2/27 Wild swings. No curve. Holding dose

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DL and Pinky

DL and Pinky

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Pinky had her first insulin dose this am. Her AMPS was 265. Gave .5. BG tested every two hours and results uploaded to SS.
Lowest reading taken at +6.25 was 171. Next reading at +8.25 was 323.

Providing her PMPS reading is over 200, it looks to me as if I am clear to administer .5 tonight based on the fact of the low being well out of hypo territory. If experience says otherwise, I would be grateful to know about it.

I am really pleased with the outcome today, so thank you all for all your help and effort that I have benefited from through this site.

Laura

Thank you, Pinky, for putting up with it all. Keep it up!
 
Beautiful, looks like she'll do nicely on ProZinc (if one day of data is enough to base that statement on lol)

She appeared to bounce a bit from that 171, that it totally normal and will take some time to settle down. Let's re-evaluate the dose in 4 days, unless of course she sees green, please tag me so I can look at her data.
 
Thanks for your input and encouragement. I'll take it even if the data's thin. I will stick with the dose.

FrostD said: She appeared to bounce a bit from that 171, that is totally normal and will take some time to settle down. Let's re-evaluate the dose in 4 days, unless of course she sees green, please tag me so I can look at her data.[/QUOTE]

Oh, a bounce. I feared I had stressed her too much. Good to know. I will tag you if she goes into green.
 
Stress is usually temporary high numbers, then comes back down within a few hours' time (maybe 3 ish if I had to pick a number?).

It's a good start! I see quite a few reds and blacks with newly diagnosed cats so this isn't too bad at all
 
@FrostD she never tested in the green. I hope you meant for me to tag you anyway at this juncture.

Four days of Prozinc at .5 have passed. I am not sure there is enough data in her SS to give an accurate picture. Unfortunately, a dose was skipped in the PM Feb. 3rd.

I plan to get a +6 after the PM dose tonight to address the void in data on the overnight BG levels.

I can monitor her for the day and do a curve on Tuesday, if an increase is warranted.

Thanks for any insight offered, and thank you all for your help. I so appreciate it.
 
I think you have enough spot checks to increase to 0.75U, I really dont see her going any lower than that blue you saw. When nadirs are mostly above 200 (meaning very little high blue at all), you do have the option to increase by 0.5U. I personally would feel better if you did a curve before opting for that, but it's completely up to you and your comfort level. The slight downside is that much of an increase may cause bouncing, but she doesn't appear to be a bouncy cat
 
Thank you for having a look and a mulling over. I am very comfortable with 0.75U.
I will increase her dose on Tuesday? to keep an eye on her and do a curve then?
 
DL and Pinky said:
Thank you for having a look and a mulling over. I am very comfortable with 0.75U.
I will increase her dose on Tuesday? to keep an eye on her and do a curve then?
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You could increase tonight/tomorrow if you wanted, I don't see her getting even close to green numbers. But whatever you're comfortable with!
 
I was so amazed to see blue this morning, I forgot I am not to shoot blue and fed her. Rats and double Rats! My only recourse now, is to skip or give a token dose for SLGS.
I am going to go with a token dose of 0.25U, which falls within the guideline, I think.

I would really like some input if someone can understand my SS better than I can. There will be someone home to monitor her but they are not yet testing. I will be at work.
 
I gave a Skinny 0.25 as best as I could draw it up with a magnifying glass. She will have an eye on her, but it looks like her system is fighting for control at the insulin's peak. It has thrown everything its got at the insulin's peak around +6 for the last two cycles.

I tried to do a curve yesterday, but just could not get a +12 and went on the +10 based on her previous total lack of green of any kind. I checked her at +6 the next cycle for safety and she was in pink.

I welcome any feedback about her SS and my decision making here.
 
Another error, i have just realized. 0.25U is not 25% 0.75U, it is 33%. Glad I made it skinny, but this is not a good trend. Even though it is likely to be just fine for her, this streak of mixed up thinking has got to be sorted out.
 
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No harm done. 178 and 238 aren't all that far off, my guess is she's going to bounce anyway from the blue numbers. As for dose, I also think 0.25U was fine, you can only measure so much on these syringes!

Yesterday is a little odd, it reads almost like a bit of a bounce from the night before. Bounce breaking cycles tend be longer slides down with late nadirs, so I suspect that explains these lower preshots.
 
Thank you. That helps so much. I find yesterdays numbers incomprehensible. I invented a whole hypothesis this morning to explain them. Probably an invalid one, but it made sense at the time with one eye open. Bounces are so tricky. They are not at all straightforward to the uninitiated.
 
It's complicated!

Each cat bounces differently, some people may not even call that a bounce because it's all within meter variance (we had a discussion on another thread yesterday about it lol). But from where I sit, those higher/flatter cycles or huge jumps following a lower number or big dive is usually a bounce of some sort. The good news is that he handles it pretty well, back into lower numbers quickly
 
It's easiest to think of it this way - on a normal day, the insulin just does it's thing, unimpeded by anything else except food usually.

On a bounce day, the insulin now has to fight the sugar that the liver dumped. So instead of dropping to blues, the best it can do is yellows. The same is true with infections, stress, etc - anything that raises BG. So one or two cycles scattered around is no big deal, likely just a bounce or an off day. But if you are noticing continuously elevated numbers for consecutive cycles, it's prudent to keep an eye out for infections, illness, etc. Look at my spreadsheet from 11/23 - he ended up with a 105 fever.
 
Thanks for your help FrostD, and the head's up on your spreadsheet and for the bouncing explanation.

Based on the total lack of green, I am going to go up to 1U tomorrow morning. I will be home to monitor. If anything in the SS says different, I would appreciate the input.

I took the suggestion that her dental issues be addressed sooner, rather than later, to heart. Unfortunately, there is a bit of a vet shortage where I live due to the pandemic. The place I had hoped to bring her specializes in dentistry, but is 2 months out for an appt. Still looking for a reputable alternative.

Otherwise, she is doing quite well. Her energy is much increased and she has gained weight. She comes to her testing spot voluntarily. I would not have thought this possible without the encouragement I got here that it was indeed possible. That is not to say she just sits there patiently suffering through my missteps. But she is there. Night before last, I got up for the bathroom, Pinky was asleep on the bed. As I was headed into the bathroom, I was thinking I was too bleary eyed to attempt a test, on my way out I almost tripped over her lying right where I walk back to the bed. Not normal at all for her. So. I cleared the sleep out of my eyes and tested her. She was very pleased with her testing treat! (Thanks, Ruby, for the inspiration!) I am still astounded by it, she is one of the most nervous cats I've ever known. She remembers everything that hurts or scares her and has run and hid from whatever it is forevermore. I mean she is scared of the sound of plastic shopping bags, LOL.

A big Thank You from Pinky and me!
 
I think an increase is ok, I would just grab a midday test today if you can. Good luck!

And you're welcome, it's what we're here for!
 
Looks like she took the increase in stride.

I used to feed them three x per day (see first curve with a +3 feeding in PM cycle only). I now feed four x per day--1/2 a meal at pre-shot, the other half at +3 every cycle (the next two curves, +3 feedings in both cycles.)
I think this is affecting the shape of her curve. I think her nadir (peak insulin) is really around mid-cycle, but that the +3 feeding is raising her BG a little and flattening out her curve making it more of a curve with a hump in the middle.

A neuropathy video was posted recently, (thank you!) After watching it, it was clear that I had been seeing signs of it, but didn't know what I was looking at. I see now that she has very early signs of neuropathy in her hind legs. When I brought it up with her other caregiver, he said he had seen it too and was keeping an eye on it. I want to start zobaline, before it progresses any further. Does it affect BG levels? Any other things about it that I should consider?

Thank you so much for any counsel you have to offer. I appreciate the help so much.
Laura
 
If I understand SLGS correctly, I hold at this dose, based on the last week of data.

I believe that the high PMPS today was caused by a mistake that I made.
The treats ran out about +5 (she refused all others). I substituted a 1/2 tsp. or so of low carb food as a treat for testing and thought nothing of it. In retrospect, given that there were a few tests after that, I think it likely drove up her BG as the insulin wore off.

So the end of the cycle data is suspect, but first half is good. I began experimenting today with feeding times and amounts to get her BG#s as smooth as I can.

I welcome any thoughts you might have about her SS (or anything else). I pore over it, mostly to no avail.
 
Looks good!

I would hold a few days (or week, whatever works for you) just to see how those food changes settle out. Today was a good job slowing down that early drop.

The only general comment I have is I'd like to see her under 200 for longer, because the majority of the cycle she's still near or above renal threshold. But the food experiment may help that, and also give you room for another increase. How reliable is she eating those early snacks?
 
Hi FrostD. Thank you so much for your input!

She is 100% reliable with food at this point. Treats are another matter with these empty shelves around here. Most of the low carb ones are too hard for her, but she is great with Whole Life Just One, so I'll order some.

FrostD said:
The only general comment I have is I'd like to see her under 200 for longer, because the majority of the cycle she's still near or above renal threshold. But the food experiment may help that, and also give you room for another increase
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Yes, I am very much hoping to make room for an increase. All suggestions welcome of how to make that happen. AMPS 469 this morning. Yikes.
 
DL and Pinky said:
Hi FrostD. Thank you so much for your input!

She is 100% reliable with food at this point. Treats are another matter with these empty shelves around here. Most of the low carb ones are too hard for her, but she is great with Whole Life Just One, so I'll order some.



Yes, I am very much hoping to make room for an increase. All suggestions welcome of how to make that happen. AMPS 469 this morning. Yikes.
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Just a bounce!

Let's see where she's at once she breaks the bounce. If she's consistent in eating those snacks, that will keep her curves flatter and give you room to increase ...I think. But what you doin want to have happen is one day she doesn't eat and then you have a dive
 
I can't tell whether the food changes made any difference because of all wild swings. I am not sure when to attempt to gather data and when it is a waste of time. Unable to identify opportunity to obtain weekly curve. Deviated from SLGS method for this reason.

But, based on 138 at +4.5 on the 24th, I hold this dose.

@FrostD any insight you have would be incredibly appreciated.
 
So I've been staring at her SS for a little bit now, and here's current theory - she's getting long duration from ProZinc and seeing some overlapping cycles.

The days she has a late AM cycle nadir seems to translate to a late PM nadir - which leads to lower AMPS and a rise through the first few hours of testing, then a slow shift back to a "normal" cycle, then shifts again

Can you get a +10/+11 today? And whenever you can the next few days?

But yes for now hold the dose
 
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