home test, let alone home test actively.

The recommendations your vet is providing aren't a surprise. Many people here note they get similar advice from their vets. I agree with your observation -- the vet has probably not had all that many cats go into remission. Once your usual vet is back, it might not hurt to share a copy of the Queensland protocol with him. This protocol is what has been the basis for the Tilly Protocol and the modified version we use here and is the one that has been published in a well respected veterinary journal.

Actually, the correct shorthand for 4 hours 45 min (or 4 and 3/4 hours) is +4.75. If the time is 4 hours and 40 min. it would be +4.6, 4 hours and 30 min. is +4.5, etc.

FWIW, for me, having the +11 column at the end of the PMPS cycle makes the most sense. I read almost everyone's SS on a daily basis. The consistency in the layout for those of us that open a lot of SSs is very helpful. A column for weight is just fine!

hey everyone, Jose here
thanks for the feedback, I'll be checking in a few times today since I'm working from home (but g-d do I have work to do, sigh) we're appreciative of the support and I think we are finally getting some of the figuring out what on earth is going on behind us so that we can start learning better how to really apply the protocol well.

to second what yoshi said, it's been well impressed upon us that we need to make posting on a daily basis a real priority.

I am SO glad to see your post today!! :thumbup I have peeked at Jack's SS so often and was hoping you would come back to post a condo! :mrgreen:
As far as the notations in the SS for snacks...I put <sn to indicate that the previous hour a snack was given ...or sn> to indicate the following hour. However, if I am testing often and there is a BG number in every box, , I usually put an asterisk after the number as 90* and then I manually change the box color to match the color coding for the BGs which would make that 90 a green. In the note section, I will write snack *+3, 4 whatever it was. You are welcome to click on Shadow's SS to see how it looks. So much information to put in the SS and it is all important.

What insulin did that other vet want to switch Jack to anyway?

I agree that the dose should be lowered to allow for consistency....shooting the same dose AM/PM. Let's see what others say but you might need to go down to 1.0u to see if that works.... I do hope that yo will be able to post each day....you are both doing a great job!! :mrgreen:

Good Morning Jacksdads - good to see you here. I can see from your SS that you guys have been working hard. lots of good advice here, hope to see you often around these parts.

Pat+Raja+Shadow said:

What insulin did that other vet want to switch Jack to anyway?

I agree that the dose should be lowered to allow for consistency....shooting the same dose AM/PM. Let's see what others say but you might need to go down to 1.0u to see if that works.... I do hope that yo will be able to post each day....you are both doing a great job!! :mrgreen:

Click to expand...

I'll let Yoshi respond to this, as he's been the one that has been speaking directly with the vet more than myself. Thanks for checking in so much, it's a real kindness and we appreciate it.

I agree with the others that a lower dose would help Jack's numbers. The high numbers are coming from skipping doses every day, and by the time the next dose rolls around he is too high. Also, normally 40's earn a dose reduction, and the fact that the 40's came in the cycle after a skipped shot (when the shed was emptied) really means that Jack is getting too much insulin. It's hard to say how much too much, but I would rather err on the side of caution and go down to 1.25 or even 1 unit. You can always work up from there quickly if it's not enough.

You're testing around the clock, and that is awesome, but a little reduction might give you a bit of a break too. I think if you can reduce the dose a little and start shooting every 12 hours, that will flatten Jack out some. Then we can see at what level he flattens out, and determine whether the insulin dose needs adjusting.

FYI, it's not uncommon for cats to run down the dosing scale very quickly once they start getting good numbers. You build up to a good dose slowly, then often have to back down from that dose pretty quickly until they choose a lower dose to settle on.

Hey Jose and Yoshi

ditto to the feedback you've recieved.
And it would be great to see you guys posting often, daily, weekly, whatever works for you.
I also took a peek at your SS while you were gone, and so that's why I do a ditto to the feedback here

Good to hear from you! I hope you are able to find a dose that works for Jack.