3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 +5 98Still have dose ??

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MikeysMom

MikeysMom

Member Since 2011
AMPS 122
+2 103
+4 116

PMPS 97 We were a little late getting started with out condo today. Mikey's numbers are pretty good. I still haven't increased him back up to .25 since he hit the 40's on the current .1 I'm still wondering if I should hold a little longer (PM numbers are good) or increase back to .25...or something in between. What are your thoughts

Yesterday: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=66812
 
Re: 3/22 Mikey PMPS 97 Still have dose ??

nice. :smile:

question - the night you shot the 68, you noted that you fed HC at PMPS to prop him up. Is that something you do often? And approximately when (and how much) HC did you feed when he was in the 40s that night?
 
Re: 3/22 Mikey PMPS 97 Still have dose ??

+1 112

The other night he had about 3/4 can of gravy lovers' FF. Because Mikey is such a diver, I always give a teaspoon of HC with his PS meal to get a food spike if his PS is under 100 and usually up to 120, otherwise he starts dropping at +1 and keeps going.
 
Re: 3/22 Mikey PMPS 97 +1 112 Still have dose ??

did he get HC tonight at PS? How about this morning and last night with the lower preshots?

I know, lots of questions, I'm just making sure I understand his spreadsheet.
 
Re: 3/22 Mikey PMPS 97 +1 112 Still have dose ??

Tonight he got about a teaspoon. I don't generally give any in the AM as he doesn't tend to do the crazy dives in the day, but he got a 1/2 teaspoon today and also gets a little with breffis if I can't be home to test. Most of the evening cycles on his SS that drop in the 60's or below are managed with some extra carbs. He gets regular LC at PS, +1 and +2 of every cycle.
 
Re: 3/22 Mikey PMPS 97 +1 112 Still have dose ??

+2 71 Added a 1/2 teaspoon of HC to his regular food to make it closer to MC since nadir is still 1-2 hours away. His PM numbers are looking great on this reduction, if we could just get those AM's in line...
 
Re: 3/22 Mikey PMPS 97 +1 112 +2 71 Still have dose ??

+3 64. Very, very pretty for Mr. Cat tonight.
 
Re: 3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 Still have dose ??

Here's what I'm thinking: I definitely don't think Mikey needs a dose increase. I would rather see you try to eliminate some of the HC. I think the food might be propping his numbers up quite a bit. Most caregivers find that even if they used to need quite a bit of HC to hold the numbers up, once the dose gets this low you might find that low carb is plenty to keep him surfing. That would be a good thing to try next time you're home during a lower cycle.

There are a couple of possibilities. One, Mikey might earn a dose reduction and answer these questions for us. ;-) Or two, if the cycle isn't being artificially raised with high carb food, his preshots might come down quite a bit. Also, sometimes when a cat no longer needs insulin, their numbers might go up a little bit. If this is happening AND there is high carb in the mix, that could actually be a big reason he is seeing so much blue. I think the high carb food is clouding the data and making it hard to see what Mikey really needs, know what I mean? Obviously we need to be sure Mikey is safe, but it's worth a try when you'll be home.
 
Re: 3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 Still have dose ??

hi amy. i just wanted to pop in to second everything libby has said.
the hc does appear to be clouding the picture. he may just earn a reduction without it. :mrgreen:
 
Re: 3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 Still have dose ??

I'm trying my butt off to NOT make him earn a reduction...he's already at .1, and I don't know where else to go; he's clearly not ready to go OTJ, and there's not much less I can do and keep him in the blues and greens. I don't know how to manage the dives without the HC...the last time he dipped into the 40's it took a ton of HC to stop the dive and bring him up again. I would WAY rather stop the dive with food before he gets that low than go through night after night of testing 8-10 times a cycle and trying to bring him up from the 40's. Wouldn't the effects have worn off by his AMPS? Plus, in the evening cycles where PS is low (especially 100 or less) if I don't give HC at PS, he starts diving immediately and it's much harder to control the cycle than if we get a food spike like you're supposed to with Lantus. LC works to get him surfing only when he doesn't drop fast by +2. If he has a big drop, it's usually not enough to stop it, so I add just enough HC to make the overall mixture a MC at most.

For whatever reason, he rarely dives in the AM like he does at night and never has.
 
Re: 3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 Still have dose ??

MikeysMom said:
I'm trying my butt off to NOT make him earn a reduction...he's already at .1, and I don't know where else to go; he's clearly not ready to go OTJ, and there's not much less I can do and keep him in the blues and greens. I don't know how to manage the dives without the HC...the last time he dipped into the 40's it took a ton of HC to stop the dive and bring him up again. I would WAY rather stop the dive with food before he gets that low than go through night after night of testing 8-10 times a cycle and trying to bring him up from the 40's. Wouldn't the effects have worn off by his AMPS? Plus, in the evening cycles where PS is low (especially 100 or less) if I don't give HC at PS, he starts diving immediately and it's much harder to control the cycle than if we get a food spike like you're supposed to with Lantus. LC works to get him surfing only when he doesn't drop fast by +2. If he has a big drop, it's usually not enough to stop it, so I add just enough HC to make the overall mixture a MC at most.

For whatever reason, he rarely dives in the AM like he does at night and never has.
Click to expand...

we don't know if he's ready to go otj or not because of feeding hc and i know it seems hard to believe, but even 0.1u of insulin if not needed can actually drive numbers up in stead of down. if you look at alex's 2006 ss just before she went OTJ you'll see inverted curves on only 0.1u of insulin. there's NO hc to cloud the picture. when a kitty gets down to these microdoses and we see inverted curves, we pay attention. it often means kitty is receiving too much insulin.

in mikey's case, we may not be seeing any inverted curves because of the hc. also... feeding hc at night could be messing with the action of the insulin enough to muck up the morning numbers.

if it's at all possible, we'd like to see what he does without the hc. we may be looking at a cat who's done with insulin.

however, there's one thing i want to make very, very clear...
if you elect to lay off the hc to prop his numbers up initially, that doesn't mean you should withhold hc if he should drop low.
give him hc if he needs it!
 
Re: 3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 Still have dose ??

MikeysMom said:
he's clearly not ready to go OTJ
Click to expand...
Actually this is not so clear to me. I know his spreadsheet doesn't look like a typical OTJ spreadsheet, but it does look a bit like a cat that is getting too much insulin. It's subtle and hard to read around the food. If he is getting so much action from one drop of insulin that he is diving and bouncing, maybe the one drop is too much. You're working really hard to keep his numbers up, and that shouldn't be necessary at this dose. Usually when somebody has to fight this hard, we suggest a reduction. His next reduction would be to zero.

I can see a couple of options. One is to try insulin without feeding HC (unless, as Jill said, it is needed for low numbers). The other is to try no insulin and see where he lands when the diving and bouncing stops. We'll know very quickly. What do you think?
 
Re: 3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 +5 98Still have dos

I'll try not giving the HC if he's low tomorrow night and see what happens. I just can't go through night after night of testing every half hour because he drops low. I can't afford the test strips when i go through them that fast. I'm almost certain he's not OTJ ready because the one time I skipped a dose for a low PS number, he was in the 190's by morning...not exactly what I'd expect from an active pancreas. Also, wouldn't not controlling the dives make the bounces worse? Should I make his 2nd and 3rd feedings a slightly higher LC, perhaps? What he's getting right now is 1%. Maybe I should try like a 4-5%?

The .1 was supposed to be temporary because I was out of town and wanted to keep him safe with the sitter. I had fully planned to bump him back to the .25 by now, but those 40's threw me. I think I will hold and see what happens, but is this really too little insulin or not enough? The numbers were better on the .25.
 
Re: 3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 +5 98Still have dos

40s mean don't increase! You may not have planned to continue the 0.1, but Mikey did. :lol:

The time you skipped and he went up was 3 weeks ago. That's an eternity in feline diabetes. :smile: Usually the past two weeks are the most relevant. The big picture is important too, but it usually doesn't pay to look at details much farther back than that.

His preshots have come down a LOT in the past few days, if you disregard the 212 that was probably a bounce from the 40s and maybe influenced by the HC the previous cycle too.

I have to go to bed now, but will check back in with you tomorrow.
 
Re: 3/22 Mikey PMPS 97 +2 71 +3 64 +4 70 +5 98Still have dos

amy, i know we've given you a lot to think about. we're just sharing thoughts and our experiences with you.
like libby, i have to head to bed real soon.
see you tomorrow!
 
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