4/7 OliverTwist pmps 90 +1 123 +2 117 +3 105 +6 77

yesterday's condo
today
amps----191
+2-------130
+3--------78 1 tsp 4%
+4--------51 2tsp 4%
+4.25-----44 <1tsp 8%
+4.5-------53
+5---------51 <1tsp 4%
+5.5------59
+9--------72
pmps--- -90
+1-------123
+2-------117
+3-------105
3.7-------81
4.7------74
+6-------77

All our company has left and it's just the cats and me. whew! it was a fun day and Ollie decided to get center stage!! Anytime he wants to be green... he's the star!!

Here's my dilemma.. I lost my patience pants and when i saw Oliver's amps of 191 this morning, i added a bit to his old dose of 1.75. I raised him to a s2 this morning. After the last several days of him creeping up at pre shot...only getting to the 80/90s during the day...and with my history of holding doses for too long.... i thought it was the right thing to keep him from just climbing back up into nasty numbers. Then the little guy pops out 44 at 4.5
I have two questions.....
1) Could his body already have reacted to that tiny bit of an increase? Or would your experienced eyes think today was a reaction to his old 1.75? (i thought it would take awhile for his depot to change before his BG would reflect any increase in insulin)
2) Now what the heck do i do? I'm trying hard not to force him into the scenario i want and instead react to what his spread sheet is saying. But i'm not smart enough to know!!!!!!!!!!!!!!!!!!!!! I don't speak spreadsheet very well.
I am inclined to hold him at s2 and make him drop below 50 3 times before he gets his reduction. I'm saying that because i (don't know what i'm talking about mostly) I don't want to bring him down too quickly and have his reduction fail.

Does he have a better chance of sticking the reduction if he has to drop below 50 3 times? Or am i keeping him at too high a dose by not giving him his reduction for the 44?
sorry to be so long winded and not get much of anything done. I would love your expertise
thanks mary

Re: 4/7 OliverTwist amps 191 +4.25 44 increased at am - hold

I'll give my $0.02 worth so it won't be worth much. ;-) :lol: I see some nadirs in the 50s and 60s in the past few days. Those look pretty good to me. I would say the 1.75u is a good dose for now. It's hard to ignore those higher pre-shot values so I understand why you wanted to raise the dose. Oliver, can you work on those a little bit?
Liz

Re: 4/7 OliverTwist amps 191 +4.25 44 increased at am - hold

Hi Mary.....I don't know what I'm doing, so am no help. I hope someone comes along before your pmps, to help :smile:

Re: 4/7 OliverTwist amps 191 +4.25 44 increased at am - hold

Thanks Liz, I like the $0.02!! :lol: :lol:
I've swung from being afraid to give him any insulin to being afraid of not giving him enough. I guess i was looking more at the 80/90s and less at the 50/60s. I could give him another day or two at 1.75 to work on those pre-shots and see what happens to his nadirs. I'll be so glad when this starts to really make sense to me.
This is like me trying to really understand ground school for flying... that took me years! I hope i catch on quicker here.
thanks dear

Re: 4/7 OliverTwist amps 191 +4.25 44 increased at am - hold

My $0.02 as well, since Ollie's SS is pretty different from Leo's. It took about 8 cycles for Ollie to start working the 1.75 but then he had some night cycles with 50's and 60's so I think I would have let him continue to ride on the 1.75 to see where he would take it. I see he's been working down the doses and now you want to get his numbers back where they were, but the last several cycles weren't terrible!

The business about "making" him drop below 50 three times ... that's something that depends on the cat and the situation IMO, and the "three times" isn't a rule. The notion of flexibility within the "rigid" rules of the protocol - that you might decide you don't want to take one immediately and you play it by ear. There are times when a cat is skirting around a reduction for a couple cycles and finally dips below once, and I'd give the reduction to Leo. Other times, when he had a higher pre-shot and I could sense that the dip below 50 was due to a sharp dip that was unusual based on the last couple cycles, I wouldn't give him the reduction. I'd "make him earn it" - if you look at his SS earlier, you can see spots of green dips in the middle of high number streaks. He had a real sputtering pancreas. If I reduced him right away, I'd just end up working him back up a couple cycles later so I started to hold off on the reductions, sometimes once, sometimes twice, and maybe three times ones. (Sometimes I was wrong ) Ollie isn't like that.

For example, on 2/24, you took a reduction for a 48 that I probably would not have taken, especially with a PMPS of 211 ... I probably would have "shot through the bounce" on that one at least even if I didn't take the reduction. (However, you had started a new vial/pen which is a variable to consider in potency differences. I also can't tell where you are "steering" and how hard you steered.) A couple points here or there on this side of 50 is within the error of the meter, so it can be a judgement call. If you want to skip the reduction and you have enough strips, time, coffee and desire, you can keep the same dose and see where he takes you.

...and the short answer is ... I think it is probably a toss up whether you should have increased or not but looking at what he did, if you do decide to shoot the higher dose, be ready for a pajama party!

Re: 4/7 OliverTwist amps 191 +4.25 44 increased at am - hold

I think of the testing requirement like this. The pre-shot tests are to make sure it's safe to shoot. The nadirs tell you what to shoot. It seems like maybe you are trying to dose based on the pre-shot rather than the nadir.
Liz

Re: 4/7 OliverTwist pmps 90

Thank you Lisa and Liz and Barb. I kept the 1.75.
Hi Lisa Thank you very much - I will go back and read through your explanation Lisa. I see what you mean about Ollie's reduction on 2/24.. i appreciate how you explain using the difference between Leo and Ollie. I'm just printing out their spreadsheets and your post.. i'll read them while i'm waiting to test the little bugger at +1 ;-) :smile:


Thanks soooo very much.Liz

The pre-shot tests are to make sure it's safe to shoot. The nadirs tell you what to shoot

Click to expand...

That's putting it in a nutshell my brain can understand!! I'm sure there are nuances i'll pick up later...but this really helps. thanks!! My brain was worried that the 80/90s would take over his 50/60s and he'd turn yellow and pink again. I thought i saw the beginning of insulin resistance ...

Hey Barb!! thanks for the hand holding my dear... :YMHUG:

Re: 4/7 OliverTwist pmps 90

I hope the 1.75 units brings some good pre-shot numbers for Oliver. It's easy to look at those pre-shots and forget dosing is based on nadir.