Help to Understand Skipper's Values, Part Two

Kathy4Skipper

Kathy4Skipper

Member Since 2021
Part One is located here: post-2811519

On 6/29/2021, Skipper's PMPS values were dropping:
PM test at 8:49pm = 198.
PM test at 9:10pm = 197. Fed everybody else but Skipper, which might have been a mistake because "anticipation releases insulin." per google search.
PM test at 9:40pm = 190.
PM test at 10pm = 178.

I wasn't sure what exactly to do since he was dropping, so I gave a token dose of 0.25u. I remember that @FrostD said he might drop if he hadn't eaten in a long time, but I fed 1/2 his meal at +9, so my thought was that he was dropping because the insulin was still working. (thoughts welcomed!)

The token dose obviously wasn't enough because his next morning AMPS=HIGH. The rest of the day was good with a PMPS=272, so I gave his full dose of 1.75u in the evening.

This morning's AMPS=185, so I stalled 20 minutes.
AMPS+20 minutes = 203, so I went ahead and gave his full dose of 1.75u.

Now that I'm thinking about it, I read that if his "preshot is above 200 but lower than his normal preshot, a lower dose may be wise."

Since I didn't give a lower dose this morning but rather his regular dose, I'm wondering if I messed up... or if you think this was a good dose to give since we're finally getting into the lower numbers.

What do you think?
 
Kathy4Skipper said:
Part One is located here: post-2811519

On 6/29/2021, Skipper's PMPS values were dropping:
PM test at 8:49pm = 198.
PM test at 9:10pm = 197. Fed everybody else but Skipper, which might have been a mistake because "anticipation releases insulin." per google search.
PM test at 9:40pm = 190.
PM test at 10pm = 178.

I wasn't sure what exactly to do since he was dropping, so I gave a token dose of 0.25u. I remember that @FrostD said he might drop if he hadn't eaten in a long time, but I fed 1/2 his meal at +9, so my thought was that he was dropping because the insulin was still working. (thoughts welcomed!)

The token dose obviously wasn't enough because his next morning AMPS=HIGH. The rest of the day was good with a PMPS=272, so I gave his full dose of 1.75u in the evening.

This morning's AMPS=185, so I stalled 20 minutes.
AMPS+20 minutes = 203, so I went ahead and gave his full dose of 1.75u.

Now that I'm thinking about it, I read that if his "preshot is above 200 but lower than his normal preshot, a lower dose may be wise."

Since I didn't give a lower dose this morning but rather his regular dose, I'm wondering if I messed up... or if you think this was a good dose to give since we're finally getting into the lower numbers.

What do you think?
Click to expand...
I peeked in on his spreadsheet yesterday, seems like you learned the lesson ;) Token dose was too low BUT it was not a mistake, just a learning opportunity. This early on all you can do is try things and see what happens, build the data. Look at my spreadsheet from early on, you'll see I was all over the place.

By the way "dropping" is considered something more than meter variance...so the 198, 197, and 190 I'd all consider the same number. The 178 is iffy.

I've not heard the "anticipation releases insulin"...perhaps that is true for non diabetics, but remember the pancreas in diabetic cats doesn't work properly. It is always better to withhold the food 2 hrs before PMPS for consistent data, barring any other health issues or low numbers (sometimes you just need them to eat, data/protocol be damned).

You did the right thing last night and this morning!

The "lower than normal preshot" guidance is for new members with not a lot of data. You have enough data now that we can see what his dose is doing/how low it's taking him, so we know the you can shoot a full dose at/above 200 safely (provided its flat/rising).

The other thing is you're starting to hit a breakthrough dose, meaning his numbers will start to come down more overall...so he doesn't have a "normal" preshot right now. Just be sure to get the midcycle tests that you can and ideally nadir so we can can keep an eye on him. When we start to see lower blues (120 or so) is when we'll want to be a bit more cautious.
 
Thank you both for taking a look at Skipper's spreadsheet. And for the insight on meter variance and about the "anticipation release" not being applicable to diabetic cats. And that I don't need to follow the "lower than normal preshot" guidance anymore since we're at the breakthrough dose! I've updated my notes to reflect all of this great information!

I'm so glad to hear that we're at the "breakthrough dose." I'll check his numbers a few times this afternoon starting about +6 since I think his nadir is around +8.

Thanks!
 
Kathy4Skipper said:
Thank you both for taking a look at Skipper's spreadsheet. And for the insight on meter variance and about the "anticipation release" not being applicable to diabetic cats. And that I don't need to follow the "lower than normal preshot" guidance anymore since we're at the breakthrough dose! I've updated my notes to reflect all of this great information!

I'm so glad to hear that we're at the "breakthrough dose." I'll check his numbers a few times this afternoon starting about +6 since I think his nadir is around +8.

Thanks!
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You're welcome! One small tweak - I don't think you're at the breakthrough dose, just very close to it. You're starting to see movement, the breakthrough is what will get you down to more consistent lower blues and possibly higher greens
 
FrostD said:
You're welcome! One small tweak - I don't think you're at the breakthrough dose, just very close to it. You're starting to see movement, the breakthrough is what will get you down to more consistent lower blues and possibly higher greens
Click to expand...
Thanks for the tweak to my understanding.

The breakthrough isn't today.
It's weird that yesterday he was high in the morning then yellow at night.
Today he was blue in the morning and pinks so far this afternoon. I expected him to be lower this afternoon.
Strange.
 
Kathy4Skipper said:
Thanks for the tweak to my understanding.

The breakthrough isn't today.
It's weird that yesterday he was high in the morning then yellow at night.
Today he was blue in the morning and pinks so far this afternoon. I expected him to be lower this afternoon.
Strange.
Click to expand...
We don't know what he did overnight, so my guess is this is a bounce, albeit a small one (which is good!). If it is, he's clearing it quickly which is also good!

Some days they just do weird things, it can be maddening.
 
FrostD said:
We don't know what he did overnight, so my guess is this is a bounce, albeit a small one (which is good!). If it is, he's clearing it quickly which is also good!
Some days they just do weird things, it can be maddening.
Click to expand...
Good! I'll take small bounces. Hopefully, tomorrow will be better.
 
I still don't understand Skipper's numbers. :(

His AM+8 compared to the PMPS numbers are so varied. The last two days, his PMPS has been in the 400 range. Rereading about a bounce, this isn't a bounce, right, because he ate after AM+8. I don't know why he's been red at PMPS. Maybe I'm expecting him to settle out too fast?

I got a PM+9 test this morning, and he was blue and then jumped to red at AMPS.

Thoughts will be appreciated!
 
I think your AMPS looks like a bounce.

George has done the same thing before when he’s bouncing…has been in the blues at +9 and then the reds at shot time. If you look at my spreadsheet this happened in the am cycle on 6/28. As you can see George went low at +4 that day, then maintained pretty good numbers but bounced by PMPS. It also happened to him on 6/22 when he was still having wonky numbers from a previous bounce. It can take a previous bounce up to six cycles (three days) to clear.

6/16 and 6/17 were similar for us as well (bounce on 6/16 and then still off numbers on 6/17 from the previous bounce).

Without those midcyle tests though I wouldn’t have known that he went into the greens.

If it’s possible you may want to try to get some more tests earlier in the cycle some days to get a clearer picture of what may be going on.
 
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Hshray said:
I think your AMPS looks like a bounce.

George has done the same thing before when he’s bouncing…has been in the blues at +9 and then the reds at shot time. If you look at my spreadsheet this happened in the am cycle on 6/28. As you can see George went low at +4 that day, then maintained pretty good numbers but bounced by PMPS. It also happened to him on 6/22 when he was still having wonky numbers from a previous bounce. It can take a previous bounce up to six cycles (three days) to clear.

6/16 and 6/17 were similar for us as well (bounce on 6/16 and then still off numbers on 6/17 from the previous bounce).

Without those midcyle tests though I wouldn’t have known that he went into the greens.

If it’s possible you may want to try to get some more tests earlier in the cycle some days to get a clearer picture of what may be going on.
Click to expand...
Thanks for detailing your spreadsheet.
Do you think I should have given Skipper a little food at PM+9? I thought being in the blue was a good thing but if he bounced, maybe food would have prevented him from going into the red?
 
Kathy4Skipper said:
Thanks for detailing your spreadsheet.
Do you think I should have given Skipper a little food at PM+9? I thought being in the blue was a good thing but if he bounced, maybe food would have prevented him from going into the red?
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No, blues are good! Blues and greens are what we want to see. I don’t think it was that 198 that caused him to bounce, but he may have been bouncing from a lower number or quicker drop earlier in the cycle or even a previous cycle. I was just using my spreadsheet to let you know that what you’re doing seeing isn’t abnormal and illustrate how tests earlier in the cycle may be helpful to see exactly what is happening with his numbers. For example, he may have come down lower in the pm cycle of 6/30, which could have caused a bounce the next day if the blue amps was him actually coming up from an even lower number. And the bounces can can cause strange numbers for three days afterwards. Of course we don’t know in your case, but that’s why I was providing my spreadsheet as an example of what could have happened.
 
@Deb & Wink wrote this excellent post about bounces found in this thread:
https://www.felinediabetes.com/FDMB/threads/help-pmps-5-2.233900/#post-2618378

The BG level does not HAVE to go really low, for a cat's body to overreact and think it needs to bring that BG number back up to what it's used to.
So for some cats, even numbers down in the yellow colored ranges on the SS can be lower than the cat has been getting for some time, and cause a bounce.

Black color coded numbers on the SS almost always means bouncing.
Red color coded numbers on the SS usually means bouncing too.

It's the relationship between the pre-shot and the lows (aka nadirs) during the cycle that lead to the bounce.
If there is only a 10-20% drop, there may not be a bounce.
If there is a 20% drop in the first hour or 2 of the cycle, that may lead to lows in the middle of the cycle and then the subsequent bounce.
How hard and fast the drop happens determines how low a cat's BG levels will go and then rise up at the end of the cycle.

Your cat drops from those pink colored coded ranges on the SS, down to the blues? Expect a bounce.
Your cat drops from those yellow color coded ranges (or the pinks or reds) on the SS, down to the greens? Expect a bounce.

Duration of the insulin also comes into play.
Not all cats get the same duration from the different insulins.
Duration can vary a bit from cycle to cycle also, as a cat eats or sleeps or plays more.
 
Hshray said:
If possible you might want to try to get a test around +3 or +4 just to see if it’s onsetting yet or if he’s starting to see earlier onsets.
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I'll be sure to get a +3 or +4 reading tomorrow to see if his onset is changing with the new higher dose.
Thanks!
 
Today hasn't been a typical day, and I'm concerned that he will be too low to shoot tonight. I won't be able to stall because I'm shooting at 10:30 pm. Maybe he'll surprise me, but I'm not banking on it.
 
Kathy4Skipper said:
Today hasn't been a typical day, and I'm concerned that he will be too low to shoot tonight. I won't be able to stall because I'm shooting at 10:30 pm. Maybe he'll surprise me, but I'm not banking on it.
Click to expand...
Good job getting tests throughout the day! The good thing with all of the tests is that you will be able to know if he’s going up or still going down by shot time. If you need dosing advice at that time you may want to try tagging @FrostD @Deb & Wink or @JanetNJ and/or posting on the main forum. Nice numbers today!
 
Good numbers! Still have awhile to go.

Im not sure I'll be around tonight, having some trouble with Mr Kitty and I need sleep.

This is possibly a bounce break today, he may go lower yet.
-If he's rising from +11 to PMPS (so more than 20% increase) and above 175 I'd suggest full dose. I'd usually say 150 but you just increased so I'm a little more conservative.
- If he's flat, I'd suggest 1-1.5U if 150-200, 1.5U+ if above 200.

As always, it's whatever you're comfortable with!
 
FrostD said:
Good numbers! Still have awhile to go.

Im not sure I'll be around tonight, having some trouble with Mr Kitty and I need sleep.

This is possibly a bounce break today, he may go lower yet.
-If he's rising from +11 to PMPS (so more than 20% increase) and above 175 I'd suggest full dose. I'd usually say 150 but you just increased so I'm a little more conservative.
- If he's flat, I'd suggest 1-1.5U if 150-200, 1.5U+ if above 200.

As always, it's whatever you're comfortable with!
Click to expand...
Thanks for the dosing advice! I tested at +10, and he up to 186 (from 147 at +8). The drop of blood wasn't as big as I was getting earlier, so I hope this is a good number. Perhaps the three blues may be considered "flat" taking into account the inaccuracy of the meter. I'll see what the next test brings.

My thoughts are with you and Mr. Kitty.
 
Kathy4Skipper said:
Thanks for the dosing advice! I tested at +10, and he up to 186 (from 147 at +8). The drop of blood wasn't as big as I was getting earlier, so I hope this is a good number. Perhaps the three blues may be considered "flat" taking into account the inaccuracy of the meter. I'll see what the next test brings.

My thoughts are with you and Mr. Kitty.
Click to expand...
Thanks!

Nope thats a rise!
 
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