Could I get some opinions on Dosing?

[Bobbie And Bubba]

Now that I have tried going up and got the same flat cycle, I decided to go back down. Once I hit 2 units again, which was yesterday AM cycle, he dropped the most he has since 10.17 and had his first smile curve since then. Then last night I dropped him to 1.6 thinking that it was 2 units that he was on when he went so low on 10.17 and after that point his cycles went really flat starting on 10/20. And increasing was not breaking that flatness. My thoughts were maybe to go lower and see if that would be a better dose. It does not appear that 1.6 is that dose as he is flat again. Should I go back to 2 units this PM or up it to 1.8 and see what that does? I am not optimistic that tonight's PMPS will be any different unless something magical happens. Any input would be appreciated.

 

[Carl & Polly & Bob (GA)]

Just my opinion.
His best cycles have been in the 2.0 to 2.4 range. His best cycle ever was on 10/16, AM cycle where you shot 2u at a 241. There's also a nice one PM of 10/4, when he went from 213, down to 77 and gave you a nice 214 the next morning (on 2.4u). But that was "then" and this is "now". He's not the same cat a month later. Don't get me wrong, yesterday was the best cycle you've seen in quite some time. I'm just not believing that he dropped far enough after the 305 last night to cause a bounce. I'm not sure I understand your note at +8 last night about the 354 / 284 though.

The other thing I'd mention is don't get overly attached to "smiley curves". Yes, right now a smile is nice, but only when a series of smiles lead to lower preshots. If the preshots go down, the nadir should follow. When you see a point where the smile on that lower preshot goes too low in the middle, then you reduce the dose, again to avoid bouncing. That will flatten the curve, but the numbers will all be lower than they were. If it flattens too much, you increase a smidge until you see a nadir you like seeing.

You're not going to avoid the bounces, nobody does. He'll keep bouncing until he's used to the lower numbers he's not used to. I just wish I could figure out where the lows are happening if indeed he is bouncing.

Bottom line, I don't really know what I think you should do.

 

[Merlin]

So far, since 10/17, really nothing has worked, right? You tried consistent dosing, increased dosing and reduction of doses. I really don't see Bubba bouncing here recently. If he were mine, I think I would have three options to choose from; 1) go back to your highest dose and increase rather quickly until you get the desired nadir (if it happens), 2) change to a different insulin or 3) try a sliding scale. I kind of like trying #3, then #1 and lastly #2 in that order. The only thing with a sliding scale, you typically need recent data and Bubba has not given us good data where you could create a sliding scale. However, in July, August and September, you did get some blue nadirs. If you decide to try a sliding scale, you could possibly create a sliding scale from older, past data. Not sure if it would work since it is old data but maybe worth a try. Maybe Bubba needs a mixture of doses...who know. Do you want to try different doses for different numbers i.e. sliding scale?

 

[Bobbie And Bubba]

Just my opinion.
His best cycles have been in the 2.0 to 2.4 range. His best cycle ever was on 10/16, AM cycle where you shot 2u at a 241. There's also a nice one PM of 10/4, when he went from 213, down to 77 and gave you a nice 214 the next morning (on 2.4u). But that was "then" and this is "now". He's not the same cat a month later. Don't get me wrong, yesterday was the best cycle you've seen in quite some time. I'm just not believing that he dropped far enough after the 305 last night to cause a bounce. I'm not sure I understand your note at +8 last night about the 354 / 284 though.

The other thing I'd mention is don't get overly attached to "smiley curves". Yes, right now a smile is nice, but only when a series of smiles lead to lower preshots. If the preshots go down, the nadir should follow. When you see a point where the smile on that lower preshot goes too low in the middle, then you reduce the dose, again to avoid bouncing. That will flatten the curve, but the numbers will all be lower than they were. If it flattens too much, you increase a smidge until you see a nadir you like seeing.

You're not going to avoid the bounces, nobody does. He'll keep bouncing until he's used to the lower numbers he's not used to. I just wish I could figure out where the lows are happening if indeed he is bouncing.

Bottom line, I don't really know what I think you should do.

Thanks for looking at the SS . The note on +8 was about the + /- variance, the number I got, the 354 could have been 284 only because my AM number was lower.
About the smiley curves, good to know. It seems like the 2 unit dose became flat on 10/20 so on 10/25, I raised it to 2.2 and it continued to stay flat regardless of raising. Sigh, Don't you have a crystal ball, Carl, LOL?

 

[Bobbie And Bubba]

So far, since 10/17, really nothing has worked, right? You tried consistent dosing, increased dosing and reduction of doses. I really don't see Bubba bouncing here recently. If he were mine, I think I would have three options to choose from; 1) go back to your highest dose and increase rather quickly until you get the desired nadir (if it happens), 2) change to a different insulin or 3) try a sliding scale. I kind of like trying #3, then #1 and lastly #2 in that order. The only thing with a sliding scale, you typically need recent data and Bubba has not given us good data where you could create a sliding scale. However, in July, August and September, you did get some blue nadirs. If you decide to try a sliding scale, you could possibly create a sliding scale from older, past data. Not sure if it would work since it is old data but maybe worth a try. Maybe Bubba needs a mixture of doses...who know. Do you want to try different doses for different numbers i.e. sliding scale?

Is a sliding scale something you could help me with? And do you think me going back to 2 units tonight would be a good idea since he did better with it yesterday?

 

[Carl & Polly & Bob (GA)]

Thanks for looking at the SS . The note on +8 was about the + /- variance, the number I got, the 354 could have been 284 only because my AM number was lower.
About the smiley curves, good to know. It seems like the 2 unit dose became flat on 10/20 so on 10/25, I raised it to 2.2 and it continued to stay flat regardless of raising. Sigh, Don't you have a crystal ball, Carl, LOL?

OK, my advice? Remove the concept of "+/- 20%" from your head. You'll go insane. Try really hard to take each number at face value, no matter what the number is. I think that "meter variance" thing causes people to 2nd guess themselves forever.

 

[Bobbie And Bubba]

OK, my advice? Remove the concept of "+/- 20%" from your head. You'll go insane. Try really hard to take each number at face value, no matter what the number is. I think that "meter variance" thing causes people to 2nd guess themselves forever.

I think you're right, and I usually do unless a +8 PM number is higher than the AMPS.

 

[Merlin]

Assuming that Bubba will test at a mid-300 at PMPS, you may want to go back to your 3.5u or you can shoot 2u. On 11/13, when you shot 3.5u, he gave you at least a yellow, flat cycle. Regardless, he will probably just give you a flat cycle. Yes, I would love to help you with your sliding scale. How about we both work on it together?

Here are the steps that I take in creating a sliding scale.
1) Pick a range of dates where I will derive the number and doses from (I am thinking maybe from 9/1 - 10/17).
2) On a spreadsheet or piece of paper write down all numbers/doses (cycles) where you got a green or blue nadir (preferably a low blue nadir)
3) Start grouping it by doses i.e. 2.0, 2.2, 2.4 along with the numbers
4) Throw out the weird numbers that are either too low or too high (you may or may not have this)
5) Zero in the doses and what numbers worked with those doses
6) Create the number ranges for each dose i.e. 2.0, 2.2, 2.4, 2.6, etc
7) Then go back and "test" the data to see if any particular number would fall into that scale with predicted nadir. Testing is basically going back to previous numbers on ss to see if this suggested dose would give us a desired nadir.
8) Check out this thread regarding how I created the sliding scale for Lisa and Ben (#4). I explained how I got to her numbers. http://www.felinediabetes.com/FDMB/threads/in-search-of-the-right-dose.146694/#post-1526209

Now after we get done, we may just up the scale by 0.2 or 0.4 just because it is old data and you have since then, increased the dose...but we will see what we get first. We could start low but quickly adjust the whole scale by 0.2, then 04, etc. I am thinking that with Bubba, he is going to tell us pretty quickly if we are too low in the doses. The other thing we could do is create several sliding scales; one with a lower dose and one with a next higher dose. That way you can switch to it fairly quickly.

 

[Bobbie And Bubba]

He is at 405 at PMPS

 

[Bobbie And Bubba]

He is at 405 at PMPS

I shot 2unit. The sliding scale creation makes my head spin . I will start working on gathering the data tonight an thanks, Cindi!

 

[Merlin]

It really is not that hard. Just work on #2 which is making a list. I can probably work on it tonight too.

Yeah the high PMPS is due to not enough insulin.

 

[Carl & Polly & Bob (GA)]

Assuming that Bubba will test at a mid-300 at PMPS, you may want to go back to your 3.5u or you can shoot 2u. On 11/13, when you shot 3.5u, he gave you at least a yellow, flat cycle. Regardless, he will probably just give you a flat cycle. Yes, I would love to help you with your sliding scale. How about we both work on it together?

Here are the steps that I take in creating a sliding scale.
1) Pick a range of dates where I will derive the number and doses from (I am thinking maybe from 9/1 - 10/17).
2) On a spreadsheet or piece of paper write down all numbers/doses (cycles) where you got a green or blue nadir (preferably a low blue nadir)
3) Start grouping it by doses i.e. 2.0, 2.2, 2.4 along with the numbers
4) Throw out the weird numbers that are either too low or too high (you may or may not have this)
5) Zero in the doses and what numbers worked with those doses
6) Create the number ranges for each dose i.e. 2.0, 2.2, 2.4, 2.6, etc
7) Then go back and "test" the data to see if any particular number would fall into that scale with predicted nadir. Testing is basically going back to previous numbers on ss to see if this suggested dose would give us a desired nadir.
8) Check out this thread regarding how I created the sliding scale for Lisa and Ben (#4). I explained how I got to her numbers. http://www.felinediabetes.com/FDMB/threads/in-search-of-the-right-dose.146694/#post-1526209

Now after we get done, we may just up the scale by 0.2 or 0.4 just because it is old data and you have since then, increased the dose...but we will see what we get first. We could start low but quickly adjust the whole scale by 0.2, then 04, etc. I am thinking that with Bubba, he is going to tell us pretty quickly if we are too low in the doses. The other thing we could do is create several sliding scales; one with a lower dose and one with a next higher dose. That way you can switch to it fairly quickly.

Cindi, hi. I'm glad to see you helping people with sliding scales! There was a wonderful lady here when I joined named Kim who helped with scales. Her "Kitty" was a great example of ECID, and Kim shot TID sometimes with a scale to boot. She was extremely creative, and Kitty kept her on her toes.

You mentioned one thing I'd point out as important too:
Now after we get done, we may just up the scale by 0.2 or 0.4 just because it is old data and you have since then, increased the dose...but we will see what we get first.

All data is good data, but I agree with the "old data" emphasis. Because as conditions improve, or worsen, with time, the older the data, the less relevant it can tend to be. Because kitty isn't the same kitty today as he/she might have been a month or two ago. A given dose that worked great "way back when" won't necessarily work as well (or might work even better) today. That's why sliding scales are subject to adjustments on an "as needed" basis.
One other thing I used to try to point out to scale users is that you don't want to adjust the whole scale at once, because if you've never had the opportunity to try a dose at a certain range, then you don't really know if it will work or not. Sometimes, it is the "ranges" that might need to be adjusted instead of the "doses".

 

[Bobbie And Bubba]

Hi everyone, Could y'all look at his SS. This Am back to 310, I don't have any info after 11:45 or +5.75 last night. Cindi is talking about a sliding scale. What does everyone think? I am thinking shot 2 u again this morning, I have been moving his around too much too fast........Ideas? I'm thinking Glucose toxicity now....

 

[Carol & Murphy (GA)]

Hi everyone, Could y'all look at his SS. This Am back to 310, I don't have any info after 11:45 or +5.75 last night. Cindi is talking about a sliding scale. What does everyone think? I am thinking shot 2 u again this morning, I have been moving his around too much too fast........Ideas? I'm thinking Glucose toxicity now....

Oh Bobbie - what a dilemma - I will anxiously await with you with the experienced ones say - Rachel should be on the board soon

 

[Rachel]

Haha you all know my time line well. I'm checking his SS now...

 

[Rachel]

Bubba is certainly a puzzle. I think it may be time to try some higher doses again. If we can get some recent data in the higher doses, Cindi can probably work that info into her sliding scale...it's just hard to tell what he will do since older data on Bubba really isn't as helpful due to surgery, dental etc.

If he were mine, I'd go with maybe 3 today? And monitor of course. I say that because 2 has gotten you some nice drops, but not low enough. BUT...you hold the syringe. If you feel 2 is best, go with that. Either way, it's data to see what is going on. What are you thinking?

 

[Bobbie And Bubba]

Bubba is certainly a puzzle. I think it may be time to try some higher doses again. If we can get some recent data in the higher doses, Cindi can probably work that info into her sliding scale...it's just hard to tell what he will do since older data on Bubba really isn't as helpful due to surgery, dental etc.

If he were mine, I'd go with maybe 3 today? And monitor of course. I say that because 2 has gotten you some nice drops, but not low enough. BUT...you hold the syringe. If you feel 2 is best, go with that. Either way, it's data to see what is going on. What are you thinking?

I shot 2 u about 30 minutes ago to stay on schedule. Could you awaken 30 minutes earlier, Rachel, LOL! Well assuming I get more of the same, I could increase tonight to 3units. Could this be glucose toxicity? It doesn't make sense that through the surgery and post surgery he hung flat in the yellows and then started going up and when I started increasing, he got worse. Sigh....

 

[Rachel]

Hahaha! I'll work on wake up time lol.

I think 2 u was fine. It'll give you some data to see what happens and then we can talk about an increase later. Honestly, I don't know if moving up is the right answer. I just thought some higher ranges of insulin might give some data to work with.

I don't know very much about glucose toxicity, but from what I understand, it could be that. Honestly, Bubba has never quite followed what we think he should do. Even looking back...sometimes 2 units got you a real nice drop. Sometimes, it was just a few points..sometimes it was enough to change the color, but only really around 20 or 30 points difference.

Also, remember that with Bubba, we tried different things because he was going through different things...surgery, the cone of shame, etc. We were concerned about pain and stress. Even now, I would have given the same advice I did then. I would be too worried about whether or not pain and stress was causing increased BG....which would lead to a sudden drop and possibly hypo once it was over if we cranked the dose up.

I well know that my voice here is often very conservative. I have a hard time even typing advice that seems aggressive since I just can't be here all day and I worry about what will happen. With Bubba, I just don't know what to do most of the time. I think the best thing to do is to try some higher doses maybe while you and Cindi work on a sliding scale. See if that helps. Take it from there.

 

[Bobbie And Bubba]

Here is something I found on Glucose Toxicity.

Various methods through this "glass floor" have been tried, to varying degrees of success. One way is to continue gradually raising insulin dosage until the tissues pick up the insulin and start absorbing glucose, then quickly back off to a lower dose. Another is to "jumpstart" the process with a fast-acting insulin or a deliberately high dose of the regular insulin, then quickly back off to a lower dose. Another is to reduce the carbohydrate content of the food further, or to eliminate dry food entirely (even low-carb dry food), thereby presenting less of an obstacle for insulin effectiveness and reducing insulin needs. Aggressive attempts to break glucose toxicity are best regarded as dangerous and should be addressed in close partnership with a diabetes-experienced veterinarian.

Anyone have any experience with either of these methods?

 

[Carol & Murphy (GA)]

maybe post that info and question on the health forum?

 

[Sharon14]

Several people on L&LL Forum use the fast acting insulin with their regular insulin and many raise the doses aggressively to try to break through. They are usually cats that have tested positive for IAA. Is that the same as glucose toxicity?

 

[Bobbie And Bubba]

Several people on L&LL Forum use the fast acting insulin with their regular insulin and many raise the doses aggressively to try to break through. They are usually cats that have tested positive for IAA. Is that the same as glucose toxicity?

What is IAA? And how is Siete Sharon?

 

[Sharon14]

IAA= Insulin Auto Antibodies. There is a test for it, but I've read that if the cat has been on insulin for awhile he would test positive, so maybe no point? I don't know and I don't understand. I've just started researching it some.

Siete is doing better he ate some on his own this AM, not enough, but a start. He's sitting by the front door, wants to go outside.

 

[Bobbie And Bubba]

IAA= Insulin Auto Antibodies. There is a test for it, but I've read that if the cat has been on insulin for awhile he would test positive, so maybe no point? I don't know and I don't understand. I've just started researching it some.

Siete is doing better he ate some on his own this AM, not enough, but a start. He's sitting by the front door, wants to go outside.

Glad he is better. So strange his urgent crying......

 

[Sharon14]

Glad he is better. So strange his urgent crying......

He was definitely in distress. Still isn't well, but better, so I'll just keep watching him and hope he fully recovers. Thanks for asking.

 

[Sue and Oliver (GA)]

Re the glucose toxicity:

I have seen most of the methods used with varying results, depending on the cat (I know - always that caveat ECID)

People have used the lower carb food idea when the kitty is going off the juice. Sometimes a lower carb will help with a tiny dose on lower ranges when more insulin would be too much.

I have never seen a fast acting insulin used with ProZinc and could not advise for it. It is used with the depot insulins with cats who are in high ranges, but only very carefully and with supervision. It can work there because the nadir is later and flatter with the depot insulins and a fast acting insulin will nadir earlier and steeper. Since ProZinc does not work that way, I would never suggest adding one.

Yes, adding more insulin should finally get you to a dose that would "break through". Lots of people have tried that and I would say it usually has worked. That's where the protocol came from for increasing at high numbers: increase every 3 cycles by 0.25 or 0.5 if in high numbers. Since Bobbi is not in reds and blacks, and he has finally stopped the bouncing (don't forget - that was the first issue you had to conquer and it took a long time before he stopped bouncing) I'd try the 0.25 every 3 cycles., if he were mine.

 

[Carol & Murphy (GA)]

He was definitely in distress. Still isn't well, but better, so I'll just keep watching him and hope he fully recovers. Thanks for asking.

Is he still having the mucous discharge? If nothing else, I would take a stool sample into the vet

 

[Sharon14]

Hasn't had a bowel movement since the diarrhea yesterday. I couldn't see what it looked like because it was covered in the litter. I'm going to get some pellet litter today.

 

[Bobbie And Bubba]

Re the glucose toxicity:

I have seen most of the methods used with varying results, depending on the cat (I know - always that caveat ECID)

People have used the lower carb food idea when the kitty is going off the juice. Sometimes a lower carb will help with a tiny dose on lower ranges when more insulin would be too much.

I have never seen a fast acting insulin used with ProZinc and could not advise for it. It is used with the depot insulins with cats who are in high ranges, but only very carefully and with supervision. It can work there because the nadir is later and flatter with the depot insulins and a fast acting insulin will nadir earlier and steeper. Since ProZinc does not work that way, I would never suggest adding one.

Yes, adding more insulin should finally get you to a dose that would "break through". Lots of people have tried that and I would say it usually has worked. That's where the protocol came from for increasing at high numbers: increase every 3 cycles by 0.25 or 0.5 if in high numbers. Since Bobbi is not in reds and blacks, and he has finally stopped the bouncing (don't forget - that was the first issue you had to conquer and it took a long time before he stopped bouncing) I'd try the 0.25 every 3 cycles., if he were mine.

Okay, that's what I will do. @Sue and Oliver (GA) , when you say .25, how do I do that with 100U syringes? I do have U40 syringes but they don't even have 1/2 markers on them and if I were to buy some with 1/2 u markers, I would have to eyeball it? Or should I just do .2 increases?

 

[Sue and Oliver (GA)]

Yes, you could try 0.2 increases. If, after a few cycles, that is not making enough of a difference, you could try 0.4.

And of course, as you always do, monitor.

 

[Carl & Polly & Bob (GA)]

Here is a link to a little info on IAA. The "sandy & black kitty" mentioned is still an active poster on the L&L forum.
http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/

But I don't think that's the issue at this point. If I remember correctly, the "high dose conditions" didn't start getting mentioned until the cats were in the 5-6u dose ranges of higher. Lu & Grayson, who posts here at times would also be a good person to talk to about high-dose cats.

When I first joined there was someone using "R" with pzi I think. Sue might remember her. She posted on Kim's threads occasionally I think, as Kitty got 3 doses a day sometimes equalling about 10u. I'll try to search for her name.

I know that when Bob was at the ER, he was given pzi and "R" simultaneously to try to get his numbers down quickly. But he was monitored 24/7 and they also used IV "sugar" to control how low he went. I would definitely get vet input on doing that.

I don't think Bubba is "there" yet. If ketones were present, then yeah, you'd need to get his numbers down quickly, and I'd be sending you to the vet asap.

 

[Bobbie And Bubba]

Here is a link to a little info on IAA. The "sandy & black kitty" mentioned is still an active poster on the L&L forum.
http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/

But I don't think that's the issue at this point. If I remember correctly, the "high dose conditions" didn't start getting mentioned until the cats were in the 5-6u dose ranges of higher. Lu & Grayson, who posts here at times would also be a good person to talk to about high-dose cats.

When I first joined there was someone using "R" with pzi I think. Sue might remember her. She posted on Kim's threads occasionally I think, as Kitty got 3 doses a day sometimes equalling about 10u. I'll try to search for her name.

I know that when Bob was at the ER, he was given pzi and "R" simultaneously to try to get his numbers down quickly. But he was monitored 24/7 and they also used IV "sugar" to control how low he went. I would definitely get vet input on doing that.

I don't think Bubba is "there" yet. If ketones were present, then yeah, you'd need to get his numbers down quickly, and I'd be sending you to the vet asap.

So is IAA and glucose toxicity the same thing? I am confused.

 

[Carl & Polly & Bob (GA)]

No.
Glucose Toxicity probably happens to every diabetic cat. When long periods of hyperglycemia causes the cells to become resistant to insulin temporarily. The "fix" is to get rid of the hyperglycemia so that the cells and tissues can heal and better use the insulin.

Every one of our cats was in that shape when diagnosed, because they had high blood sugar for a long time before they started showing us the classic symptoms like PU/PD, weight loss, lethargy, etc.

That is why the sooner the numbers get under control, the less time a cat is hyperglycemic, the better the chances they will get better.

IAA is a high dose condition verifiable by lab tests that show high levels of insulin autoimmune antibodies present in the cat. Insulin resistance to a much greater degree.

 

[Carl & Polly & Bob (GA)]

When I first joined there was someone using "R" with pzi I think. Sue might remember her. She posted on Kim's threads occasionally I think, as Kitty got 3 doses a day sometimes equalling about 10u. I'll try to search for her name.

The caregiver was Nancy and Payne. Nancy shot TID, sometimes 4-5u per shot, and also used "R" on occasion. Payne survived DKA. Four times.

If you look at the older pages of posts on this forum, like page 65 and higher, you can "meet" some of the people from years ago and see how they treated their cats. And look over their spreadsheets.

 

[Bobbie And Bubba]

The caregiver was Nancy and Payne. Nancy shot TID, sometimes 4-5u per shot, and also used "R" on occasion. Payne survived DKA. Four times.

If you look at the older pages of posts on this forum, like page 65 and higher, you can "meet" some of the people from years ago and see how they treated their cats. And look over their spreadsheets.

Thanks for this information and the distinction of Glucose Toxicity and IAA.

 

[Carl & Polly & Bob (GA)]

"Toxicity" is a scary sounding word. Probably why I like it, because it catches people's attention. But it's a very important thing to make people aware of, especially at the start of this "dance", IMHO.

 

[Merlin]

Hey Bobbie - Just wanted to reiterate that I have gone through the numbers and I know that you did too. Since there were so many, I picked out the numbers that were 130 or less at nadir time. That got me down to I think around 13. It looks like all your doses were mostly between 2.2 and 2.4 and you did get some pretty good low numbers back then. What is making it hard is how do we get Bubba down to those low numbers again? How do we get him out of this flat cycle funk? I might be able to put something together but it would only be for the low numbers and since Bubba is running a higher and we don't have any cycles where he got a low nadir, the scale isn't going to be complete. So I like the idea of continuing to increase your doses until we get some movement. If he were mine, I wouldn't stay on any dose too long until you get your desired result. Once you get some lower nadir, we can work together in creating a sliding scale. Sounds like a plan?

 

[Bobbie And Bubba]

Hey Bobbie - Just wanted to reiterate that I have gone through the numbers and I know that you did too. Since there were so many, I picked out the numbers that were 130 or less at nadir time. That got me down to I think around 13. It looks like all your doses were mostly between 2.2 and 2.4 and you did get some pretty good low numbers back then. What is making it hard is how do we get Bubba down to those low numbers again? How do we get him out of this flat cycle funk? I might be able to put something together but it would only be for the low numbers and since Bubba is running a higher and we don't have any cycles where he got a low nadir, the scale isn't going to be complete. So I like the idea of continuing to increase your doses until we get some movement. If he were mine, I wouldn't stay on any dose too long until you get your desired result. Once you get some lower nadir, we can work together in creating a sliding scale. Sounds like a plan?

Sounds good Cindi. We just went to 2.2 today. He had a decent cycle today started at 288 and ended at 260 with a nadir of 214. We are making progress.
It seems like me taking him up and down and now back up kick started him a bit to stop the flat cycle stuff. Fingers and Paws crossed. I appreciate your help on this.

 

[Merlin]

Yes I saw that cycle today....yeah. I just wanted to let you know that I didn't forget and as soon as he gets us something to work on; we will jump right on creating that scale.

 

[Bobbie And Bubba]

Yes I saw that cycle today....yeah. I just wanted to let you know that I didn't forget and as soon as he gets us something to work on; we will jump right on creating that scale.

I appreciate that and I figured we were waiting to collect some more nadir data. I didn't think you forgot about us