5/2 Gracie PMPS 106 +2 82 +3 86 +4 117 +6 217

Gracie's Yesterday

Recap:
AMPS: 310 8th cycle f .5u
+2: 306
+5: 275
+9: 253
PMPS: 264 9th cycle f .5u
+2: 200
+4: 141
+6: 242

Good Monday morning LL. Lots of things in our world today to say prayers for and we are saying them for peace and for our beloved sugarbabies in LL who need the extra care as well as their beans.

Not sure what to say about these cycles. Thanks Michelle, Ann, and Barbara for responding this morning regarding my dosecrease question. I couldn't tell if last night was still part of a bounce clearing or what but I left her dose alone today. I just feel it is not really getting her anywhere and she doesn't take this long to clear bounces on higher doses. In nine cycles, she's only had decent numbers in three (not counting the first one which was probably some carryover from her sk .75u). We'll see what today brings. She seems a little quieter today.

I flaked out really early last night. We had a drink after Gracie's routine...well, I had a drink and a half (coconut rum and Fresca) and I rarely drink. :lol: :lol: We ate some great taco soup that Mike made from scratch and then I was out like a light! All that work yesterday and a little alcohol and food and that was it for me so sorry I didn't get back on and check on kitties. Good thing Mike was wide awake. Not sure what we will do today. It's so windy here that it makes sitting out by the pool or hiking not so enjoyable. Maybe a movie!

Have a great day.

Re: 5/2 Gracie AMPS 332

Nice to have a day to relax, I hope you get a reply from an advisor soon.

Re: 5/2 Gracie AMPS 332

Morning! I do hear you on the cycles. there are times I just don't know what to make of Mannie's or what to do for that matter. I especially struggle with the ones where he's all yellow for 6 cycles, get already to increase and then he pulls 2-3 blue/green ones in a row. It drives me crazy.... Well, I hope Gracie comes down from the pink this morning - I know that it not what you had hoped to see. I too hope you hear from an advisor soon.

Nice on last night - it sounds like a nice relaxing enjoyable evening. We all need nights like that once in a while. Enjoy your day today - movie sounds nice - I haven't done that in ages.....

Gracie!! You awake there today? Guess what!! A pool party at Zoe's!! We can grill and everything!! AND she has a pool with those noodle thingies. You wanna come? I can picks you up. ~~ Mannie

Re: 5/2 Gracie AMPS 332 +2 306

Mmmmm, soups sounds good. Glad you could relax as it doesn't come too often for us sometimes. Give Gracie a hug for us.

Re: 5/2 Gracie AMPS 332 +2 306

YES! Coming down. Headed the right way Gracie!

Re: 5/2 Gracie AMPS 332 +2 306 +6 225

responding to marjorie's PM here:

i wouldn't increase the dose just yet. gracie dropped to 50 less than 48 hours ago.
if it were me, i would sit on this dose for the next couple of cycles. if you increase now and she clears the bounce at the same time you'll have one heck of a time bringing her numbers up.

there is something i've been thinking about and wanted to reference here. in Phase 3 Holding the Dose, Kirsten mentions (emphasis mine):

"Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way)".
http://www.tillydiabetes.net/en_6_protocol2.htm

we usually don't recommend holding the dose in the 40s. doing so requires a lot of monitoring as well as knowing your cat very well... how your cat responds to intervention using food/karo. you and mike have schedules which allow you to monitor carefully. although, i'm sure it's at great sacrifice to your personal lives. i have wondered if this approach will get gracie over this hurdle. however, i would be remiss if i didn't mention there's an increased risk running cats lower than 50.

i think this is something for you and mike to talk over between yourselves. it's not a decision anyone can make for you.

>>>>>>>>>> those who are reading... please don't get any ideas from this. this method was brought up for discussion/consideration in this condo for gracie and gracie alone. she has been stuck at this point repeatedly. gracie has TWO beans who have been able to offer round the clock monitoring when needed.


ps - this is not a recommendation. i'm simply bringing up an option available in the tight regulation protocol.

Re: 5/2 Gracie AMPS 332 +2 306 +6 225

Hi, your evening last night sounded like fun and relaxing. I'm a lightweight, too, one glass of wine I'm fine, but two I'm in la la land! The homemade taco soup sounds good, too. Well, it sounds like you've decided to stay with the same dose, and Gracie is coming down slowly. Hope she soon gets back to where she needs to be and no surprises.

Re: 5/2 Gracie AMPS 332 +2 306 +6 225

Just stopped by to say Hi!! Looks like you have your hands full! Hope Gracie levels out & you find a way to keep her in safe numbers--I'm still trying to find that perfect dose too :lol: :lol:
We have been inncommunicato last 2 days but are back now--I could use a nice swim in your pool just about now--Hugs from us!!

Re: 5/2 Gracie AMPS 332 +2 306 +6 225 +10 162

Jill: thank you very much for your response. We will hold tight on this dose tonight and tomorrow a.m. cycle. She is looking like she might be breaking a bounce today so we'll see where she is headed.

Regarding your thoughts, I have read that in the protocol and wondered, when Gracie was on sk .75u, if we should give her more time at that dose even though she had been below 50 three times....she just had too much bouncy stuff still going on. Interestingly, for the most part, we have made her earn reductions by going below 50 three times and on many occasions, she went below 40 the same cycle as the third time she went below 50. I think we are willing to give this a try but not at any dose above sk 75u because I don't think we can keep up with that. She really likes to surf in the 40s and has done so on many occasions and I've commented on that. So we are willing to try and hold her dose until she goes below 40 ONCE. We'll monitor her carefully and, if at any time we believe her safety is at risk, we'll stop. We don't intend to really change the way we manage her from cycle to cycle but she'll earn a reduction when she goes below 40. We'll try and see what that does for her and if we can break through this.

The other thing that is interesting was I was studying Mocha's SS. Devon and Peter left her on f1u for 38 cycles (approx) and she had some big bounces in between her blue/green cycles. Her SS looked very much like Gracie's lately (actually, I think they have always had similarities). And then all of a sudden, Mocha started bouncing less with lower numbers and then she snapped. Mike wonders if just buckling down and keeping Gracie at this dose for as long as possible, even if she has some bouncy cycles but as long as she is getting normal ones, will give her some consistency and help her breakthrough. Thoughts?

Thanks Michelle, Susan, Ann, and Roni for visiting today. We were busy with the pool pump guy this morning, then the vet chiropracter, and then ran out to exchange the outdoor cushions while Gracie was safe. Just got back, got in our walk, and are getting civvies ready for squids and Gracie ready for PS. Hope everyone is well.

Re: 5/2 Gracie AMPS 332 +2 306 +6 225 +10 162

Hi guys - looks like Gracie is coming down - YAY!

lots of info here. I'm not sure I'd ever be comfortable holding a cat in the 40's. I know some do that naturally (for now I can't remember who...), but it's just plain scary for me. Gracie is so different than Mannie that it is hard for me to give a helpful opinion. anyone who knows Mannie knows he is on a dose for quite sometime before a change is even possible. I think for him, and I'm not sure this is for Gracie, that if I can hold him at a dose, get some consistency, some normal cycles, that maybe there will be that breakthrough. Good luck with the approach of reduction when below 40 once. I hope it works for her.

have a great night guys!

Re: 5/2 Gracie AMPS 332 +2 306 +6 225 +10 162

Good luck with holding the dose. We were on one dose for 3 months. jojo said, one day it will happen, the bouncing will stop, and it did. Tuffy loved to drop to the 20s and 30s. Even then, I had to shave the dose. Full reductions did not hold. Without Libby, Jill and jojo, I don't know where Tuffy would be but their suggestions worked. I never thought about OTJ, just regulation - still surprised. Hang in there the marathon continues. :lol: :lol: :lol:

Re: 5/2 Gracie PMPS 106

Thanks Michelle and Barbara!!! I always remember, Barbara, about your Tuffy and where she liked to surf....Gracie likes lower numbers, too, but not that low :lol: :lol: And I'm not sure I have the intestinal fortitude for that

Just to be clear, our number one priority is Gracie's safety. Mike and I don't see this as managing her any differently than we ever have; we have always tried to keep her around 50 and if she's surfing the 40s, we've always let her and watched her very closely. The only difference is we'll be holding the doses longer and making her work a little harder to earn the reductions so we won't automatically reduce with one or three times under 50. We will automatically reduce if she goes below 40. So that is our cut off for reduction...a goal; we may have to change that plan. But we intend to still work to keep her in safe numbers but like all the other cats, she may inevitably drop below the cut off number where she earns an automatic reduction. We love our little girl too much to put her at risk and there seem to be several OTJ cats that really enjoy surfing the 40s....that may have been where Gracie liked it when she was not a FD.

Din din time for us. I'll try to check in later and catch up.

Re: 5/2 Gracie PMPS 106

Hi, Marjorie!! Such an interesting conversation going on about dosing! I'm learning alot (no help to you, I know... :lol: :lol: :lol: ). It sounds like you guys have a good plan in place, and I hope it helps Miss Gracie to clear whatever roadblock has been in her way. Hope you have a good night!

Re: 5/2 Gracie PMPS 106 +1 96

Nice +1, and there she goes, once again! Be good Gracie - and surf well!

Re: 5/2 Gracie PMPS 106 +2 82

So far so good. Afraid to say anything more than that!!! I'm headed for bed.....don't know why I've been so zonked lately. Mike has night duty.

Re: 5/2 Gracie PMPS 106 +2 82 +3 86

interesting discussion about gracie and her dosing - i always like to read other people's stuff. good info.

coconut rum & fresca? is there a comma in there, or is there a kind of rum that's coconut rum? sounds good.

enjoy snoozing tonight, marjorie, and welcome to night duty, mike! i'm off to bed too!

Re: 5/2 Gracie AMPS 332 +2 306 +6 225 +10 162

Marjorie and Gracie said:

Regarding your thoughts, I have read that in the protocol and wondered, when Gracie was on sk .75u, if we should give her more time at that dose even though she had been below 50 three times....she just had too much bouncy stuff still going on. Interestingly, for the most part, we have made her earn reductions by going below 50 three times and on many occasions, she went below 40 the same cycle as the third time she went below 50. I think we are willing to give this a try but not at any dose above sk 75u because I don't think we can keep up with that. She really likes to surf in the 40s and has done so on many occasions and I've commented on that. So we are willing to try and hold her dose until she goes below 40 ONCE. We'll monitor her carefully and, if at any time we believe her safety is at risk, we'll stop. We don't intend to really change the way we manage her from cycle to cycle but she'll earn a reduction when she goes below 40. We'll try and see what that does for her and if we can break through this.

Click to expand...

ideally, you'll want to try to keep her from earning a reduction. actually, that's what using food manipulation is all about. by manipulating the cycle with food you can keep as much insulin in the cat as possible without having to reduce the dose. this is especially helpful with bouncers who have a hard time holding reductions.

The other thing that is interesting was I was studying Mocha's SS. Devon and Peter left her on f1u for 38 cycles (approx) and she had some big bounces in between her blue/green cycles. Her SS looked very much like Gracie's lately (actually, I think they have always had similarities). And then all of a sudden, Mocha started bouncing less with lower numbers and then she snapped. Mike wonders if just buckling down and keeping Gracie at this dose for as long as possible, even if she has some bouncy cycles but as long as she is getting normal ones, will give her some consistency and help her breakthrough. Thoughts?

Click to expand...

i've wondered the same. i'll be very candid... the only reason i haven't mentioned it is because you appear to have a difficult time holding the dose especially after a bounce. i don't think they make industrial strength patience pants in any color! :lol: :lol: :lol:

very few of the current participants in this group are aware of any dosing method other than the Tight Regulation Protocol. for years, members started out on the Health forum where they were taught all the basics including the START LOW, GO SLOW (SLGS) approach. in recent years, for whatever reason, members have shown up on the insulin support groups doorstep without having all these basics under their belt... often by-passing the Health forum completely. it's a shame really. think of the Health forum as feline diabetes 101 and the ISGs as more advanced courses. jumping into the ISGs has to be extremely overwhelming without a sound knowledge of the basics. i sigh every time i see a new member arriving in this group prematurely... either by accident or by invitation, but i digress.

the FDMB has and does advocate the SLGS approach. the SLGS method has you holding a dose for 1 - 2 weeks before making adjustments. there's a reason for that. *some* kitties take longer to respond to a dose adjustment. we used to call them "slow responders". i remember one cat took about 20 days to really do well on a dose. that's unusual, but ECID!

the Tight Regulation Protocol works well for the majority of cats. the idea is to get the kitties into normal numbers as quickly as possible after diagnosis which has shown to increase their chances of a strong remission. however, maybe gracie is a slow responder. if so, holding her dose for a longer period of time *might* work out well for her. the Tight Regulation Protocol is an accelerated method with a specific purpose, but it doesn't always work for every cat. we say ECID a lot around here. as always, the key is finding what works for YOUR kitty because every cat IS different. unfortunately, finding what works often involves a lot of trial and error.

just some thoughts. take them for whatever they're worth...

DH here - Just a quick post before I get some sleep. It looks like Gracie broke her bounce and is starting another one. This is why we sometimes get antsy about holding her at a dose too long. it appears as if she has enough insulin to get her down, just not keep her down. Her cycle today and tonight was very gradually descending and she didn't get low, so the immediate bounce is frustrating and hard to understand. Not enough juice? Still settling into the dose? Maybe there is no explanation, just like the Thermos - keeps hot stuff hot and cold stuff cold. How do it know? I think we are decided on shooting the same dose in the morning and see what she does tomorrow. As long as she is getting fairly good cycles with short bounces we can live with that, but for how long it seems there is no right or wrong answer.

Jill - Thanks for the post. This is why I hate trying to communicate via email and text because there always seems to be an unanswered question or misinterpretation. My/our interpretation in a nutshell: if and when we get Gracie to a dose where she is throwing green cycles of longer duration at lower numbers, we are going to manipulate her to keep her from earning reductions like we always have. the difference will be the dose reduction trigger point. If she is dropping rapidly towards/through 50 we will use carbs to slow and stop it. If, on the other hand, she is calmly surfing in the 40's we aren't going to carb her to get her up into the 50's. She won't get an automatic dose reduction for any specified number of times below 50. 40 becomes the new trigger point, and 1 time below 40 gets her a reduction, just like it always has. Is my interpretation in line with your thoughts? Thanks as always for your wise counsel and help with our little girl