? 11/19 Methos pmps 85; 219@+1. What to do when PS earns a reduction

[SmallestSparrow]

My last very similar post (I’m obviously slow learner)
https://felinediabetes.com/FDMB/thr...l-predicting-bounce-breaking-409-amps.295459/

My last one about his numbers (also very similar)
https://felinediabetes.com/FDMB/thr...-5-190-8-192-10-183-pmps-231-2-25-309.295420/

I feel like I’m again headed to a nadir as preshot. I read someone say this means bounce breaking but I’m still not clear what that means to what I will see tonight in terms of drama and karo mistakes. I read elsewhere it’s a sign that the dose is too high. D I’ve read someone say their cat does/did it all the time. I’m still not clear on if o give him 3U at say 150 and then push medium carb food at him half the night if that’s the goal and if it will eventually stop.
Or of this means he probably ought to be lower dose and I’m artificially keeping him from reducing the dose —he gets them only when a 75 catches me unawares where it doesn’t belong.
He may fool me and pull up in the next two hours but he’s been heading lower than I want him every other day or so. A few days ago I had to feed him close to pmps then my vet and I debated how much and compromised on 2 (I wanted 3 but in fairness he’s fragile, and we’re not sure if some of this dropping is his increase in vetoryl).
She decreased him to 3 but I cheated the next morning and gave 3.25. Which is maybe why I woke up to another low amps 2 days later—that time chickened out because I still don’t understand how to know if these nadirs at PS are normal or a sign he’s on too high a dose.

so I’m about to undoubtedly make the wrong decision here again —hoping someone can explain the goal of this shoot then stuff full of MC food cycle (although he loves that food…mmmm wheat gluten and meat by products?

let me find my last post and I’ll be back to edit. Thanks to everyone in advance

 

[SmallestSparrow]

Hi Heike! So what do I do? Am I supposed to give him 3U if he’s 100 something?

 

[Heike & BInie]

Hi Heike! So what do I do? Am I supposed to give him 3U if he’s 100 something?

Hi Colleen,

let me tag some of our experts for you: @Sienne and Gabby (GA) @Wendy&Neko @tiffmaxee @Bandit's Mom

I remember Wendy gave the advice to have a look at your data and which number you shooted before and slowly lower the number you shoot full dose. If I see it right, you always shooted a reduced dose in blue numbers. So if it were me, I would not feel comfortable to shoot the full 3 IU if he is at 100 because there is not enough data. But of course he needs some insulin. So far my not expert adivce.... Sorry I can't be more helpful. Hope someone with more experience answers soon...

 

[Wendy&Neko]

A late adir is a sign of a later nadir. . Neko had later nadirs all the time, it's just what she did. Cycle where the excess glucogons and counter regulatory hormones from a bounce clear out of the system also tend to nadir later. Neko did that a lot too, she bounced a lot. It is NOT a sign of the dose being too high. In fact, often a reduction earned in a bounce breaking cycle will fail.

There's been times were Methos' nadir was +11 and he went up at +12. TBD if that's what he's doing today. I used to shoot Neko much higher doses at quite a bit lower numbers, cause I had the deta to do so. And had higher carb food and plenty of strips and the ability to monitor.

What data do you have? Let's look at when you shot a dropping number or nadir close to PS, for example Nov 10 (shot full dose), Oct 25 (shot full dose), Oct 19 (shot half dose), August 5th and 10th where you shot reduced doses.

As for what will happen tonight, my crystal ball is a bit murky. Will he bounce from that 126 or the steep drop to 126?

 

[SmallestSparrow]

A late adir is a sign of a later nadir. . Neko had later nadirs all the time, it's just what she did. Cycle where the excess glucogons and counter regulatory hormones from a bounce clear out of the system also tend to nadir later. Neko did that a lot too, she bounced a lot. It is NOT a sign of the dose being too high. In fact, often a reduction earned in a bounce breaking cycle will fail.

There's been times were Methos' nadir was +11 and he went up at +12. TBD if that's what he's doing today. I used to shoot Neko much higher doses at quite a bit lower numbers, cause I had the deta to do so. And had higher carb food and plenty of strips and the ability to monitor.

What data do you have? Let's look at when you shot a dropping number or nadir close to PS, for example Nov 10 (shot full dose), Oct 25 (shot full dose), Oct 19 (shot half dose), August 5th and 10th where you shot reduced doses.

As for what will happen tonight, my crystal ball is a bit murky. Will he bounce from that 126 or the steep drop to 126?

He’s 85. He got MC food and after I recheck him will think about insulin. This is not going well

 

[SmallestSparrow]

Not sure what’s meant about reduction failing but this would be a reduction technically and my vet and I were discussing how we didn’t really want to lower him anymore but might think about lowering him and depending on his PMPS I was going to do 2.75 or 3 but now my courage has failed and my focus is turning his ship around since he was dropping by 40 every hour. In this normal?

 

[SmallestSparrow]

15

A late adir is a sign of a later nadir. . Neko had later nadirs all the time, it's just what she did. Cycle where the excess glucogons and counter regulatory hormones from a bounce clear out of the system also tend to nadir later. Neko did that a lot too, she bounced a lot. It is NOT a sign of the dose being too high. In fact, often a reduction earned in a bounce breaking cycle will fail.

There's been times were Methos' nadir was +11 and he went up at +12. TBD if that's what he's doing today. I used to shoot Neko much higher doses at quite a bit lower numbers, cause I had the deta to do so. And had higher carb food and plenty of strips and the ability to monitor.

What data do you have? Let's look at when you shot a dropping number or nadir close to PS, for example Nov 10 (shot full dose), Oct 25 (shot full dose), Oct 19 (shot half dose), August 5th and 10th where you shot reduced doses.

As for what will happen tonight, my crystal ball is a bit murky. Will he bounce from that 126 or the steep drop to 126?

15 min after the medium carb food (and a pill pocket—he needed his tumor meds) he’s 143. So I can breathe and think.
Do I give him 2.5? 2.75? 3?

 

[SmallestSparrow]

I feel really dense and you’d never know I have an off the chart IQ but—if I understand what is called a bounce he’s always in one, and his reduction earning numbers are always breaking a bounce. His only steady/flat curves are when he’s getting around 2-2.5 and his nadir is above 250. The rest of the time he’s diving rapidly unless I’m shoving food in his face or soaring afterwards. He’s pretty much pink/yellow until suddenly a string of blue and if he doesn’t get a reduction (which of course he doesn’t) he then hits green until he gets a reduction.
I’ve tried short doses. I’ve tried full doses. Nothing seems to alter the cycle of blue-green-red—pink pink yellow yellow Blue green red. I think we e tried going higher and going lower. sigh

edit: I feel like the closest he got was when he was 2.5 until I had to stop his vetoryl for a couple of days and decrease his spirsnolactone. That’s what I was discussing with my vet, that we increased his insulin but since then increased his vetoryl so maybe he should go back to 2.5 or 2.75 but her concern (and mine) is he’s been running into higher ketones each time his dose is lowered.

 

[SmallestSparrow]

My vet’s input aside, doesn’t the forum’s SLGS guideline say reduction under 90? I think I read someone tell another member that, I can’t find the guidelines but I think my vet’s rules are very similar to what I see told to people for SLGS except she usually goes in half unit steps.

 

[SmallestSparrow]

Neko had later nadirs all the time, it's just what she did.

I thought you were who said their cat did it all the time. A different advisor just told someone this week it was a sign of a bounce breaking. Someone a week ago said too high a dose.

it’s very confusing.

 

[Wendy&Neko]

Point me to the post where someone said the dose was too high if a late nadir. This a peer reviewed board, and I want to review. Late nadir can be a sign of a bounce breaking, and that is what he did today. Late nadir is not always a sign of a bounce breaking. Some cats nadir early, some late. ECID.

Looks like Methos has picked the option where he starts a new bounce tonight. I am glad you shot 2.5 units, getting closer to a full dose. Another chance to gather data.

Methos will stop bouncing as much when he sees more lower BG values. It took Neko a year to stop bouncing to reds. Pink was progress.

SLGS says to reduce under 90, but over time as people learn their cat, they can lower the reduction point a bit. The Dosing Methods Sticky Note has the details.

 

[SmallestSparrow]

Point me to the post where someone said the dose was too high if a late nadir.

I may have mis remembered. I will try to recall the thread but I’m old, stressed and sleep deprived. I was pretty certain it was you with the always late nadir cat (bc you’re nice and have helped me so much) but tbh a lot of this goes over my head when you all talk.

Late nadir can be a sign of a bounce breaking, and that is what he did today.

Again I’m confused how I’m supposed to know when once he goes above 2.5 U he tends to push his nadir toward PS. So how do I know if it’s normal for him or a bounce? And how do I know it’s a bounce and not he needs more insulin? Bc I’m wondering if we moved through his dose and now just in permanent bounce

Looks like Methos has picked the option where he starts a new bounce tonight.

I swear my IQ hits the ceiling on the Stanford Binet but i do not understand what you are telling me.

SLGS says to reduce under 90,

That’s what I thought someone told Sheila the other night. So how do I square that (meaning Methos earned another reduction) with reductions earned in bounce breaking fail and what do I do ? (I forgot to ask my vet in our determining his dose tonight. We’ve switched roles with me saying “I can do more” instead of me saying “what? I can’t do that” and she’s now the one urging less. And upon reflection she’s right (as always) bc we don’t know what the vetoryl is doing or what his tumor is planning. Better to be cautious I guess.

 

[Wendy&Neko]

Bounce breaking cycles typically start high and slide down for most of the cycle. It's when he ditches the yellow/pink/red colour scheme and drops into blues and/or greens. For example, he broke a bounce AM cycle of Nov 16th, then his body freaked out at the greens and he started bouncing again. Sixth cycle after the previous greens, he hits them again today.

What can make patterns harder to see is when you don't have consistent dosing. The last 4 days/8 cycles (including tonight) have seen 6 different doses. Not blaming, just saying that it makes it harder for me to understand what is happening. With the dosing methods we use here, we stick with the same dose unless either a reduction is earned, or an increase is needed after an appropriate length of time on a dose to see how low the dose is taking the cat.

Depending on the cat and the circumstances, nadirs may move around. Those of us blessed with cat with secondary endocrine conditions are having to deal with additional forces other than the basic insulin action, that are changing what the cycle may look like. I spent a lot of time looking at Neko's spreadsheet and trying to see patterns in data over several cycles. Part of it was self interest, I wanted to know when it was safe to go to bed. It did take a while, plus many games of "guess the BG" with my meter before I understood some of the cycles. Most importantly, what did the 3 or 4 cycles before a reduction earning cycle look like and could I use that data to predict an action cycle.

And how do I know it’s a bounce and not he needs more insulin?

Look at the nadirs he's getting in the non bounce cycles over the last 7 days. When following SLGS, if the nadirs are not in the 90-149 range, he needs more insulin.

how I’m supposed to know when once he goes above 2.5 U he tends to push his nadir toward PS. So how do I know if it’s normal for him or a bounce?

I hate to introduce something new, but as he goes higher in dose, he's getting better duration from the insulin, and likely seeing better numbers for longer during the cycle. But that doesn't look like that all cycle numbers slide of a bounce breaking session. You also get to learn roughly how many cycles he will bounce for and can count until it's likely he'll come down again.

 

[SmallestSparrow]

Look at the nadirs he's getting in the non bounce cycles over the last 7 days. When following SLGS, if the nadirs are not in the 90-149 range, he needs more insulin.

Not arguing just desperately trying to figure this out but the internist said the fact that he’s getting 75s says he doesn’t need more insulin and may be too high already. That was when he was 3 (which he’s now been reduced to before this last 85).

Which is my problem:
His nadir says “needs more” but at the same time his 75/85, especially when half of them are preshot, says “needs less”. We’ve tried giving in to both need more and need less approaches and neither has resulted in decent numbers.

and what do you do when the PS is a reduction number (like tonight and a few other times in my SS)—would the reduction be that cycle? In which case my 2.5 is only 0.25 less than that) this is very confusing

 

[Wendy&Neko]

What's adding to the confusion is the mix of doses. When you lower the dose, the larger depot can influence 4-6 cycles after the reduction. Thus, a little bit of the 3.5 unit depot was still in play today. But what size does the depot think it is after all the different doses - I don't know. So it's hard to say which way the dose should change because I can't answer the question "how low is the dose taking the cat?". That question implies a stable depot.

what do you do when the PS is a reduction number (like tonight and a few other times in my SS)—would the reduction be that cycle?

Delay and see if the number comes up before shooting, then shoot a 0.25 unit reduced dose.

 

[SmallestSparrow]

What's adding to the confusion is the mix of doses. When you lower the dose, the larger depot can influence 4-6 cycles after the reduction. Thus, a little bit of the 3.5 unit depot was still in play today. But what size does the depot think it is after all the different doses - I don't know. So it's hard to say which way the dose should change because I can't answer the question "how low is the dose taking the cat?". That question implies a stable depot.


Delay and see if the number comes up before shooting, then shoot a 0.25 unit reduced dose.

He rarely comes up without food. In fact I don’t think he’s ever come up without food. In the early days (2 months ago ) when I skipped shots there were times he continue to drop for 3-5 hr.
But the main point is the reduction happens then since we’re talking about his habit of sub 90 PS —it’s not just that he’s having nadir at PS, or even sub 90 nadirs, he’s combining them for sub 90 PS nadirs in a cat doing essentially slgs. And not exactly nadirs bc I can tell he is not done dropping he just ran out of time before next shot. His sub 90 nadirs mid cycle aren’t great either but not the same dose dilemma. I realize he’s “special” as my vet says but his cycles at the same time signal “must reduce” and “ should increase” and I’ve had another sleepless night begging him to eat so I don’t know what else to try for him.
My vet is considering trying him lower again. We haven’t tried 2.75 yet bc I didn’t have syringes for that the previous two times he’s moved between 2.5 and 3 so anymore two digit PS and that’s probably his new number. Until then it’s 3 with medium carb food handy

 

[Heike & BInie]

He rarely comes up without food. In fact I don’t think he’s ever come up without food. In the early days (2 months ago ) when I skipped shots there were times he continue to drop for 3-5 hr.
But the main point is the reduction happens then since we’re talking about his habit of sub 90 PS —it’s not just that he’s having nadir at PS, or even sub 90 nadirs, he’s combining them for sub 90 PS nadirs in a cat doing essentially slgs. And not exactly nadirs bc I can tell he is not done dropping he just ran out of time before next shot. His sub 90 nadirs mid cycle aren’t great either but not the same dose dilemma. I realize he’s “special” as my vet says but his cycles at the same time signal “must reduce” and “ should increase” and I’ve had another sleepless night begging him to eat so I don’t know what else to try for him.
My vet is considering trying him lower again. We haven’t tried 2.75 yet bc I didn’t have syringes for that the previous two times he’s moved between 2.5 and 3 so anymore two digit PS and that’s probably his new number. Until then it’s 3 with medium carb food handy

Hi Colleen, seems like Methos is bouncing today after this long stretch of blue! For the 2.75 IU issue: I'm not using calipers but the German version for dosing: paper rulers. I don't understand at all how I dosed with just the scale and the syringe. They are really quite handy and you can measure tiny amounts of insuline. So wouldn't that be an idea? Calipers to help with the fine dosing? I could also sent you the PDFs for the paper rulers but Wendy told me one day, that you don't have A4 paper in the US so that might not be too useful for you. Hugs for you and kisses for the boys!

 

[Wendy&Neko]

The rulers were designed for the BD Microfine syringes, not sure if they work for any other BD syringes.

 

[Heike & BInie]

The rulers were designed for the BD Microfine syringes, not sure if they work for any other BD syringes.

You are absolutely right Wendy. I just wanted to point out there are tools which help with fine dosing, like paper rulers in Germany and calipers in the US.

 

[SmallestSparrow]

Hi Colleen, seems like Methos is bouncing today after this long stretch of blue! For the 2.75 IU issue: I'm not using calipers but the German version for dosing: paper rulers. I don't understand at all how I dosed with just the scale and the syringe. They are really quite handy and you can measure tiny amounts of insuline. So wouldn't that be an idea? Calipers to help with the fine dosing? I could also sent you the PDFs for the paper rulers but Wendy told me one day, that you don't have A4 paper in the US so that might not be too useful for you. Hugs for you and kisses for the boys!

Thanks Heike but the BD syringes have fine lines so I can do 0.25 estimates on them (may not be 0.25 but it will be consistent)—but for the near future he’s a 3U cat. Sadly it looks like tonight could be a copy of last night. If so I will try to get him to eat enough low carb food but he just gets so full so fast and tends to loose interest. But the MC proplan with wheat gluten and animal by products? He’s all over that. On cycles he gets that he will be lounging on the day bed and when I walk in with a plate he’s like “oh I’m just so weak, could you bring it here and feed me in bed (admittedly I do that often), because I’m soooo weak I just couldn’t—-saaaaay, is that proplan? OUT OF MY WAY WOMAN!!! PUT IT DOWN IN MY EATING SPOT NOW!!!!
The other day when he hopped off the daybed to get to it

 

[SmallestSparrow]

Post testing low carb boost the other night (in bed )

 

[Wendy&Neko]

Whatever it takes to get them to eat! I do like the pic with the fork on the plate.

 

[Heike & BInie]

Thanks Heike but the BD syringes have fine lines so I can do 0.25 estimates on them (may not be 0.25 but it will be consistent)—but for the near future he’s a 3U cat. Sadly it looks like tonight could be a copy of last night. If so I will try to get him to eat enough low carb food but he just gets so full so fast and tends to loose interest. But the MC proplan with wheat gluten and animal by products? He’s all over that. On cycles he gets that he will be lounging on the day bed and when I walk in with a plate he’s like “oh I’m just so weak, could you bring it here and feed me in bed (admittedly I do that often), because I’m soooo weak I just couldn’t—-saaaaay, is that proplan? OUT OF MY WAY WOMAN!!! PUT IT DOWN IN MY EATING SPOT NOW!!!!
The other day when he hopped off the daybed to get to it
View attachment 71469

Hi Colleen,
so good you have the right syringes now to measure smaller doses! One day you will need it again. Methos is so cute, eating his food in bed. Since Binie is sick, I always feed her in the places she stays on shot time. The sofa, her cat-bed, on the terrace or my bed. I feel she enjoys the upgrade in service! I can see that in Methos too, not even getting up enjoying his meal. I hope you could catch up on sleep last night with Methos still being a bit higher. As nasty as these bounces are, we should use them to sleep.

I also have this MC dilemma here. Sometimes you need it but the quality is awful.

I am sending you many hugs and a chin scratch to sweet Methos!

 

[SmallestSparrow]

Whatever it takes to get them to eat! I do like the pic with the fork on the plate.

My fingers are so cut up I don’t want to bleed into his food but he’s used to me moving the edges closer to his mouth, so now I use a fork. Unless of course it’s proplan. Then he hops off the bed, shoves past me and inhales it all in seconds