? 6/13 Jill AMPS 320 | +3.25 155 | +5.25 133 | PMPS 190 | +3 79 | +4 79 | +5 104

Friday's post (I didn't post yesterday) >
Friday's BGs: AMPS 252 | +3 175 | +4.25 202 | PMPS 279 | +2 179 |+3.5 149
Saturday's BGs: AMPS 233 | + 1.25 191 | PMPS 250 | +2.25 145

I increased Jill's dose on Thursday 6/10 to 1.5 units and now it seems like her numbers are higher than she was a 1.25. We got a couple of lower readings on the first day that we increased, but otherwise numbers seem a bit higher. What should I do?

 

I have had the same problem, Debra.

 

She might have gone lower last night. I would see what happens today but if no blue or green take her ip to 1.75

 

She probably did go lower but based on the past week or so I didn't think she'd go much lower, and I wasn't worried about her going too low, so I slept!

 

I'm not sure why you think her numbers are higher? I would get some tests at +4 and +5 to see how low she is going on this dose. Like @tiffmaxee said, it's possible she went lower last night after that 100 point drop in the first two hours. She tends to see green later in the cycle (+3 to +5).

When you are increasing in 0.25U and getting enough tests to see how low the dose is taking her, it's unlikely that you bypass a good dose.

 

I did the same thing. Didn't think Susie was going to go much lower after I checked her +2 last night. Especially with her nadir occurring around +3. So, I slept too. Maybe our kitties are dropping lower than we think in the middle of the night.

 

I guess I was thinking that all/most of her numbers would be lower with an increase but her PMPS are a little higher and her overnights are too when compared to BGs taken at the same time from last week. Is that a wrong assumption? The science of this stuff is so hard!

 

Jill's been living in some high numbers so some toxicity might have built up, so you're still looking for the right dose of insulin that will bring down the numbers in a more consistent way. Keep doing what you are doing and increase doses as soon as the TR protocol allows. She will get there.

 

Katherine, what do you mean by "toxicity"?

 

Also thinking I can replace a few of her 5% carb meals with the 2% food she has at other times during the day. Adding the 5% seemed to help with her 1.25 dose, but maybe going back would help more now.

 

Glucose Toxicity sounds a lot worse than it is. When a cat stays in high numbers for too long, it's body gets used to higher numbers and treats them as normal. It then requires much more insulin to break through to lower numbers.

I don't think Jill is seeing glucose toxicity though. I just think she needs a little more insulin - assuming we aren't missing the lows she is making without tests later in the cycle.

 

Bhooma’s the real pro here. Listen to her!

 

Fast/steep drops can also cause bounces. Sometimes worse than the lower numbers types of bounces. What is your feeding schedule for Jill? Just wondering if there is a way to changer her food earlier in the cycle to slow the drops. And it might in fact mean higher % low carb, not lower, earlier in the cycle, to slow the drops. Also, if you are feeding much after nadir, you are causing the insulin to wear off sooner, shorten duration, which would result in higher preshots.

Here is the post on Feline Diabetes and Glucose Toxicity links

 

I agree with Bhooma. If toxicity were setting in you would not see the blues. She would not come down.

 

I beg to differ.

Take a look at Boomer's spreadsheet for 2019. April 25th he took an undeserved reduction down to 2.0 units (long term diabetic), which took him into some higher numbers, though he did see some blues. Glucose toxicity set in. Judy had to keep increasing to 3.75 units, seeing blues and greens along the way, before she finally broke through and Boomer got his greens and blues back. Also Butters 2020, nicely regulated at 1.0 unit when a bad pancreatitis episode set her off track in October. Same thing, saw some blues and green on her way up to the breakthrough dose at 4.25 units. Both cats are examples of increasing until you get to that dose they need. Insulin is a hormone, not a drug. You don't always see a little bit of improvement with each increase. You just need to keep increasing until you hit that breakthrough. Try not to over analyze what numbers you get on the way. Regulation is the end game and you keep increasing until you get there.

 

You are all giving such terrific insight!! Thank you thank you thank you!!
I'm sure everyone wishes that this was all much easier Good point about insulin being a hormone, not a drug.

 

I have a slightly different concern. You've indicated that you're following TR. However, you're holding the doses longer than what the protocol specifies.

Jill is no longer new to nadirs in the 100 - 200 range. You should be evaluating the dose every 6 cycles.

I'm not convinced this is glucose toxicity but I wouldn't rule it out. As others noted, when you're feeding your cat may be influencing the higher pre-shot numbers. In addition, the nadirs in the PM cycle may be at a different time than in the AM cycle. It helps to remember that nadirs can and do change.

 

You're right, I am going thru more cycles than I need to - there were a few things that made me hesitant to increase over the past couple of weeks - some greens and a possible furshot. I should have increased this morning but I was concerned since I expected to see a change with the last increase I didn't see. I also don't like to increase in the PM in case things go south overnight. I plan to increase tomorrow AM.

RE what she's eating, I have a "mealtimes" tab on my ss that lists. I know he shouldn't have a 6pm dinner (that's +9) but I've got 7 other cats who eat then and she goes insane if she doesn't get anything.

 

So Jill gets 5/8 of a can in the PM cycle and only 3/8 of a can in the PM cycle? As long as the +9 is zero carb and just a small bit, it should be OK. I'm more worried about the disparity in amounts fed between the AM and PM cycle. It looks like with 7 other cats, it's really hard to make sure she has food later in the cycle should she need it.

 

So here's a dumb question, would it be possible to shoot at 6:00? Then everyone is on the same schedule for meals. It also means you wouldn't be up all night if. you needed to monitor during the PM cycle.

(Understand that my shot time was at 5:00. It was the only way I could monitor Gabby before I left for work given that she had an early onset and nadir. Of course, my non-diabetic got fed at the same time. Gabby has been gone since 2015 and Gizmo continues to wake me up, aggressively wake me up given he's a 15+ lb Norwegian Forest Cat, at 5:00 AM.)

 

Would love to see a picture of your 15+ lb. Norwegian Forest Cat.

 

Yes, 5/8 can in AM cycle and 3/8 in PM cycle plus the 0 carbs at +9 for dinnertime. I could adjust that so it's 1/2 can in AM and 1/2 can in PM if you think that would make a difference. She's been higher in BGs at night. If at any time she's low(ish) and needs a snack I do give that to her (but I have to fend off 7 other cats with knives!). I've been making comments on the spreadsheet when that happens - like on 6/5 overnight she was in the greens but dropping so I gave her snacks at +3 and +5.

@Sienne and Gabby (GA) Totally not a dumb question about shooting at 6. With 7 other cats who think they are being starved it would be really hard. Once I'm out of bed, they think it's time to eat and so everyone else's mealtimes and routines would have to shift. We have a couple of cats with special behavior needs - and meds - so routines and mealtimes are really important to keep as stable as possible. Coordinating Jill's care has been tough in combination with the other cats' care! If my cats learned to wake me up at 5 am to eat I'd move out. Ha!

Her PMPS is 190 so I'm feeling better about that

 

I'm not really seeing that. She seems to be pretty even AM vs. PM for greens in the last month. Lucky you - Neko preferred diving at night.

Good to know, but I'm not seeing that example on the spreadsheet.

 

I make the comments in the cell where the BG is recorded - do you see a little yellow triangle at the right corner? That's where the comments are.

 

I guess she was listening. +3 is 79. Just gave her 1/8 can of 5% carbs pate.

 

We got some greens last night so I am holding the dose today, right?

 

Yes. Congrats on the green!

 

After all the discussion yesterday, right?! What a stinker!