3/22 Neko PMPS 220 +4 99 +5 87 +6 88

Yesterday was yet another day of mostly pink, with just a brief touchdown at yellow at PMPS.

3/21 Recap:
AMPS 321 +4 343 +7 304
PMPS 259 +4 347
I declare this cat is driving me crazy. cat(2)_steam I need some advice on how to dose her. If I can keep her seeing quite a bit of green, she doesn't bounce as much. January was one of Neko's best months. Ever since we dropped to 2.25 units, she hasn't seen as much green/blue. She did earn a couple of deductions since then, but it's getting harder and harder to get her into nice numbers. Hence she is bouncing more and longer. Did I mention I hate pink now?! I am currently at 1.75F units which is half way between 1.75 and 2.0. On my syringes and using calipers, I can measure 3 levels between 1/4 units. So there is 1.75, 1.75f, 1.75F, 2.0s and 2.0 units. If I take Neko up to 2.0 units, she sooner or later drops below 50. But at 2.0 I start getting those nice blues and greens I was getting in January. As soon as I drop it below 2.0 units, pink becomes dominant along with the bouncing. Any advice or thoughts would be greatly appreciated. I know it's only 5 cycles since we last dropped down, but that seems like a really long time for her to not see any improvement, and she wasn't doing great at this dose before. Patience pants are worn out.

Our last vetty visit was end of January (when her BG was going great). B/W seemed fine. Her T4 had gone up a bit, but still below when she got her diabetes Dx. I am planning on going again the end of April for B/W and thyroid check again.

WCR: 5 P's (play was whacking Theo), CPC as ever, currently racked out in the sunny solarium in her basket, head lolling out of the basket entrance, momma just gave scritches, light breeze through the screen window is ruffling her fur and the neighbour is practicing his jazz saxophone so there are even good tunes to listen too. What more can a cat ask for?

Re: 3/22 Neko AMPS 377 +4.5 370 - Dose?

Ack, I can hear your frustration. Wow on the three levels each 1/4u. I guess with calipers you could get even finer but it all comes down to eyesight. It takes me several minutes any more to gauge the dose trying to look through the syringe at a light. I wish Lantus could be diluted! Then this microdosing would be easier and we could fine-tune more consistently. I think errors in measurement (bad eyes, slop in the syringe markings, syringe rubber thingie not level in the tube, etc) are part of the bouncing no matter how hard we try.

I'm no dosing expert. That being said, I had the same problem with Leo. He'd do sort of well, then dip and bounce through a couple reductions quickly, and then we;d end up fighting reds and pinks trying to go back up to a good dose. I stopped giving him reductions right away, but waited for more than one dip below 50 (the "up to three dips before reduction" guideline). This helped make sure that he was *really* ready for a reduction and not just doing some random blip. And also to avoid taking back-to-back reductions caused by the bounce. I also started microdosing. Those two together kept him at higher dosing values for longer times. I've really had to watch him though. You test quite often, so maybe that's something you might consider, and it sounds like you're already thinking more about micro-micro-dosing.

Good to hear that Neko has not a care in the world with her sun and jazz accompaniment! :lol: :lol: :lol:

And by the way ... I've been stalking you all day to whack you about taking BCS bets! :lol: :lol: :lol:

Re: 3/22 Neko AMPS 377 +4.5 370 - Dose?

I'll be watching the recommendations with interest.

Looks to me like the reduction failed and it might be time to return to last good dose?

I know the rules are different with acro, but Chip doesn't get a reduction until he drops below 40.

He's surely not acro, but not tested. I doubt he has pancreas. But he does that same thing where he's cruising along tight and flat, then he will drop 20 points to 30's earning his mandatory reduction.

Levemir is slightly different than Lantus.

I also break my 0.25U into thirds, but I'm really just using 1/8 unit increments now and having some apparent luck.

What syringes?

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

+8 289
Well, not pink, but just. Hopefully trending down more for PMPS.

@Lisa - I have thought of the 3 drops below 50 or one below 40 for Neko. She has 3 times told me 2.0 was too much, but I wasn't holding the dose after she dropped. This is just such a different pattern for her. All the other drops she kept on trucking after a 1/4 unit drop, or at least seeing more blue. The only thing I'm concerned about the 3 under 40 rule is that Neko has a completely unpredictable nadir and her tendency to go lower at night. :shock: I am with you on how sure we are on the microdosing, especially with the slop in the rubber stopper. I usually check the measurement in three different places around the syringe but there are times when I've dialed in the calipers .1 up or down and haven't seen a difference. I completely ignore syringe markings, they are out as much as .25 or even more sometimes. And hey, not taking bets just observing. :lol:

@Dale - I use BD syringes, pretty much the only thing available in Canada with 31 gauge needles. There have been times when it's taken Neko 11 cycles to get back on track so not sure if the reduction has failed completely. I haven't seen many rules with acro, I'm ignoring the one I've heard that says you should keep them in blue all the time and avoid green.

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

Yeah, those rubber stopper are terrible. I ignore the markings too, but lots of people don't, and the Terumos are bad. About Neko's behavior ... I saw that on your SS and Leo does the same thing ... his PMPS (AS YOU SO WELL NOTED :lol: :lol: :lol: ) is often lower at night. Quite honestly, it occurred to me in the last couple days that BCSing at night on a regular basis might not be completely ridiculous. But you didn't hear that from me and I hide solidly behind the ECID label that that one Wow = 11 cycles to get back on track ... it's too bad there isn't more trend info with acro to help you along. How many cats here have acro?

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

Pink was never a favorite color of mine, even less now. :roll: :lol: I hope Neko comes down tonight. She is sure a bouncy cat, like most cats here. Otherwise, we probably wouldn't hang out in LL so much. Lucky us.
Liz

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

Wendy&Neko said:

@Dale - I use BD syringes, pretty much the only thing available in Canada with 31 gauge needles. There have been times when it's taken Neko 11 cycles to get back on track so not sure if the reduction has failed completely. I haven't seen many rules with acro, I'm ignoring the one I've heard that says you should keep them in blue all the time and avoid green.

Click to expand...

And it's paid off since they heal more with green. I believe the "no green" was in case the pancreas hindered steering and bringing number up if needed?

Isn't she technically more like a cured acro at this stage after the SRT?

With Chip, his rule about no substantial pink after a reduction was evolution. He's had a terrible time holding reductions. But I have had better luck bailing on the reduction when I see too much pink. I have been able to keep him generally flat and green which (believe it or not) is actually easier to manage than bouncing and diving.

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

I think I would wait the one more cycle tonight, and then if needed go up to 2.00 in the morning.

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

@Lisa - I've seen two research papers on acrocats. One was a study that said as much as 30% of diabetic cats are acro, the other said 17-19%. On the other hand, 90% are supposed to be male and 80% short hair. Go figure, Neko should play the lottery. So a fair number of acrocats, but we were either the 33 or 34th to get SRT at CSU. A few have had it done at Yonkers, but it's more expensive there.

@Liz - I used to like pink. :roll: And yes, we are all a bunch of bouncy cat lovers. LL's a good place to be where other folk understand your pain.

@Dale - she is still an acro after SRT. SRT isn't a guarantee, it neuters the tumor cells, only about half go OTJ, but it does mean the insulin needs reduce and that the nasty growth factor side effects can go away. I think the no green rule was become someone had a really hard time bringing her cat up when he went low. With a large shed, it can take a lot to move the numbers. Fortunately Neko has been sensitive to gravy and is now on a much smaller dose. The working pancreas can play a role. People with acrocats shouldn't use LC to get their cats to surf as it can cause the pancreas to work and dive the numbers. I've seen that happen with Neko, but not consistently.

@Dyana - I was thinking of doing as you suggested but hoping for suggestions to stop the up to 2, go low, reduce, fail, go back up to 2 cycle.

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

I agree with Dyana. This could easily be a bounce.

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

Wendy - thanks for all the information. I admit I'd gone internet surfing after seeing the notation in Neko's SS about the SRT but I really don't know much about it. She's a lucky kitty for sure.

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289 - Dose?

Wendy

I have two suggestions. One of them Lisa suggested...I'd not give her a reduction until she has dropped between 40-50 three times or below 40 once. The other thing is....have you considered using "R" to prevent the bounces from going so high? It can be a very effective tool for an experienced CG like you as the bounce starts. It's in and out in four hours....I know Julie uses it with Punkin and other acro moms have used it including Libby with Jazzy.

If you are interested, I'd PM Libby and/or Dyana because they both have alot of experience using it. Libby is good at looking at SSs and telling you when the best time to use it is. You have to be sure the nadir does not overlap your basal insulin nadir and you don't want to use it to bring the numbers down but to keep them from going higher and that's why you want to use it at the onset of a bounce.

I also tend to be a more aggressive with dosing so if, on a reduction, six cycles have occurred with no blue or green, I assume a failed reduction and increase. I know you said Neko takes longer but sometimes just increasing for a short time....a few cycles, will get the numbers back where you want them. And you are great at monitoring her.

Re: 3/22 Neko AMPS 377 +4.5 370 +8 289

OK - thanks all for the advice. Neko goes up tomorrow if no action tonight. And I will try the multiple times below 50 to see if that can sort her out.

@Marje - I have thought about R. Neko has such an inconsistent nadir, can dive from red to green easily in a cycle, and does these confounding short duration mini bounces where she has gone from yellow PS to pink 3 hours later then green 3 hours after that. I'll PM Libby to see what her thoughts are. Neko usually does see blue or green within 6 cycles of a reduction. This is the first in a long time I haven't seen at least blue.

Re: 3/22 Neko PMPS 220

I do see some places where she was just starting a bounce that you could have used it but Libby has the best eyes for it.

Re: 3/22 Neko PMPS 220

Wendy, I should have placed odds with you and shot the BCS. Here I am with Leo at a 48, when I should be asleep trying to get rest for this race. And I'm here typing as Leo bats a mouse around the kitchen. Ack! These darned kittehs!

I'm glad Marje has some good advice for you and that others can give some perspective from a great experienced viewpoint.

Re: 3/22 Neko PMPS 220 +4 99

PMPS 220 +4 99
Rotten kitties indeed! She must have read the threat while I was out for dinner. :mrgreen: :lol: Let's make the bean look foolish for not waiting out the bounce - mission accomplished. :evil:

@Marje - I think I see spots where Neko soared red where I'd be comfortable with R. Not so much the pinks, that where I scratch my head.

@Lisa - My sympathies - I've got a rotten cat tonight too! At least this one isn't bouncing around the house.

Re: 3/22 Neko PMPS 220 +4 99

Hello Wendy,

Rex is looking over my shoulder reading your post. Sorry to hear about the bouncy bounce!

Rex is not sure if he wants the .25u dose or not. We are also going to consider delaying his next reduction by 1 or 2 cycles depending on his bounce!

Sending good thoughts up to Vancouver

Re: 3/22 Neko PMPS 220 +4 99 +5 87

+5 87
Yipee, slowing down!

@Rich - Thanks for the good thoughts. Neko does like to be different and keeps mixing it up. It is the job of a cat to unpredictable and she's very diligent at her job. :lol: As my condo says, sometimes you gotta go up to go down.