12/28/20 Chicamonkey AMPS 509/PMPS 380/+4 296/+5 274

Good morning, I’m holding Chicamonkey at 2.25 for a few more cycles. I’m a little nervous going up to 2.5.
I will evaluate her numbers with your help over the next few days and most likely bump her up by Wednesday or Thursday... when I will have some time off to watch her more closely

here is yesterday’s
https://felinediabetes.com/FDMB/thr...534-6-380-pmps-368-4-268.240579/#post-2706938

 

I'd be nervous waiting...her numbers are so high. I hope some of the others will weigh in...

She needs more insulin - sooner than later would be good. I understand your anxiety and the info you posted about your uninformed vet (sorry to say it, but your vet obviously knows very little about feline diabetes, it's common and we often hear about uninformed vets)...I do hope you can find someone else who's more supportive.

 

I know I feel the same way. But I’m so scared...
Let’s say she’s bouncing and clears it
And goes low while I’m at work

 

as sue mentions, perhaps others will weigh in.
if you'd like to let others know you're considering (or not) a dose increase, you can add the "?" prefix to your title and then put some description about your question in the text.
so for today it would look something like

? 12/28/20 Chicamonkey AMPS 509 dose increase timing?​

 

If you don't see blue or green today or tonight, I would take her up tomorrow.
She is running high and likely needs more insulin.
If you take her up tomorrow (tuesday), it will be a few cycles before you see the full effect of the dose, you will have held for 8 cycles with that blue, it can takes up to 6 cycles for the depot to settle.
Some cats do have a strong reaction to a dose change but I don't see that on her SS.

The one niggle I do have is if she is going lower at night, last night her +4 was 268 some 60 points lower than her +2, I would have liked to have seen a +5 or even a +4.5, to make me more certain that she's not seeing anything lower, it is possible she went lower in the early hours, many cats do have their lower cycles at night.

 

Her numbers are quite high at this point - and have been fairly stable at those higher numbers. However, the thing that I rely on when I can't be here is the auto-feeder. Do you have one yet? If not, you may want to check them out - they're truly a lifesaver when you need to be away or have a night where she just won't cooperate but you're exhausted and just have to get some rest - it happens - everyone has a life and many work outside of the home.

I find the auto-feeder can give you great peace of mind. With many who work outside the home, getting up a bit earlier than usual to test/shoot allows you to have an hour or so to test again just before leaving - and then feed accordingly. If the numbers are headed down quickly, then you leave MC (medium carb) in the feeder; or perhaps if she's intent on zooming even lower, then HC is in order.

Unfortunately FD doesn't appreciate or understand the need for many of us to leave the house in order to make a living so we can support our FD cats - among other things - so we look for ways to accommodate FD and those numbers AND go to work - or in some cases just to be able to leave the house for more than an hour or so at a time!

I hope this is helpful.

 

I just tested her and her +8 was 364.
I think with the feedback I’ve gotten, I’m going to bump her up tonight.
I’m not comfortable with her higher numbers either.
Wish me luck

 

Could you fill the SS in when you get a chance please? Did you get more tests today? (maybe you were working) but if you did fill in those numbers too, thanks.

I'd wait till you see what pmps does at the very least, she is lower than amps at +8, if pmps is lower than +8 it might be that she is clearing the bounce (especially if she is mid to low yellow) in which case I would recommend not to increase the dose, and to make sure you get a +2 as well as the before bed test.
If at that before bed test her numbers are still falling, I would strongly recommend getting another test in, a +4.5 or a +5 to see if she is still dropping.
Lantus dosing is based on how low the dosing is taking Chicamonkey, and I'm not convinced that we know that with any real certainty.

Take last night she dropped 100 pts by +4 from 368 to 268, that is quite a lot, when I then see the black the following PS, it makes me wonder how low she went. If you had got a +4.5 or +5 you might have seen if she was still dropping quickly or if it was slow or infact if she was flat or already rising. That would help you to dose a bit more confidently.

I did TR and I hate seeing high numbers as much as the next person, but it has to be done with the data to back up the decision, I just think that you may be missing some data for that decision.

 

I wanted to ask about food.
What are you feeding and when?
How many times a day?
Does she free feed?
Are you taking food up two hours before PS?

 

I think she might have gone lower than yellow the last two nights. When that happens can you set an alarm and get a test a few hours later or at +6?

 

Is it too much insulin? Is Is it not enough insulin?

We have no data at all for what’s been going on from PM +7 to PM +11, which is almost 1/4 of the full picture.

My $0.02
As long as there are no ketone issues ...
Before changing the dose one way or another, shed some light on that area of the ss. A PM. +7 one night, a PM+9 on another, a PM+11 on yet another etc. In a few days a picture will emerge that will either point one way or the other.

The best dosing decisions are made when you have data for the whole picture.

 

I could not agree with Gill more. The black AMPS could be the high before the break and she is headed down. While I suspect she will need an increase, I’d be sure she isn’t breaking a bounce first.

 

I updated her spreadsheet..
I kept her at 2.25 tonight .will try for + 5 tonight
I agree ... more data needed

 

I sent my vet her spreadsheet in a second email and asked him to review it along with what I’ve been doing on TR with monkey.
Basically he doesn’t want me to go above 2 units, and warned me heavily if I go to 2.25 units I need to be with her to make sure she doesn’t go low.
( I’m already at 2.25..... now he has me totally freaked out

 

Vets doesn’t realize that we can test at home and keep them safe. If you look at the spreadsheets of cats here you will see what he says is not true. That’s why we are data oriented here. That’s also why as you agree, you need more data to determine the best dose for her at this time. Don’t let him scare you. When I first joined the FDMB I was asking my friends why would I listen to strangers rather than my trusted vet. Before long I was mostly because he couldn’t help me after office hours. He’s a boarded diplomat of internal medicine and he told me I managed Max’s diabetes better than any client he had and showed my spreadsheet to his 3rd year vet students when they spent a week shadowing him.

 

I love this! I am thinking the same.
This weekend maybe pull some all nighters with her and my hubby to get some postprandial data

 

If you are able, rather than pull an all nighter you can try setting an alarm for the times you want to test, grab the test real quick and assuming it’s a safe number go back to bed. We call this “sleep testing“. If there are 2 of you that can alternate testing times even better.

The rule of thumb is to be able to step back from your ss, look at the past 2 weeks as a whole, and within that whole not see any wide open spaces of white (no data).