Bear 3-26/AMPS 428/+4.5 175/+11 367/PMPS 404/+4.5 503

Bear & Lora

Bear & Lora

Member Since 2018
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It has become obvious that Bear is suffering from glucose toxicity.
He is climbing up the ladder on dose increases and the same prior doses are not bringing the same results/numbers.
The Hypoglycemia induced Hyperglycemia/bouncing is far worse than before.
His liver is dumping larger stores of glucose and the amount of his Lantus dose isn't overcoming the amount of glucose in his blood stream.
I am wondering how far up the dosing ladder he will have to go before this problem is better managed.
This is frustrating....

On a positive note Bear is back to eating his normal amounts of food plus a little more at times.
I guess it is time to start weighing him weekly.
 
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@Wendy&Neko
I think Bear needs an increase tomorrow morning.
Since he is bouncing a lot into the reds, do you feel half unit increases would be better with his DKA history?
 
If following TR, which would mean getting some tests in the PM cycle, you can go right back to the last good dose. The question is, what is the last good dose when he was eating well. It’s a bit muddied due to his health crisis. It could be argued 4.5 units, but that is probably a bit much of a jump. Also, will you and/or Jeff be able to get a second test in the PM cycles? I am also hesitant to increase quicker with only three cycles of data on this dose.
 
Wendy&Neko said:
If following TR, which would mean getting some tests in the PM cycle, you can go right back to the last good dose. The question is, what is the last good dose when he was eating well. It’s a bit muddied due to his health crisis. It could be argued 4.5 units, but that is probably a bit much of a jump. Also, will you and/or Jeff be able to get a second test in the PM cycles? I am also hesitant to increase quicker with only three cycles of data on this dose.
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Tonight will be Bear's 6th cycle on 2u.
I can get some PM cycle tests up to his PM +4 if needed, meaning his PM +2 is yellow or below I would continue to test him.
I can't figure out what his last good dose was either.
3-01 was the last day Bear was eating normal which was the day before his Pancreatitis Flare and he was on 5.25u.
I think you are right that is too much of an increase.
I just haven't seen any significant change in his glucose toxicity as we are increasing.
In your experience if we set on a dose longer will his body react less as far as his bouncing?
Does the Lantus Insulin dose have to be much higher to overcome the amount of glucose his liver is dumping or could gradual increases improve his bouncing?
 
Friday is the only day I will be totally absent and won't be able to test AM +2 thrrough +7, funeral, graveside, then family lunch all held an hour's drive away from home.
 
Bear & Lora said:
In your experience if we set on a dose longer will his body react less as far as his bouncing?
Does the Lantus Insulin dose have to be much higher to overcome the amount of glucose his liver is dumping or could gradual increases improve his bouncing?
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To answer your first question, no. The longer you linger on a dose that isn't doing anything, the more the glucose toxicity sets in. I guess in a sort of way he might bounce less because he'll be just high and flatter. Not what you want.

I am not entirely sure what you are asking with the second question. The higher the dose, it usually damps down the height of the bounces a bit. But of course, the higher the dose the more likely he'll see numbers he's not used to. However, that's a short term side effect that should lead to less bouncing in the long term as he gets used to those lower numbers. I found it better to get to those good doses faster. Primarily to reduce the glucose toxicty effects.

My other concern about too high an increase tomorrow is that it would make Friday as cycle 5 and 6 when the depot is full. I presume Jeff will be going with you. You could still do a smaller increase tomorrow.
 
My deepest sympathy in the loss of your uncle. :bighug::bighug::bighug::bighug:

I’m with Wendy about not increasing his dose too much without some tests at night. While my “radar” for invisible numbers tells me he likely didn’t go too low the last two nights, I’m on the “be careful about increasing when you don’t know how low the dose is taking you” bandwagon :):p I also agree that you won’t see anything positive from a dose that has him seeing these kinds of swings.

To answer your second question, in my experience, the closer you get to a good dose, the less likely you are to see so much bouncing but there can be a fine line and it does require, generally, managing the curve with food to flatten the cycle out. Will that mean a lot more insulin? Only Bear knows.

My Gracie was a bouncer and I got her into nice, long cycles of green with minimal bouncing by feeding the curve so I could safely get more insulin into her and also using R to shoot the bounces down. If you look at her 2012 SS, on 3/29, I started getting more proactive on the feeding and dosing. You can see how I got her into better numbers but I’ll be honest that it took time and the ability to be here to test and feed around the clock. It was grueling but she was young and I wanted to give her the best chance of remission. She was always one to toss me a 20 something number out of nowhere. When I let up, she started bouncing again. In 2013, I started using R in early March and got her into good numbers. Using R can take more commitment to be there to test but it can be a great tool and since there is no depot to it, it’s easier to skip it if you can’t be there to test.

I don’t know your and Jeff’s schedules but it’s always possible for you to use R again to help him until you get to a better Lantus dose and for bouncy times. I found that after using it for a while, Gracie was doing so much better, I didn’t need it anymore. It looks like you haven’t used it since 3/10 but now that he’s feeling better and eating, it could really be a help.
 
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@Wendy&Neko @Marje and Gracie
Thank you for your suggestions and condolences.

I increased Bear's insulin by .25 and will reevaluate his dose after Friday.
With Jeff and I's schedule round the clock monitoring isn't possible.
I can fully monitor Bear's AM cycle but Bear's PM Cycle +6 through +12 is pretty much the only time I can sleep and that is when Bear bounces.
Jeff is totally out of the picture except AM tests though PM +1 on the weekends.

Wendy&Neko said:
I presume Jeff will be going with you.
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You are right in your presumption. :)
 
Let us know if at any time you want to start using R again. Other than that, the best thing to do is continue to take the dose up per the protocol and don’t sit on doses that aren’t working past six cycles.

If he were not getting the occasional blue, I’d say you could fast track back up but once we see blue in the picture, we don’t typically fast track.
 
Bear is certainly a member of the bouncy kitty club.

When are you feeding Bear? In part, I'm curious what he'll do today after the drop from the high of 515 last night to the low 200s today. I'm hoping that you've been spreading out his food between pre-shot and whatever Bear's typical nadir is. This may help to soften a drop (e.g., from AMPS to your +4 today) that is likely to produce a bounce. While Bear is by no means in low numbers, the size of the drop -- either from last night or from the 348 at AMPS to 216 could be enough to start a bit of bouncing. By either feeding the curve or routinely spreading out food over the time prior to nadir, it may help to flatten things a bit. The only thing that will ultimately get rid of high numbers is additional insuln. Like Marje and Wendy suggested, sticking with TR and increasing every 6 cycles is the safest route.

 
Sienne and Gabby (GA) said:
Bear is certainly a member of the bouncy kitty club.

When are you feeding Bear? In part, I'm curious what he'll do today after the drop from the high of 515 last night to the low 200s today. I'm hoping that you've been spreading out his food between pre-shot and whatever Bear's typical nadir is. This may help to soften a drop (e.g., from AMPS to your +4 today) that is likely to produce a bounce. While Bear is by no means in low numbers, the size of the drop -- either from last night or from the 348 at AMPS to 216 could be enough to start a bit of bouncing. By either feeding the curve or routinely spreading out food over the time prior to nadir, it may help to flatten things a bit. The only thing that will ultimately get rid of high numbers is additional insuln. Like Marje and Wendy suggested, sticking with TR and increasing every 6 cycles is the safest route.
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Bear's appetite is the largest between Preshot and +5. I have been feeding him at preshot and +3, after 4.5 test he gets a snack (lesser amount of wet) then he naps on and off till +9 to +9.5 when I also feed a lesser amount so he has a little on his tummy to sustain him to PMPS. The night feedings are the same as day except lately when Jeff gets up at 5AM (+9) all of Bears food left out for his overnight feeding is gone and Bear is begging him for food, so he has been giving Bear a little extra and Bear has eaten it all before Jeff leaves at 5:30 (+9.5). I think Bear is eating his left out overnight food around +6.
 
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