6/14: Sammy - AMPS 244; +5 236; PMPS 162; +2 128

[Tina & Sammy]

Yesterday's Condo

Thank you @Jill & Alex (GA) for stopping by yesterday, and sorry I didn't post back. I was out until PMPS, but I did read your post before shot time and stuck with the current dose last night.

@Vyktors Mum the patiences pants did arrive, thank goodness.

Yesterday and last night were not what I had hoped for. I just don't get why Sammy was doing so well with the .1 unit dose for so long and now we are progressively increasing. He does not appear to be feeling bad at all. Last night we went out side at dusk and were outside until it was nearly dark, and Sammy was have a blast running around the yard chasing all the bugs. He did finally come and sit at the table with me, but he was very rambunctious.

Anyway, with the higher AMPS this morning I did go ahead and increase to 1.10 units (1.28mm). I hope now that we are using the calipers the dosing will be much more accurate and we can get this under control. Like I mentioned yesterday, I am really trying to get into the mindset that he will just be on insulin for the rest of his life, and I am going to have to make preparations for that. I can always pray that he will eventually go back into remission, but it isn't looking very likely at this point.

It is a rainy day here in Michigan, so I will probably just stay inside and knit most of the day. I was inspired to design a new cowl pattern yesterday and I plan on working on that today.

 

[Tina & Sammy]

Not much progress here this morning after the increase. I know NDW can come into play for the first 6 cycles of a new dose, although in the past Sammy has typically leveled out when I have increased his dose. So I don't know what is happening here. It continues to make me wonder if the dose was increased too quickly. I will probably give this another cycle or two and if I don't see some improvements then I am probably going to decrease to .25 again and start from scratch.

I know this is totally against protocol, and against the advice of people with more knowledge than I have, but it is really frustrating me that I think he is getting too much insulin. I figure worse come to worse he will just have higher numbers with less insulin and it will force me to come to realize that he does in fact need more insulin. I can always go back up, but unless I try I might continue to increase without ever knowing for sure.

I will wait to see how tonight's cycle goes with the help of fluids, and unless I am seeing a lower PS tomorrow morning then I might decrease back down either tomorrow night or Tuesday morning.

I really need to focus on my knitting pattern today so I can stop being a helicopter mom, like @Amy&TrixieCat talks about all the time. I feel like I keep waking him up to test and check on him, and he is probably not too happy about his cat naps getting interrupted.

 

[Jill & Alex (GA)]

You're welcome, Tina. Stopping by wasn't a problem.

I just don't get why Sammy was doing so well with the .1 unit dose for so long and now we are progressively increasing.

You're not alone. Any of us who have danced the sugar dance for any length of time have wondered the same with our own kitties. Alex and I danced together for over 8 1/2 years and through 2 remissions. There were many times when I couldn't understand "why" she'd need dose increases. I couldn't figure it out and it drove me crazy! It wasn't until I finally realized it didn't matter "why". My job was to simply give her the insulin she needed because her body couldn't do it on it's own. The dance was less frustrating when I resigned myself to this fact.

Anyway, with the higher AMPS this morning I did go ahead and increase to 1.10 units (1.28mm). I hope now that we are using the calipers the dosing will be much more accurate and we can get this under control.

See how things go with the increased dose. I don't know whether calipers will help or not... I've never used them.

I can always pray that he will eventually go back into remission, but it isn't looking very likely at this point.

You never know!

I know NDW can come into play for the first 6 cycles of a new dose, although in the past Sammy has typically leveled out when I have increased his dose.

Actually, NDW has recently taken on a life of it's own in this ISG. It's not a phenomenon that lasts for days. NDW usually lasts for less than 24 hours... contrary to what I've been hearing around here lately. From the TR Protocol:

"Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations."

Personally, I'm not surprised at the yellow numbers you're seeing so far today. Sammy was on his way up already at +6 last night so all things considered, this morning's AMPS wasn't too bad at all. Knowing that the L insulins have a harder time pulling down BG numbers when starting with a higher preshot number... IMO, things are going as expected today. Give the dose time to work. Everyone's mileage varies, but with Alex it would usually take 5 cycles for me to see the results of an increased dose.

I know this is totally against protocol, and against the advice of people with more knowledge than I have, but it is really frustrating me that I think he is getting too much insulin. I figure worse come to worse he will just have higher numbers with less insulin and it will force me to come to realize that he does in fact need more insulin. I can always go back up, but unless I try I might continue to increase without ever knowing for sure.

You have to do what you have to do. I think most/many of us have experimented with lowering the dose only to find out it hasn't worked, but you'll never know if you don't try it at least once. It's all part of the learning process. Just a word of advice from a voice of experience (been there, done that)... if you do opt to lower the dose and the results aren't looking too good... don't wait or hesitate to take the dose right back up. You don't want glucose toxicity to set in from having lowered the dose. Having to break through any glucose toxicity that has set in caused by lowering the dose is frustrating and it takes time (and usually even higher doses of insulin) to get back to the point where you once were.

It is a rainy day here in Michigan, so I will probably just stay inside and knit most of the day. I was inspired to design a new cowl pattern yesterday and I plan on working on that today.

Good for you! Use days like this to do things you want to do!

 

[carfurby (GA)]

Good luck with the dosecrease. I hope Sammy shows you what he's going to do with it soon.

I've been convinced in the past that Furball was getting too much insulin. I decreased her dose against the advice of others and found out they were right and I should not have decreased. But we have to do things on our own sometimes just to find out what works. Good luck if you do decide to decrease soon.

 

[Tina & Sammy]

You have to do what you have to do. I think most/many of us have experimented with lowering the dose only to find out it hasn't worked, but you'll never know if you don't try it at least once. It's all part of the learning process. Just a word of advice from a voice of experience (been there, done that)... if you do opt to lower the dose and the results aren't looking too good... don't wait or hesitate to take the dose right back up. You don't want glucose toxicity to set in from having lowered the dose. Having to break through any glucose toxicity that has set in caused by lowering the dose is frustrating and it takes time (and usually even higher doses of insulin) to get back to the point where you once were.

Do you think that glucose toxicity might be why Sammy isn't responding to the insulin as well? He was doing pretty well on .1u back in April, then in early May we tried a reduction to a skinny .1u and when the numbers started to rise we went back up to .1u and then when that wasn't working we increased to .25u. Then on 5/22 we had a bit of a hiccup with a probiotic and gave a one time increase to .5u and then went back to .25u only to find that his numbers were climbing again and we increase to a f.25u. Then yet again after a week of good numbers we tried a reduction to a s.25u and his numbers started to climb again. Then on 6/4 we started using the calipers and I didn't do the proper measurements, and just measured the current dose, only to discover that I inadvertently increased to .6u without meaning to do so, and that is when his numbers really started to climb. And next I increased again to 1.0 unit with the rising numbers and so the tale goes. His numbers has been good on the f.25 unit, although he could have actually been getting more than a f.25u depending on the markings on the syringe.

 

[Peg and Toby]

It seems like these fur babies are always changing it up. Sometimes it hard to know what to do. So I guess we just do the best that we can and muddle along.

 

[Jill & Alex (GA)]

Tina, when I'm analyzing a spreadsheet anything prior to about the last couple/few weeks doesn't mean much to me mostly because one has to deal with what's happening in the here and now. It's kind of like "that was then and this is now".

It looks to me like Sammy lost momentum with the switch to using calipers. Like I mentioned earlier, I've never used calipers. Personally, the only benefit I see to calipers is dosing consistently when more than one person is shooting the same cat. Dosing *that* precisely/consistently means nothing to me when one considers all the variables involved as well as the fact that insulin absorption can vary up to 50% from one shot to the next... so I never bothered with them, but to each his own.

My point of view and action plan if this would have been Alex:
Has glucose toxicity set in? Perhaps/probably some, but I really like to think this is more a case of losing momentum. You've caught this early. Sammy's numbers aren't bad at all and increasing the dose should get him back on track in no time. Just be aware and remain flexible because it's *possible* the dose may have to be increased more than once before you're able to pull his numbers down to under 100 overall. It's a process. Once the numbers are pulled down and stay down I think it will only be a matter of time before one would then be looking for signs to reduce.

Sometimes you have to go up in order to come back down...

 

[Tina & Sammy]

I am very happy to report that Sammy's numbers have come down a bit this afternoon and are still dropping after PMPS. I hope they continue for the rest of the night and we are in the GREEN by the morning.

 

[Jill & Alex (GA)]