Mia & Monica - Continued (part 3)

Starting a new thread here for my kitty Mia as the previous one was getting extremely long.

Previous thread (2nd) here.
First thread here.

 

So Mia just had a BG of 1.9 at +2. Should I not have given her insulin when her BG preshot was 5.5?

 

Hi Monica. You are experienced in handling these low numbers, I know. Keep checking every 20 minutes and giving the honey (HC food would help, too, in very small amounts as we talked about before when you were on vetsulin). As her BG comes up you can extend the time between tests gradually. Don’t stop testing until it’s been a full 2 hours after the last HC

 

The only dose smaller than the one she’s currently on would be a “drop dose” where you insert the syringe into your pen with the plunger fully pressed and then let go. It sucks in a tiny amount of insulin. @Wendy&Neko @Sienne and Gabby (GA) what do you all think for going forward?

 

I have to go out now but will check in periodically. @Dyana is around and can be a help to you if needed.

 

Hi @Suzanne & Darcy Yes I have given her honey and some of her old favorite treats. HC is high calorie? Will definitely continue testing. But not sure what you mean by full 2 hours after the last HC? What is that short for?

 

I am outside, but will try to keep checking on you every 15 minutes or so.
You could try to give her some of the shrimp with jelly if that bumped her up before. HC is over 15% carbs.
I'll be back to check on you.

 

Oh, and even if you have no high carb food available, you can mix a drop of honey into some of her regular food. Keep the amounts of food small in case you need to keep giving it to her for a long period of time — in case she doesn’t come up quickly or drops back down.

 

HC means high carbohydrate. Sorry

 

Good idea about that shrimp in jelly

 

That just means to test her periodically for two hours after whenever you have given her the final dose of honey or other high carb food. The reason for this is that the cats numbers can go up and then later can drop back down after the high carbohydrate, food or honey has worn off fully.

 

Oh ok! So keep checking until 2 hours after she has had her last high calorie meal?

 

Last high carb of any type— honey or high carb food. Yes

 

New BG was 2.2, 30min after previous one. Will check again in 30 min

 

Still under 50. More honey and shrimp in jelly or other high carb food. Only a teaspoon. Test in 20

 

Until she is over 50 please test in 20 minutes. After she’s above 50 go to thirty minutes

 

I'm glad she's up a little. I would contiunue to give her a little tiny bit of honey with a teaspoon of regular food or HC food and test again in 20 minutes.

 

What’s the next number? It’s been long enough

 

She tested 2.2 twice in a row and then 1.6 last test. Gave more honey and more food

 

See what I mean about dropping back down. Keep up honey and please add a teaspoon of high carb food. Test in twenty.

 

Please remember that we don't want her to get so full that she doesn't want to eat any more. It is early in the cycle, and we may need to have her eating for a while.
Feed her a little food for now plus some honey and keep us updated.

 

@Suzanne & Darcy got her up to 3.9 now!

 

Okay. So test again in 30 minutes. If she will eat a little food - 1 teaspoon - it would be good.

 

No more honey right now. Only a bit of food

 

@Suzanne & Darcy ok thank you!

So for her am shot in 7,5 hours. So I am prepared, what numbers should I be looking at? What number do I not shoot or lower to the drop dose like you explained?

Now she was at 5.5 preshot, which apparently was too low. The lowest I have shot with til now is 6.4 which was this morning. The lowest bg in that cycle was 3.7 at +4

 

I would not have predicted this low with a PMPS of 99. You didn’t do anything wrong. Let me know her next number.

 

Was there anything different about this evening in terms of what she ate for dinner or how much she ate?

 

Yes infact I see she only ate a little bit when she got insulin. Around half of the usual, but then ate plenty, enough to make up for it and then some, around 1 hour after insulin.

 

@Suzanne & Darcy she is 3.9 now again

 

Well since she was in the 30s, she has earned a reduction. I know she is on a small dose, but I would still reduce to a drop dose for the morning (even if her BG is high) and hold the drop dose and see how it goes.

 

She’s holding steady. I would still test again in 30 minutes

 

@Suzanne & Darcy

Ok so no matter her BG for her next shot I go for a drop dose then?

And to be sure I understood the explanation. A drop dose is measured by just putting the syringe into the insulin pen and back out again, without drawing out anything into the syringe?

 

You take the syringe and fully press down on the plunger and insert the syringe into the insulin pen while the plunger is still depressed. After the needle is inserted, let go of the plunger. You can experiment with it tonight to see if you get a drop.

 

Do you have another test on Mia? It has been one hour since the last test.

 

Never shoot if a PS is under 50 (human meter). For some cats, the no-shoot number can be higher. It also depends on whether you’ll be around to test and intervene if she drops low again, as there can be some “hang time” with Lantus (meaning the insulin that’s already in her system can still affect tomorrow’s cycles).

Suzanne has already advised you to go to a “drop dose.” I concur. If you push the plunger down extra hard into the syringe (squishing the rubber to compress it), then take your finger off the plunger to let it retract, you’ll get a drop of insulin.

@Suzanne & Darcy, given Mia’s history, what do you think should be a no-shoot number?

 

That’s a good question. I am not sure at this point. We have so little history to fall back on. We don’t know how she will be doing in the morning. And I see no tests after the last 70 (3.9). If it’s at all questionable in the morning, given this evening’s 30s, then there’s no harm in skipping the dose to see how Mia does. Skipping could be very informative. @Gill & George will you be around in the morning to help advise? It’s going to be the middle of the night for me.

 

So her last test last night was done at +6, and was 4.4. my significant other took over as I had to get some sleep.

Will be doing her preshot test in a couple of minutes

 

Her number psam is 7.9

 

How would I wrote a drop dose in the SS?

 

Write drop

 

Can you check in one hour?

 

One bit of advice. Just in case the situation arises again. When you shoot a number that's lower than usual, or where you see her numbers alling into the ps I would always recommend getting a +1.

A ps number that's lower say than the +10, can often be an advance warning of an active cycle.

 

Yes of course, I'll make sure to check at +1

 

This is in regards to a situation with a lower than usual preshot number?

 

@Gill & George her +1 is 8.2

 

Yes.

Thinking about lantus cycles,
By PS we are at the end of the cycle so there's not a lot of insulin available so usually when we do ps the number will be higher than the +10, if you are getting good duration (about 12hours) that PS number will be only a little higher or perhaps about the same.
If the PS number is lower, it may be a sign that you are getting longer duration, that's ok, it's still, in most circumstances ok to shoot. But when we do shoot we need to be aware that if the next shot onsets before the previous duration has finished we can see a sharp drop even though we have fed.

Mia has typically been onsetting before +2. Getting a +1 last night would have given you an advance warning, you may have caught her before the drop to 34 , a small feed at +1 may have kept her from dipping into the 30's. (Or not)

 

Amps 145, +1 142.

Those numbers are about the same. She's not getting a found bump (slight raise in BG caused by the food you gave at Amos) She's probably going to have an active cycle ( she will drop down further today)
My guess will be that it will be active but not too active like last night.

So now you need to decide when you will do her next test....
You could leave her till +3, or as she may not have onset yet you could check at +2 (she seems to usually have onset by then) to see how much movement you get in the BG.

The depot of the 0.1u will still be affecting this part of the cycle, it can take up to 4 cycles to see the complete effect of the dose reduction. In the same way as when we take the dose up it takes up to six cycles to see the full effect of the dose, it's the same when we take the dose down.

 

Oh ok, this all makes sense! Thank you will definitely keep in mind a +1 test next time the PS is lower than at +10

 

@Gill & George from her previous cycles I don't expect her to drop into lime green numbers in this cycles either. Especially seeing I have reduced the dose now.

Will test at +2 and see what the number is, and then decide if I'll test at +3 too or then wait til +4

 

I like that plan. A girl after my own heart.

 

Mia's giving you a crash course in feline Diabetes and lantus cycles

 

Haha oh yes she definitely is But I couldn't have done any of this without the help from all you guys in this forum

Her +2 was 7.6, so seems like the insulin has kicked in now. Will check again at +4

 

Seems like a gentle slide so far. +4 sounds good to me.

 

+4 is 103. No drama today is a good thing, I think.

 

Super nervous to see how high it's going to go until her preshot to be honest

 

She's had less insulin, and she also dropped into lime green, it's possible that she may react with a bounce and we will see a higher than usual Pmps.

She earns a reduction with that drop into the 30s, and it's the Nadir's that govern our dosing decisions with Lantus, so if she's high at pmps, don't panic and continue shooting the reduced dose. With one proviso, that she's eating and behaving normally, no signs of lethargy or sickness. It would also be a good idea to check for keto es as we've reduced the dose. Not enough insulin can be a trigger to developing ketones especially if there were to be something else going on(inappetence, illness, inflammation), in those circumstances we might make a different decision with regards to dose at pmps.

If all's well stick with the drop dose, if there's any issues with the above, shout out and we'll make a different plan.

 

I agree with what Gill said about ketones, etc. The dosing protocols call for definite reduction with a drop into the 30s. But don’t be upset if you feel her numbers are too high. It’s really not a good idea to rush the process— and it is a process! Many cats will need reductions and then need an increase afterwards. Some go back and forth between does for a while. And some cats really surprise us and don’t need to go back up in dose. Your sweet Mia is doing sooo well in such a short period of time. There are many people who would love to have your spreadsheet numbers for their cat.

 

@Gill & George yes I realized after my last post that I have to keep in mind the possibility of bouncing with the next cycles. Not sure if I have asked this before, but is there a general period of time we can expect to see results of a bounce?

Will also try to get in ketone tests daily the next couple of days. And of course keep an eye on her general condition. Thank you

 

@Suzanne & Darcy will try to remain cool as a cucumber when testing throughout this cycle and next one, and keep in mind that higher numbers might be from her bouncing. Will ask you too, how long can we see effects from bouncing usually?
And again, thank you for all your help, wise words and support

 

Bounces are when we see high flat numbers for at least one cycle, they can be triggered by a drop into low numbers that the cat is not used to ( not necessarily lime green) and they can last up to a maximum of 6 cycles, but not unusual to see them be anything between 1 and 6.

A long spell in lower than usual numbers or a sharp drop can also trigger them.

To be honest, Mia hasn't been bouncing since she's been on Lantus, so my guess would be that she won't, but time will tell.

 

@Gill & George Ah ok, very familiar with bouncing while she was on Caninsulin, just wasn't sure how long the effects could last. Good thing to keep in mind when checking her BG levels the next 3 days then.

This is the first time Mia has gone down into lime green numbers on Lantus though, so I guess we don't know if she has bounced on Lantus or not yet?

 

Actually looking at her caninsulin numbers I don't see bouncing, I see lack of duration.

Caniinsulin is an in out insulin, which means when the cycle is over her BG shoots up because there's no insulin available to keep her BG down, so by PS her numbers shoot up, you shoot her next dose and insulin becomes available her BG dived.

Bouncing, as we refer to it on this forum is when a cats body is actually responsible for the high BG readings, irrespective of there being insulin. Think of it as the liver going into 'panic mode' it reacts to a 'percieved dangerous BG level'. (The lower than usual BG numbers etc) And releases hormones that result in glucose being dumped into the blood stream, which results in the spike in BG, and then those levels remain high and flat (we don't see a curve with a defined onset, nadir and duration), by definition we get at least one cycle of high flat numbers and for most cats these high flat numbers will subside (liver stops releasing hormones/glucose) within 6 cycles.

Mia went up and down, which certainly feels like 'bouncing' or at least being on a seesaw, but I see the lack of duration of caninsulin and it's rapid action, and lack of insulin depot being responsible for the crazy cycles you experienced,

 

I don’t see any indication of a bounce yet. I doubt if she will bounce because she’s not shown herself to be a bouncy cat so far. She also had a gentle curve today.

 

@Gill & George oh ok, that's a new perspective to me. I am just going by what I have been told on the forum in my previous threads. Which was that her high numbers after having lime green numbers were due to her bouncing because of the liver going into panic mode like you said.

 

@Suzanne & Darcy Yes she's had very stable numbers today. Her preshot BG will be in around 45min

Regarding the "bouncing", have i misunderstood all the previous posts on ny other threads when she was on caninsulin? I feel like we discussed her bouncing due to the lime green numbers on several occasions

 

You've probably not.

But folk sometimes don't distinguish well between bounce and lack of duration.

Take a look at George's ss
15/12/2015 as an example, when he first started seeing green.

You can see that he saw green in the morning cycle and by the evening cycle he was in high yellow by +7 and stayed there , even though I shot the same dose, he remained high, was pink at amps the next morning but by +6 he was in low yellow, note this wasn't his nadir, he continues to drop Al the way into pmps, we are not seeing a curve, just a downward slide, giving me a blue pmps t, this was him' clearing the bounce' his liver has stopped releasing glucose and the hormones, his BG is stabilising. I shoot blue and he returns to creen, we have a cycle with s clear nadir, he has stopped bouncing in the pmps of 16/12/2015. His drop into green triggers another bounce, which starts towards the end of the pm cycle of 16/12/2015, he is punk at amps of 17/12 and stays in yellow bobbling about in that cycle on this occasion he starts to clear the bounce mid cycle in the pm cycle of 17/12.

Note how he spends time high inspire if being given insulin, and how in his bounce cycles he hasn't got a defined curved.

He wasn't a very bouncy cat, he cleared his bounces quickly, and his bouncy 'period' didn't last long, he gave up bouncing quite quickly.

Hope that helps with the explanation

If you look at Mia's numbers you see she has clear defined curved, even on caniinsulin, albeit steep curves, the problem with caninsulin was that she didn't get duration, her insulin r
'run out' and her BG shot up, only to come back down sharply when she received her next shot and she onset. It doesn't look like her liver was responsible for it.

Moving to lantus has worked for her in that it's a 'gentler' slower acting insulin which typically gives better duration in cats, helped by the insulin deposit.

That's why you are not seeing her shoot up like crazy at PS. She still has some insulin helping her BG levels remain more stable.

 

Well if you look at her spreadsheet while she was on Caninsulin, when she went into lime green then green then yellow by the end of the cycle that’s not because of a bounce. It’s just that the short-acting (in a cat) Caninsulin wore off — there just wasn’t any more insulin available to her. So if she were bouncing, you would see those yellows continue into the next cycle and perhaps even climb into pink (or higher,) but in Mia’s case, when she got her next insulin shot her numbers went back down again and frequently went into lime green again. That shows that she was not bouncing because if it was a true bounce the insulin would have had little effect (BG not really going down and certainly not way down into low green and lime green.) Does this make sense? So when we see higher numbers toward the end of a cycle but then the next shot is given and the numbers go down again, we call that loss of duration (meaning the previous shot wore off.)

 

Ha ha. I keep cross posting with Gill! I think I will now sit back and let her do all the work!

 

Well at least we are singing of the same song sheet. Your explanation was much more concise.

 

103 @+2, no sign of a bounce looks like she will have an active cycle, perhaps some green tonight.

 

She had a 95 at +4. I hope she will stay in green for a while.

 

Mia just had diahrrea when she used her litter. Should I be worried? She was fine all yesterday and ate normally. And got in a ketone test during the day which was negative.

Should I take her to the vet in the morning? She is still acting normal, purring etc.

 

Have you introduced new food?
How liquid is it,?

George used to get diarrhea (very soft poop)after I fed him high carb food and when he had a lime green event

 

@Gill & George No new food, she has been eating the same low carb food since we switched her diet weeks ago. Apart from the one meal she had 4 days ago with the new food that made her BG jump. She got some of her old dreamies treats 2 days ago when she dropped into lime green numbers, but nothing after that.

It was liquid with some parts that were firm in it.

In her meal this morning with her shot I mixed in fortiflora to see if it helps.

 

https://drive.google.com/file/d/1ww6IEM-HGeKXJy6czXAY9fPoPTOHbjfs/view?usp=drivesdk

 

What are the vets opening hours today? Is it half day today?
Do you have a vet available on Sunday if you were to need it?

From what you are saying she seems ok and is not showing any signs of pOn/discomfort, other than the poop she seems herself.
Do you have s good relationship with your vet? Will they talk to you if you phone and ask for advice?

Has she had pancreatitis in the past? Or periodic problems with diarrhea?

 

Yes they have half day today and closed tomorrow. But there is an emergency vet available.

She seems ok other than the one round of diarrhea last night. She ate like normal this morning so her appetite seems fine, she was purring and running around too.

I do have my vets phone number on Whatsapp so I can message 24/7.

She does not have a history of pancreatitis or diarrhea

 

It might be just a one off event. I know some of mine occasionally do that for no reason I can figure out.
Is she an indoor cat?

Given she seems ok is eating and behaving normally in your position I'd probably speak to your usual vet for advice, and watch for any signs of pain/discomfort, and monitor her ketones, and see of her next poop is normal or still problematic.
Any signs of her not eating or of lethargy, would set alarm bells going for me.

My worry with what I've said above is your access to care if you need it, for me here in Spain we have the same hours, and the nearest out of hours vet is an hour's drive away, so that often influences my decision on whether to take them or just observe when they get sick on a Friday night.

 

@Gill & George yes definitely hoping it was just a random one time thing. She is strictly indoors, but has access to a balcony, so bugs, dust etc.

Will keep an eye on how she is feeling today or if she continues to act normal and eat normally. And will check after she visits the litter as well as try to get in another ketones test.

Regarding care later today or tomorrow if needed, luckily nothing is anymore than 30min drive here in Malta. There is an emergency vet on call at all times, they just vary which vet office it is. But if needed we always have a vet we can bring her in to for tests etc. From what I have googled so far, pancreatitis and IBD would be the two most common things to check/test for if we do take her in

 

LOL yes I know Malta is pretty 'compact' I'm from Gibraltar originally, though I live in Spain, we visited Malta on a youth exchange trip. My Great Grandmother was Maltese, Gib has always had close. links to Malta.

Keep us posted of you're worried about anything.

I see she's gently heading down this morning sorry o stepped out, took 5 cats and two dogs for their vaccinations this morning.

 

Looks like mía spent some time in green today,

How is she? Any further BM?

 

Morning Monica,
How is Mia?

Just looking at her SS, which broadly looks good, her Nadir's, seem to have crept up and she appears to be sending less time in green. I'm feeling that thissy be a 'failed' reduction.

With TR, we are looking for her to have most of her Nadir's to be that of a healthy cat (between 50-80).

I might give her a couple more cycles to see if she can bring her BG down, but in your shoes I would be looking to take her dose up in an attempt to get her seeing more green, if she continues to creep up.

 

@Gill & George Oh, love that you have maltese blood in you! Have yet to visit Gibraltar myself

Mia has been doing good over the weekend, Saturday she didn't have any poop for me to check in the litter, but yesterday I checked after she had been and there is still some diarrhoea in between the normal looking poop. So I am not sure if maybe she had some "leftovers" that still needed to come out and is back to normal now, or if she is still having abnormal BM. Will keep on checking the litter after she has gone. Managed to test for ketones again yesterday and was negative so that's good.

Apart from that she is eating like normal, playful, purring etc. so I haven't seen any other changes apart from the bit of diarrhoea we still saw yesterday.

Yesterday evening she had a bit of a weird cycle were we didn't see her numbers going down until +6, which has been unusual for her. Both her morning/afternoon cycle yesterday and Saturday got her into green numbers at +4 and +6. So not sure why she doesn't go into green in the evening/night cycles

Will follow your suggestion and give it a couple of more cycles until making any changes to her dose

Took a photo of her BM yesterday evening, which was a strange mix of normal looking poop with liquid in between. https://drive.google.com/file/d/10ULDo1Rn1DRLXFJAq0BPfRirR_ciz4CO/view?usp=sharing

 

Before you take her up check with us, I'm going to the UK for a conference today, so I may not be around very much, Tuesday and Wednesday. I'm back Wednesday afternoon.

She had a pretty flat cycle last night, sometimes a flat blue cycle precedes a very active cycle. So let's see if she's playing games with us.

LOL. A lot of families are descendants of malteses families, if you looked in the phone book you'd recognise a lot of surnames.

 

@Gill & George

Of course, not doing anything at all until I check in with you guys on here! Just did her +2 check, and it has gone down from 8.6 to 6.2, so definitely already more active than last night!

Haha and yes, us Maltese are definitely everywhere! Just always get surprised just the same seeing Maltese surnames etc from this tiny little island

 

Sorry for the lack of reply here @Suzanne & Darcy! Took a little "break" from it all over the weekend (apart from testing and insulin of course). But yes your explanation of her low numbers while on caninsulin definitely makes sense in regards to it being a short-acting insulin. So for it to be a bounce, it will result in longer lasting higher numbers and not actually just "bouncing" from low to high during a cycle.

 

Is this your latest thread, Monica?

 

@Suzanne & Darcy Yes, still going on this one

 

How is she doing? I saw you had negative ketones . I think you should got ahead and take her back up to 0.1 units. She’s been in too much blue and we’ve lost the greens. Even when she did go green it was not for long. What do you think? Do you want to wait until tomorrow morning?

 

Yes managed to get in another ketones test, and was negative luckily! Haven't been able to check her poop today, so not sure what the update is on that yet. But have been adding probiotics (fortiflora) to her food twice a day so could be that has done the trick.

She has already gotten her dose for this evening/night where we stuck to a drop dose. But seeing that she has been in blue numbers for the past 5 cycles now, I would have to agree that it seems like she needs an increase to 0.1u again. Will be getting a caliper tomorrow hopefully, which should make consistent measuring a lot more easier. I have had a slight feeling the last couple of days that she went into lime green numbers because of wrong measurement of the 0.1u dose as I have recently noticed the markings on syringes have varied slightly. So I have a theory that the newest syringes have their markings slightly lower down on the syringe itself. Have you ever experienced this?

Got any tips on how to use a caliper in order to measure the 0.1u on our syringes?

 

Unfortunately, I have never had the need to use calipers, but other people on this Board have.

 

@Suzaune Oh ok! It seems like it could be a great tool to get these tiny measurements correct and the same every single time. I spoke with Stefania too and she said she has also seen the same thing with the syringes we are getting here in Malta. That the lines can be a little off. Will have a look on the forum to see what I find about using a caliper and how it works

I have given Mia her morning shot now and increased it back to 0.1u. So we'll see how her numbers will do on this cycle

 

@Heather82372 and @SmallestSparrow you both use calipers and have had some good discussions about it lately. Can you help Monica with using calipers to measure a small 0.1 dose?

 

@Suzanne & Darcy right back to green numbers today it seems like. But not too happy about her going all the way down to 2.9 even though it is technically in the green and not lime green numbers

 

I understand your anxiety. The 50s are good numbers (2.9/52) is safe. We have cats on the Board who hang in the 50-80 range for long periods of time. It does take some time to become accustomed to that. In Mia’s case, it looks like she went up to 74 within an hour. After that, I can’t tell what happened. We would like her to spend time in dark green.

 

Yes of course very happy to see those green numbers again! Just found it to be quite a big drop from her pre shot number. Her +6 is coming up now in 30min, so will update the SS then.

 

Actually my last post about calipers was me asking about it because it was so confusing to me. Honestly, life has been too busy for me to even figure it out yet. Sorry I can't help.

 

Didn’t someone post a video about how to use them? I haven’t been able to find it yet.

 

When her preshot numbers start to come down and you are “shooting low to stay low” then the cycles will smooth out and be much flatter.