Pita's Dosing Party: 3

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Kris, do you mean having a different AM dose and PM dose? Or the kind of sliding scale where you shoot different amounts based on the pre-shot ranges?

Weren't the 1.2 to 1.6 shots when it looked like Pita was moving down the dosing scale? If that's right, then at that point (going down the scale), I absolutely agree that a sliding scale is appropriate to keep the kitties safe. My push for consistency is when a kitty is moving up the dosing scale which is the direction Pita has been going the past couple of weeks. Right now, I'm inclined to say lower it a little because of the two recently low pre-shots, and see if the pre-shots settle down a bit, and keep getting data on the mid-cycles to know if you can hold at 2.4 (or maybe even 2.2?) or need to go up or down from there.

Yesterday's cycle with the 2.0u dose and getting to 99 early in the cycle makes me think he may possibly maybe kinda be thinking about moving back down the scale again. Or it might just be one of those things...only time will tell.

And Caitlin, I'm so sorry you woke up to test and found a flat cycle!!! That's so frustrating. But good job getting that +6 anyway. The flat cycle does tell us that he might have gone rather low during that AM cycle which is good info to have anyway.
 
Yong said:
I see what Kris is talking about and it could be a good thing to try, if you are up for it ;). Second observation, hopefully others have noticed too and maybe can explain to me, around starting 1.6U and going higher Pita seemed to give more pink PS. Of course he threw his own wrench in now :p. I'm having problems with finding words right now :facepalm:... Pita was doing very good on lower doses, has had a little time in higher (for him) numbers, and might be going back to good numbers. Could there be a flare up something attributing to his possible pattern?
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In general the pink PSs coincide with the consistent dosing regimen near end of April onward.
 
Djamila said:
Kris, do you mean having a different AM dose and PM dose? Or the kind of sliding scale where you shoot different amounts based on the pre-shot ranges?

Weren't the 1.2 to 1.6 shots when it looked like Pita was moving down the dosing scale? If that's right, then at that point (going down the scale), I absolutely agree that a sliding scale is appropriate to keep the kitties safe. My push for consistency is when a kitty is moving up the dosing scale which is the direction Pita has been going the past couple of weeks. Right now, I'm inclined to say lower it a little because of the two recently low pre-shots, and see if the pre-shots settle down a bit, and keep getting data on the mid-cycles to know if you can hold at 2.4 (or maybe even 2.2?) or need to go up or down from there.

Yesterday's cycle with the 2.0u dose and getting to 99 early in the cycle makes me think he may possibly maybe kinda be thinking about moving back down the scale again. Or it might just be one of those things...only time will tell.

And Caitlin, I'm so sorry you woke up to test and found a flat cycle!!! That's so frustrating. But good job getting that +6 anyway. The flat cycle does tell us that he might have gone rather low during that AM cycle which is good info to have anyway.
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My fault! I haven't been clear on what I meant by a sliding scale. To me a sliding scale is one where the dose changes based on PS numbers. That can be a tweak up or down depending on what the PS is but "sliding scale" also includes adjusting the dose to a set amount if PS falls in a certain range. Either way, the dose is changed based on PS at a point in time versus giving a set dose both AM and PM for several cycles if numbers allow. I guess I view one interpretation as a looser definition of sliding scale and the other is a more prescriptive set of directions. That's where I'm coming from .. sorry if I confused things. o_O
 
Thank you all SO much for all this input so far! His +2 was 215, +4 was 105. I have been wondering if I should try a small adjustment in the units for am/pm. Even just .2 more during the day and. 2 less at night. But as you guys said also, it may not need to be a set amount, just change it depending on PS number. Hmm, what to do, what to do?! I'll see what the rest of the curve brings today. Also, he has an appointment with the new vet Tuesday at 5, so I'm hoping it all continues to go well with her!
 
Oh Caitlin! I'm so glad you got a vet appointment!!! Hopefully the new vet will be a better fit, and more willing to collaborate with you on Pita's care.

Maybe that 2.6 was your breakthrough dose and Pita will start moving back down again. I think if you need to offset the AM/PM doses a little, that's totally fine. Can't wait to see your +6 today!
 
I'm so glad you have an appointment with a new vet. You're already doing things the FDMB way and you can show her your SS, etc. She might have her own ideas about how often to test, etc. but she should respect your wish to do what you've been doing. :)
 
+6 was 47. He and his brother were outside for the last hour, enjoying the sun. I was calling him to test on the deck, but nope, he was waiting for me downstairs! I tested him and the feeder had been set to open in half an hour, but I obviously opened it immediately. He ate as much as he wanted and is now sitting on the deck again cleaning his face. I know 47 is a bit scary, but I fed him and he's now back outside. I can monitor him outside and test again at the +8. If the consensus is to try to test sooner I will, but I actually feel ok with everything. Thoughts?!

PS- what are you doing Pita?! Lol
 
IMG_20170528_110847.jpg

Post test, enjoying the sun again!
 
Aww he looks super happy! That 47 is a crazy number...how much did he eat? I might grab another test just to be sure he's coming back up..I know he ate and that's good but if it was me, I'd just want that peace of mind!
 
Lol...ah kitties and sunshine! If it was me, I think I'd do a +7 just to be sure, and then skip the +8 as long as he's risen enough by then. And of course keep an eye on him between now and then and test sooner if you suspect anything.
 
Rachel said:
Aww he looks super happy! That 47 is a crazy number...how much did he eat? I might grab another test just to be sure he's coming back up..I know he ate and that's good but if it was me, I'd just want that peace of mind!
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I can't say for sure how much he ate but he was in front of the bowl for 3-4 minutes. Not helpful at all.....
Djamila said:
Lol...ah kitties and sunshine! If it was me, I think I'd do a +7 just to be sure, and then skip the +8 as long as he's risen enough by then. And of course keep an eye on him between now and then and test sooner if you suspect anything.
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I'm thinking a +7 might be good as well. Then I can do a 9, 11, PMPS.
 
Djamila said:
Oh, and you probably know this, but...I think a little dose reduction is in order!
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How is it that we were all just discussing his dose and where to go..and now this! Sneaky kitty. Yeah I'll probably go with 2 units and see where he goes. I happened to be out until midnight last night so that's why I tested. I'll have to set an alarm and see what he's doing tonight!
 
There ya go! I think that would be fine.

After looking over your SS, I'm inclined to think a sliding scale might be in order too. I used one for awhile with Gypsy, but she's not a great example because she was also sick with other things at the time, which we didn't know. However, that seemed to help a bit.
 
Rachel said:
There ya go! I think that would be fine.

After looking over your SS, I'm inclined to think a sliding scale might be in order too. I used one for awhile with Gypsy, but she's not a great example because she was also sick with other things at the time, which we didn't know. However, that seemed to help a bit.
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Was your sliding scale a different but set dose for each shot, or you dosed based on her PS each time?
 
I wonder if we could all give very specific examples of what we mean by sliding scale, and then work on some precise vocabulary for each type since it seems like we use those words to mean several different things, and I'm getting confused. Here is what I think I've gathered so far as possible interpretations:

Example 1: A different AM dose than PM dose, but both are held with some consistency. So for example, you may give a 2.0u in the morning, and a 1.8u at night, but shoot those doses consistently (until the cat does something to make you change it).

Example 2: The Vetsulin version
350-300 = 2.6
300-250 = 2.2
250-200 = 1.8
200-170 = 1.4
170 and below= no shot

Example 3: Go with your gut? The dose may vary by 0.2u (or so) up or down, depending on a combination of the pre-shot and the nadir from previous cycles. So on Monday you get a pre-shot of 200 and a nadir of 47. The next day you get a pre-shot of 212, so you lower the dose a bit because of the similar pre-shot and wanting to stay a bit higher. On Wednesday you get a pre-shot of 284, so you raise the dose a little bit again to accommodate the higher number and get a nadir of 65. On Thursday you get a pre-shot of 173, so you lower the dose by quite a bit since the previous cycle had been responsive and you were staring lower. So not a set scale, but instead factoring in everything and making an educated guess. (This approach most often just results in bunch of unpredictable cycles, but sometimes given works schedules it's the best you can do).

Example 4: Responsive Flexibility? Used mostly when moving down the dosing scale: You get a nadir of 42, so you lower the next dose. Three days later, you've had a bunch of higher flat cycles, so you raise it a tiny bit again. A few days later, you get another low nadir of 48, so you bring the dose back down again, hold it, get another low nadir, bring it back down some more....then get some higher flatter cycles, so you raise it a little bit again....and so on. So it's consistent dosing, but the cat's responses are making you shift more frequently. It's a lot of adjust and hold...adjust and hold...but the "holds" might only be for 2-3 cycles before the cat does something that requires another change. This approach requires more frequent monitoring than Example 3, and can be a bit more aggressive. And it's much more strongly weighted toward the nadir than the pre-shot.

Any other examples? Or changes to these?
 
Djamila said:
I wonder if we could all give very specific examples of what we mean by sliding scale, and then work on some precise vocabulary for each type since it seems like we use those words to mean several different things, and I'm getting confused. Here is what I think I've gathered so far as possible interpretations:

Example 1: A different AM dose than PM dose, but both are held with some consistency. So for example, you may give a 2.0u in the morning, and a 1.8u at night, but shoot those doses consistently (until the cat does something to make you change it).

Example 2: The Vetsulin version
350-300 = 2.6
300-250 = 2.2
250-200 = 1.8
200-170 = 1.4
170 and below= no shot

Example 3: Go with your gut? The dose may vary by 0.2u (or so) up or down, depending on a combination of the pre-shot and the nadir from previous cycles. So on Monday you get a pre-shot of 200 and a nadir of 47. The next day you get a pre-shot of 212, so you lower the dose a bit because of the similar pre-shot and wanting to stay a bit higher. On Wednesday you get a pre-shot of 284, so you raise the dose a little bit again to accommodate the higher number and get a nadir of 65. On Thursday you get a pre-shot of 173, so you lower the dose by quite a bit since the previous cycle had been responsive and you were staring lower. So not a set scale, but instead factoring in everything and making an educated guess. (This approach most often just results in bunch of unpredictable cycles, but sometimes given works schedules it's the best you can do).

Example 4: Responsive Flexibility? Used mostly when moving down the dosing scale: You get a nadir of 42, so you lower the next dose. Three days later, you've had a bunch of higher flat cycles, so you raise it a tiny bit again. A few days later, you get another low nadir of 48, so you bring the dose back down again, hold it, get another low nadir, bring it back down some more....then get some higher flatter cycles, so you raise it a little bit again....and so on. So it's consistent dosing, but the cat's responses are making you shift more frequently. It's a lot of adjust and hold...adjust and hold...but the "holds" might only be for 2-3 cycles before the cat does something that requires another change. This approach requires more frequent monitoring than Example 3, and can be a bit more aggressive. And it's much more strongly weighted toward the nadir than the pre-shot.

Any other examples? Or changes to these?
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This was amazing! I think due to my work schedule I'd need to go with examples 1 or 2 since I can only get midday tests during the weekend. Which is great, but it's only 2 out of 5 days so I wouldn't feel totally comfortable with example 3. I like example 1 but I've done it before- which is good because I'm familiar with it. I like the sound of example 2, I may just change the PS #'s a bit as well as the dosing due to his numbers so far...I'd probably want some guidance creating my own PS to dosing #'s. Example 4 raises the same concern for me as example 3 with knowing nadir during the week. Maybe I should flip a coin and choose 1 or 2!
 
Yes, to clarify on example 2 - those were totally random numbers - not meant to be used for Pita at all. If you wanted to try that approach we would need to look at Pita's spreadsheet and try to design it from his numbers right now.
 
Djamila said:
Yes, to clarify on example 2 - those were totally random numbers - not meant to be used for Pita at all. If you wanted to try that approach we would need to look at Pita's spreadsheet and try to design it from his numbers right now.
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Oh ok good! I'm very intrigued by that idea....
 
The way I did it was example 2. I had a specific number to shoot based on the preshot values. We can certainly design you something like that if you want to try it?
 
Not Pandora's box in a bad way though! I think it's good to talk about things like this and figure out what we all think about it! It's that whole idea that we are all together smarter than any of us alone. Pita's been tricky to figure out, so working together maybe we can have a better chance of figuring out a helpful approach for him!
 
Rachel said:
The way I did it was example 2. I had a specific number to shoot based on the preshot values. We can certainly design you something like that if you want to try it?
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I think that would be great. I'm willing to try something new!
Djamila said:
Not Pandora's box in a bad way though! I think it's good to talk about things like this and figure out what we all think about it! It's that whole idea that we are all together smarter than any of us alone. Pita's been tricky to figure out, so working together maybe we can have a better chance of figuring out a helpful approach for him!
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Not at all bad! I agree with you all the way. I'm such a talker that sometimes it's even harder for me to get out exactly what I mean by typing. So really being able to figure things out and explain helps me SO much. And I know I'm almost 4 months in, but I still feel very new, especially when looking at the SS. I'm still waiting for when I can look at it like so many of you do and have better educated thoughts! And yeah, Pita has been all over the place!

+9 was just 72.
 
+11 was 157. He almost doubled in the last two hours, while sleeping. I'm hoping he doesn't rise too much more. Trying to anticipate it a little for dosing tonight. Thoughts?!
 
200 PMPS. I gave 2.4 this am on 184. I had every intention of only giving 2.2, but I just realized I gave 2.4 again. :eek: come on Caitlin! So, yes, we shall see what my .2 mistake brings in the am.
 
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Alrighty, I meet with the vet tomorrow and will see how it goes. I'd like to come up with a new PS# = dose amount, this week. Any and all help would be amazing!
 
Hey Caitlin, how did the vet visit go? I'm assuming tonight's PMPS might be vet induced? I'm not super great at coming up with sliding scales...Yong, how are you at it?

Caitlin, did you want to try the different AM and PM doses first?
 
Caitlin, before you try a sliding scale, you might look around at some kitties who are using one. I think EricH does it, and ShipsCat. Not sure if anyone else has tried it. Maybe someone else can chime in with examples?
 
I'm wondering if doing 2.2 in the morning and 2.4 in the evening wouldn't work out for you. That MIGHT help even things out.

When I did a sliding scale, I basically had one dose for yellows and a dose that was 0.2 higher for pinks. My baby never got into those blue preshots though...she stayed pretty darn flat.
 
I'm not confident enough to make a sliding scale yet ;). Eric does use a sliding scale for Phoebe but I think the smaller differences like Rachel suggested above, work better for Pita. I'll look at his SS when we get back :)
 
Holy Moly, look at that bounce! Good call on the big reduction this morning! Looks like 2.4 might be too much right now given the lime green and then the black. Can you hide Pita under your desk at work to get some more mid-cycles? ;)
 
Hey all! I wanted to wait until I had my computer to respond.
Rachel said:
Hey Caitlin, how did the vet visit go? I'm assuming tonight's PMPS might be vet induced? I'm not super great at coming up with sliding scales...Yong, how are you at it?

Caitlin, did you want to try the different AM and PM doses first?
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Rachel-you are very correct on the vet induced number! I gave him Cerenia for his motion sickness while traveling. It worked but he still drools/foams at the mouth horribly. Drooling doesn't even do it justice! The vet visit was okay overall. She was nice! I brought info I had printed regarding human meters and his SS and she didn't want any of it. She said 'the numbers you have mean nothing to me'. Fair enough, but it takes two seconds to look at it and understand. She also wants to do an initial curve on him before prescribing more insulin. So I have an appointment on Monday. HOWEVER. I need to drop him off at 8:30, so I would need to spend all weekend moving his shot time around just for them/one day. That frustrates me! She said she knows the numbers will be a bit off, but we can compare mine to hers. Ok, so now I need to learn a pet meters range in order to understand what she gets. ::Scratching my head:: We got home and it was his shot time, but yes- 559 PS! I knew he got stressed but in the three months I've tested him, have never seen a black number. That got my head spinning a bit and I couldn't sleep. I reflected on it all and decided to call the other vet, because she had said she didn't even require an initial curve (I forgot she had said that :confused:) and she herself had a diabetic cat. I left a new message with her and hope to hear back today or tomorrow. I liked the vet last night well enough and she is willing to 'work with me' to an extent. I honestly can't picture bringing him in, having a stranger poke him all day and then have them 'happy' with the results, especially given his PS last night. I also worry about the backlash I may get from it. What if it takes a few days for him to recover and then I can't even test him because he's so traumatized?! So, I still have the appointment for Monday but am hoping to cancel it once I speak with the other vet.
Djamila said:
Holy Moly, look at that bounce! Good call on the big reduction this morning! Looks like 2.4 might be too much right now given the lime green and then the black. Can you hide Pita under your desk at work to get some more mid-cycles? ;)
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Djamila I would love to bring him! Lol
Djamila said:
Caitlin, before you try a sliding scale, you might look around at some kitties who are using one. I think EricH does it, and ShipsCat. Not sure if anyone else has tried it. Maybe someone else can chime in with examples?
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Rachel said:
I'm wondering if doing 2.2 in the morning and 2.4 in the evening wouldn't work out for you. That MIGHT help even things out.

When I did a sliding scale, I basically had one dose for yellows and a dose that was 0.2 higher for pinks. My baby never got into those blue preshots though...she stayed pretty darn flat.
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I'll have to look at those two members you suggested Djamila! Thank you. Rachel, wouldn't I give a slightly higher dose for the am since it's 13 hours and the slightly smaller for pm? I looked back at my SS because there had been a time I was trying to do a sliding scale, but now that I look back, I don't think it ever fully worked that way! I feel like I'm just shooting in the dark (no pun intended but haha!) based on his numbers! I'll try to really think about it today and come up with a dose based on numbers system.
I hope this all made sense to everyone! There's so much in my head I may be hard to understand :smuggrin:
 
Oh, that's why he had a black number! I forgot about the vet visit! It honestly doesn't sound like that new vet is that great either. Even when my vet wasn't that great at FD (their clinic has learned a LOT in the past couple of years), he still didn't require an in office curve. And while they aren't a fan of the human meter, they are willing to work with me on it.

Fingers crossed that the next one will be a better partner in all of this!
 
Well, you've been through the wringer, Caitlin! :confused:

Re vet: I'd be miffed if a vet completely dismissed what I was doing (meter, SS) without so much as a glance at it. I also don't think an office curve is required. At Teasel's diagnosis, my vet told me up front that I would be doing a curve at home. I think it's OK for a new vet to want to see the kitty for a once over before prescribing insulin but other than that, you should be able to do your own curves at home (even if it means getting a pet meter for curves only - that sacrifice is probably worth it) and you should be able to call in for more insulin when you need it. Again, going with my experience with my vet.

Re sliding scale: I have no experience with that and couldn't have done it with Teasel because he's both erratic and overreactive. I wouldn't be of much help designing one. However, if I was dealing with a slightly more moderate cat, I could see myself using what I'd call "responsive dosing" - ie. tweaking the dose up or down a small amount (o.2 u?) based on PS and past history.
 
Pita climbs up the dosing scale...Pita slides down the dosing scale...Pita climbs up the dosing scale.....Pita slides down the dosing scale....

:bighug::bighug::bighug:
 
EVERYONE! I am ecstatic and obviously wanted to share. I called back the other vet and finally just spoke this evening. She seems AMAZING! She herself had a diabetic cat, used a human meter to test and just needs to see him once to give a prescription. No curve necessary at all. She'll look at my SS and that's it. I am so excited and have an appointment in Tuesday morning. ::Massive sigh of relief::
Oh, side note- I'm moving across the country on September 6 so I'll have to start calling vets in LA before then. I'll make a post about that closer to the date itself :D
 
Oh Caitlin! That's so great! Hooray!!! And what about this move?!?! Which part of LA? Why? What are you doing?!?! LA is in the state or the city (I'm assuming you mean SoCal, but maybe not?)
 
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