06/25 Abbott AMPS 402 +2@410 +4@358, PMPS 383 +2@255 +4@170

https://www.felinediabetes.com/FDMB...-amps-373-4-328-pmps-184.265031/#post-2967858

@Bandit's Mom
Hey there!, well it's officially Sunday here so getting back with you as planned!

FYI- I take pictures of every syringe dose with a magnifier app and so I went back and looked at yesterday's AMPS shot and it was definitely a 1u shot, I had it on the ss as a .75* but remember in our last convo I said it was closer to a 1u. I have updated the ss to read 1u.

So I gave him 1u at AMPS today and so back to previous dose before token dose.
His AMPS was a bounce to the reds like you predicted and that cycle looked very similar to yesterdays AM cycle before we got into the blues.

Tonight's drop is a bit more severe than last night:
PMPS 383 +2@255 +4@170
I don't think he's on course to break his record of 90 but will continue testing

I have been giving 1 tsp LC after testing. +5 is coming up in 25 min.
Thoughts? Maybe up dose to 1.25 tomorrow depending on AMPS?
Anything I can do tonight to break this AMPS bounce cycle?

+5 154, fed 1 tsp LC

 

Good to see more blues on his SS. Looks like he has slowed down between +4 and +5, so just his usual food will do tonight.

With SLGS you hold doses 7 days. Even with TR you hold doses 3-5 days depending on the nadirs. If you think you can test enough (at least 4 tests a day, more in active cycles), you could switch to TR which is a more aggressive protocol. It's only been 4 cycles on 1U and one of them was a token dose. So the 1U depot hadn't built and you don't know yet what he will do on it. Tonight was cycle 2 on 1U (a token shot resets the cycle count since the depot is disrupted) and you hold for at least 6 cycles, so another 2 days.

 

Ok dang that’s right I forgot about that token dose! I’m already testing on average 5 times a day so maybe I could switch to TR but I’ve read the sticky on that and still a bit confused.

Holding 1u for six cycles. I have a sneaking suspicion that since he has broken this last bounce quickly I might be looking at an AMPS in the blues.

150 to 200 gives me 3 options and last time I stalled and gave token dose. I really don’t want to do that again because I feel like we are finally getting some momentum going in the right direction.
I will be able to monitor all day and have hypo kit and HC so do you think I have enough data to shoot if i get an AMPS in the 150 to 200 range?

+6 at 155

 

Any questions on TR I can help with? When a cat is new to nadirs under 200 (which Abbott) is, you hold a dose for 10 cycles.

Yes, a skip or a token does set you back a bit because it disrupts the depot. For cats new to insulin and where there is not enough data and the caregiver does not have experience with dealing with low numbers, we recommend a skip below 150 when following TR. With time and experience the idea is to shoot any number over 50 (50 for TR and 90 with SLGS). Lantus is very good at giving flat cycles at lower numbers, which is why we say "Shoot low to stay low".

Abbott might just bounce tomorrow but if you can monitor, I would recommend that you shoot the full dose at AMPS. Sometimes stalling can cause the numbers to drop without food, making the shooting decision even harder. If you do shoot a lower PS, remember not to fill him up with food with the shot. The idea is to keep him hungry enough to eat a little every hour for the first part of the cycle, if required. So, you want to break up his PS meal and feed some of it at +1 and +2. We use food to flatten the curve and counteract the insulin to prevent steep drops.

 

Thank you for that concise and well thought out answer! You are so thorough with your responses I often have other questions I didn’t even know I had answered just by reading your posts! Went back and reread the TR sticky for the 5th time and I think I have been getting stuck on the testing aspect of TR.

——“Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.“

If I’m only testing 5 times a day that’s: 2 PS, and where would the other 3 tests come in? Onset and nadir? I guess you would really have to know your cat’s nadir. Or would you just test every hour on the hour if you are dropping towards that 50 number and that’s how you’d find the nadir?

and I’ve been breaking up his meals the last 4 cycles into +0, +1, +2, +3. +1 and +2 better?

 

…oh you said it in your last reply: more in active cycles…

so what would testing look like in non active cycles?

 

Initially, the idea is to figure out your cat's onset and nadir. Nadir is a little difficult to pin point in unregulated cats because they tend to be pretty bouncy. Numbers can bob up and down in bounce cycles and nadirs can be later in bounce clearing cycles. When you get a "typical" or "normal" cycle is when it's easy to tell what a cat's usual onset and nadir are. Last night (6/24) would have been a more typical cycle and it looks his nadir is around +3 or +4. Tonight's cycle was a bounce clearing one which is why you are seeing a later nadir. And yes, in cycles like these a test every hour or two will tell you where the nadir is.

Usually, a test at +2 can act like a crystal ball of what the rest of the cycle is going to look like.

• If the +2 is about the same as the PS, it's probably going to be a pretty normal cycle - gradually down to nadir and then gradually back up to the next PS.
• If the +2 is a lot higher than the PS, that usually means there's a bounce starting and it's usually OK to take a little bit of a break from testing.
• If the +2 is (a lot) lower than the PS, that's your early warning that it could be an "active" cycle and numbers might go much lower later in the cycle and it's important to try to get more tests.

Of course, some cats have an onset later in the cycle like +2.5 or +3. In that case, a test at +2.5 or +3 would be a better indicator than a +2.

The idea behind testing is (a) to see how low a dose is taking the cat so you can know whether the dose is too high or not enough and (b) by extension keep the cat safe (by testing and feeding if it looks like the BG is going to drop too low).

Once you understand your cat and/or your cat gets regulated and starts seeing flatter cycles, you may not need to test as much.

 

Missed this Q. This is great. In some cycles you might just have to feed at +4 and/or +5 as well. If you look at posts/spreadsheets of other members, you will get an idea of what testing and feeding involves.

 

Nadir is a little difficult to pin point in unregulated cats because they tend to be pretty bouncy. Numbers can bob up and down in bounce cycles and nadirs can be later in bounce clearing cycles. When you get a "typical" or "normal" cycle is when it's easy to tell what a cat's usual onset and nadir are.

OMG this cleared up so much for me. Thanks!!! It’s just such a moving target right now with all the bounces.

I guess I initially picked SLGS because I wanted to imagine a world where I wouldn’t be up all night testing and here I am again— up all night testing.

I’m thinking if I really want to squash this thing that TR will get me there sooner. It’s kind of what I have been doing anyway. You inspired me Bhooma, I am changing my signature

 

LOL. That's why I thought you might want to switch to TR.

Totally. Especially with newly diagnosed cats, the chances of regulation/remission are higher if you get them to good numbers sooner. Of course, there are a few lucky cats who get there with SLGS as well.

 

Hi Drew Soooo happy to hear you're trying TR! It's a little more work but the amount of anxiety is the same . Bhooma (and everyone here) is AMAZING. She has a remarkable way of quelling the anxieties of the CareGiver. We (Cleo especially) love this place and her ❤️❤️❤️❤️.
My cat is one of those bouncy kitties. It gets easier once you figure out the kitty's patterns. Then expect the kitty to change it up and you feel like the first day all over again. Onset and nadir move around but that's all part of the dance. Keep asking questions and posting. Someone will always answer you

 

Thanks Angela, well speaking of bouncy kitties, AMPS is at 328. I was crossing my fingers I might carry these blues into the morning but nope

 

Those pinks break my heart too! But look on the bright side, the Liver is doing its job so that's good .
This is a great data point for you. Now you can count how long it takes to clear a bounce. Cleo used to take all 6 cycles in the beginning. Now she clears them in about 3. Except when she doesn't like today and cleared the bounce in 1 1/2 cycles . Sometimes we mambo sometimes we cha Cha and sometimes we waltz. Only kitty knows the next song. Our job is to have on our dancing shoes on lol. Ok enough metaphors.
Take advantage of the bounce and do something for yourself.

 

Yep like sleep! Do you still break up the food on bounce AMPS? Just in case a +2 shows a drop?

 

Not sure what would be best for you but I try to keep to as close to a feeding schedule as I can depending on the cycle. Cleo is food obsessed and is an absolute terror (almost like an insane dictator) if she doesn't eat when she wants to eat. That's mostly due to before dx where she was free fed combo of wet and dry, she had a choice all day long. She also has feline idiopathic cystitis and stress can cause a flareup.
When she bounces I still feed at shot time, +3, +6 and +9. Sometimes it's shot time +2, +4 and +8-10. Each portion gets smaller so by the tail end of the cycle it's very soupy.
This took a lot of experimenting. But seems to be working, well mostly working lol.

 

Also, I strongly suggest you start a new thread everyday even if it's not an active cycle and if you don't have anything to report. That's more for the human psyche than the cat.

 

Unless he shows that he is the kind to really dive at onset, you might just be able to skip the +1 snack and test/feed at +2 in cycles where he starts so high. After an active cycle the previous night, a 2 hour nap after AMPS would be most welcome!