Yemala 10/27 PMPS 245; +1 205; +2 116*; +3 108*; +4 118; +6 148
- Thread starter Hroswitha
- Start date
Rosie & Bailey
Member Since 2018
Hope Yemala get's back into the greens soon.
Hroswitha
Member Since 2011
+6 is 205.
However, the +4 was taken on a different meter, given the complexities of using the One Touch. I have noted before that the One Touch gives a higher reading than the CVS meter - we have seen a difference of 20 points on the same sample.
It may be that we'll shave the PM dose a little higher - between .5 and .25, if possible, and see where we are this evening.
However, the +4 was taken on a different meter, given the complexities of using the One Touch. I have noted before that the One Touch gives a higher reading than the CVS meter - we have seen a difference of 20 points on the same sample.
It may be that we'll shave the PM dose a little higher - between .5 and .25, if possible, and see where we are this evening.
Chris & China (GA)
Member Since 2013
Please don't change the dose again …..stay with the .25 for now. Remember, every time you change the dose, you disrupt the depot. We need to stabilize it so we really know what's going on.
It looks like she's "bouncing" from yesterday's low number. Bounces don't always go straight up and then come straight down....they can "wobble" a bit and go up, down a bit, up again, down a little....and then (hopefully) start to come down and stay down (and return to those "good numbers" we are wanting)
Chris & China (GA)
Member Since 2013
Yes (edited to add..Up to 6 cycles..with a caveat explained below)
Awwww.....well of course she wants adoration......she's a cat! They expect to be treated like the kings and queens they are!!
We are just the servants
Last edited:
No, we don’t hold the dose after a reduction a set number of cycles like we do increases. Remember that I explained the other day that on reductions, you only hold the dose long enough for any bounce to clear and see whether she comes back to green. Could that possibly be six cycles? Yes, because “most” bounces will clear within six cycles but she might clear in two. If she does, and she’s not in green, then you don’t continue to hold the dose.
I’m sorry I didn’t get to check in yesterday but I read the condo early this morning and I have some comments so let me copy all of that and move it over here.
BTW, I used a One Touch for quite a long time and I actually am convinced that it is one of the most accurate and reliable human meters. (I had several including the OT, two ReliOns, a Contour, and an AT2). The only reason I switched from OT to ReliOn Micro was due to the sample size being so large for the OT.
Last edited:
Hroswitha
Member Since 2011
She's at 242 after a +8. This is a bounce, right?
When it clears, she should be either in the greens or the low blues. At least, that's what I understand so far.
If she continues in the 200s, we consider that a failed reduction? How long do we wait to see if the bounce clears? She may clear in 2, you write, but if she's still in higher numbers in 4, do we take her back to the higher dose?
Again, I'm struggling to find patterns in her numbers.
As meters go, I was using the Accucheck Aviva for a long time. The price of the strips keeps increasing, and given how much Mala needs to be checked, I had to go to something else. I don't like the OT, as the sample size is bigger, the meter times out too quickly, I don't get audible signs when the meter is ready or has enough blood, and it's not as fast.
I worry, though, about the CVS meter, though reviews on line are pretty solid. It tends to be around 20 pts. lower than the OT, though I've only done one test on both.
When it clears, she should be either in the greens or the low blues. At least, that's what I understand so far.
If she continues in the 200s, we consider that a failed reduction? How long do we wait to see if the bounce clears? She may clear in 2, you write, but if she's still in higher numbers in 4, do we take her back to the higher dose?
Again, I'm struggling to find patterns in her numbers.
As meters go, I was using the Accucheck Aviva for a long time. The price of the strips keeps increasing, and given how much Mala needs to be checked, I had to go to something else. I don't like the OT, as the sample size is bigger, the meter times out too quickly, I don't get audible signs when the meter is ready or has enough blood, and it's not as fast.
I worry, though, about the CVS meter, though reviews on line are pretty solid. It tends to be around 20 pts. lower than the OT, though I've only done one test on both.
Chris & China (GA)
Member Since 2013
Probably yes (she's a slow bouncer!...most cats bounce within the same cycle that they drop low or very soon after)
That's what we hope!
Let's say she continue to "bounce" up to 300 (this is just an example)…..then tomorrow she starts to come down throughout the cycle down to 190....you give .25 again and she continues down but only to 130 and gets "stuck" there with no more downward momentum.....at that point, we'd call it a failed reduction even if it hadn't been 6 total cycles.
Does that make sense?
Hopefully Marje can help explain too. Sometimes one person's explanation is clearer than someone else's but what's important is that you understand what we're thinking.
Last edited:
Bobbie And Bubba
Member Since 2015
Failed reductions are one of the hardest things to wrap the mind around. As Chris says, when they are bouncing the numbers wobble around, go high, go lower, go higher, go lower. If after a cycle of the lowest number then all of a sudden the numbers don't wobble any more , but rather start a straight upward movement, that's when it is a failed reduction. Or another scenario is as Chris said, they get "stuck" in that lowest number blue number with no more downward movement.
Hroswitha
Member Since 2011
Okay, so let me think here about what happened yesterday.
She received a .5 dose at 6 AM. At +2, she had dropped to 150. Before I left for work, I fed lc food to help with the surf, if possible, as her nadirs are between +4 and +7. My son tested at +3 and found her in the 70s. He fed some medium carb food, about a T, and checked again a half hour later. At that point, she had already dropped into the 30s. He tested and fed 17% carb food laced with honey from +4 - +7, checking every half hour. At +7, she was in the blues and he stopped feeding.
Given what we have learned about her cycles and the TR protocol, this would seem to indicate the necessity of a reduction in dose to .25. For 2 cycles, her PS numbers have been blue, but she spikes at +2 slightly, then drops into the blues. Last night, we let her rest after a full day of testing once she was through the nadir. AMPS wasn't bad - 132 - but she's spiked back into the yellows.
This means a bounce. So we're looking for it to clear within a few cycles and, if it does, we maintain the dose if the numbers are green. If she remains in the mid-100s or continues to bounce higher, it's a failed reduction and we increase again to .5.
She received a .5 dose at 6 AM. At +2, she had dropped to 150. Before I left for work, I fed lc food to help with the surf, if possible, as her nadirs are between +4 and +7. My son tested at +3 and found her in the 70s. He fed some medium carb food, about a T, and checked again a half hour later. At that point, she had already dropped into the 30s. He tested and fed 17% carb food laced with honey from +4 - +7, checking every half hour. At +7, she was in the blues and he stopped feeding.
Given what we have learned about her cycles and the TR protocol, this would seem to indicate the necessity of a reduction in dose to .25. For 2 cycles, her PS numbers have been blue, but she spikes at +2 slightly, then drops into the blues. Last night, we let her rest after a full day of testing once she was through the nadir. AMPS wasn't bad - 132 - but she's spiked back into the yellows.
This means a bounce. So we're looking for it to clear within a few cycles and, if it does, we maintain the dose if the numbers are green. If she remains in the mid-100s or continues to bounce higher, it's a failed reduction and we increase again to .5.
Chris & China (GA)
Member Since 2013
Bounces can take UP TO 6 cycles to clear, but generally, yes, you've got it!
Right
This post is addressing yesterday’s cycles but I’ll also respond to your posts #9 towards the end.
It’s possible yesterday's lows were from the 0.75u depot but I, like Wendy, don’t take chances with 30s. It’s safer to reduce the dose and then go back up if the reduction fails.
I’d like to answer some of the questions you posted yesterday.
I know we’ve been saying that you have to be a bit more aggressive this time around but safety always has to come first and if that cycle looks like it is stacking up to potentially be a low one and there’s no one there to test/feed, then take the safest option. Just remember that if you do skip a shot because numbers might potentially go low, you will still want to leave out some MC food because the depot could cause some lower numbers at least earlier in the cycle. You could even feed a MC food before you leave, give it 30 minutes, test to be sure she is headed up. If she gets a pretty good food spike before you leave and she doesn’t have a shot in her to onset from, then hopefully the MC food will keep her up a bit. Other options:
--shoot two 18 hour cycles if you will be home by +18
--if she’s running consistently lower and you are really worried about being gone, drop the dose back for a couple cycles starting the night before to start a depot drain. It’s not ideal but it’s safe and it gets a small amount of insulin in her so you aren’t draining the depot to the extent you would with a skipped shot.
With Mala, if she’s going to dive, it might even be waiting too long to wait to +2 to test her. What I’m seeing yesterday is the beginning of a bounce at AMPS. Going forward, it might be worthwhile if you see a low yellow number at PS, you might want to test at +1, if you are there, and see where she’s headed. The only way to figure this out with her right now, is to test a little bit more. And remember that if the dose is lower, the bounces might last longer. We can’t predict what any bouncy cat will do but with a little bit of investigative work, we might be able to really start to see some patterns as you get more data.
Here’s a good example of a failed reduction: Luci’s SS
Scroll down to 2/14/18 when the reduction was earned from 0.75u to 0.5u during the a.m. cycle. Sue shot through the bounce the evening after the reduction which was a good move on her part. She gave the reduction the next morning as Luci continued the bounce. She held the reduced longer than I would have but it’s likely because she wasn’t sure whether the bounce was completely cleared when Luci dropped into blue. She might have even thought the 428 was a high before the break but since it wasn’t, I would have taken the dose back up absolutely by 2/17 and that would have been pretty conservative. As you can see, she did eventually increase the dose back up and Luci came back down into green within three cycles and earned a reduction. The dose was reduced, the reduction failed, she took her back up.
This is a very distinctive and common pattern. I’ve seen many, many times in tons of other cats and also in Gracie and have said myself, and often hear, “one dose is too much and the next is too little”. That’s what Wendy was also saying to you.....we might need to find a dose between 0.25u and 0.5u that works for Mala but I’d stick with 0.25u until we can see.
A cat that has dive/bounces might be at 300 at PS and 50 or lower at nadir. So you can see, if that is a consistent pattern on a specific dose, you wouldn’t want to call that a failed reduction and increase the dose. What we do is work with the food to flatten all of that out and bring the low part of the cycle up which would then allow for a dose increase safely.
First, go back to onset, nadir, duration. See if you can identify those in her SS. That’s so important. What I often find is members don’t have a clue what their cat’s duration is (and it can change). When they see numbers go from green to pink in a couple of hours, they consider it to be a bounce. Most likely, it’s a loss of duration. It might eventually have a touch of bounce in it as well but if you see numbers skyrocket within a few hours in a cycle, be prepared that they might come right back down once the next shot onsets.
I know this will frustrate you but data is your best friend right now and you all are doing a great job collecting it. Your clue today that she was going to bounce was that her +2 was more than meter variance (20%) higher than her PS. You might want to remark on her SS that you used a different meter at +4. What meter did you use at +6 for the 205? These are important things to know but even more important is sticking with one meter
I’ve thrown a lot of info at you but you had a lot of unanswered questions and I want to help you. I’ve got to be out the rest of the day but will check back tonight for any further questions, ok?
It’s possible yesterday's lows were from the 0.75u depot but I, like Wendy, don’t take chances with 30s. It’s safer to reduce the dose and then go back up if the reduction fails.
I’d like to answer some of the questions you posted yesterday.
You have to take it a cycle and day at a time. We can’t predict what might be happening in four days. One thing you can try, though, is to get an auto feeder and set it up for the times you would need to feed to manage the curve. If you get up that day and you are worried she might drop, you can put MC in the feeder or skip the shot.
I know we’ve been saying that you have to be a bit more aggressive this time around but safety always has to come first and if that cycle looks like it is stacking up to potentially be a low one and there’s no one there to test/feed, then take the safest option. Just remember that if you do skip a shot because numbers might potentially go low, you will still want to leave out some MC food because the depot could cause some lower numbers at least earlier in the cycle. You could even feed a MC food before you leave, give it 30 minutes, test to be sure she is headed up. If she gets a pretty good food spike before you leave and she doesn’t have a shot in her to onset from, then hopefully the MC food will keep her up a bit. Other options:
--shoot two 18 hour cycles if you will be home by +18
--if she’s running consistently lower and you are really worried about being gone, drop the dose back for a couple cycles starting the night before to start a depot drain. It’s not ideal but it’s safe and it gets a small amount of insulin in her so you aren’t draining the depot to the extent you would with a skipped shot.
We usually don’t even look too far back past a few weeks to find patterns so going back to 2011, especially given her CKD diagnosis, is likely not helpful. IMHO.
Those pinks weren’t a bounce. That was loss of duration from the skipped shot. How can I tell the difference? (1) skipped shot so depot will drain (2) BG increased rapidly the cycle where you gave no shot (3) as soon as you gave the evening shot, the BG came right back down; while bounces can clear quickly (as we saw with Mala yesterday), all of these together tell me that was totally loss of duration, not a bounce.
I know it doesn’t help your frustration but believe me, I’ve been there. Gracie was often very unpredictable but we got to the point where we could read her unpredictability fairly well; she still surprised us. She could go along for weeks in green numbers and then, out of nowhere, start dive/bounce cycles. That’s when I upped the testing and feeding to slow those big dives down and get her flattened back out. The challenge is finding out what it takes to get Mala to do that. It is completely ECID. But...what I did, even on levemir which onsets much later than lantus, was to start testing at +1 and if the numbers started to drop even that early (from a bounce clearing), I started going with the higher LC food and gave a little extra of it. If the drop at +1 was big, I’d bring out bigger carb guns,
With Mala, if she’s going to dive, it might even be waiting too long to wait to +2 to test her. What I’m seeing yesterday is the beginning of a bounce at AMPS. Going forward, it might be worthwhile if you see a low yellow number at PS, you might want to test at +1, if you are there, and see where she’s headed. The only way to figure this out with her right now, is to test a little bit more. And remember that if the dose is lower, the bounces might last longer. We can’t predict what any bouncy cat will do but with a little bit of investigative work, we might be able to really start to see some patterns as you get more data.
It’s just not possible to be thinking of a dose three days out. See my response above.
Let’s be sure that we understand that there is a difference between low numbers in the hypoglycemic range and an actual hypo. I don’t believe she has had a symptomatic hypo since she’s been on insulin this time. You said last go round she had a 23 and you almost lost her but I don’t see that on her SS. I see a 27 but there is no mention of any hypo symptoms. I also didn’t see where anyone predicted she would bounce yesterday. It might have been said that she “might” bounce but one could say that about any cat who has been a bit bouncy after lower numbers.
One thing that can help a lot is reading other condos and looking at other SSs. I know you are busy but there’s a lot to be learned as to what different patterns look like and a lot of great information gets disseminated in different condos.
Here’s a good example of a failed reduction: Luci’s SS
Scroll down to 2/14/18 when the reduction was earned from 0.75u to 0.5u during the a.m. cycle. Sue shot through the bounce the evening after the reduction which was a good move on her part. She gave the reduction the next morning as Luci continued the bounce. She held the reduced longer than I would have but it’s likely because she wasn’t sure whether the bounce was completely cleared when Luci dropped into blue. She might have even thought the 428 was a high before the break but since it wasn’t, I would have taken the dose back up absolutely by 2/17 and that would have been pretty conservative. As you can see, she did eventually increase the dose back up and Luci came back down into green within three cycles and earned a reduction. The dose was reduced, the reduction failed, she took her back up.
This is a very distinctive and common pattern. I’ve seen many, many times in tons of other cats and also in Gracie and have said myself, and often hear, “one dose is too much and the next is too little”. That’s what Wendy was also saying to you.....we might need to find a dose between 0.25u and 0.5u that works for Mala but I’d stick with 0.25u until we can see.
A cat that has dive/bounces might be at 300 at PS and 50 or lower at nadir. So you can see, if that is a consistent pattern on a specific dose, you wouldn’t want to call that a failed reduction and increase the dose. What we do is work with the food to flatten all of that out and bring the low part of the cycle up which would then allow for a dose increase safely.
First, go back to onset, nadir, duration. See if you can identify those in her SS. That’s so important. What I often find is members don’t have a clue what their cat’s duration is (and it can change). When they see numbers go from green to pink in a couple of hours, they consider it to be a bounce. Most likely, it’s a loss of duration. It might eventually have a touch of bounce in it as well but if you see numbers skyrocket within a few hours in a cycle, be prepared that they might come right back down once the next shot onsets.
I know this will frustrate you but data is your best friend right now and you all are doing a great job collecting it. Your clue today that she was going to bounce was that her +2 was more than meter variance (20%) higher than her PS. You might want to remark on her SS that you used a different meter at +4. What meter did you use at +6 for the 205? These are important things to know but even more important is sticking with one meter
She was down a lot at +2. I would have fed more than her regular LC (a higher LC or more of it) because she wasn’t surfing.....she was dropping. Surfing is once you get them flat and you want to hold that. Max did a really good job yesterday.....smart young man!
Correct except, if it were me, if she doesn’t come back into green, I’d increase the dose. I would not hold a dose that left her in mid 100s. Also, remember that some cats will get a high before the break; in other words, the numbers wobble, then go really high, and then break and that bounce clearing cycle can be really active. If you look at 10/18, this gives you an idea of what that might look like (although the numbers might not be that high). She bounced up, came down to yellow, then went higher, was red at PMPS, and then cleared to blue.
I’ve thrown a lot of info at you but you had a lot of unanswered questions and I want to help you. I’ve got to be out the rest of the day but will check back tonight for any further questions, ok?
Last edited:
Hroswitha
Member Since 2011
Dave and I will have to revisit this post and do more digesting, but I did want to remark on one thing.
A feeder will not be possible in our household. Right now, Mala is only the oldest of 6 indoor cats. She gets frequent feedings to help with surf, but meal times involve multiple humans working to keep cats eating the correct food and out of the special food. Our young ones - Castor, Zadok, and Dippy - are excited about Mala's Weruva.
Mala, on her part, nibbles, walks a few steps away, then returns to "rediscover" the food. She'll take up to a half hour to fully eat, which makes lc feeding for surfs challenging if no one can monitor.
Locking her in a room is not possible. Don't ask. The last time we tried, it took months to find all the piss pools and poops she deposited.
I am considering getting her a feeding crate with a thing on a collar that will permit Mala and only Mala in to eat. I'm not convinced we can get her to use it - covered cat boxes are snubbed, so god knows if she would use an expensive feeding crate - but we might move in that direction.
We will continue to gather data. She is frustrating.
One additional note - the hypo in question isn't on any chart. It was 2015, Mala had not been on insulin for 4 years. She woke me at 4 AM showing clear and absolute signs of hypo. She couldn't walk, hold her head, she was in tremors, her hind quarters shuddered and couldn't be steered. We tested her, and she was under 20. The nearest emergency vet was 40 minutes from us, so we fed her honey and kibble and anything we could get in her. When we did get her to a vet, no signs of a stroke or poisoning or any other issue. She was normal by then. I don't want to go through that again.
A feeder will not be possible in our household. Right now, Mala is only the oldest of 6 indoor cats. She gets frequent feedings to help with surf, but meal times involve multiple humans working to keep cats eating the correct food and out of the special food. Our young ones - Castor, Zadok, and Dippy - are excited about Mala's Weruva.
Mala, on her part, nibbles, walks a few steps away, then returns to "rediscover" the food. She'll take up to a half hour to fully eat, which makes lc feeding for surfs challenging if no one can monitor.
Locking her in a room is not possible. Don't ask. The last time we tried, it took months to find all the piss pools and poops she deposited.
I am considering getting her a feeding crate with a thing on a collar that will permit Mala and only Mala in to eat. I'm not convinced we can get her to use it - covered cat boxes are snubbed, so god knows if she would use an expensive feeding crate - but we might move in that direction.
We will continue to gather data. She is frustrating.
One additional note - the hypo in question isn't on any chart. It was 2015, Mala had not been on insulin for 4 years. She woke me at 4 AM showing clear and absolute signs of hypo. She couldn't walk, hold her head, she was in tremors, her hind quarters shuddered and couldn't be steered. We tested her, and she was under 20. The nearest emergency vet was 40 minutes from us, so we fed her honey and kibble and anything we could get in her. When we did get her to a vet, no signs of a stroke or poisoning or any other issue. She was normal by then. I don't want to go through that again.
Hroswitha
Member Since 2011
Slight correction: she doesn't snub the covered boxes; she happily hops right into them...then happily stands there right where she landed and happily whizzes right back out the opening all over the goddamn floor (grumbles the poor slob who's been cleaning these up almost daily).
Torties, man.
Torties, man.
Was she on insulin at that time in 2015? We’ve had cats in remission here drop into the 20s and 30s (no insulin involved). I liken it as being similar to a human who doesn’t eat and their blood glucose drops. However, there is a condition where they do this consistently and Judy (Boomer’s mom) has a civvie who has issues with this (dropping into low BG such as 18-20 and he’s never been diabetic.
Having said that, we certainly do not want any kitty on insulin getting so low that they have a symptomatic hypo.
Chris & China (GA)
Member Since 2013
Good catch!!
Looks like she's clearing that bounce fast!
Looks like she's clearing that bounce fast!
Yes, and really good job catching the drop. You’ll have more room for the PMPS numbers if you edit the title and delete all the AMPS numbers. We don’t need them now and we can always check her SS if we want them. Thank you.
Chris & China (GA)
Member Since 2013
That's really the same number as the +2, not really dropping
It would be great if the next test was in the same general area....Like between 90-110'ish
I agree with Chris. Now we want to see if she can surf.
Fantastic! See...you can do this!
Hroswitha
Member Since 2011
If she's not dropped into low numbers by now, I don't think she will. She may surprise me, but I have a feeling tonight she's stay in high greens and low blues.
Tomorrow, same dose, yes? See if it can bring her down into a nice and safe even keel and banish the yellows.
Tomorrow, same dose, yes? See if it can bring her down into a nice and safe even keel and banish the yellows.
Yes, same dose tomorrow.
I would really suggest you grab one more test. It’s still early in the cycle and you fed some MC. If she’s very carb sensitive, she could come back down a bit.