9/1 Beenie AMPS 213, 170 +4, 127 +7, 105 +9

[Beenie (GA)]

Condo:http://www.felinediabetes.com/FDMB/...2-4-119-6-151-8-pmps-250.183217/#post-2033019

Monring

I increased Beenie to 12.25 U. Was it a failed reduction? I don't want to wait another cycle and need to stay ahead of the IAA so I increased this morning. Hope to get back to blues today.

 

[carfurby (GA)]

I hope the dosecrease helps bring Beenie's numbers back down.

 

[LizzieInTexas]

I have gone up/down several times with the doses. I don't worry so much about the quantity as the resulting numbers. I completely understand the wanting to stay on top of it. Back down to blue Beenie .

 

[Tuxedo Mom]

Looks like Beenie liked the 12.5 unit dose better. With the IAA and acro you don't want to hold a reduction too long when it is not getting good numbers.

C'mon Beenie..back to blues and greens.

 

[Beenie (GA)]

Looks like Beenie liked the 12.5 unit dose better. With the IAA and acro you don't want to hold a reduction too long when it is not getting good numbers.

C'mon Beenie..back to blues and greens.

Should I go back to 12.5 U? I shot 12.25U this morning. I was a little uncomfortable with her dips to 51 and 52 so I thought if I went to 12.25 U would be a happy medium. Or do I give it a cycle or two to see if she comes back down and if not go back to 12.5?

 

[Tuxedo Mom]

Should I go back to 12.5 U? I shot 12.25U this morning. I was a little uncomfortable with her dips to 51 and 52 so I thought if I went to 12.25 U would be a happy medium. Or do I give it a cycle or two to see if she comes back down and if not go back to 12.5?

You are dealing with 2 high dose conditions so that makes the dosing a little more difficult. With the higher dosing that Beenie is on changes are usually done in 1/2 unit doses since a 1/4 unit is a very small percentage in relation to the total dose. She was doing good on the 12.5 unit and although she was hitting lower greens she never got into a hypo range. If you are able to continue with the amount of testing you do, especially later in the cycle the 12.5 unit dose seems to work better. If you are not comfortable with the lower numbers that also has to be taken into account.

That is my thoughts on the dosing but since I am not an experienced high doser I will tag a couple of the "high dose experts" and see what they have to say.

@Wendy&Neko @Sandy and Black Kitty

 

[Alicia & Maggie (GA)]

I hope Beenie finds a dose she likes so she'll stay in blues and greens.

 

[Beenie (GA)]

If you are able to continue with the amount of testing you do, especially later in the cycle the 12.5 unit dose seems to work better. If you are not comfortable with the lower numbers that also has to be taken into account.

I will certainly do what I have to in order to keep her in blues and greens. Curious what Wendy and Sandy think. I opted for the 12.25 based on protocol that when a decrease fails don't go back to the original dose if it brought them too low. But you're right she didn't technically go below 50 but she was so close. This is what I don't understand though, the night she went to 51 was I supposed to just wait an re-test to see if she goes lower? If the motto is not to go too low even for one minute I though steering her was the right thing to do. And I didn't over do it either, just a little LC with a dollop of MC gravy on top. Is the only way to earn a reduction by either testing and getting a number below 50 or if a little above 50 keep re-testing and expect them to go lower so you earn the reduction then take action? I'm confused

 

[Tuxedo Mom]

I will certainly do what I have to in order to keep her in blues and greens. Curious what Wendy and Sandy think. I opted for the 12.25 based on protocol that when a decrease fails don't go back to the original dose if it brought them too low. But you're right she didn't technically go below 50 but she was so close. This is what I don't understand though, the night she went to 51 was I supposed to just wait an re-test to see if she goes lower? If the motto is not to go too low even for one minute I though steering her was the right thing to do. And I didn't over do it either, just a little LC with a dollop of MC gravy on top. Is the only way to earn a reduction by either testing and getting a number below 50 or if a little above 50 keep re-testing and expect them to go lower so you earn the reduction then take action? I'm confused

It is always a tough call when you are close to a "prescribed" reduction number. This really comes down to knowing your kitty and knowing how she rises and falls with the dose and feeding the drop. You have a lot of data and a good feel for how Beenie reacts, so sometimes you go with your own gut feeling. With my kitties, sometimes I would hold a dose even if they dropped low and sometimes I would reduce even if it wasn't "called" for. Sometimes I fed higher carb food even if they didn't seem to be dropping too low, but the timing of the drop bothered me. All things you have to take into account.

As far as dropping lower, you are getting a lot of data on how easily you can bring her back up with different foods. You don't want to go TOO low, but 50 is not always a worry...it depends where in the cycle it is happening and how fast or how big a drop happened. 50 is the "take action" number...either feeding some LC/MC food to keep the numbers from dropping or if it happens early in the cycle or too quickly you would want to give syrup and or HC. It is all about the data (which you have LOTS of) and knowing how the insulin works (which you have a good idea of) and knowing your own kitty (which you do)

 

[Beenie (GA)]

It is always a tough call when you are close to a "prescribed" reduction number. This really comes down to knowing your kitty and knowing how she rises and falls with the dose and feeding the drop. You have a lot of data and a good feel for how Beenie reacts, so sometimes you go with your own gut feeling. With my kitties, sometimes I would hold a dose even if they dropped low and sometimes I would reduce even if it wasn't "called" for. Sometimes I fed higher carb food even if they didn't seem to be dropping too low, but the timing of the drop bothered me. All things you have to take into account.

As far as dropping lower, you are getting a lot of data on how easily you can bring her back up with different foods. You don't want to go TOO low, but 50 is not always a worry...it depends where in the cycle it is happening and how fast or how big a drop happened. 50 is the "take action" number...either feeding some LC/MC food to keep the numbers from dropping or if it happens early in the cycle or too quickly you would want to give syrup and or HC. It is all about the data (which you have LOTS of) and knowing how the insulin works (which you have a good idea of) and knowing your own kitty (which you do)

Ok so I feel I did the right thing in both cases of her lower numbers. On 8/27 her PMPS was 52. I didn't steer it because it was the end of the cycle and she always goes up. Since "always" can change I waited to re-test to confirm she was rising on her own and shot on the 61. On 8/28 she was at 51 but only +7.5 into the cycle. That is where I felt action was needed. I gave her a little food, FF naturals with zero carbs with maybe half a teaspoon of MC gravy on top and with the little steering I did she surfed nicely. Would she have done it on her own? Maybe but she typically hits nadir later that +7.5.

Thanks for the feedback Mary Ann. I can't wait to test her to see where she's headed today

 

[Tuxedo Mom]

Ok so I feel I did the right thing in both cases of her lower numbers

You have gained an amazing amount of insight and information and you are certainly in tune with Beenie. Keeping our kitties safe is #1 priority and getting glucose numbers in good ranges comes right behind that. As well as your informed and gut feelings, sometimes life comes into effect...such as needing some sleep and you need to adjust to fit that as well.

Fingers and paws crossed for some good readings today

 

[Bronx's dad (GA)]

Good call on the increase

This is what I don't understand though, the night she went to 51 was I supposed to just wait an re-test to see if she goes lower? If the motto is not to go too low even for one minute I though steering her was the right thing to do. And I didn't over do it either, just a little LC with a dollop of MC gravy on top. Is the only way to earn a reduction by either testing and getting a number below 50 or if a little above 50 keep re-testing and expect them to go lower so you earn the reduction then take action? I'm confused

I think the test 30min or an hour after one in the 50's would determine if you should steer or not, and if Beenie earned a reduction (if it goes below 50).

 

[Kris & Teasel]

I can't offer any advice on dosing a kitty with acro and IAA but I can weigh in on using your gut feelings to guide you. The protocol is a great resource but it has to be tempered with judgments made on how you know your kitty is likely to react. There's a lot of "feel" that has to go into dosing , especially if you have a very tricky cat or one with other issues. Always, always, let your experiences with your own kitty be your final guide.

 

[Sandy and Black Kitty]

But you're right she didn't technically go below 50 but she was so close. This is what I don't understand though, the night she went to 51 was I supposed to just wait an re-test to see if she goes lower? If the motto is not to go too low even for one minute I though steering her was the right thing to do.

I think going up to 12.25 is fine. If it doesn't produce the desired result you go back to 12.5.

For the record, the motto is:
'Better a day too high than an hour too low. '

If you have a cycle where you find yourself struggling to keep above 50, it's fine to take a reduction. Particularly for a multiple high dose condition kitty.

High dose conditions have forces at work that are unpredictable. Is the tumor active? Are the antibodies releasing previously bound insulin back into circulation? These can't be measured but must be considered in all dosing decisions for safety sake.

High dose=Huge Depot =potential High Drama.

 

[Sandy and Black Kitty]

The protocol is a great resource but it has to be tempered with judgments made on how you know your kitty is likely to react. There's a lot of "feel" that has to go into dosing , especially if you have a very tricky cat or one with other issues. Always, always, let your experiences with your own kitty be your final guide.

Amen to that

Your experiences will build your instincts. Trust your gut.

 

[Beenie (GA)]

I think going up to 12.25 is fine. If it doesn't produce the desired result you go back to 12.5.

Will do!

For the record, the motto is:
'Better a day too high than an hour too low. '

Thanks Sandy!!

 

[Beenie (GA)]

I can't offer any advice on dosing a kitty with acro and IAA but I can weigh in on using your gut feelings to guide you. The protocol is a great resource but it has to be tempered with judgments made on how you know your kitty is likely to react. There's a lot of "feel" that has to go into dosing , especially if you have a very tricky cat or one with other issues. Always, always, let your experiences with your own kitty be your final guide.

Thanks Kris

 

[saltycat]

I would have done the same thing with Jack. If you had retested with the 51, it could easily have been a 49 on the next test, there is some variance in the meter's accuracy.

IAA can be very unpredictable and changes happen fast. Sometimes they are short lived, just a cycle or two as the IAA has a sudden die off then gets back to normal. I tend to feed Jack before he gets to the 50's, remission sadly is rare with acro cats. My goal is decent regulation, not pushing hard to stay in the greens. You are correct that staying ahead of the IAA is important to keep from a constant climbing of the dosing ladder. I might have given her one more cycle to see if she got out of the yellows on 12u, she's had a few cycles on 12.5u where she went blue-yellow-blue, but that is just me being a little more conservative with dosing lately.

She is looking great on the switch to Lev so far!

 

[Beenie (GA)]

I would have done the same thing with Jack. If you had retested with the 51, it could easily have been a 49 on the next test, there is some variance in the meter's accuracy.

IAA can be very unpredictable and changes happen fast. Sometimes they are short lived, just a cycle or two as the IAA has a sudden die off then gets back to normal. I tend to feed Jack before he gets to the 50's, remission sadly is rare with acro cats. My goal is decent regulation, not pushing hard to stay in the greens. You are correct that staying ahead of the IAA is important to keep from a constant climbing of the dosing ladder. I might have given her one more cycle to see if she got out of the yellows on 12u, she's had a few cycles on 12.5u where she went blue-yellow-blue, but that is just me being a little more conservative with dosing lately.

She is looking great on the switch to Lev so far!

Thanks Wes. Beenie has been so predictable on Lev that I'm not used to seeing any "changes"
Still learning as I go. Can't wait to get Carbergoline in the mix and see where that brings her. Starting that on Tuesday after she finishes her AB.

 

[Wendy&Neko]

I agree with the others, I would have tried 12.25 too. The saying here is Know Thy Cat. It is even more true for high dose cats because of the extra, seemingly random, factors at play. Some high dose cats are sensitive to small changes, so you have to see if that is true for Beenie. I have seen one acro/IAA kitty here over 20 units and sensitive to 0.25 unchanges.

My goal was always to be at a dose that minimized time over renal threshold, yet gave me decent sleep. A dose with nadirs in low 50's is not that! So maybe the 0.25 increase can tweak the nadirs up a bit but keep the higher numbers down. At least until the acro tumour output changes or IAA decide to act up. I found keeping at a dose with some greens helped keep the IAA somewhat better behaved.

In general, you will always be tweaking and modifying the dose due to the other factors. What is a good dose today, might not be next week. Be flexible and follow where the numbers lead you.

 

[Beenie (GA)]

I agree with the others, I would have tried 12.25 too. The saying here is Know Thy Cat. It is even more true for high dose cats because of the extra, seemingly random, factors at play. Some high dose cats are sensitive to small changes, so you have to see if that is true for Beenie. I have seen one acro/IAA kitty here over 20 units and sensitive to 0.25 unchanges.

My goal was always to be at a dose that minimized time over renal threshold, yet gave me decent sleep. A dose with nadirs in low 50's is not that! So maybe the 0.25 increase can tweak the nadirs up a bit but keep the higher numbers down. At least until the acro tumour output changes or IAA decide to act up. I found keeping at a dose with some greens helped keep the IAA somewhat better behaved.

In general, you will always be tweaking and modifying the dose due to the other factors. What is a good dose today, might not be next week. Be flexible and follow where the numbers lead you.

Thanks Wendy!!

 

[Sandy and Black Kitty]

 

[Beenie (GA)]

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