Mia & Monica - Continued (part 3)

Ah yes that makes sense! Thank you for calming my head down once again!

 

Here’s some info about dosing with calipers:

https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

 

Sorry I’ve been sleep deprived lately. I haven’t used calipers (yet…may eventually if I don’t end up on an even number of U) but this is the video I found
https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

 

That’s the one! It’s Marje’s video.

 

Morning Monica,

If you see this I might get a +1 today, she is slightly lower BG than she's been giving latel, also she had a flat blue coming into amps. It might signal a more active than usual cycle, as the depot builds.

If she is dropping at +1, give her some a snack (just a teaspoon or two of food)at +1. To try and slow her down, in an attempt to avoid a visit into lime green.

 

Hi! Unfortunately I didn't see this msg until now, just did her +2 check. But can get in a +1 this evening if you think that's a good idea?

about her cycle last night, I suspect she had slightly higher BG readings at pmps and +2 because of her vet appointment. the pmps reading was done at the vet and the +2 was around 1 hour after we got home. I put notes about this in the SS.

 

I saw, last night, that note about the vet visit and I was also speculating on that yellow number being due to the bet trip. Good news that the bloodwork was all good!

She’s having a very nice cycle so far today! Have a nice day today!

 

Yes exactly, I doubt I will have the same high numbers during her evening cycle today. And very happy with her cycle today! Hoping to see more and more green numbers throughout the day and more during the evening too as she has generally seemed to have higher BG numbers in her evening cycles

 

Lovely cycle this morning.

I didn't see the note about the he vet visit, that explains last night's numbers I thought she was taking s run up for a dive. Not the case.

Not necessary to take a +1 tonight unless she were to surprise you with a lower than usual pmps.


I like that she's seeing s lot more green on this dose.

 

A very pretty cycle today! She had an even longer run in green. An excellent PMPS, too. When will you next test her?

 

@Gill & George no worries about the note, they are a bit hidden being all the way to the right. Don't really notice them unless you look for them

 

@Suzanne & Darcy yes was super happy seeing she stayed in greens so long! Will do a +2, +4 and +6 as usual, and of course more tests if there are any surprises with her numbers. Her +2 is at 21.30, so in 1 hour and 45 min now

 

@Suzanne & Darcy @Gill & George

Mia had quite a sharp drop to 2.9 now at +2. Will feed her and check again at +3 instead of waiting til +4

 

Hi Mónica.

What % carbs did you feed?
It's very early in the cycle for 53, i hope the food does the trick and encourages her to surf.

 

She was flat and low blue at pmps, so looks like you were getting good duration from this mornings dose,
Tonight's dose has onset and with the longer duration that's possibly why you are seeing the sharper drop at onset.

Watch out for those flat blues at the end of the cycle, they can indicate increased duration and be a signal that they're going to before active than usual.

It's also cycle 4 of the new dose so you are starting to see the full effect of the dose.

 

I just gave her another portion of her usual low carb food. It is 3.33% carb dry matter

 

@Gill & George when you say she was flat at pmps, what exactly do you mean? That there wasn't a big increase from her +10?

Should I have waited for 20 min before giving her the shot to see if it went further down/stayed stable/started going up?

 

No shooting on time is best.

Mia, it seems likes to onset early, i think in your shoes and as this is the second time she's done these fast drops early, i would probably start taking a +1. Then decided if you need to get a +2 or if you could wait to +3.
By doing an earlier test you might be able to manage her curve with food, using a snack at +1 (perhaps one with a little more carbs than her normal food) to try and get her to surf in green and not drop into lime green.

What I

Exactly she was just about the same at pmps as at +10 so she was still getting some insulin action from the mornings dose.

If you find yourself in a situation where you see a sharp drop into low -0's it might be an idea to test again in 30 min rather than waiting for an hour, particularly if it's early in the cycle.
I'm sorry I didn't see your tag earlier.

She's sent a reduction again.

 

I know you've been handling lows, so high carb and 20 min checks till she comes up.

 

Just doing the night time feeds, I'll pop back in when I'm done

 

She's up on 3.2 now at +3.5

 

What's that in US ? 57 ?

Good she's out of the lime green.

A teaspoon of LC now and chec again in another 20min if she's stil dark green at that point then another LC snack if she'll have it and check in one hour.

Did you give her honey or HC when she went lime green?

 

Tested again now at +4 after waiting 30min and she is 3.1, which is showing on the US SS as 56.

Gave her a tiny bit of honey when she went into lime green along with 10grams of her regular food and 3 dreamies snacks/treats. That was 1 hour ago now.

Will check her BG again in 1 hour and feed her again in the meantime too

 

My significant other will be taking over the next couple of tests now, so won't have the SS updated until tomorrow morning when I take over again

 

So I decided to give her a drop dose this morning, it was either that or not shooting. Her preshot number was 5.1 which is the lowest preshot number yet. Considering she last time went into lime greens when her preshot number was 5.5 and even yesterday when her preshot number was 7.1 I hope it was the right decision. Will be doing a +1 in 15min

Found some vomit after she got her shot and fed her. I was in the shower so not 100% sure its hers, could be of my other cat

 

I'm so confused right now. Her +1 now shows she has gone up to 7.3

 

Good decision she earned a reduction, but she's perhaps not yet ready for no insulin.

Her duration of last night's dose is up, not enough insulin in system resulting in a little food bump, you will probably find that once she onsets she comes down again.
Duration can differ from one cycle to another, things that can affect it are absorption of dose which varies one day to another, but another factor is the amount of carbs we give during the cycle, typically when they go lime green we feed high carbsnand that can shorten the duration, which is possibly why we are seeing a shorter duration this morning. That said she's still had a decent duration, just not long enough to overlap with this morning new dose.
She will probably come down mid cycle, but if I had to guess it would be a normal cycle, I wouldn't expect lime green.


She's looking good. A lot of time in
Well done for shooting your first green.
Here's your award

 

The link below has a post on shooting a falling PS (it may help to clarify what I was talking about with the flat blues)
Talks about duration, feeding strategies to help you get your cat to spend as much time as possible in green. If you look at George's ss and look at the months before he went into remission, you can see he went very flat with his lantus curves, the thing that was the game changer for us was implementing a feeding strategy to flatten him out, it stopped him bouncing, and diving into lime greens, prior to that he gave me some roller coaster cycles that were too exciting for my liking.
Mia, on lantus in some ways is not as dramatic as he was, but we want to try to get her into a dose where she is staying between 50-80 for most of the cycle, I'm not sure that the drop dose will cut it, but we will see in the next few cycles, if you have to go back up again implementing a feeding strategy may help you hold on to that 0.1 dose safely avoiding drops onto the 30's, and if she can see enough green it will encourage her pancreas beta cells to heal and we may start to see it start to function more normally.






https://www.felinediabetes.com/FDMB/threads/tight-regulation-slgs-myths-debunked.111088/


This other thread in manipulating the curve with food, is an interesting read and if I were in your shoes I would start considering perhaps implementing the principles, in an attempt to flatten her out 'and hold on to a dose' that's keeping.het in green. It's something that I followed and did with George, it really helped.

This is a typical active cycle taken from the new to the group sticky on the lantus forum, the pink is my addition, something I found held true for George and that Mia seems to be following, and is probably the point at which you should try to intervene with food to flatten her out.
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number. ( If you don't see a food spike and this number is the same or lower than ps it can be an indication of a more active than usual cycles)
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

 

Morning Monica, I was just checking in on Mia's SS, I see you've taken the dose up again.

I do think that it looked oks like a failed reduction, in your shoes I would have been looking to take the dose up.


That said, she had dropped quite low on the 0.1u, so you probably need to adjust feeding schedule, and or quantity of carbs fed to try to get her to surf in those dark greens and avoid dropping into lime green.

If you are going to be feeding differently and trying to manipulate the curve with food, it's important to bleep notes preferably on the SS recording what you have fed and when, to help you adjust to come up with a method that works for Mia, and to help us help you and give you safe advice.

How a curve evolves is governed in part by the dose and in part by carbs fed.

Did you get the calipers?

 

Hi Mónica,
Those are really nice cycles. Thanks for making notes about the food.

Using dreamies as an emergency is fine, they are approximately 40% carb and they are dry.

There are a couple of problems with using dreamies to manipulate the curve
1) they are too high in carbs, ( you wat to manipulate the curve with LC food (below 10 % ideally, I used medium carb at times, but mostly 10%)
2) they are dry, and for TR/ the cat needs to be on strictly a wet diet. (Dry food can remain in the system for quite a long time/not predictable/ and when it does come out of their system BG can crash)

Do you have any higher carb wet food?

Some of the Purina gourmet golds might be suitable

Chunks in sauce are 30%
Some of the pares, come in at around 10%

Absolutely fine to use dreamies in the event of an emergency, but not recommended for routine use of manipulating the curve.

Have you been using dreamies on a regular basis?
Or only the last couple of cycles?

 

Hi @Gill & George ! So sorry for the lack of replies here, been super busy with work lately and just trying to keep up with all the testing and feeding times in between.

Will definitely stop using dreamies to manipulate her cycles going forward then and just keep them for emergencies. I have bought a couple of tins of Mia's old wet food which is the Purina Gold savoury cake. Just checked now and they are 9.6% carb dry matter basis. So they are 3 times as high in carbs as the wet food she is currently getting.

Until I saw your recommendations about manipulating her cycles with higher carbs we had only used dreamies for emergencies. So only used them for those couple of cycles.

Are there any suitable treats that you can recommend instead? I'm just thinking if Mia isn't hungry, how I would be able to get to manipulate the cycle. With treats she never refuses, maybe there are some liquid treats that aren't too high carb?

Oh and yes we have started with the caliper. We had kept a syringe from the first batch of syringes we bought once we switched to Lantus, so I just used that to base the measurements as we never felt any of those first syringes had crooked markings.

 

Hey Mónica,

No problem I could see you were reading your posts and with the notes you were keeping I could see you were taking it in.

The 9%mouse is probably a good option.
One thing I sometimes did to get a higher carb is mix equal amounts of food, so 1tsp of 4% and one teaspoon of 18%. Would give me 11%

Or one teaspoon of9% and one teaspoon of18% would give me 13.5%

I used some of the cosma tins which are complimentary foods back when George was on insulin, some of them were between 10 and 15 % it's a long time ago so you will need to check the carb content. I'll take a look and see if I see anything.

@xelo y sinver uses a liquid treat that's 18% perhaps she knows of others.

Great that should help with consistency

 

Ok, awesome! Thank you So as you can see from her SS Mia ended up going down to 2.6 at +3 during her PM cycle yesterday. At +2 she was 2.9 so we gave her 10 grams of high carb wet food, which apparently wasn't enough to keep her from going lower within the next hour. So I think I now know next time she is below 3, she will need more high carb food than 10 grams. I am thinking I will skip lowering her dose to a drop dose even though she went into lime green at +3, just because I think we have seen from the other two times we have decreased her dose from 0.1 to drop dose that we have had to increase it again after a couple of days anyway. Would you agree?

What had me a little surprised this morning was that she was suddenly at 10.6 for her preshot BG. Could it be that her system takes some time to absorb food, so the high carb food she got yesterday affected her morning BG reading? In total during her PM cycle yesterday she got the first 10 grams of high carb food at +2 and then got another 10 grams at +4.5.

 

I agree with you keeping her at the .1 dose for now. You did a good job heading off that drop last night with food. She probably would have dropped lower than 47 if you hadn’t been proactive with the HC when she was at 52.

She’s already back to green today so if there was any residual carryover of high BG from the carbs, it’s gone now. It’s possible that later in the cycle after you went to bed that she did climb into higherBG than what is normal for her — due to all the carbs — but her AMPS wasn’t too terribly high and at least was still blue.

 

@Suzanne & Darcy Ok that's great to hear you agree with the 0.1 dose. And appreciate the feedback on yesterdays cycle. I must admit I got really disappointed when I saw she went into lime green and felt like I failed the goal of manipulating the cycle with food.

Do you have any thoughts on the amount of high calorie food to give next time? Seeing she still went into lime green when I gave her 10 grams HC

 

Do you mean 10 percent carbs? I assumed that 10 gram was the amount (portion size) that you gave her. I hope she’s not having diarrhea from the HC food.

 

@Suzanne & Darcy No, not 10 percent carbs, just the amount of high carb food I should give in order for her not to get too low again. Like yesterday evening she got 10 grams of the high carb food, which I calculated to be 9.6% carb. But still she went into lime green. Was just thinking how much I should have given her when 10 grams wasn't enough to keep her out of the lime green numbers?

 

Well, every cat is different, and normally I don’t recommend feeding HC unless they drop below 50; however, in Mia’s case on this dose, it seems she does need some medium carb food. I would try something around 14-15 percent to keep her out of lime green.

 

@Suzanne & Darcy Yes it looks like the low carb she is getting might be a little too low on this dose, I agree. Do you mean that you would switch completely to wet food around 14-15% carbs? Or are we misunderstanding each other?

 

Not completely switch no. I am only saying to ise a higher carb when you are trying to keep her out of lime — like when she’s in the low 50s at only +2 for example.

 

A lot of this feeding is trial and error at first - as you find out which level of carbs will bring Mia up enough to help her surf in dark green without shooting her up way too high and kind of spoiling the whole cycle.

 

@Suzanne & Darcy ok got it! we're on the same page then!

So basically same thing happened this morning with a high preshot number of 11.9 after feeding her high carb wet food last night. So we are apparently giving her too much of it, but then again the evening before she did need more it seems as she stayed in lime green after getting 10 grams of wet the high carb wet food.

Seems like Mia might have a slow digestive system causing it to affect her BG for quite some time.

I'm having issues since yesterday with the SS as it keep on showing as view only, which is why it's not updated

@Gill & George did you experience these high BG numbers after regulating the cycle with high carb food?

 

Something strange is going on with Mia's cycle this morning. Again she was a little high preshot at 9.1. Just checked her +2 and its gone up to 10.4. she has never been higher on her +2 compared to her pre shot number

 

@Suzanne & Darcy @Bron and Sheba (GA) @Gill & George @JL and Chip

Could you have a look at Mia's SS and let me know what you think?

 

Monica, Mia’s doing very well! I would not be concerned about the +2 going up from 9.1 to 10.4. They are basically the same BG when you take into account there can be a 20% variance in the BG with the meters.
And she has now gone down to 7.4

 

Hi everyone! @Bron and Sheba (GA) @Suzanne & Darcy @Gill & George @JL and Chip

Haven't posted in a while, but we have some weird numbers going on with Mia lately. So wanted to check if any of you have advice pr experience with this.

If you have a look at her SS, she stays in blue at preshot numbers for several days and then suddenly has a yellow preshot number. The first time this happened we had recently been adjusting her cycle with high carb food and snacks, so we assumed it was because of that. But yesterday during her amps and today's amps she had yellow numbers again and we haven't given any high carb food or snacks for a week now.

Any idea why this is happening?

 

I would try giving a snack at +9 overnight to see if that brings down the AMPS. Do you have an automatic timed feeder?

 

@Bron and Sheba (GA) Oh! Really? That sounds so opposite of what makes sense in my head regarding BG levels We don't use an automatic feeder. To give you an idea of her feeding schedule, I can give an example of how much and when she ate yesterday. She gets 40 grams at both AM and PM shooting times, which sometimes she eats in one go and sometimes she takes an hour to finish. At +2 she got 20 grams, at +5.5 she got 20 grams, and 20 grams at +9 before removing food 2 hours before PM shot. Got her 40 grams with her PM shot, another 20 grams at +3 and 10 grams at +6.

Regarding a snack at +9 during the night, could you explain? I don't understand how a snack would make her AMPS lower?

 

@Bron and Sheba (GA) did you see my last post?

 

Sorry I didn’t get your first tag so thanks for the second one.
The reason I am suggesting the +9 snack at night is because she is down to a 0.1 unit dose and sometimes when a cat gets down to that dose and the preshot is still higher, we find if we give a +9 snack before that preshot, the BG often comes down. This is because if the pancreas is beginning to splutter back into producing some insulin, if you give a snack of food, it should stimulate the pancreas to produce some insulin and that should bring down the BG about 3 hours later. Does that make sense?
It only works when the cat is on a tiny amount of insulin (which means the pancreas is possibly producing some insulin on its own). And this is how a healthy pancreas works. Food stimulates a healthy pancreas to produce insulin which in turn will bring down the blood glucose after eating.

 

@Bron and Sheba (GA) no worries! I've missed tags before too so I guessed it can happen to others too

Oh ok that definitely makes sense the way you explain it! Will tell my hubby to do this the next couple of days and see if there is any changes. I am abroad for the first time since Mia was diagnosed, so getting updates from him as well as her latest BG numbers. I just updated the SS now with her numbers from the last couple of days. Could you have a look? She's been in yellow through her whole am cycle til now. Could she be bouncing? Another member answered me on the FB page and said that even with BG 3 could cause a bounce. Never seen Mia staying in yellow and the insulin only lowering her with a couple of numbers.

Any idea what might be going on?

 

I don’t think the yellows are caused by a bounce. There is nothing I can see in the SS that would explain a bounce.
Could she have got into any other food?
See how she goes over the next couple of days. She may need a dose increase if they continue.

 

I think you could start to post over on the Lantus page where everyone uses a depot insulin and you will get a lot more eyes on your thread.
HERE is the link for the page. And here is a link to getting started over there
There is no rush to do it…just when you are ready.

 

Another possibility (other than contraband food that Bron mentioned) might be something that affected the 0.1u insulin measurement, such as an air bubble in the syringe. Those tiny doses do sometimes get muffed, even with calipers.

 

@Bron and Sheba (GA) Yes according to what you guys have told me previously, lime greens are needed to cause a bounce. Just found it strange two members said that low 3s also can result in bounces.

There is no other food she can have gotten into. We have been experimenting with the flavors of her food though, but still the exact same brand that she had been on since going onto low carb wet food. She has had a little bit of a bad stomach sometimes, and I read that in case of IBD, proteins such as beef, chicken, lamb etc should cause less issues. So we have been sticking to the fish flavors along with veal and turkey.

Could there be other things than food causing this sudden increase in BG numbers? Also, her evening cycle is looking similar to the morning one where both the +2 and +4 were higher than preshot

 

A bounce can be caused by several things…if a cat has been used to very high numbers for a while, any numbers that are lower can cause a bounce. So a drop from the 400s to the 200s can cause a bounce in some cats.
And if the BG drops into low numbers (under 3 or 4 if the cats isn’t used to them) that can also trigger a bounce.
And if the BG drops quickly over a short space of time, that will trigger a bounce.
If you look at Mia’s numbers she is very used to green numbers and even when she drops into lime green numbers, as she did on 13/11 and 17/11, she had a yellow amps but quickly went back to her normal numbers. And I can’t see anything that could have caused a bounce in the last few days.

Things to look out for if a cat suddenly goes into higher numbers for no apparent reason are: are they getting into other food, could they have a UTI, are there any bad teeth?
Could she he stressed because you are away?

 

@Bron and Sheba (GA)

Hmmm ok, well the biggest recent drop was the 28th, from 10.1 at preshot down to 5.4 at +2. Not sure if that qualifies?

Is there anything my hubby can do at home to check for UTI and bad teeth? Or should he take her to the vet for a check? She could of course be stressed because I'm away, but I have been away since Tuesday now and this is happening now/yesterday. Also, she is used to us travelling regularly before her diagnosis. So its nothing completely new to her, especially seeing hubby is still home with her.

 

@JL and Chip Oh ok, I will ask hubby to be extra careful. What I am finding strange, apart from the higher preshot numbers, is that her BG is increasing at +2 and now even at +4. Haven't seen that in her before

 

It is possible that could have triggered a bounce. Let’s see what happens over the next couple of cycles.

 

@Bron and Sheba (GA) Ok, will try not to panic and tell hubby to do the same. So you don't think these numbers are any cause for alarm?

Hubby's biggest question right now is if he should take Mia to a vet or not.

 

How is she acting? How is her appetite?

 

She is her usual self, playful, cuddly with both Hubby and our other cat, and is also eating her normal amount of food throughout the day. So there doesn't seem to be any change other than the higher numbers

 

I don’t think a vet visit is warranted if she is as you say above.

 

@Bron and Sheba (GA) Ok thank you the only reason we started discussing a vet visit was to rule out anything else going on, like you mentioned above, UTI, tooth infection etc.

 

I agree with Bron. If Mia seems to be feeling fine and acting normal, then I don’t think you need to take her to the vet just yet.

One “off” day doesn’t constitute a pattern. A number of things can cause a blip in a cycle. If her numbers continue to trend higher, it might be worth revisiting the idea of a vet visit (but it already looks like her BG is returning to a more expected pattern, so that’s reassuring).

 

So she had a nice am cycle yesterday where she went back into green numbers at +4 and +6 and stayed in blue for her pmps. Her amps today has gone even higher though, now into pink numbers at 16.9. when should we consider increasing the dose?

 

Dosing decisions are based on the lowest numbers, not the highs (so in this case you would ignore the pink when evaluating whether an increase is warranted). @Bron and Sheba (GA)

 

Correct. You would not increase the dose with the greens yesterday.

 

Yes of course, not asking based on the high amps. Just in general, how long do we wait until increasing the dose seeing her numbers have been increasing lately? Again she has had a yellow am cycle, not going down into blues. Would no more blues or greens for a certain amount of days/cycles be the deciding factor?

 

Just another reminder --

Please keep your threads to under 50 posts. There are 169 messages in this thread. Most of us don't have the time to read that many posts in order to offer knowledgable help.

 

@Sienne and Gabby (GA) Sorry about that! Will get a new thread started