? 01/09 Eddie AMPS 319 +8 349 PMPS 365

[Jodey&Eddie&Blue]

Good morning,

here is yesterday:

https://felinediabetes.com/FDMB/threads/01-08-eddie-amps-290-7-385-pmps-473-6-371.272782/

First day back to work for me...

@Wendy&Neko am wondering if you could elaborate on the "Why?" question you posed in yesterday's thread?

 

[JL and Chip]

Not Wendy, but I’ll give my two cents.

You ask “why” in order to put things in perspective. And to talk yourself off a ledge, if need be. And to avoid making rash decisions (such as raising dose prematurely).

Perspective and explaining to yourself “why” something happened let’s you calm your mind that there’s a logical reason and reminds you not to panic, even to put on your patience pants if needed.

Instead of looking at a high number and saying “OMG, that’s a scary number, something is wrong, I must do something…”
try sitting back, taking a deep breath, and saying to yourself “Hmmm, I wonder why I’m seeing that high number… let’s draw a box around the numbers from the last few days and see analyze what might be the cause.”

First thing I would ask myself did I skip a shot or give a fur shot. Nope.

Then I would look at the preceding cycle(s) and see if they give me a clue. With the limited data in the spreadsheet, I see that the January 7th AM cycle appeared pretty flat yellow (which can hint that the next cycle might be more “active” — i.e., show movement/drops in BG), and that the PM cycle shows one entry of a blue. What happened before and after that blue? Did he drop lower and you didn’t catch it? If so, that might have triggered a bounce. Did he drop lower anywhere else and you didn’t catch it? Ditto on prospective bounce.

The January 8 cycle showed a steady rise, which is the hallmark of a bounce. So I tell myself, ok, Eddie likely bounced, now what? Well, we just have to wait it out until it clears. And that can take up to 6 cycles, so be patient and don’t panic if he runs a bit high.

What causes a bounce? Well, we’ve been over this a gazillion times and it’s documented in the stickies, but the gist is that it can be caused by the BG dropping rapidly, or dropping too low, or dropping too low for what the cat’s body is comfortable with (even if not a dangerously low number in reality).

The key is always to find the lowest BG number and that will guide you in dosing decisions. Ignore the highs. Even if the highs make us panic, they lead us down a treacherous path of wanting to react impulsively rather than methodically.

Consider finding the lows to be like a treasure hunt. When you start seeing them, look closer, test more.

I sometimes wonder if you feel testing is a negative thing for the cat and so do it only if you absolutely have to. I consider testing a positive, an additional clue in the figurative “treasure hunt” that fills in the picture and helps give the “aha” moments. It helps us “know thy cat” and be able to better predict what’s likely to happen, when it’s likely to happen, and to stay on course.

Also, I’m under the impression that you feed every time you test. Is that true? If so, I wouldn’t do that as it can alter the cycle. I’d feed only at regularly scheduled times or only if you need to intervene to either bring up a low BG or blunt a cycle where the BG is dropping too fast. I never fed any of my diabetics just because I tested … a treat or pat on the head will suffice. And I tested often, especially whenever I saw movement in the numbers. Find that “treasure” (low BG). Find the pattern. Test and test and test until you see it. [ok, I get that you can’t do that in reality while teaching, but maybe become a testaholic on weekends and breaks]

I’m counting on @Wendy&Neko to correct anything I’ve explained poorly or incorrectly (this is a quick brain dump with very little editing). She could give a master class in reading/interpreting data and spreadsheets; I’m just trying to fill in a few tidbits and offer support.

 

[Amy & Herman]

Not Wendy, but I’ll give my two cents.

You ask “why” in order to put things in perspective. And to talk yourself off a ledge, if need be. And to avoid making rash decisions (such as raising dose prematurely).

Perspective and explaining to yourself “why” something happened let’s you calm your mind that there’s a logical reason and reminds you not to panic, even to put on your patience pants if needed.

Instead of looking at a high number and saying “OMG, that’s a scary number, something is wrong, I must do something…”
try sitting back, taking a deep breath, and saying to yourself “Hmmm, I wonder why I’m seeing that high number… let’s draw a box around the numbers from the last few days and see analyze what might be the cause.”

First thing I would ask myself did I skip a shot or give a fur shot. Nope.

Then I would look at the preceding cycle(s) and see if they give me a clue. With the limited data in the spreadsheet, I see that the January 7th AM cycle appeared pretty flat yellow (which can hint that the next cycle might be more “active” — i.e., show movement/drops in BG), and that the PM cycle shows one entry of a blue. What happened before and after that blue? Did he drop lower and you didn’t catch it? If so, that might have triggered a bounce. Did he drop lower anywhere else and you didn’t catch it? Ditto on prospective bounce.

The January 8 cycle showed a steady rise, which is the hallmark of a bounce. So I tell myself, ok, Eddie likely bounced, now what? Well, we just have to wait it out until it clears. And that can take up to 6 cycles, so be patient and don’t panic if he runs a bit high.

What causes a bounce? Well, we’ve been over this a gazillion times and it’s documented in the stickies, but the gist is that it can be caused by the BG dropping rapidly, or dropping too low, or dropping too low for what the cat’s body is comfortable with (even if not a dangerously low number in reality).

The key is always to find the lowest BG number and that will guide you in dosing decisions. Ignore the highs. Even if the highs make us panic, they lead us down a treacherous path of wanting to react impulsively rather than methodically.

Consider finding the lows to be like a treasure hunt. When you start seeing them, look closer, test more.

I sometimes wonder if you feel testing is a negative thing for the cat and so do it only if you absolutely have to. I consider testing a positive, an additional clue in the figurative “treasure hunt” that fills in the picture and helps give the “aha” moments. It helps us “know thy cat” and be able to better predict what’s likely to happen, when it’s likely to happen, and to stay on course.

Also, I’m under the impression that you feed every time you test. Is that true? If so, I wouldn’t do that as it can alter the cycle. I’d feed only at regularly scheduled times or only if you need to intervene to either bring up a low BG or blunt a cycle where the BG is dropping too fast. I never fed any of my diabetics just because I tested … a treat or pat on the head will suffice. And I tested often, especially whenever I saw movement in the numbers. Find that “treasure” (low BG). Find the pattern. Test and test and test until you see it. [ok, I get that you can’t do that in reality while teaching, but maybe become a testaholic on weekends and breaks]

I’m counting on @Wendy&Neko to correct anything I’ve explained poorly or incorrectly (this is a quick brain dump with very little editing). She could give a master class in reading/interpreting data and spreadsheets; I’m just trying to fill in a few tidbits and offer support.

So well said!

 

[Wendy&Neko]

This is what you asked yesterday:

Does asking “Why?” provide you with any insight? I mean I could say “because SRT” but still worry.because, well, high numbers. I guess what I mean is if you ask “Why?” is your answer different from mine?

No, SRT does not cause bouncing. As @JL and Chip so eloquently stated, it's the lows (to them) or fast drops that cause bouncing. Our jobs is to put on our detective hats and find out how low the dose is taking the cat. That answer is what drives what we do next with the dose.

A little factoid that might help you when you do your detective work. When a cat is breaking a bounce from on high, the nadirs or those low point tend do be later in the cycle. When the cat isn't quite so high up at PS, the low points might be earlier on in the cycle. How might you use this information? If you see a higher PMPS, those late night/early AM tests can be later like you have been doing. But if you see a lower (yellow) PMPS and flat going into PS as JL pointed out, you might want to try a bit earlier spot check overnight.

I know you mentioned you are in bed by around +2 PM, which makes a before bed test not as useful for Levemir. However, even a +2 might give you data. When Neko was on Lev, my before bed test was also before onset, and I would still get that before bed test. If it was around the same or not much higher than her PMPS, it was a good idea for me to set alarms to check later. Not saying it'll be the same for Eddie, but it might help. If that before bed test was a lot higher than PMPS, then maybe you don't need that middle of the night test. I was all about giving me data for two reasons. First and foremost to keep Neko safe. Second, maximizing my sleep.

I would also see if there is anything you can do to move the PMPS and corresponding AMPS up a little bit, so that before bed test is a later than it currently is. You mentioned your morning routine, where it sounds like it takes 3/4 of an hour from when you get up to when testing starts. It took me less than 15 minutes from out of bed, test, feed, draw insulin, shoot. Yes, I had two cats, though only one had diabetes, the other also needed meds. Food/drink for me came after the cats were done. Meds were organized in those daily pill dispensers the night before. So it was just insulin that needed to be measured. I didn't do that until after testing, in case a test result changed what I shot. Neko was known to give me the odd morning surprise.

 

[Jodey&Eddie&Blue]

Not Wendy, but I’ll give my two cents.

You ask “why” in order to put things in perspective. And to talk yourself off a ledge, if need be. And to avoid making rash decisions (such as raising dose prematurely).
I know the reason for asking "Why", tbh, but I wanted to hear Wendy's answer to the Why? The issue about increases/decreases looms large. I just cannot see the rationale for holding with only one test of 196 @PM +7 the other day. I'm not saying I'm rushing to increase but it seems like that is the way it's happened before. At least to my obviously limited eye, that's what it looks like.

Perspective and explaining to yourself “why” something happened let’s you calm your mind that there’s a logical reason and reminds you not to panic, even to put on your patience pants if needed.

Instead of looking at a high number and saying “OMG, that’s a scary number, something is wrong, I must do something…”
try sitting back, taking a deep breath, and saying to yourself “Hmmm, I wonder why I’m seeing that high number… let’s draw a box around the numbers from the last few days and see analyze what might be the cause.”

First thing I would ask myself did I skip a shot or give a fur shot. Nope.

Then I would look at the preceding cycle(s) and see if they give me a clue. With the limited data in the spreadsheet, I see that the January 7th AM cycle appeared pretty flat yellow (which can hint that the next cycle might be more “active” — i.e., show movement/drops in BG), and that the PM cycle shows one entry of a blue. What happened before and after that blue? Did he drop lower and you didn’t catch it? If so, that might have triggered a bounce. Did he drop lower anywhere else and you didn’t catch it? Ditto on prospective bounce.

Yes, you are so right. If there was anything to be caught, I didn't catch it. I am doing my best.

The January 8 cycle showed a steady rise, which is the hallmark of a bounce. So I tell myself, ok, Eddie likely bounced, now what? Well, we just have to wait it out until it clears. And that can take up to 6 cycles, so be patient and don’t panic if he runs a bit high.

JL I'm not panicking. I'm trying to understand. You say below that "we've been over this a gazillion times" etc. and thank you for that. It's the mark of a good teacher that they repeat the same thing until the student is able to comprehend the lesson.

What causes a bounce? Well, we’ve been over this a gazillion times and it’s documented in the stickies, but the gist is that it can be caused by the BG dropping rapidly, or dropping too low, or dropping too low for what the cat’s body is comfortable with (even if not a dangerously low number in reality).

The key is always to find the lowest BG number and that will guide you in dosing decisions. Ignore the highs. Even if the highs make us panic, they lead us down a treacherous path of wanting to react impulsively rather than methodically.

Again, I assure you, I am not acting impulsively. I am acting--and asking questions even if they are the same ones, over and over--because it happens here that I think I'm following advice as to when to raise and lower but it's clear I have yet to understand the patterns in terms of the bigger picture told by the spread sheet.

Consider finding the lows to be like a treasure hunt. When you start seeing them, look closer, test more.

when I encounter lows, I am very calm, tbh. I know now what to do when it's a pre-shot low as opposed to a mid- or end-cycle dive.

I sometimes wonder if you feel testing is a negative thing for the cat and so do it only if you absolutely have to. I consider testing a positive, an additional clue in the figurative “treasure hunt” that fills in the picture and helps give the “aha” moments. It helps us “know thy cat” and be able to better predict what’s likely to happen, when it’s likely to happen, and to stay on course.

I don't see testing as negative. I test when I am able. My challenge is to learn to read the lower numbers as clues to action. I know Wendy doesn't think SRT factors in here for the wild ride but I've lived for all this time with two cats both of whom have had SRT and I've seen them suddenly go off insulin following SRT. That's my concern. I think that SRT works against GH secretion and the tumour gets "panicky". People always talk about a panicky liver; I think the same pertains to the tumour that panics as it is losing its capacity to reproduce itself. Eddie is still on high-dose Prednisolone (14 days 10mg daily and 60 days after that 5mg once daily. He was once on .625mg once daily.
Furthermore, I was also doing some reading regarding SRT and inflammation due to cell “death”(tumour cell debris) and found that “researchers discovered that tumor cell debris [can] promote[] tumor growth because a lipid called phosphatidylserine, which is exposed on the surface of dead and dying cells, stimulates the production of proinflammatory cytokines by immune cells known as macrophages.” They also hypothesized that “Treating mice with small amounts of resolvins inhibited debris-stimulated tumor growth and prevented cancer cells from metastasizing” (https://journals.lww.com/oncology-t...to_tumor_cells_after_they_are_killed_.17.aspx )." All of this is to say, there's a lot going on with Eddie and I know people think I'm impatient or just crashing around but I'm not. I am doing the best I can.

Also, I’m under the impression that you feed every time you test. Is that true? If so, I wouldn’t do that as it can alter the cycle. I’d feed only at regularly scheduled times or only if you need to intervene to either bring up a low BG or blunt a cycle where the BG is dropping too fast. I never fed any of my diabetics just because I tested … a treat or pat on the head will suffice. And I tested often, especially whenever I saw movement in the numbers. Find that “treasure” (low BG). Find the pattern. Test and test and test until you see it. [ok, I get that you can’t do that in reality while teaching, but maybe become a testaholic on weekends and breaks]

I feed both Eddie and Blue 4x daily. Two full meals and two "snacks". The snacks come after I test because a) it makes sense to give them their snack at +4 or +7 or when I can if I'm home. In other words, I'm feeding at regular times and those times happen to be test times. Correct me if I'm wrong but you are suggesting that I don't go that route but instead test, give a treat and then at some other point (when is that point give the snack). I'm going to do a curve on Eddie probably tomorrow because I'm working from home (I can do that now and again this term).

I’m counting on @Wendy&Neko to correct anything I’ve explained poorly or incorrectly (this is a quick brain dump with very little editing). She could give a master class in reading/interpreting data and spreadsheets; I’m just trying to fill in a few tidbits and offer support.

 

[Jodey&Eddie&Blue]

Could someone tell me how to reply to a message and keep the quoted parts separate from my own text?

 

[Wendy&Neko]

Could someone tell me how to reply to a message and keep the quoted parts separate from my own text?

Highlight the parts of the text you want to reply to, a "Reply" pop up appears, hit that. The text you want to reply to should appear, surrounded by the words quote and the authors name. Then begin typing. Then go up and highlight the next bit of text you want to reply to.

I never said that SRT doesn't factor in the wild ride. SRT factors in the wild ride down the dosing scale. It does not impact whether or not a cats body is used to lower numbers or panics when it drops quickly. That bouncing happens regardless of SRT or not. I've seen at least a dozen (if not more) cats here that have had SRT done, and their spreadsheets, and experienced it's impacts twice with Neko. Neko's second time she was a lot less bouncy, as she had overall gotten a lot better regulated prior to second SRT.

I think that SRT works against GH secretion and the tumour gets "panicky". People always talk about a panicky liver; I think the same pertains to the tumour that panics as it is losing its capacity to reproduce itself. Eddie is still on high-dose Prednisolone (14 days 10mg daily and 60 days after that 5mg once daily. He was once on .625mg once daily.

SRT neuters tumour cells, it doesn't kill them. In the fullness of their lifespan, the tumour cells die off, which they would anyway. The tumour cells continue to send out extra GH, until they stop and die, but without reproducing.

By the way, 5 mg prednisolone is not a high dose for a cat his size. If SRT was 10/24-10/26, shouldn't he be just about finished 14 days + 60 days? Will he be tapering down to his old pred dose soon? I was never clear why he was on prednisolone post SRT anyway. Not something I've ever seen in any other post SRT cat, except the odd cat who was on pred for maybe a week due to inflammation from intubation or radiation.

 

[Jodey&Eddie&Blue]

Highlight the parts of the text you want to reply to, a "Reply" pop up appears, hit that. The text you want to reply to should appear, surrounded by the words quote and the authors name. Then begin typing. Then go up and highlight the next bit of text you want to reply to.

I never said that SRT doesn't factor in the wild ride. SRT factors in the wild ride down the dosing scale. It does not impact whether or not a cats body is used to lower numbers or panics when it drops quickly. That bouncing happens regardless of SRT or not. I've seen at least a dozen (if not more) cats here that have had SRT done, and their spreadsheets, and experienced it's impacts twice with Neko. Neko's second time she was a lot less bouncy, as she had overall gotten a lot better regulated prior to second SRT.


SRT neuters tumour cells, it doesn't kill them. In the fullness of their lifespan, the tumour cells die off, which they would anyway. The tumour cells continue to send out extra GH, until they stop and die, but without reproducing.

By the way, 5 mg prednisolone is not a high dose for a cat his size. If SRT was 10/24-10/26, shouldn't he be just about finished 14 days + 60 days? Will he be tapering down to his old pred dose soon? I was never clear why he was on prednisolone post SRT anyway. Not something I've ever seen in any other post SRT cat, except the odd cat who was on pred for maybe a week due to inflammation from intubation or radiation.

SRT neuters tumour cells, it doesn't kill them. In the fullness of their lifespan, the tumour cells die off, which they would anyway. The tumour cells continue to send out extra GH, until they stop and die, but without reproducing.

Everything I've read says that SRT "kills" cancer cells, although "kill" and "neuter" may be moot. See, for example, VCA : https://vcacanada.com/know-your-pet/radiation-therapy "Cancer cells grow and divide faster than most normal cells. Radiation therapy works by damaging the cells’ DNA to interfere with cell replication and kill them. In this way, radiation can either shrink a tumor or destroy it."

Anyway, I see that bouncing can happen regardless of SRT or not; the only thing about SRT is a disruption to the product of GH by the tumour, right? And, it's GH that works to get the liver going with IGF-1 and then we've got resistance happening. But when the SRT is beating up on the tumour, there's an corresponding BG change--or at least, the potential for a big drop in BG. I'm not arguing against what you are saying. I am saying though that I seeing these long rolling numbers with Eddie. See post (Jan 10 for the BG curve).