07/23 "Blackie's Quest" AMPS 343

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Pssst, Ms Blackie, iz me Harley. Yuz looks beeutiful todaz (wink). Ya wanna come and surfs the bluez wif me tudaz? iz shoez u how, iz not so gud at it yet, iz ony twy a cuple timz butt wuz fuunnn! wadda u say? (wink) (wink)
 
Rob, you're a hoot! LOL :) Thanks. :)

268 @ +5 @ 10:42 a.m.

PMPS will be the final one until tomorrow morning. She's starting to get rebellious about too much poking, that's including shots.
 
Oooh, we'll have to call you Angela the Brave, you go girl!!!! #s aren't budging much though, hmmmm, well sometimes it's like that.... guess we'll just have to stay tuned to the Quest & see what happens next!
 
Considering this is the first day of 2.0u, and she's only received 1 dose of it, thus far, we'll see what happens throughout the next 5(?) days. It takes a bit of time for both insulin and little body to get adjusted to it... Right?
 
To me, the holding doses several days stuff is more to take some of the stress out of it. For one thing, you don't need to get spot tests every cycle if you are taking that approach, you can start a new dose, let it go for a few days, get a nadir test in here and there, maybe run a curve or get more spot tests on a weekend, and then make your dosing decisions then. A LOT less stressful than changing doses every day or two and needing to get in plenty of spot tests to be sure you aren't shooting too much insulin.

With PZI, I don't think it takes all that much time for the insulin to build up, there's no extended shed as far as I know, although I do think there is a small one. As for their body adjusting, from what I have seen that tends to work in the opposite direction of what you want. If their body adjusts, it will resist the insulin. That's where you get stuck in higher #s and need a BAM dose to bring them down (sorry this one didn't work - I had high hopes!!!).

Of course, other people see it differently, so I can't say that my perspective is right, that's just the conclusions I have come to based on what others have taught me here, what my own experience has been, and what I have observed from the limited range of cases that I have followed here.

It appears to me that Blackie is stuck in higher #s, so she may need more insulin to get a breakthrough. I was hoping you would get dramatic improvement on cycle 1 of 2u, and then might be able to back off the dose a bit. No go though, so I would probably keep this dose long enough to let the overlap build up - 4 cycles I would say - and then if you are still not seeing any improvement I would raise it.

I generally don't argue against holding a dose a few days longer if there are signs of progress, or if there are practical concerns, like someone wants to do curves on the weekends and then make decisions at that point. Or if there isn't much data and you wouldn't want to raise before gathering more data to see how a dose is doing. But you are getting in lots of spot tests that so far are showing (to my eyes) that the doses are too low, so in that case, assuming you are home to monitor the effects of dose changes, makes sense to me to raise it every 2-3 days, rather than waiting longer.

The key thing when you are raising faster like that is to keep an eye that the PSs aren't improving REALLY dramatically, and if you do get a lower PS, or I would say once you get to shot 3 at this dose regardless of the PS, I would get in an early cycle spot check, maybe +3 give or take, to make sure it isn't too much insulin. If it is you feed some LC, or HC if warranted, to balance it out.

If she is acting well though and there are no signs of ketones, you can wait 5 days if you want to. But I don't think the likelihood is high that you will see better #s if you aren't seeing them in the 1st couple days, that's what I'm trying to say, longwinded-ly. :lol:

You can wait 5 days, but know that you are doing that because it's what you want to do (and you may have good reasons, I'm not saying there's anything wrong with doing that). That is, it's not because there is much hope that on day 5 the results will be any better than they were on day 2. If the PSs are gradually coming down, then yes, you would want to hold a dose to see if that progress continues. But if her results are like they have been lately, just not much movement in the #s, then I don't think there is a need to hold the dose longer out of some idea that her body will adjust and the results will improve.

To a large extent, I think the thinking that a dose should be held for several days comes from when one isn't home-testing. Back when I didn't home-test and I went to my vet for curves, it made sense to hold the dose for a week or longer b/c we had NO idea what was going on - if the PSs were improving, you would want to hold the dose, so waiting some time like that made sure that things got shaken out some before the vet saw the #s. But once you are hometesting, you can see what each shot is doing. If the #s aren't coming down, then you can conclude right away you need more insulin. If the #s are coming down, then you can conclude this dose is helping, so you may want to hold it longer to see where it goes.
 
I know Laurie likes a 5 day hold, so out of curiosity I just took a peek at Mr. Tinkles' SS.

One thing that jumps out at me is that he threw some seriously wonky #s, making it really really tough (at least for me) to make clear sense of the data and know how things were going on a dose. In cases like that, then it does make sense to me to hold a dose for longer - either to gather more data, try to make sense of things, or see if the wonkiness is going to settle down and give you some more predictable data. When the #s are all over the place, it makes it hard to draw conclusions about a dose.

The difference I see with Blackie is that the wonkiness level is a lot lower. When you make a decision whether or not to raise, in my view you want to make that decision because you feel clear how a dose is working. If you are getting steady #s in 2 days with shallow curves and no improvement in PSs, then you raise. If on the other hand it isn't clear yet how this dose is working, or whether it's too little or maybe it's too much, then it does make sense to me to hold it for longer, until it is clearer hopefully.

Laurie, if you are reading, kudos on getting through all that mess and getting Mr. T into some excellent #s!!! I think I would have been tearing my hair out at some of his earlier #s, I am impressed with his improvement, YAY!!! :mrgreen:
 
OH ANGELA! you actually shot the 2u! I did'nt see this coming so quickly...'the bg's rule our lives' from 'the days of our lives' is my favorite. altho' this would'nt only apply to the blackie drama but pretty much all of us. ever get a minute or 3 when your NOT thinking about your cat?
 
yes joanna, i can see where laurie took her que's from. in her case it made all the sense in the world to wait and see. we have some pretty good data on blackie so i'm proud of angela for tossing the chicken s*** and getting her big girl panties on. Watch Out BG's---WERE COMIN FOR YA!
 
5 days IMHO is too long. But one thing to consider is that it is my strong personal belief that the kitties get used to however they are dosed. Changing dosing protocols will encounter some transition time [perhaps a couple weeks at most] but ultimately their little bodies get used to however one typically doses. LOL or maybe it is the bean getting used to it. If one wants to be on the ball with testing in the beginning, then changing every 3 [maybe 4] cycles max is fine. Or one can go hog wild and try changing sooner. Ultimately it just becomes a trial and error -what works best for the bean and kitty. I also believe in making smaller changes - perhaps .1u or even .2u at a time now that you are at 2u. So basically in sum, my belief is in smaller but more frequent changes. And IMHO there is no "shed" to PZI/ProZinc. Maybe a little overlap for some but IMHO the word "shed" connotes something that would slow down the regulation process and be highly disadvantageous to the kitty. Just my knee jerk reaction because one of our vets thought it took weeks for a dose to settle [a recommendation I had to override].

I preferred a variable dosing regimen for my own convenience as it is the most flexible time wise [time pretty much goes out the window with variable or "scale" dosing]. When we did move to ProZinc from PZI vet I did slow things down a bit [after I got punished for my own bravado] and tended to only change every 3 cycles. But once we got the data and figured out his new dose it was back to the fast and lose with variable dosing.

What I see perhaps in your SS is kitty getting used to getting insulin. And Mr. P sayin', "eh, I've worked hard enough, I think I'll take a break right now." I would kind of have this thing where would up the dose and he was like "Oooo, neat more insulin!" and then he would slowly go back up. So we just kept upping in small increments until we got where we wanted.

Just my $0.02 :smile:
 
LOL Angela, it wouldn't be a soap opera now would it if you don't get a few reds here & there? ;-)

Gator, I get your point now about why words like overlap & shed drive you nutso. I agree, if one is waiting for something like that it can definitely slow down regulation.

I usually encourage people to wait a few cycles not because I feel like that's necessarily needed with PZI, but because I don't know how prepared they are to deal with unexpected lows if they do get some overlap (Bix seemed to, but from what I've seen many cats don't). For the most part it's simpler, and feels safer, to explain to hold a dose for a few cycles than it is to explain that heck, they can shoot more insulin if they want right away, you can do that with PZI, but if you do, know your risks, when to get in spot tests, and what to be on the lookout for. And realistically, many people don't have a lifestyle that allows them to make a lot of dose changes quickly (those pesky jobs & stuff!!!), not to mention the stress & exhaustion & all that in doing it.
 
you know when i think it does apply to wait 4 or 5 days? when you first start. those very first 4 or 5 days. i know back 3 years ago i had tom on the good diet 3 days before the insulin arrived and his #'s were so much better. i think he went from 545 to the 300's. then we started 1u of insulin and boom he was amps and pmps in the 400's and touching 200 for his nadir. he needed that time to adjust. after that we were the dream team and otj in a month like squishy.
alas, here we are again ....on the juice for 6 months now. :sad:
 
Joanna & Bix said:
Gator, I get your point now about why words like overlap & shed drive you nutso.
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Yes, "nutso" is pretty close. :-D You know I'm down for "overlap" or even better "minor overlap" [even though I swear it never happened with H] but "shed" is just something I cannot stomach... at this point. :smile:
 
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