1/5 BuddyM: AMPS 172 | +2 96 | +8 59 | Dose?

Thank you so much for to everyone who encouraged and supported a stressed out cat nurse yesterday:
https://www.felinediabetes.com/FDMB...-what-is-going-on-lower-than-expected.240990/

It looks like the depot is finally backing off for Buddy. I saw the 70 at +3 last night and thought lord another drop. I gave some 15% food and that seemed to kick him off.

He's 139 at +11. I gave some food because he's going a mile a minute this morning and getting the +11 without food was already a nightmare. I'll take the AMPS but it might be a little food influenced.

I want to try his dose at 3 today. I realize this may be an upward trajectory for his bg today, but I will not be able to monitor as carefully. Work is ramping up today and I could not focus with the drama yesterday. Hopefully with the depot drained 3 will at least not drop him into the danger zone.

 

That’s a really big reduction, from an earned 4.25 or 4.0 to 3.0. Maybe if the amps is higher you might feel comfortable giving a bit larger dose but you hold the syringe. I hope it’s a drama free day.

 

I know! After the shenanigans with him going down when by all logic he should have gone up the previous two cycles though I am concerned.

He's really shooting up now so maybe I'll split the difference and give him 3.5. Would I be able to go to 4 tonight if today is high? Or would I get locked in to do the slow increasing again?

 

If high tonight you can take him back up. See how today plays out.

 

Great. Thank you so much for being patient with all my fears!

I gave him 3.5.
Hopefully he doesn't shoot up too high and we can get back on track soon.

 

All the recent dose changes might give you some wonky numbers. It also makes me wonder if a fructosamine is even smart to do now. Just my two cents fwiw.

 

I was also thinking of maybe trying to delay the vet visit until he was more stable. Also because I'm finding it impossible to predict when he's going to be diving and I might not want a vet visit on my plate when dealing with a dive day.

Vet's about 30 minutes drive and Buddy absolutely freaks out in the carrier. I thought I'd try giving him some Gabapentin this time (left over from his neutering last year), but then I'm not sure if that plays nice with the diabetes.

When do you think a good time would be for fructosamine?

 

Why do you want to spend $$$ on a fructosamine when you are testing and have data?

Stick to a dose you are comfortable shooting for a few cycles. If you shoot different doses in different cycles, you won't know which one is working!

 

The only reason why I was suggesting a fructosamine at your vet visit was because you were so worried about shooting 4 or more units. With all the recent dose changes it won’t tell you anything.
As for gabapentin, it’s fine with diabetes. Max inevitably would be low when I had a scheduled vet visit. Then he would bounce from the stress. My vet was close but I often was kept waiting. The first few times I brought food and my meter with me. Some cats drop at the vet.

 

My vet wanted to do one in December but the appointment got pushed back a few times. So this is his first follow up after the diagnosis.

 

You are testing a lot so you gave real time data my vet only ran a fructosamine once when he thought Max might be going into remission. He wasn’t. It just showed really good control. There’s nothing magic about a fructosamine test. It just shows the average over about two weeks.

 

I don't understand what you mean that the fructosamine would give me information to shoot 4 or more units? Do you mean after the low nadirs in the cycles on 1/3 and yesterday? How will the fructosamine inform me on the dose?

 

The fructosamine gives a score as to how well controlled his blood sugar is. I think if you had not reduced it would have showed he was controlled but not that you were giving too much insulin. Now because if all the recent dose changes it won’t tell you anything.

 

Do you think he would have been safe if I shot 4 units yesterday morning?
Because I was relieved I didn't shoot 4 yesterday when he was dropping so low.

 

It’s hard to say with so many changes. Lantus likes consistency. When we don’t have that predictions are tough. I think I would stick with 3.5 now for three days minimum now. You can see what others think.

 

What does the cat needs, 1 unit, 4 units, 8 units or more, has no impact on whether you shoot lower numbers or how they handle lower numbers. A cat needs however much insulin they need.

You can shoot 3.5 if you want - I would not go any lower. However I wouldn't hold it for 3 days if you start to see the numbers trend back up again.

 

With the fur shot and the three BCS shots one would assume that the depot from 4.5 should not really be that much in play anymore right?

So why is Buddy's numbers not higher today?

From all the other spreadsheets I've seen a skip or BCS causes the immediate cycle to go up from normal and definitely causes the next cycle to have higher numbers while the depot at the new dose builds.
Please correct me if I'm wrong?

Is it impossible that Buddy needs less insulin than 3.5 units right now? I know most cats are able to descend slowly, but is it possible that Buddy can't?

If so can you guys please explain to me like I'm a 5 year old so I can understand why I should ignore his numbers and give him this dose again tonight? Because from my (limited) understanding the 3.5 depot should be building at the moment after the drain from last night, and then the next cycle should be lower than this one. I really don't want him to go any lower tonight.

 

I saved this one because I was in awe of the race downward - see the 2017 tab.
https://docs.google.com/spreadsheets/d/1-8O8Wt-_7o_sLhrgJf2y9jkUBt6bMnrduV1EDImtRio/pubhtml#

Perhaps Elise or Wendy will be by again to weigh in about dosing. FWIW, he had a beautiful cycle today. It took me awhile to get used to the healthy lower numbers myself so I get you some of the anxiety you have. If your goal is remission, it's nice to keep in mind that if you can keep the greens going then Buddy will have a better chance at remission (and a strong one at that).

Hope you had a wonderful day Mariette

 

Thank you so much for linking that Susanne! I haven't seen this spreadsheet yet.

I'm glad you understand my anxiety. I'm responsible to make sure he's safe, and if I did something to put him in harm's way I won't get over it.

I totally want to keep the greens going, but as safely as possible. I wish I could enjoy the greens though! I'm terrified that he'll start dropping and I won't be able to bring him back up enough with food alone.

Got to say he's not feeling the best with the greens. He was super energetic this morning but have just been so doped out and lethargic all afternoon.

Hope you have a lovely evening!

 

OK, so we are looking for a spreadsheet for a cat on a bit higher dose, a reduction earned followed by a BCS or a skip, and then cycles following looking like nothing had happened? I know I've seen a few, but here's one for starters. Moe's SS. 11/24 PM earned a reduction, skipped that morning, then it looked like Moe didn't even notice the skip. 12/18 there was a BCS is the evening and he was back in business the following morning. Ditto with BCS morning of 12/26.

I'll keep trying to remember more of them. I know there's plenty of times I've commented on it.

 

Thank you for linking Wendy!

This is more the exception than the rule correct? It is likely that Buddy will drop lower tonight?

I am anxious to know why you don't think I should shoot lower than 3.5 units for Buddy? Is there something in the spreadsheet that makes you believe he needs this or a higher dose?

 

How long before PMPS?

 

It's in 2 hours.

 

He hasn't earned a reduction so far at this dose.

 

I understand that according to TR he hasn't. I decided a few days ago that going forward I wanted to give him a reduction at 60. So if I'm following my own guidelines he has actually earned a reduction.

 

Maybe Henry’s SS might help. Look at 2020 tab, 12/6, a skip, then reduced dose. It took a couple cycles where the BG went up but then Henry kept churning out green. He also shot a BCS on 12/1 a.m. cycle which was 0.5u less than normal dose. By PMPS, he decided to hold that dose but then the BG drifted up a tiny bit so he raised by 0.25u.

Butter’s SS...look at 2020 SS on 12/3@. She skipped. Dose reduced by 0.5u and BG went up into yellow. However, she then started getting back I to greeen but had some blue to the dose was raised again.

We want to be cautious about taking too many back to back reductions. You took one on 1/2 a.m. cycle and then again the p.m. cycle. Normally, we wouldn’t have suggested the second reduction that night but I won’t play Monday morning QB on that. However, if you had kept shooting as most of us would, he might have earned another reduction but he wouldn’t have earned down to 3.5u or lower.

We can give you our thoughts but you hold the syringe and you are there. You should follow your gut. It takes more than a cycle, typically, for a depot to build and some cats react to the first cycle of an increase by dropping lower.

What is the -1 and -2 on his SS before AMPS?

 

On Henry's SS, when he takes the skip on 12/06 that cycle is green, but the next one is higher AM on 12/07. And then the one after is lower.
So that is my concern that I will see the same with Buddy. That this AM cycle we're still on will actually be the higher while the depot re-establishes, and then tonight's PM cycle will be lower. I definitely don't want Buddy lower tonight.

With Butters, are you talking about 12/31/20? That is showing the same pattern as Henry. Where the cycle after the skip cycle is higher. Then the next one is lower.

Unfortunately the fur shot happened for me on 1/03 and that was not a question of me not wanting to continue shooting at 4 units. But then when I saw him go really low I didn't want to give 4 that evening because I was dead on my feet I didn't feel like I'd be able to cope in case of a hypo.

Going from 4 to 3.5 is a 12.5% reduction... the equivelent of someone on a 1 unit dose reducing by 0.125 units. So it doesn't seem that crazy of a reduction to me.

 

I want to try Buddy on a 3 unit dose. Even though on 01/04 he was still too low on 3 units for my liking. If I'm using my guidelines of giving a reduction at 60, he would have earned a reduction then.
But those lower numbers could have been leftover 4.5 depot, and I'm a little scared that today's 3.5 will still be affecting the PM dose the same way. So I'm leaning towards doing a 2 or 2.5 BCS again tonight and starting the 3 units tomorrow.

I know it sounds kooky!

 

My bigger concern is you modifying TR. By doing so, you aren’t doing TR; there is no such thing as “TR light” I understand the low numbers are scary but you have your meter and food and that’s how you keep him safe. Believe me, I completely understand because my girl could do some crazy things like drop from 60 to 27 in 30 minutes in the middle of the night when she had been pretty flat.

If you feel you need a break and want to shoot 3u, that’s your decision but I really advise against modifying TR as you are suggesting.

 

Thank you Marje!

I realize now 'TR light' sounds very flippant and that wasn't my intention. I just thought it would be a shorthand way to let people know that I'm striving to do TR, but not quite able to.

I was considering switching to SLGS because the lack of sleep really affects me. I am not able to go back to sleep after doing a test at night. I can toss and turn for an hour afterwards. Especially if I get a scary number. Then I may as well go make a cup of tea. It wasn't sustainable and I was honestly at breaking point this past weekend. I felt like going to SLGS would be too much of a setback for Buddy's diabetes, and decided that doing a reduction at 60 was the best compromise between the diabetes and me being able to function. If I can't function then that's also not good for Buddy's diabetes.

Like I said I really strive to still do TR. And for increases I can definitely manage it.