09/15 Ivana AMPS=362, +2=349, +4=288, +6=277, +8=239, +10=310, PMPS=248, +2=70, +2.25=63

Yesterday's post

It's curve day! Prepare for lots of updates

 

Come on Ivana!!

Work that juice!!!

 

Oh yeah, she's working it. She worked it so hard she needed a nap. Poor thing could hardly lift her head up to eat her post +4 test treat ;-)

 

I know I haven't finished Ivana's curve yet, but looking at her spreadsheet has me wondering if she isn't doing as well on the 1.25u dose as she was on the 1.5u dose. I'm still doing SLGS as I don't want to start TR until the automatic feeder arrives incase she needs carbs through the day. So, looking at the SLGS protocol, her nadir is definitely >8.3/150, so should we increase 0.25u to be back at 1.5u?

Also, there's a part in the SLGS protocol that says "rushing towards regulation will cost you time in the long run, because you may shoot past the right dose" - that to me seems to go against the TR protocol, which is to get regulated as soon as possible, is that right?

 

You have to read the sentence right before it "Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is!"

The same sentence could be used in the TR protocol too...if you try to increase the dose too often or by too much, you could go past what might be the best dose for your cat.

Although the strict SLGS protocol says to hold the dose for a week, I think you could go back to 1.5 if you're able to continue testing as often as you have been, but let's see what other opinions are out there @Wendy&Neko @Marje and Gracie @Sienne and Gabby @Jill & Alex (GA) @julie & punkin (ga)

 

- Ok cool, that makes sense then! Thanks

 

I can't see from your signature line what glucometer you're using? Is it a human glucometer? I think so, so all this below assumes that's what you're using.

Here's the reference from SLGS:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit

• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose

• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

• As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!
​

I think it's a little ambiguous in your situation. For choosing to adjust the dose, I'd go by the lowest point in the past few days on this dose, which was 149. Right on the border between the "hold the dose" and "increase the dose." Overall, I agree with you - i think she looked better at 1.5u.

If you didn't test so much, I might suggest holding the dose. Most people use SLGS because they are feeding their cat dry food, or because they can only test occasionally. In your case, it's pretty clear what's going on in Ivana's body and you can see nicely how she's doing with the dose.

When you decrease the dose, the idea is that the good nadirs continue - in Ivana's case, it looks like the dose reduction has taken her out of green numbers. So based on that, I'd go back up to 1.5u immediately. When you've taken a dose decrease because the cat dropped below the reduction point, and then the cat's blood sugar trends up, you don't wait x number of cycles to increase. That's considered a failed reduction, and as soon as you determine that the reduction failed, you can go right back up to the last good dose.

When you're initially increasing the cat's insulin dose, it's important to hold the dose the appropriate length of time (and not rush things) before increasing the dose again. That's the time to not hurry things and make sure you don't overshoot a good dose.

Does that make sense?

 

Thanks so much Julie, yes we're using a human glucometer, I've added the details to my signature.

We will go back to 1.5u as of tonight's shot, now that two other people think so as well as us. We can always go down again if we need to, and hopefully that will be the case.

I'll finish today's curve and will continue testing past 12 hrs for as long as I can stay awake. I'd really like to pull an all-nighter sometime to get a full PM curve, we don't have much data for that and I've heard it can be a bit lower than the AM curve.

 

Just did the PM shot myself as hubby wasn't home. I still get the nerves. Gone back to 1.5u.

 

Talked to hubby about switching to TR and he's all for it - yeah!! Now hurry up and arrive, auto-feeder!

I'll be sending Ivana's spreadsheet to the vet today after today's curve is finished, and letting her know what we're doing - hopefully she's ok with us doing TR.

 

From a PMPS of 248/13.8 to a +2 of 70/3.9 - I'll check her again in 15mins, if she's dropped again I'll give her some carbs. On a possibly related note, she didn't eat as much dinner as usual, probably because of treats from all the tests. She's still very interested in the treats so I'm not worried that she's lost her appetite.

ETA: 15mins later and she was at 63 so I gave her 1tsp of carb food. Will test again shortly.

 

That is a big drop in 2 hours......9.9 or 178. And then a further drop to 63 in 15 minutes.
I would give her some high carb food as it is still early in the cycle. And don't leave it too long between tests at this point.

 

Last test was 1.3. Turns out our honey had crystallised (!) so we gave her condensed milk and more 22 carb food. Testing again very shortly. Stressing out! She has no signs though.

 

1.3 is very very low Tara. You might need to take her to the vet.
Rub some of the crystallised honey on her gums now

 

@Sienne and Gabby
Can you help here please

 

Got some honey into her, about to test again, have vet emergency number on standby.

 

Good work. Will stay with you

 

I am also here if needed

 

1.7 now, going up thank god.

 

Thankyou ladies xxx

 

Hay..glad to help

 

Ok you need to give more honey on the gums. You need to get her up to over 50 or 2.9 so still a way to go.
Put the honey on the gums now please

 

Yep Darryn is on it now.

 

How often should I test to check?

 

I would say every 15 min

 

Did you give more honey on the gums

 

Yes, she's licking it off Darryn's finger.

 

That is good...

 

Ok test every 15 mins and if still under 2.9 you need to give more honey. And will you post it all as we are watching for you thx

 

Yes will update with next test results shortly. Thankyou for staying.

 

She appears fine, by the way, none of the signs from the hypo sticky post.

 

she has still not reached nadir yet so you still have the insulin working to lower the blood sugar so you need to get the blood sugar up

 

Yes I understand that Magellan never shows symptoms either of hyps

 

You are both doing a great job by the way

 

You are lucky she has not shown any symptoms......but we are not out of the woods yet and she still could show symptoms.
I am not trying to frighten you....just give you the facts.
Keep up the good work

 

2.3

 

Yeah I know, that's why I'm freaking out... but she's coming up which is such a relief. I don't think I'm going to get any sleep tonight!

 

Yes you and Darryn are doing very well and rock!

 

Great. 2.3 is good. give some more honey

 

is this your first bout of hypo Tara?

 

More honey? More carb food?

 

Honey

 

Yes Julia, first time.

 

Hugs breath your doing very well I was a total basket my first dance... huggles breath and give sugar kitty honey

 

Oh I'm a basket case now, if only you could see us here! Darryn is very good at staying calm though while I lose it.

 

Ok what is the BSL now? If it is still under 50 give honey

 

give bot your men folk big hugs..

 

Darryn is doing it now.

 

2.4

 

More honey

 

Yes, more honey
Ok once we get her up over 50 will you give her a teaspoon of the 22 carb food. This is because the honey will raise it quickly but will only last about an hour. If we give some. 22 carb it will last longer. But let's get it up to 50 first

 

Just shoved some more honey between her gritted teeth. Have also smeared some on her paw for her to lick off.

 

How's it going Darryn? This is baptism by fire!!!
You are both doing a great team job

 

Do you have a syringe with the needle removed??? that might be helpful in getting honey into her.. have to do that with Magellan

 

How is Ivana doing with it all?
We don't want to freak her out
Good girl Ivana.......you do what your auntie Bron says OK?

 

Indeed it is! Darryn is the calm one at the moment, as Ivana is peeved at me for honeying her and I'm still mega-stressed. Poor thing has had a rough day with doing her curve all day and now this. Just waiting a bit longer to test again.

 

She's letting me put in the side of her mouth, she's just not happy about it. She's licking her lips though.

 

LOL at least she does not bite!

 

what is her bgl at this point??

 

I can't believe we have got out of this unscathed, considering!

 

Tara it is very normal to be stressed at a time like this. Sheba dropped to 1.6 on me the other day so I know what it feels like.
The important thing is you posted and got help and are following directions really well....so try not to stress out too much...we are in a better place than a hour ago.

 

Bron what does that mean to us meters???

 

Bron what does that mean to us meters???

 

3.3

 

3.3

 

3.3 sorry lost internet for a minute.

 

Like wise wierd

 

Sorry...my internet connection went off for a few minutes.

Ok that is great.
Now can you give her a teaspoon of 22 carb food so we can keep her up there please

 

Bron looks like we all had the same issues... wtf??

 

Sorry Julie....multiply by 18 to get US numbers so 3.3 x18 = 59
1.3x18= 23

 

Must have just been this board. She's eating the food.

 

I am thinking another test 15 min after the last.. goal looking for at least 3 above 50.. what do you think Bron?

 

thanks for the info Bron will write it down

 

Will do another test in 5mins.

 

Great!
Really pleased we have got this far after such a really low number.
OK our job now is to keep her in normal numbers for the rest of the cycle
So do a test in 15 to see where we are at. I would like to get her a bit higher than 50 just because I don't know when her nadir is and we don't want her to drop again

 

Your rocking this Tara

 

Don't worry Bron I have no doubt I will be pulling an all-nighter tonight to sit with her and monitor. No way am I going to be able to sleep now.

 

From what I am getting off of her ss is the nadir is about +7.. but that is a guess.

 

Geez Julia I don't feel like I'm rocking it!! Are hypos common? I really hope not.

 

We're at +4 now.

 

Depends on the cat.. and yes you are rocking this Magellan early on was getting them about every other day... but he was on Novalon N

 

3.4

 

Doing real good....now to take care of you.. are you a chocolate lover or good wine??

 

Oh man, now that you mention it, I could really do with a glass or three of wine!

 

And my task tomorrow is clean up all the honey on the lounge.

 

Ok now that I am freaking out a bit less now, what went wrong? Did I do something I shouldn't have for this to happen?

 

Yes it looks like it the nadir could be about +7..... Haven't had a chance to look until now. On the first day we tested and she got the 68 remember and we fed her some food to bring her up. That was at +5 but she could have dropped further if I hadn't tested her.
Hypos are not really all that common....certainly not as low as 1.3
Usually we can catch them as they drop and feed to stop the drop but Ivana really dropped like a stone tonight. You are going to have to get advice from @julie & punkin (ga) , @Wendy&Neko and @Chris & China before you give the morning dose. So don't give any insulin in the morning until you have made contact with Julie, Wendy and Chris because it needs reviewing

 

LOL don't stress the small stuff right now ok??

 

3.4 is good. OK how about we don't feed and see what it is in 15 mins?

 

my knee jerk is to say a reduction..

 

Definitely no shot until I get advice. I will also call the vet first thing too, what an interesting day to do her curve...

 

Tara you did nothing wrong. It is just one of those things.....lets just thank God that it was caught and we were able to bring it back up.
Don't stress about it.
It is all part of being a cat mamabean and a papa bean!
I think we need to leave the dosing for the morning to the ladies I tagged as it is a bit complex.
Tara and Darryn you have both done really well tonight in a very stressful situation.
No going to bed yet though we still have work to do!

 

I agree and you rocked as well Bron!

 

Thankyou both for all your advice and calmness, it is very much appreciated

 

Happy to help.
I am just thankful I happened to go online...I wasn't going to.

 

Still 3.4 just now.

 

sweet that is good

 

Has she had all the food she would normally eat for this cycle yet?

 

In volume, yes. She still has a bit of her normal non-carb in her bowl, but she's eaten the high-carb food in it's place.

 

OK. So she is at about +4.5 in the cycle ,right?

 

Yes, shot at 6pm this evening.

 

and it is?? here it is 5:41 am