? Yemala 10/24 AMBG 55; retest 54; +16 135; +18 199; +23 315; PMBG 322; +2 211; +4 106; +7 88

When you get a PS you're not sure about shooting, you should stall, DON'T FEED and post for help. Test again in 20-30 minutes to see if they're heading up without the influence of food.

We want to know if the number will come up on it's own …..which would indicate the last shot is starting to wear off
 
At 6:30, she's still at 53.

I can stall, but this kitty is starving. 5 other indoor kitties have their food, she's hungry and hard to ignore. Holding off food will be difficult.
 
At this point I think she is too low for you to shoot. It looks like she might have come off a bounce from those greens the day before yesterday.
You can stall for another 20 or 30 mins or you could skip the dose if you don’t want to stall any more. Are you going to be home all day ?
 
I will be home until later this afternoon. We have not given her a shot.

I would prefer to feed her and see where she goes later this morning. As I type this, I'm fending off a paw slapping me in the face.

She's not a fan of not being fed.
 
If you don’t want to stall any more I think you will have to skip the shot as she is not rising at all. Don’t attempt to give her insulin in a few hours though. You will need to wait until the PM dose to give her insulin.
 
Wow, that was an exciting morning. Under TR you would hold the dose, under SLGS you would reduce to .50. Typically we try to hold a dose longer then 3 cycles but sometimes the kitties dictate what we do. If it was me, I would reduce to .50 and see how the dose plays out. If she needs to go back up for a bit, we can do that when the times come.
 
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Exciting. Yeah. Yemala loves to keep me guessing. This is one reason why we test as often as we can - she won't be predictable. Looking at yesterday's numbers, I would have predicted a similar curve or even a moderate bounce. Other kitties are predictable. Not my torti.

I looked at the TR protocol on reducing the dose, and two days ago, she earned a reduction from 1 u to .75. I just tested her 4 hours without a shot, and she's in the blues.

Of two minds here. I would love to get additional eyes on this, as we have time before the PM testing.

Yemala is, of course, eating again now. In fact, her nose (which stinks of fragrant chicken lc food) is only an inch from mine, which helps to remind me that she's STARVING!!!
 
Hi! May I ask why you increased from 0.75u to 1u on 10/20 when you just had some beautiful greens on 10/19? I think what you are seeing is some depot from that 1u. I would stay with 0.75u and see if Yemala can truly earn a reduction.
 
http://www.felinediabetes.com/FDMB/...-516-8-499-11-586-2-443-5-116-6-5-126.205136/

I have multiple reasons why we increased the dose, though it's possible none are good.

1. Despite this being Mala's third time as a sugar kitty, she has never been on insulin longer than a month before. Ergo, we are comparative noobs at this. We do our best to test, get advice, and shoot appropriately, and I have practically memorized the TR protocol, but Mala doesn't follow the patterns of other cats. She won't be predictable.

2. We waffled a lot on whether or not to increase her dose. The .75 had given her a few blue and green numbers, but not for long. It seemed that, with numbers in the 500+ range, a dose increase was reasonable.

3. See reason number 1. We're still working on this. We are fallible. We make mistakes. Mala isn't a typical sugar kitty (which one is?) and determining the best path forward is hard.

Which is why I'm trying to gather advice on what to do at 6 PM today. We will get more numbers for her, and try to figure out what's best for her, but there's no easy answer for her diabetes.
 
OK, I went back and read the last few condos. I saw that @Gill & George did say you didn't have much room to increase to 1u. I think it's best to stay course with 0.75u for at least 6 cycles *unless she drops below 50. Any data gives you the opportunity to learn. I was asking if there was a certain reason so thank you for giving me several. It's hard to see how the dose is working when you have to deal with the ugly bounces in between. :bighug:
 
Ok, we've done 3 cycles on .75 since the decrease, and skipped a dose this AM. Depending on where she is at 6 PM, we'll shoot the .75 again.

I'll test in 5 minutes to get a +18 from her PM dose.
 
To put a slightly different perspective on things, Mala did not earn a reduction down to 0.75 units from 1.0 units. She is a long term diabetic, diabetic longer than a year. For long term diabetics under TR, the reduction point is under 40. For kitties that are returning from the falls, we also try to make it a little harder to earn a reduction. The faster you can get her regulated, doing it safely of course, the better her chances to return to the falls.

Since she wasn't dropping today, that number may have been safe to shoot, especially if you were going to be home for at least the first half of the cycle. But that's water under the bridge now. You can try 0.75 again but if those greens are few and far between again, I'd consider going back up to 1.0 units. That dose did seem to banish the reds.
 
+18 number posted.

So was the error in taking her up to 1 u, or dropping her back to .75?

I'm entirely unclear on how to apply the protocol to Mala, given her extraordinary high bounce numbers and the duration of those bounces. We felt we held the .5 dose too long, despite signs that it was insufficient. We increased to .75, but her bounces continued and, on the 20th, jumped sky high. None of the surfs held for long. The 1u dose curbed those high numbers, and the drops into the greens weren't so worrisome that we couldn't handle them.

But an AMBG of 54 is hard to justify shooting, unless we are absolute experts. Which we are not.

Right now, I'm planning to dose her at .75 at 6 PM. Davey will be here to monitor her for onset to see where she goes. She's popped up to 199 at her +18, and will be higher by +24. Unless we see dramatically low numbers - under 40? - we'll hold the dose for at least 6 cycles. Mala's bounce cycles seem to last up to 5 days, not the usual 3, but even that isn't consistent, which makes this all the harder.

Thank you anyone who has ideas and suggestions.
 
I just looked at your Profile, Yemala at a Glance. It reminds me of what I was doing years ago. I had 13 at one time. Strays & a litter of 5 kittens no one wanted.
I love the unusual names you gave your kitties!

Take a look at Ravan's SS if you want to see an unpredictable,:D BOUNCY Kitty.

I've been doing this for only 9 months & Ravan is Very bouncy. I find if I hold the dose for the full 3 days It causes less dramatic bounces when I increase or decrease.
I've been told by one of the "experts" that kitty can bounce from being in Low numbers or from reducing the dose. Insulin is a powerful Hormone & their little body takes a while to adjust to the new dose.

Why don't the LOW ,below 50, #'s go Lime Green on your SS?
I didn't even notice that Yemala went that low. Maybe someone can look at your SS & correct it?

Hope your day goes GREAT!:)
 
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I haven't even posted here about the foster boys on the porch.

Darmok and Jalad (at Tanagra) are learning how to trust humans and gain weight and kill time until I can get them neutered. I linked in a photo of Darmok, who is a LOT easier to get on camera. Jalad is a squirmy devil, never stands still, and thinks cameras are things to sniff n biff.

Jalad is black and has a spot of white on his chest and tummy; Darmok is nearly solid black with a few white hairs on his chest.

Other than that, we have Yemala (sister Erzuli GA March 2017), Gary, Emmeline Pankhurst (GA Sept. 2018), Rosalind P. Kittenhead, Castor, Zadok, and Serendipity.

On the back porch, we have the parents of Castor, Esther and Brighton.

Full cat house here. Looking for a new home for the little boys on the porch. It's not heated out there, we're in Iowa, and once they're fixed, they need a permanent family.
 

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JoyBee&Ravan said:
Why don't the LOW ,below 50, #'s go Lime Green on your SS?
I didn't even notice that Yemala went that low. Maybe someone can look at your SS & correct it?

Hope your day goes GREAT!:)
Click to expand...

I don't know for sure, but Mala's chart was established first in 2006. We lost all that data during an FDMB update. The current chart was established in 2011, and the programming may have been tweaked since then. Perhaps a more experienced hand could take a look and see if we can get that changed.
 
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So, how many people who watch Mala's thread can tell that two VERY different people post here?

Good God, Davey. You are a casual wordsmith.
 
I have cut and pasted this from Taco's convo with Margie and Gracie, who I KNOW are experienced hands. I'm trying to determine whether this is a viable strategy for Mala. On a smaller scale, we've been changing up the dosage in ways that feel rapid (though I still think we held the .5 dose too long) and too often, our decisions seem ad hoc and not part of a long term strategy.

So a reduction would be warranted IAOI Mala (who is now considered a long-term diabetic) drops below a 40. If she is below 50 at her nadir, AND her PS level is over 300, maintain the dose. Decrease the dose by .25 IF her PS level is under 200.

How else do they earn a dose decrease? What is the criteria for determining whether kitty needs a higher dose? I know it takes 3-6 cycles for the insulin to shake down and show results, and we were just starting to feel comfortable with the numbers after the increase to 1 u when it looked like she was moving in the wrong direction.

Please be kind - we're really noobs and utterly out of our depth here, and while I do read everything that looks relevant, it all begins to swim in my head after awhile.

What, BTW, is a BCS? I can't find that one on the glossary list.

I’d suggest that next time he earns a reduction, unless you can’t test for whatever reason, that you just reduce the dose by 0.25u or, if he has started to bounce by shot time, shoot through the bounce with the dose that warranted the reduction and then reduce by 0.25u at the next shot time.

An example:
A 3u dose results in a BG below 50 during the cycle warranting a dose reduction.
Next PS after the low is 300 or more; it would be fine to shoot through the bounce with a 3u dose provided the CG can monitor.
Conversely, if the next PS after the low is in the 200 range or lower, reduce the dose by 0.25u.

Make sense?
 
Easy answer first....BCS is slang for a temporarily reduced dose. It actually stands for big chicken sh*t dose. ;)

For a long-term diabetic, dose reductions are earned by dropping below 40 once, dropping between 40 and 50 on three separate days, or being in normal numbers (mostly green) for a week. That is for TR. I haven’t read through the entire condo yet but I would like to....I just saw you’ve asked the question some time ago and hadn’t received a response.

Under the TR protocol, if you aren’t seeing green nadirs, the dose should be increased. Once you increase the dose, it can take six cycles for the depot to fill. If you are seeing nadirs in the 100-199 range or lower, you should hold the dose longer.

It’s important to understand the context under which I wrote that for Cindy and Taco.

Some time ago, members started shooting BCS doses after a reduction if the numbers were still blue or green so they could drain the depot. This is not a good tactic unless you’ve got a high dose cat with a huge depot or unless there is no way you can monitor that cycle. For one, it’s not necessary and, secondly, there is a good chance the cycle will play out the same way it would have with the full (reduced) dose. I noticed that Cindy had done this twice recently at the advice of other members and I just wanted to comment that shooting a BCS like that is more for the CG and not the cat; that’s fine if the CG is exhausted and just can’t test all night but the reality is the BG might drop low again either way due to the effects of the higher dose reduced from.

I was also explaining about shooting through the bounce after a reduction and that’s what the example above referred to.

Hroswitha said:
If she is below 50 at her nadir, AND her PS level is over 300, maintain the dose. Decrease the dose by .25 IF her PS level is under 200.
Click to expand...
We don’t typically dose on the PS level so you wouldn’t reduce the dose based on the PS unless the PS is her nadir (as in cats that have late nadirs on lantus or are on Levemir). And even then, you wouldn’t decrease the dose if the PS was higher than 40 for a long-term diabetic and that’s if the PS is the nadir.

Please let me know if I’m not understanding your question correctly.

I’d like to take a few minutes and read through the condo and then edit any comments that might have resulted from me misunderstanding what you are asking. I’d also like to look at her SS and see if there is something I could suggest to help you although I see Wendy has been posting here today and she and I are usually on the same page.

Hroswitha said:
I don't know for sure, but Mala's chart was established first in 2006. We lost all that data during an FDMB update. The current chart was established in 2011, and the programming may have been tweaked since then. Perhaps a more experienced hand could take a look and see if we can get that changed.
Click to expand...
I’ve been suggesting to CGs with old SSs like this that we make a new SS and link the old one to it. The reason is because the old SSs were corrupted. I’d be happy to do this for you if you want to send me a PM. I can move the data over to a new SS so you won’t lose anything.
 
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Pls read my post above before this one.

I’d like to toss my hat into the ring of commenters. My thoughts are the same as Wendy’s but I’ll add a few others. To summarize:
  • You could have shot the AMPS this morning on time without stalling or perhaps could have stalled just long enough to see if anyone be could be with you today online and walk you through any low numbers.
  • IMHO, Mala doesn’t look much different from most of the cats whose SSs I’ve looked at over the last 8 years so there is no reason you can’t follow the TR protocol for long-term diabetics; she doesn’t need any special dosing at this time.
  • As you noted, you’ve held doses too long. Not a criticism, just an observation to help you. As Wendy said, returning from remission, you need to be more aggressive in dosing because getting them back into remission a subsequent time is usually harder. That doesn’t mean increasing a dose on a bounce clearing cycle but it means don’t hold doses long if you aren’t getting anywhere.
  • I wouldn’t have reduced the dose on the evening cycle of 10/4; she didn’t earn it and you’ve correctly noted that by how long she stayed in high numbers after you reduced.
  • Because she was just offering you a spatter of green here and there on 0.75u, I would have increased the dose to 1u around 10/16 or 10/17 to see if that extra insulin could have kicked her in the pants :)
  • And, as Wendy already noted, she didn’t earn a reduction from 1u but since you’ve taken her down, see how she does. Because you skipped the shot this morning, you’ll want to give her a few cycles to rebuild her depot. You can see tonight that she ran out of duration from the depot but she’s coming back down now that she has onset. That’s great!
One comment I read said that the CG had been told bounces are caused by low numbers and when the dose is reduced. This isn’t actually accurate. Bounces are caused by numbers lower than the liver is used to, low numbers, and fast drops like you see when a bounce is clearing (it’s what we call a dive/bounce pattern). A cat might bounce after a reduction but that’s likely due to one of the other reasons for bounces that I just mentioned.

And that brings me to why you are likely seeing reds and pinks.....fast drops and lower numbers like the evening of 10/13 where she went from 203 to 60 in three hours. I have found the faster the drop, the harder and higher the bounce.

Bottom line: I’d try and follow the TR protocol as closely as you can and remember you have a tougher battle to get her back into remission than someone with a newly diagnosed cat. But it can be done and you and Davey make a good pair to do it.

At some point, we might need to discuss feeding schedules.

Pls let me know if you have questions.
 
+ 7 is 88.

Feeding schedules?

Okay, that's a good question to ask. Let me give you her feeding schedule now.

Yemala is fed small amounts of lc food quite often. She's a nibbler, and will never eat more than about 1/3 to 1/2 what she is presented. When she's finished, we remove access to the food and wait.

So on average, Mala will get food at 6 AM. She'll eat some, but not finish a full portion. She walks away and attempts to investigate the dishes of other cats, but we try to stay on top of her and remove unfinished dishes left by the civvies in our care. Eventually, she'll make her way back to her own dish, and nibble a little more before walking off to bathe and nap.

About 2 hours later, she's awake and hungry again. She'll get around 1 T of lc food, and she typically eats all of that. Rince and repeat through the morning.

On average, she will eat around 5-6 ounces of lc food which is also low in phosphates but high in protein. She eats Nature's Recipe grain free chicken and chicken liver in broth and Weruva chicken frickazee. Both fall into reasonable ranges given her CKD and diabetes.

We are particularly focused on feeding her when she's surfing to keep her numbers from falling too low and the bounce from jumping too high afterwards.

If any of this is incorrect, we can do some adjustments. But Mala is a particularly focused and demanding kitty when it comes to food. When she wants it, she won't accept a no. I have to physically leave the house to get her to stop - it's head butts, paws slapping at my face, howls at close range, total torti stuff. Theoretically, we could train her to eat more at meal time, but she has been in this pattern for some time.

So if I understand the protocol correctly, we were holding the .5 dose for too long, which I had suspected. She should have gone up to a 1 u dose before we took here there, and she didn't earn a reduction to .75 when we took her down. We should try to hold the .75 for at least 6 cycles and see where the numbers take her as the depot fills up again. If she doesn't drop below a 40 at nadir, we maintain. Decrease only comes from a below 40 nadir or roughly a week of greens with a few blues.

Going forward, unless she drops below 40 as noted, hold the .75. If she slides back into pinks or reds, increase the dose after roughly 6 cycles to 1u and hold for another 6 cycles unless she earns a decrease legitimately. We need to be more aggressive and more courageous in dosing low numbers, as long as someone can check on her during that cycle.

Am I even close?
 
Hi @Marje and Gracie. Good to see you!
I just wanted to comment and clarify a couple of things you said above, as I was the one who suggested Renee not shoot the 55.
I was surprised you said she could have shot that number without even stalling. Also that both you and Wendy were happy for her to shoot the 55 even though she had not shot a higher green before and the number wasn't rising.
Her previous lowest preshot was 113 and she has had no green preshots at all, this time around. She had also given a small amount of food without realising what stalling meant and after testing twice the bsl hadn't moved........I know that not having food at this point can keep the number down but I felt that given that she had not shot a high green before and the number wasn't moving, even with a small amount of food, it would be safest to skip ( and I couldn't stay with her as it was late at night here). I know she has lots of data........
I'm just wanting to understand it all..............it is not unusual to find myself being the only one on the board, that I can see, with any experience to help in these situations, or who is willing/ able to help someone with a very low preshot (when you are all asleep on the other side of the world) and I don't want to give incorrect advice.
Thanks Marje.
Bron
 
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