NEW Update: Josie's bouncy return

I actually think I could play hooky today! I mean, "work from home."

I'll see where she is in another 15 minutes and then decide. But surely the food should have kicked in already, right? Since when a cat is in low numbers, we feed and retest in 20 minutes, I assume that 30 mins is enough to start seeing an impact even when their [they’re] *not* in too-low numbers? But maybe the physiology is different when their numbers are "good" -- ?
 
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Djamila said:
That's what I'm afraid of....that it would work until it didn't.
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Me too! Every time I've reduced on a low PS, it's been the wrong decision . . . except that one time a few months ago when it wasn't and we were up with her till 2 am!

Kris: you must have nerves of steel!
 
(Also, at some other time, could someone explain to me how to tell/if it's possible to tell the difference between a late nadir that means the dose is too high and a late nadir that means the cat just has a late nadir?)
 
There isn't an exact way to tell. Mostly you look at the big picture of the numbers over time. If the increases have been steady and appropriate, and the cat isn't getting any low mid-cycle numbers (and the human is testing enough to know that), then it's probably late nadir. If the increases have been too fast, too big, or the dosing inconsistent. Or if the kitty is swinging from greens to pinks to blues to blacks, then the dose is probably too big.

The other way to tell that it's too high of a dose is if you see a low PS, reduce the dose, and get a better cycle.
It's too low of a dose/late nadir if you see a low PS, lower the dose, and get a worse cycle.

Honestly it's pretty rare for a kitty to be on too high of a dose if they've been here for awhile. That's more often seen in newly diagnosed cats when they show up here having been following bad vet advice for awhile.
 
I want to decide to stay home! I'm jealous. Alas, my day is FULL of meetings, so no luck. I'm going to try to sneak home at lunch to give Sam a little more R. It seems to be the only thing holding his numbers down right now.
 
Jenna Josie said:
(Also, at some other time, could someone explain to me how to tell/if it's possible to tell the difference between a late nadir that means the dose is too high and a late nadir that means the cat just has a late nadir?)
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The answer to this still eludes me. Maybe I have nerves of steel after almost 3 years of Teasel antics or maybe I've just charted a moderate course through choppy waters ... All I know is that I can't dose him close to the edge. Many would look at his SS and say, "What the heck is she doing??" :confused:;)
 
Kris: Or some might look at Teasel's SS and say, when will I ever know so much? ;)

Djamila: I think we're even on the jealousy. I may get to work from home spontaneously most days, but you get to go see PNB whenever they're in season! And probably other concerts when they're not. :) I am sorry that Sam's BG is giving you so much trouble, though.
 
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I ended up giving Josie 1.6 this morning based on one last test that was at least a little higher than during the “Teasel Reverse” experiment. She had, for her, a nice long soak in the blues — about 15 hours, I think, beginning at her +3 last night.

I’m not sure what to do for tonight. I think (though what do I know, really — she’ll do what she does! :rolleyes:) that she’ll be in the high yellows or even the pinks for her PS based on her +7 (231). My hypothesis is that she’s bouncing up after the blue stretch.

So a week on 2u didn’t do much for long, but her first 2.2u dose last night resulted in this AM’s drama. Still, she does seem to have a pattern of big reactions (for her, anyway; I.e., very long cycles) in the first cycle of a dose increase, so I don’t know if I should keep the 2.2 and ride it out, or go back to 2, or maybe eyeball a 2.1? (A “fat 2u”). All assuming, of course, that her numbers stay headed in this trajectory ...

On the plus side, she feels great! She insisted on being let out on the balcony and despite her neuropathy managed a three foot leap onto the covered balcony furniture (tough landing, that!) to find the last remnant of sunshine. I think she looks quite proud of herself.
 

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Jenna Josie said:
So a week on 2u didn’t do much for long, but her first 2.2u dose last night resulted in this AM’s drama. Still, she does seem to have a pattern of big reactions (for her, anyway; I.e., very long cycles) in the first cycle of a dose increase, so I don’t know if I should keep the 2.2 and ride it out, or go back to 2, or maybe eyeball a 2.1? (A “fat 2u”). All assuming, of course, that her numbers stay headed in this trajectory ...
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An initial big reaction followed by a calmer response is a fairly common thing. You could try riding it out when you're home to monitor - more data for your reference library.

She looks very cute sitting out on the covered furniture. :)
 
I agree with Kris on both points: it's a fairly common pattern and I'd try to hold the 2.2u dose if she lets you.

And yes, there are lots of great shows around here! :)
 
She's letting me! PS = 292 (which . . . is actually what I thought it would be! That almost *never* happens, lol!)

Depending on her +3, I may set an alarm and see where she is later in the cycle. We have very little PM cycle data, except for that one +10 on election day, but that only happened b/c I left the house to vote and so didn't have to deal with her and the civvie pretending to be starving and begging for food for another two hours. :rolleyes:
 
Haha! Yes I found that going on a walk or taking a long shower when everyone is begging for food has been very helpful for me in the past!
 
Well . . . now I have some PM cycle data! lol

Josie went down 80% (!) of her PS value overnight, with a long nadir between +7 +8 +9. <--- I gave her a little bit of food at each of those tests since she was down to 60, and we think she has late nadirs.

So now at least I know that yes, she is on her way back up when she has these low (for her) PS numbers. She's at 103 right now.

Now is technically her shot time, but I am not giving her anything just yet. I'm super-happy to see greens, but wasn't that drop a little, um, dramatic?

Aiming to shoot by 8:30 CDT (one hour) if anyone has any opinions on dosing after last night's data!
 
Wow! Well isn't that interesting? At +4 she was giving no hint that she's spending her nights in lower numbers. And no hints during the AM cycles either. Good job staying up and testing! I hope you can get a nap today!

Now that raises a few questions: is she doing that often? Is she low at night and bouncing during the day? Should you lower the dose? Or keep the dose until she settles out and we start to see some daytime greens? So many questions!
 
@Djamila Yes indeed, those are the questions! :D

I’m definitely not shooting until +13. I really want to see where this prolonged cycle is heading. If it looks like the last couple of mornings, I will feel brave enough to shoot 2u, for sure, but I’ll have to wait and see about holding the 2.2u, primarily because she dropped 80%. I’m not sure about last night’s PS. I wish I had taken a 2nd test then to confirm but didn’t bc while it was a little higher than I had expected, it wasn’t completely out of line. I figured it was a delayed bounce from a soak in the blues the night before.

Thoughts? (And I’ll post additional test here in a minute ...)

The good news — beside, I mean, greens!!! — is that this upcoming week will be very flexible (bc all the students are headed out for thanksgiving break), so I can get nighttime tests with little daytime consequence for sleep deprivation.
 
I wonder if it's time to try off-setting the doses a little. I had to do that with Sam for awhile at one point. Maybe a slightly lower dose at night (2u?) and staying with the 2.2u during the day? The lower dose at night would hopefully give you a slightly higher AMPS, and the higher dose during the day could help combat the high flats you're seeing after the PM cycles.

It might not work at all, but for some cats it can be helpful.
 
Yes, that sounds like a good experiment right now!

Her +12.5 = 108, so no change. I am feeding her a bit* and will test again in 30 minutes, likely shooting 2.2u assuming some upward movement. I am not worried about throwing the schedule off a bit.

*"Teasel Reverse" <-- I always feel like I have to make a note of that b/c it's not the SOP, and I don't want anyone reading this who has a *normal* cat to think that's the standard protocol. I think I should add that to the sig block?
 
Jenna Josie said:
Yes, that sounds like a good experiment right now!

Her +12.5 = 108, so no change. I am feeding her a bit* and will test again in 30 minutes, likely shooting 2.2u assuming some upward movement. I am not worried about throwing the schedule off a bit.

*"Teasel Reverse" <-- I always feel like I have to make a note of that b/c it's not the SOP, and I don't want anyone reading this who has a *normal* cat to think that's the standard protocol. I think I should add that to the sig block?
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I break a lot of rules! I'm glad this one has proven helpful to you. Maybe make a note in your signature.
 
Man, what an ugly day this is shaping up to be for her, poor little thing. :(

I am keen to try the AM = 2.2u/ PM = 2.0u experiment, but she has been *so* high and perfectly flat all day (and she still has at least 1.5 hrs to go before even the early range of shot time.) ... would you still recommend starting the PM 2.0u tonight?

I get that we’re thinking the PM 2.2 is what set off this hideous bounce, but it always seems counterintuitive to me to reduce when she is so high. :confused:
 
Looks like a big bounce after those greens. Dosing aside you just have to ride it out. I think you could try 2 u tonight given the recent low AMPSs. With bouncing you almost have to look past those inflated numbers to see what lies beneath - the "true" insulin response. Easier said than done. :confused:
 
Yeah, it just makes me sad for her bc she looks like she feels pretty crummy ... or she’s just tired because I kept waking her up all night!

We’ll go with 2u and see what we see.
 
Oh! And something just occurred to me — not sure if it’s important or just one more complicating variable, but she does get fed slightly differently during the day: in the daytime, she gets her snack broken up, 1/4 of a three oz can at both +3 and +5 (in timers while at work), whereas at night she gets the entire 1/2 can snack at once, at +3 or +4, whenever we get her before bed test.

That could possibly be constructing to the long PM cycles?
 
Jenna Josie said:
Oh! And something just occurred to me — not sure if it’s important or just one more complicating variable, but she does get fed slightly differently during the day: in the daytime, she gets her snack broken up, 1/4 of a three oz can at both +3 and +5 (in timers while at work), whereas at night she gets the entire 1/2 can snack at once, at +3 or +4, whenever we get her before bed test.

That could possibly be constructing to the long PM cycles?
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Hard to say. Have you experimented with setting up the timed feeder overnight to see if a different food schedule makes a difference?
 
No, I haven't. Nighttime feeding is complicated by the civvie, who will eat her food, and if I leave out too much food, she'll scarf-and-barf (trying to eat it before he does!). During the work day, I put her in her own room (letting her out at midday when I can get home), and so she has her timed feeders in there with her/away from him.

I could try separating them at night for a few nights' experimenting if you think it might be worth trying -- ? (I suspect such things are harder on the humans than on the kitties!)
 
I don't think Josie is getting a shot this am (which is nuts considering what her day looked like yesterday!).

Gave the 2u last night after a whole day of flat, low-ish pinks; got a +10 a couple of hours ago: 115

AMPS: 75 (Retest = 77)

I supposed this is that high-and-flat then drop low phenomenon?

:banghead: :confused:
 
Oh sweet Josie!

Looks like she would like a bit less insulin these days!

How far off schedule can you get? Could you wait until she rises in a few hours and then move it back over the next few days?
 
She’s already 1.5 hours off! :D

The latest I can shoot tomorrow am is 9:00 CDT. That would mean the latest I could shoot tonight would be 10:00 CDT, which would mean the latest this am would be 11:00. That is in 1.5 hours from right now.

(And that of course assumes no stalling, 11-hour cycles. Not exactly her forte’. :rolleyes: )

But if I tried that with reduced doses .... maybe that could work??

EDIT: ps. I did feed her about 15 minutes ago.
 
I think I'd test her again in 1.5 hours and decide at that point. If she's holding it down on her own still - then skip. If she's jumped up to the pinks, then I think reducing the dose, but giving her something might be better than a full skip.
 
Yeah, I really don’t want to skip, but I just have no idea what’s going on with her right now. Oh, Josie :rolleyes:

By reduce ... serious reduction, like just one unit, or baby reduction to, say, 1.8 (since she got 2.0u last night, which was a reduction from the 2.2u she’s been getting the last couple of days)?
 
Jenna Josie said:
Yeah, I really don’t want to skip, but I just have no idea what’s going on with her right now. Oh, Josie :rolleyes:

By reduce ... serious reduction, like just one unit, or baby reduction to, say, 1.8 (since she got 2.0u last night, which was a reduction from the 2.2u she’s been getting the last couple of days)?
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Your call on the reduction. It's really hard to know what to give. If she doesn't go much higher I'd give a serious reduction.
 
I was thinking serious reduction like 1u. That way it will wear off sooner and you can hopefully get back to your regular schedule more easily.
 
You probably don't need to wait that long though. Are you at +14 yet? That seems to be the magic number for long cycles. (although ECID and all....)
 
Djamila said:
You probably don't need to wait that long though. Are you at +14 yet? That seems to be the magic number for long cycles. (although ECID and all....)
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She's at +13. She just finished her normal breakfast. I will test in one hour -- +14 -- and see where she is.

(Double checking my math . . . 13 + 1 = 14 . . . Yes, one more hour will be +14 :D )
 
This is sure interesting. Her +14 test = 105, and this is *with* her breakfast (3oz FF), on board for at least an hour.

I'll wait another 45 minutes to the top of the hour (11:00 CDT).

Current thought: If she's above 170, one unit; if she's between 120 and 170, 0.5u; if she's 120 or below, no shot.

?? (esp. on that middle range idea)
 
+15 = 102!! I gave her the teeny-tiniest of doses, 0.1u. At least I think I did. It didn't feel like *anything* when I shot, but I did hold it under the skin with the plunger depressed for 10 seconds.

I hope that was the right thing to do. I have read on here people doing such things and just decided to go for it.
 
Well now, Ms. Josie....what are you doing here?

You've probably already figured this out, but I think I would suggest dropping her dose tonight, no matter what her PMPS looks like. Maybe down to 1u? Maybe draw up a list of doses and throw darts at it? Whatever you decide on is going to be a bit of a guess.

It could be that she's just having one of those days. Sam gave me a lovely 24 hours, and then went right back up to his now-typical icky yellows. But it could also be that her pancreas has decided to kick in and help out a bit more and she's changing things up on you.

This has often been compared to a dance - and only the kitty can hear the music :rolleyes:
 
Djamila said:
You've probably already figured this out, but I think I would suggest dropping her dose tonight, no matter what her PMPS looks like. Maybe down to 1u? Maybe draw up a list of doses and throw darts at it?
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This made me laugh out loud.

Yes, she is going to be up. I just took her +17, which is 165. I am not going to test her again until 6:00pm CDT and plan to shoot -- one unit, probably, or whatever the ouija board tells me -- at 6:15, which is her "normal" Sunday evening shot time. At least then we can be back on schedule.
 
I forgot to ask: is this a sort of "reboot," so I hold the 1u for several cycles before increasing?

(Why yes, I am up at 2:00am getting some PM-cycle data!)
 
She certainly isn't making it easy for you but you're doing great! :) I'd try 1 u again today to see what happens. I wouldn't jump all the way up to 2 u right away. A little dose stability might be helpful.
 
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