7/28 Hello from Fred

[Purrberry]

Hi everyone,

Though I have not been posting lately, I DO keep an eye on the boards. @Liz & Minnie @Jay Dee @Suzanne & Darcy @Summer and Susie @Wendy&Neko ...hope you're all doing well and having a great summer.

We've been trucking along here, hovering withing tweaks of .25 as needed. Fred has actually been very happy, his urination is way down, and his overall demeanor is quite well these days. So though he bounces all over the place and I occasionally have to shave a dose to account for not being home, I've been happy enough with his progress. We're not perfect, but when he's happy, I'm happy.

Last night, however, was a different story. Were you to look at the spreadsheet, you'd think, "Wow! Look at that great stretch of green!". The reality was quite different. That was me instantly regretting even giving him the .5 reduced shot when that was the lowest PMPS I've ever had on Lev. I thought for sure he was having a late nadir, as it's been pushing later, lately. But then I could tell he was just dropping....and not coming up. He usually has a "mini drop" initially, until about +5. Then the big one starts. With that in mind, I was horrified at what was happening. So that lovely stretch was Karo, MC, endless testing, me shaking and sick with fear, realizing the 24 hour ER vet nearby was no longer 24 hours and closed, and no one there to help me. (and forget sleep) I've never prayed so hard for a bounce to start.

So for me...never again. I've truly tried to embrace "shoot low to stay low", but the last time I really did this, we had the same thing happen. (back on Lantus) I guess I'm just used to him bouncing at this point; I suppose I count on it a bit for safety. Lev DOES pull him down from huge numbers. So to see him at 90 when the big drop is due to start...after already pulling him up from 62...OMG. Just too friggin' scary. I know he'll bounce today, but the low AM dose was to drain the depot.

I guess the question remains...what DO I do if this comes up again? I think it will always be a BCS for me...and Fred.

Again, hope all is well, and hello to the new kitties!

 

[Jay Dee]

Yikes! How scary. Thanks for tagging me in this so I can follow the experts’ advice (and to stay in the know on how you’re bith doing) in case this ever happens to us. Our closest *true emergency clinic* is an hour away even though local clinics offer emergency services 24/7.

Sending you both a hug and good vibes for a safe day today!

 

[Purrberry]

As an addendum to this...a question. @Wendy&Neko Fred has obviously earned a reduction. But the question is...do I reduce from 4.75, which was his *main* dose, or the 4.25 I dosed last night b/c of the blue PMPS? Logic probably dictates from the 4.75 to 4.5, but I am freaked.

 

[Suzanne & Darcy]

Hi Kathleen. It's good to hear from you. I've thought about you and Fred. Sorry you had such a rough night, but I am happy to hear that Fred seems to be a lot more "himself" again! Urinating less is good, too. I know how upset you've been at times when he was acting miserable (it's so upsetting when we feel like we can't help or aren't helping them.)

I'm a little confused by your spreadsheet colors. Mine says that lime green is below 50. Yours has the lime green below 68.

 

[Purrberry]

@Suzanne & Darcy Good to hear from you, too!

That 68 lime is because I use AlphaTrack. It's 68 on AT, and 50 on the human meters.

 

[Suzanne & Darcy]

@Suzanne & Darcy Good to hear from you, too!

That 68 lime is because I use AlphaTrack. It's 68 on AT, and 50 on the human meters.

Oh .... duh... yeah... I forgot... I know about the difference between the meters but didn't realize you were using AT! Should have looked!

You seems to do a really good job handling Fred last night. I guess you lost a lot of sleep though! Fred is just so all over the place with his BG. That's such a challenge for you!! I admire your perseverence (but what are you gonna do! You love Fred! Gotta keep on truckin'). Hugs!

 

[Summer and Susie (GA)]

I'm so sorry to hear about your experience with Fred last night, Kathleen. I, too, have had a few days where I shot low to stay low and Susie just dropped and I really struggled with getting her numbers up with food. They can be very scary experiences. Yesterday, I shot a 116 at AMPS and got a 36 at +2. It was the lowest reading I had ever had for her. Talk about an "eye opener" . Susie was just fine, thank God. It is so much worse when something like that happens at night. You did great handling Fred's numbers!

It is good to hear that Fred is doing better. I hope you will be able to rest today and sleep tonight. Good to hear from you, Kathleen.

 

[Purrberry]

Yesterday, I shot a 116 at AMPS and got a 36 at +2.

Holy cow...I would have fallen to the floor! So glad Susie did well, as did you! We will hopefully all be getting some good sleep tonight!

You seems to do a really good job handling Fred last night.

I take this as a huge compliment, for you were the master with Mr. Darcy.

Fred is just so all over the place with his BG

He is indeed, but he is giving me more of a curve with Lev, thank goodness. That is...until last night! ;-) I definitely was NOT expecting to see a yellow run today on only 2.5. Wow. Thought we'd be black all day. One thing I have noticed with Fred is that whenever he goes truly low, he is very insulin sensitive for a few days after. It was another reason I erred so much on the side of caution with his dose this AM. I'm sure I will do the same for this evening.

 

[Wendy&Neko]

do I reduce from 4.75, which was his *main* dose, or the 4.25 I dosed last night b/c of the blue PMPS? Logic probably dictates from the 4.75 to 4.5, but I am freaked.

Your freak is right. It was the 4.75 unit dose/depot giving you those lovely numbers last night. A couple things to think about so you can avoid a repeat of the panic. First, is to recognize when it might happen. Fred was breaking a bounce into PMPS, from pink sliding down all cycle to blues. Recognizing this is happening means you can get prepared. Often the cycle after that can be a bit more active. Summer's Susie did the same thing yesterday. Fred kept sliding down after PS to onset so it really was the 4.75 unit dose given in the AM that dropped him so low. So how to slow him down? If he's dropping early in the cycle, forget the MC, go for the big guns or HC. What %MC are you using? It didn't seem to do much for Fred. Some cats just need more carbs, especially early in the cycle.

Glad to hear Fred was fine throughout the ordeal last night. The "reduction points" we use give a little bit of wiggle room between reduction and hypo range, to add a little bit of a margin. We just don't like cats on insulin that low, hence the reductions.

Another note, you didn't give the 4.5 unit dose a chance to work before going up to 4.75 units. Patience is key. Especially if you are following SLGS as per your signature. Consistency helps too as I see some waffling between 4.5 and 4.5f, which can itself cause some wonkiness. You can't shoot down higher preshot numbers with Levemir. Dose based on nadirs and try to follow the dosing method and give the same dose for the full 14 cycles, unless he earns a reduction.

It was another reason I erred so much on the side of caution with his dose this AM. I'm sure I will do the same for this evening.

That will be sure to bring on the blacks. But if you need the sleep, so be it.

 

[Summer and Susie (GA)]

I can understand that big drop in dose today. None of us want to experience the alarm that you went through last night. It was a nightmare for you. Your fear for your Fred was justifiable. No matter what anyone says, you have to do what you feel is right for your kitty. You hold the syringe. I know what you mean about "almost" hoping for a bounce. It gives the care giver a break and also the kitty. I'm wondering when my Susie will really start to come up tonight. I don't want to go through what you went through last night. I hope everything goes well for you and Fred tonight. No panic situations. Just a nice, quiet night full of sleep and peace.

 

[Purrberry]

Fred was breaking a bounce into PMPS, from pink sliding down all cycle to blues. Recognizing this is happening means you can get prepared.

I knew he was sliding, but I thought there was no way, being Fred, that he wouldn't pop up shortly after PM shot. Oh, how wrong I was! Live and learn, emphasis on the LIVE!I'd definitely have given him a BCS...I just feel safer that way.

If he's dropping early in the cycle, forget the MC, go for the big guns or HC. What %MC are you using?

I use his old dry food, Instinct Ultimate ProteinDuck, which is 17% carb. So I guess I need something higher. As you say, he doesn't react to what I'm giving him very much, nor, frankly, the Karo. That's why his diving is doubly scary for me. They used to eat an Rx food for Sadie's urinary crystals, and I think I still have some of that-I believe that's 20%. After that, I've never really used anything higher carb. I was always conscious of carbs in dry food.

You can't shoot down higher preshot numbers with Lantus.

Fred is on Lev now, and strangely, though it takes about 5 hours, those high pre shots (which are bounces, I'm assuming) DO get shot down. We can go from black to blue to red in one cycle. Not always; not when he's really bouncing, but quite often. So again, it adds to my fear in a situation like last night. Lev has that power in him.

hat will be sure to bring on the blacks. But if you need the sleep, so be it.

Desperate for sleep, yes. We'll see what he comes in at at PMPS.

So..just so I'm sure, what do you think his new dose should be? (after tonight, potentially)

Thanks!

 

[Purrberry]

I hope everything goes well for you and Fred tonight. No panic situations. Just a nice, quiet night full of sleep and peace.

Thank you, and I wish the same for you tongiht! Come on up...just a wee bit, Susie! Give Mama some sleep!

 

[Summer and Susie (GA)]

Thank you, and I wish the same for you tongiht! Come on up...just a wee bit, Susie! Give Mama some sleep!

Thank you. I am a little concerned about tonight's numbers. She is still low but I will load up on the m/c if I need to because sleep is very important to me as it it for all for all of us.

 

[Sue and Luci]

Looks like another active cycle is underway...is he still dropping like he's been doing earlier today? 400 to 225 is a significant drop - that always gets my radar up when Luci drops 100 or more points....

A little wobble there mid-afternoon - I probably won't be around much longer tonight - but if the numbers are still coming down be prepared for another busy night.

You handled it like a champ last night - I know it's nerve wracking to go thru that - but it sounds like you've got everything on hand that you need - I'd stick with the wet gravy style foods and karo or honey. Did you put it on the back of his paw? I'm just wondering how he went about eating it...Luci would eat anything sweet that's available - but not every kitty likes sweet stuff like Miss Luci...she yearns for ice cream...

I hope you got a nap or two today..just in case. And good luck this evening

 

[Wendy&Neko]

Fred is on Lev now

I corrected that above, same thing goes. You can't use the depot insulin to shoot down numbers. We find consistency is key with our dosing methods.

So..just so I'm sure, what do you think his new dose should be?

4.5 units, hopefully it'll work better this time. Doesn't look like a busy night to me, but we'll see what PMPS brings. Looks like the BCS dose is doing it's job.

 

[Purrberry]

BCS did its job, and now I did another BCS. Likely unwarranted, at least one that low, but I'm surprised he didn't pop up further. 349 a surprise. Caution for that, and exhaustion, has won out. Had to stay awake long enough to see Team USA to win the 100 Freestyle. (former competitive swimmer, here) ;-)

Did you put it on the back of his paw? I'm just wondering how he went about eating it.

I do a "schmear" along his gums with the Karo. He wouldn't tolerate a syringe, so this is my next best way. He then licks it all off himslef. I'm always worried he'll vomit from it, but he seems to like it as well! (just not the sticky bits)

Looks like another active cycle is underway...is he still dropping like he's been doing earlier today? 400 to 225 is a significant drop

He surfed for a bit, and then came up. But agreed... my radar is always up with those significant drops!
Thank you for the wishes!

 

[Marina & Chico]

I understand you scare very well, if you pook at Chico’s spreadsheet we have had it all, very wild rides sometimes

With the above in mind I cannot do anything but agree with @Wendy&Neko, it is important to “read” a bounce breaking cycle and start acting earlier so that you have more wiggle room to control the drop. a bounce breaking cycle is much more active then a “normal” cycle but unfortunately most cats will go thru several bounce breaking cycles on their way to regulation, there is no way around it then just tool up and be prepared, it gets easier with time with depot type insulins consistency IS key

hope you get more used to dealing with lower numbers soon and Fred sees lower (but safe) numbers soon on a more consistent basis

 

[Liz & Minnie]

Sorry I'm late catching up on this. Interesting few days you've had...and I don't see any updates on your s/s tonight! At least gives me opportunity to speculate that Fred might be dropping again for you this evening. ?

I'm still not really good at spotting breaking bounces, but I have got more familiar with the limes. It's always scary and for some reason more so at night (I think because I'm afraid of falling asleep and missing alarms!) but I found the more it happens, the less you panic. There's always that jolt of adrenaline but I've been less frightened each time. Though of course when there's been a long stretch since the last one, it's a bit of a shock!

Minnie's last 'good' stretch had me confused about when her nadir was too, she also had a stretch of +3/+15 nadirs.

I struggled with applying karo (and I hate the sticky mess!) but what I've found works for Minnie is if I mix karo in her food. Fortunately she's always been hungry the last few limes and hasn't been picky, even when I mix in the karo. The other benefit of getting 'comfortable' with the limes is that you are in a better frame of mind to experiment and figure out what works.

I don't remember, does Fred tend to get high ketones? Minnie does, so after the stress of dealing with a lime situation I'm always relieved that her ketones must be going down. And when it leads to a reduction, it makes me feel better to think we are now trending in the right direction.

Anyway, hope you and Fred are doing ok. Hang in there, we have all been there!!