3/11 Samba AMPS 160 +2.5 275 +5 304 +7 295 +8 312 +9 319 +11 292 PMPS 294 +2 277 +3 216 +4 233

[Sarah Mc]

http://www.felinediabetes.com/FDMB/...4-pmps-351-1-364-6-5-239.174201/#post-1909993

Samba has gone back and forth between 2 and 2.25 units without achieving stable numbers. When I raise him to 2.25, he earns a reduction, but at 2 units, he does not maintain good numbers. Should I raise him to 2.25 again tonight? I feel like keeping him at 2 units isn't serving him.

 

[Dyana]

Since he just had some greens two days ago, he could still be bouncing, so I would wait a couple more cycles before increasing.

 

[Sarah Mc]

According to Tilly's diabetes homepage (tillydiabetes.net), which is one of the links given on the TR protocol sticky:

"Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way)."

Is it possible that Samba is one of those cats? Twice now, he has earned a reduction at 2.25 units for going into the 40s, but then the reduction seems to have failed.

 

[Sarah Mc]

Since he just had some greens two days ago, he could still be bouncing, so I would wait a couple more cycles before increasing.

Okay, thanks

 

[tiffmaxee]

My Max failed reductions a lot. Eventually I took smaller reductions and then started waiting for three under 50. I don't think you are there yet. Bounces are frustrating. I also tried feeding mc, a little higher carb food to prevent him from going too low or earning reductions. It's called feeding the curve. You might try that when this bounce clears.

 

[Sarah Mc]

My Max failed reductions a lot. Eventually I took smaller reductions and then started waiting for three under 50. I don't think you are there yet. Bounces are frustrating. I also tried feeding mc, a little higher carb food to prevent him from going too low or earning reductions. It's called feeding the curve. You might try that when this bounce clears.

Thanks...thanks to you and another member, I have learned to feed the curve when his numbers are in the 50s or below, but should I be starting with MC food sooner? At what point with Max would you begin to feed the curve/how low would his numbers get before you would start doing that?

 

[Barbara & Uncle (GA)]

Thanks...thanks to you and another member, I have learned to feed the curve when his numbers are in the 50s or below, but should I be starting with MC food sooner? At what point with Max would you begin to feed the curve/how low would his numbers get before you would start doing that?

I THINK what @tiffmaxee means by that suggestion is this option: you may be able to start out feeding MC instead of LC and give the 2.25 That may allow that higher dose work better to bring Samba into green numbers without dropping too low. That's the interpretation I have, maybe someone will correct me and/or explain it better.

 

[tiffmaxee]

I THINK what @tiffmaxee means by that suggestion is this option: you may be able to start out feeding MC instead of LC and give the 2.25 That may allow that higher dose work better to bring Samba into green numbers without dropping too low. That's the interpretation I have, maybe someone will correct me and/or explain it better.

Exactly. With Max I fed him lc at preshot and then based upon the next test fed more lc if he didn't drop too much. If he had a big drop he'd get a little mc. I kept deciding what to feed at each test until nadir. My goal was to get him used to lower and lower numbers and not to drop under 50. So I often gave a small amount of mc if he got close to numbers that would make him bounce. I hope this makes sense.

 

[Sienne and Gabby (GA)]

Generally, you don't want to feed MC at shot time as "insurance." Samba's numbers at PS aren't low enough that I would be feeding anything other than LC. I think you're doing a great job of getting early tests when you're concerned that numbers may be dropping. Gabby had early nadirs with fast drops. If you look at her SS, you'll see how I tested and I have notes about when I intervened with HC in the Comments section.

One thought given that you're going back and forth between 2.0 and 2.25u is that you could give a "fat" 2.0 (or :skinny 2.25u) dose. Of course, the challenge is measuring the dose consistently. There are two ways. You can get a set of digital calipers or you can measure the dose using a colored liquid and using that syringe as your template for future measurements.

 

[Barbara & Uncle (GA)]

One thought given that you're going back and forth between 2.0 and 2.25u is that you could give a "fat" 2.0 (or :skinny 2.25u) dose. Of course, the challenge is measuring the dose consistently. There are two ways. You can get a set of digital calipers or you can measure the dose using a colored liquid and using that syringe as your template for future measurements.

This was my next thought for you and Samba as well. I am doing exactly that with Uncle now. Seemed his previous dose wasn't quite cutting it, but I had a very strong feeling that going up an entire extra .25u would be too much. So far my intuition is bearing out. Uncle is seeing very nice numbers without totally nosediving. That being said, I couldn't make this work without calipers. The lines on the needles are too inconsistent and at these low doses a little insulin can go a long way. There is a lot of info re. using calipers on the board and a video Marje made. If it's something you may be interested in pursuing, just reach out. We can point you in the right direction and answer questions. As an aside, I tried using the calipers a couple of months ago and got discouraged because everything seemed awkward and cumbersome. I figured out a great set up so that both hands are free -drawing up the dose isn't taking any longer than before, AND I feel much more confident re. dosing.

ETA, I just wanted to make it clear that I am not giving doing advice. You may still want to consider what @Dyana said about the fact that he MAY be in a bounce and to wait a couple more cycles. I certainly don't have enough experience giving dosing advice

 

[Tricia Cinco(GA) & Harvey]

Sienne took the words right out of my mouth. This might be a time to try fat and/or skinny doses. Remember, accuracy is not as important as consistency - decide where the dose is on the syringe and try to hit that spot every time.

 

[Barbara & Uncle (GA)]

decide where the dose is on the syringe and try to hit that spot every time.

That's where calipers are helpful for me, if the lines are off. It's hard to be consistent with dosing if you are relying on inaccurate lines.
However, maybe at the doses you are giving Samba, there is enough leeway to rely on the lines. I would go with what the more experienced people recommend. At this point I am "micro-dosing", so even a tiny change seems to effect Uncle's numbers.

 

[Sarah Mc]

Exactly. With Max I fed him lc at preshot and then based upon the next test fed more lc if he didn't drop too much. If he had a big drop he'd get a little mc. I kept deciding what to feed at each test until nadir. My goal was to get him used to lower and lower numbers and not to drop under 50. So I often gave a small amount of mc if he got close to numbers that would make him bounce. I hope this makes sense.

That's helpful, thank you. If I see a significant drop early on, I will try giving him a little MC food, especially if he's on a dose higher than 2 units

 

[Sarah Mc]

Generally, you don't want to feed MC at shot time as "insurance." Samba's numbers at PS aren't low enough that I would be feeding anything other than LC. I think you're doing a great job of getting early tests when you're concerned that numbers may be dropping. Gabby had early nadirs with fast drops. If you look at her SS, you'll see how I tested and I have notes about when I intervened with HC in the Comments section.

One thought given that you're going back and forth between 2.0 and 2.25u is that you could give a "fat" 2.0 (or :skinny 2.25u) dose. Of course, the challenge is measuring the dose consistently. There are two ways. You can get a set of digital calipers or you can measure the dose using a colored liquid and using that syringe as your template for future measurements.

Thank you...I knew nothing about calipers but was just reading some of the threads on here trying to understand. I am still having trouble finding a sticky on fat & skinny doses, and I'm sure it is right under my nose, but I am missing it...I am going to order the calipers, so using the calipers, what would be a "fat" 2 unit dose or a "skinny" 2.25 unit dose? Is there an exact # of milliliters to equal a fat or skinny dose?

 

[Sarah Mc]

This was my next thought for you and Samba as well. I am doing exactly that with Uncle now. Seemed his previous dose wasn't quite cutting it, but I had a very strong feeling that going up an entire extra .25u would be too much. So far my intuition is bearing out. Uncle is seeing very nice numbers without totally nosediving. That being said, I couldn't make this work without calipers. The lines on the needles are too inconsistent and at these low doses a little insulin can go a long way. There is a lot of info re. using calipers on the board and a video Marje made. If it's something you may be interested in pursuing, just reach out. We can point you in the right direction and answer questions. As an aside, I tried using the calipers a couple of months ago and got discouraged because everything seemed awkward and cumbersome. I figured out a great set up so that both hands are free -drawing up the dose isn't taking any longer than before, AND I feel much more confident re. dosing.

ETA, I just wanted to make it clear that I am not giving doing advice. You may still want to consider what @Dyana said about the fact that he MAY be in a bounce and to wait a couple more cycles. I certainly don't have enough experience giving dosing advice

Thank you...you have been so helpful to me...I went straight to the calipers thread and will watch those videos. What setup works for you, if you don't mind me asking? They do seem awkward to use.

 

[Sarah Mc]

Sienne took the words right out of my mouth. This might be a time to try fat and/or skinny doses. Remember, accuracy is not as important as consistency - decide where the dose is on the syringe and try to hit that spot every time.

Thanks...for me, it seems hard enough to measure a difference of .25 on the syringe, so I am having trouble visualizing what a fat or skinny dose would look like. Should I just wait for the calipers to come in the mail? I'm sure there is a sticky on fat/skinny doses, but I was having trouble finding it

 

[Sienne and Gabby (GA)]

There aren't really any good photos of fat or skinny doses. The idea is that you are shooting somewhere between the doses that are either not enough or too much insulin. Whether you call it fat or skinny is up to you. All that's important is that you can measure the amount consistently. A fat .25u would be between .25 and .50u and a skinny 0.25u dose would be between the 0.25u and the zero line. There is a picture of a 0.1u dose in the New to the Group sticky.

If you order calipers, you may want to bookmark this post on how to dose using calipers. Until your calipers arrive, you can draw up a sample dose using colored liquid and use that as a comparison for your subsequent doses.

 

[tiffmaxee]

I used calipers too. It really helped with small dose changes.

 

[Barbara & Uncle (GA)]

The set up I have is;
Lay a piece of tracing paper on the light box, set a 16 oz can on the light box as well (you could use a tall cup or mason jar).
Pop up the magnifying glass and lay it across the can. The solid base should lay across the top of the can while the window of the magnifying glass cantilevers beyond the can, giving you room to hold and look at the syringe under it.
Follow the instructions on the "how to dose with calipers" link Sienne posted above.
I'm sure you'll have questions once you get started.
Tomorrow I'll try to take a couple of pictures!

This is the pop-up magnifying glass that I got from Rite Aid
http://www.osh.com/Osh-Categories/T...ection/ICU-Eyewear-Pop-Up-Magnifier/p/2837185
Here is the Light Box I got from Amazon
https://www.amazon.com/gp/product/B0084JUNXS/?tag=felinediabetesfdmb-20

 

[Sarah Mc]

There aren't really any good photos of fat or skinny doses. The idea is that you are shooting somewhere between the doses that are either not enough or too much insulin. Whether you call it fat or skinny is up to you. All that's important is that you can measure the amount consistently. A fat .25u would be between .25 and .50u and a skinny 0.25u dose would be between the 0.25u and the zero line. There is a picture of a 0.1u dose in the New to the Group sticky.

If you order calipers, you may want to bookmark this post on how to dose using calipers. Until your calipers arrive, you can draw up a sample dose using colored liquid and use that as a comparison for your subsequent doses.

Thank you so much. I did what you said with the colored liquid tonight and attempted to create a "skinny" 2.25 unit dose. We'll see how it goes!

 

[Sarah Mc]

The set up I have is;
Lay a piece of tracing paper on the light box, set a 16 oz can on the light box as well (you could use a tall cup or mason jar).
Pop up the magnifying glass and lay it across the can. The solid base should lay across the top of the can while the window of the magnifying glass cantilevers beyond the can, giving you room to hold and look at the syringe under it.
Follow the instructions on the "how to dose with calipers" link Sienne posted above.
I'm sure you'll have questions once you get started.
Tomorrow I'll try to take a couple of pictures!

This is the pop-up magnifying glass that I got from Rite Aid
http://www.osh.com/Osh-Categories/Tools-&-Hardware/Hardware/Safety/Head-&-Eye-Protection/ICU-Eyewear-Pop-Up-Magnifier/p/2837185
Here is the Light Box I got from Amazon
https://www.amazon.com/gp/product/B0084JUNXS/?tag=felinediabetesfdmb-20

I can't thank you enough for all of the help you've given us. The way that you explain things is so helpful and thorough. Some of these concepts are difficult for me, but you make them easier to understand, and it helps me to feel more confident that I am doing okay. I'll order those items tonight! Thank you!!

 

[Barbara & Uncle (GA)]

Hi Sarah, I'm glad to know if anything I've shared is helpful. I know I couldn't do it if I was just the reading Sticky's!
I also took a picture and will attach it when I get home from work so you can actually see what I'm describing. I hope it will help Samba!!!

 

[Barbara & Uncle (GA)]

Here ya go...