08/08 Zener PMPS 221; +2.5 261 ATrak

[Anne & Zener GA]

It's a pink sunrise this morning...

Yesterday's summary:
08/07/11 Zener Alpha Trak
AMPS 275, 4th cycle @ 1.5 u
+3 290
+6 253
+8 212
PMPS 200, 5th cycle @ 1.5 u
+2 181
+4 213
+10 364 (I left out 2 t 11% carbs which he had not eaten @ +9, after testing @ +10 noticed it was gone, so he may have just eaten before this +10)

Today
08/08/11 Zener Alpha Trak
AMPS 338, 6th cycle @ 1.5 u, fed FDCK, 2 t. 11%

Well, the 11% carb experiment was a good one for appetite stimulation! He loves it. It seems he is less interested in eating during the day than night, and he ate quite a bit more last night. We also put food out for him at night and it looks like we may have had a food spike at his +10. So I may try mixing in a lower carb food when his appetite is better in the evenings, still staying in the consistent 8-11% range for now.

We are still moving his shot forward to get on to our school schedules. Today is his 6th cycle at 1.5u and he is still a little higher than we want, so will move his shot forward tonight again if numbers permit.

Starting to think about a possible increase if numbers stay in this range once we get him back on our schedule and are no longer shifting his time forward. This could happen as soon as Wednesday. Does this seem like a reasonable strategy?

 

[Anne & Zener GA]

Re: 08/08 Zener AMPS 338; +2 229 Dose question A Trak

Dropped onto the yellow brick road, hang on!

Today
08/08/11 Zener Alpha Trak
AMPS 338, 6th cycle @ 1.5 u, fed FDCK, 2 t. 11%
+1 fed 2t 10%
+3 229, fed 2t. 9.5%

Well, just when I start thinking about a possible dose increase in the near future, Zener drops over 100 in his first 3 hours of his 6th cycle at this dose. Lesson to bean (again) - must live in the moment. ;-)

We've tried mixing some of his 11% carb food with a 9% and 8% this morning, and he is eating that. Hoorah!

We'll get a +6 and see how things are looking then. It's a Monday adventure once again. ohmygod_smile

 

[Melissa & Tarragon]

Re: 08/08 Zener AMPS 338; +2 229 Dose question A Trak

He must be reading your condo and know what you are up to! :lol: Glad to see he is dropping. That is quite the sky dive in just 2 hours. I mix FF classic (4%) and FF flaked, roasted, etc (6-8%). This is the only way Tarragon will eat the LC.

 

[Anne & Zener GA]

Re: 08/08 Zener AMPS 338; +2 229 Dose question A Trak

He must be reading your condo and know what you are up to! :lol:

That wouldn't surprise me, he is a very clever fellow!

Glad to see he is dropping. That is quite the sky dive in just 2 hours.

We are glad to see him dropping too, and hope that he stops the sky dive. It doesn't seem as stressful in the daytime as at night, but in 2 weeks we'll be back at work and it will be hard to leave if he is skydiving!

I mix FF classic (4%) and FF flaked, roasted, etc (6-8%). This is the only way Tarragon will eat the LC.

Yes, you gave me this idea a week or so ago when I posted to the board asking for help with getting him to eat! Mixing these % will be our next step. Right now, we are mixing FF 11% MC with 8-9% FF LC, adding Fortiflora and he is eating without having to use the cypro, appetite stimulant. I think your Tarragon and our Zener are very finicky eaters. Zener was on dry kibble (Wellness) for over 11 years, so I should probably be happy he will eat any wet food!

Hope you all have a good Monday!

 

[Melissa & Tarragon]

Re: 08/08 Zener AMPS 338; +2 229 Dose question A Trak

I hear ya! Tarragon only had Science Diet dry for the first 10 years and is one of those that loves to crunch his food. I have been surprised that he transitioned as quickly as he did. He is still super picky though.

 

[Anne & Zener GA]

Re: 08/08 Zener AMPS 338; +2 229 Dose question A Trak

I will adopt that attitude, and be grateful too that Zener has transitioned as well as he has! He is super picky and will eat something for a day or two like it's the best food he's ever had, then turn up his nose like I am trying to poison him. @-)

 

[Anne & Zener GA]

Re: 08/08 Zener AMPS 338; +3 229; +6 171 A Trak

Back to the blue bayou....

Today
08/08/11 Zener Alpha Trak
AMPS 338, 6th cycle @ 1.5 u, fed FDCK, 2 t. 11%
+1 fed 2t 10%
+3 229, fed 2t. 10%
+5, fed 3t 10%
+6 171, fed 2t 10%

Looks like my calculations on mixing the two foods he will eat right now was a little low and it should have been 10%. I'll change that on the SS shortly.

We'll get a +9 or 10, then check again around 11.5 to see if numbers will allow us to move forward a little more tonight.

 

[Anne & Zener GA]

Re: 08/08 Zener AMPS 338; +3 229; +6 171;+10 168 ShotTime ?

It's a blue afternoon....

Today
08/08/11 Zener Alpha Trak
AMPS 338, 6th cycle @ 1.5 u, fed FDCK, 2 t. 11%
+1 fed 2t 10%
+3 229, fed 2t. 10%
+5, fed 3t 10%
+6 171, fed 2t 10%
+10 168, fed 2t 10%

We would like to keep shifting Zener's shot time because of work schedules. We shifted 10 minutes this morning, and were thinking of moving him forward 15 minutes tonight. He is hanging in the blue so far this afternoon, so I wanted expert opinions on what #s to look for that would indicate shifting a little is still okay tonight. Or, if we should hold off until morning. Our #s we are using right now are:
150 or greater - shoot regular dose
between 150-100 - stall or reduce dose
less than 100 no shot
Because of his HC, we are trying to keep his #s above 80, and if below, then an earned reduction.

Thanks!

 

[Sienne and Gabby (GA)]

Re: 08/08 Zener AMPS 338; +3 229; +6 171;+10 168 ShotTime ?

Unless Zener is below 80, I think you're fine to adjust the time. 15 min. shouldn't make a difference.

 

[Anne & Zener GA]

Re: 08/08 Zener AMPS 338; +3 229; +6 171;+10 168 ShotTime ?

Thanks Sienne, I'll post as we get his numbers.

 

[Anne & Zener GA]

Re: 08/08 Zener AMPS 338; +3 229; +6 171;+10 168 ATrak

Oops, liz tells me I goofed with our numbers. Here is what we are using as guides for now.
Greater than 180 - okay to shoot
150-180 - steady or rising - okay to shoot; dropping - reduced dose, .25 to .5 less
130-150 - token dose 10-25% of his dose which is about .25u right now
100-130 - stall, if possible
Less than 100 - no shot

We'll be getting his 11.5 here soon and decide on time for his dose tonight.

 

[Jill & Alex (GA)]

Re: 08/08 Zener AMPS 338; +3 229; +6 171;+10 168 ATrak

Oops, liz tells me I goofed with our numbers. Here is what we are using as guides for now.
Greater than 180 - okay to shoot
150-180 - steady or rising - okay to shoot; dropping - reduced dose, .25 to .5 less
130-150 - token dose 10-25% of his dose which is about .25u right now
100-130 - stall, if possible
Less than 100 - no shot

We'll be getting his 11.5 here soon and decide on time for his dose tonight.

i understand the scale and the reasoning behind it, but generally speaking a sliding scale will only put kitty on a rollercoaster when using "depot" insulins. i think we're seeing some of that on zener's spreadsheet now.

the effects of lantus are cumulative. one dose can effect up to the next three days worth of numbers. dose-hopping often results in a lot of ups and downs. lantus and levemir have the ability to grab onto lower preshot numbers than higher numbers. you want to see lower preshot numbers when you're able to monitor and manage the curve with food. something to remember... you won't see the same drop when shooting on a lower preshot number that you'll see when shooting the same dose on a higher preshot number.

obviously, we're walking a fine line because of the CH, but i think it might help to flatten him out if we're able to find a dose that can be shot consistently.

 

[Anne & Zener GA]

Re: 08/08 Zener AMPS 338; +3 229; +6 171;+10 168 ATrak

i understand the scale and the reasoning behind it, but generally speaking a sliding scale will only put kitty on a rollercoaster when using "depot" insulins. i think we're seeing some of that on zener's spreadsheet now.

Thanks for the information Jill! And we have moved Zener's doses around from when I had surgery and since a few times.

the effects of lantus are cumulative. one dose can effect up to the next three days worth of numbers. dose-hopping often results in a lot of ups and downs. lantus and levemir have the ability to grab onto lower preshot numbers than higher numbers. you want to see lower preshot numbers when you're able to monitor and manage the curve with food. something to remember... you won't see the same drop when shooting on a lower preshot number that you'll see when shooting the same dose on a higher preshot number.

I think it freaks us out a little when we see 200 drops and think about shooting something lower. Your point about not seeing the same drop when shooting a lower preshot number is a good one and we have to work on getting braver! I don't feel very confident yet about when his nadir is though.

obviously, we're walking a fine line because of the CH, but i think it might help to flatten him out if we're able to find a dose that can be shot consistently.

Any suggestions on how we might change up our numbers above? It helps us if we have this written down on his log book. Since Liz is doing AM care and I am doing PM care, we like to have something in writing right where we see it to make sure we aren't forgetting what to do!

We are on his 7th cycle with the 1.5 tonight. He also is eating a lot better on 8-11% carbs. We're not needing to use appetite stimulant.

Thanks so much!
:YMHUG:

 

[Anne & Zener GA]

Re: 08/08 Zener PMPS 221 ATrak

We shot his regular dose a little early tonight, 15 minutes, to help us back on track.

08/08/11 Zener Alpha Trak
AMPS 338, 6th cycle @ 1.5 u, fed FDCK, 2 t. 11%
+1 fed 2t 10%
+3 229, fed 2t. 10%
+5, fed 3t 10%
+6 171, fed 2t 10%
+10 168, fed 2t 10%
PMPS 221, 7th cycle @ 1.5 u, fed 3t. 10%

Will get a +2 or +3 and post later. Zener has had a good day with more energy and eating better. I don't have to chase him around with the bowl, hand feed or rub food on his nose to get him started! :thumbup

 

[Jill & Alex (GA)]

Re: 08/08 Zener PMPS 221 ATrak

probably the easiest thing to do is to gradually lower the number you're comfortable shooting a full dose... when you're around to monitor. it's what we did before the tight regulation protocol with lantus or levemir was widely accepted on the fdmb.

 

[Anne & Zener GA]

Re: 08/08 Zener PMPS 221 ATrak

probably the easiest thing to do is to gradually lower the number you're comfortable shooting a full dose... when you're around to monitor. it's what we did before the tight regulation protocol with lantus or levemir was widely accepted on the fdmb.

Maybe we just don't understand the tight regulation protocol all that well, as we thought our tentative numbers came from what we were reading, being a little more conservative for Zener's CH. And I understand completely about shooting the same dose at the same time, and how not doing so can cause some of the ups and downs. I don't think I probably appreciate yet how one dose can have an effect for three days. We read the protocol and think we have it, then we lose it. Read it again, think we get it, then it slips away.

We are around to monitor this week and next so testing more and shooting lower is possible, then we will be back at school and our time at home during the day will be very limited and our schedules pretty inflexible. Also, our time up at night for testing will be more limited too. And stalling during the week will be very difficult to impossible. We are trying to work our schedule so that one of us can come home mid-day or early afternoon to do checks and make sure he is eating. But there will be several weeks where I will be out of the country and Liz will be Zener's only caregiver and her schedule is a little less flexible than mine. So, we are starting to worry a little about going back to work and upcoming travel and how we can make it work best for Zener and us. I am sure there are lots of people on the board who are balancing these sorts of things and even more!

He has been at the 1.5u now for 6 cycles and his numbers are better. Should we be thinking about a dose increase and if so, when? Any other insight you see from his data would be great, this is all very helpful. Thanks so much!

 

[Jill & Alex (GA)]

Re: 08/08 Zener PMPS 221 ATrak

Maybe we just don't understand the tight regulation protocol all that well, as we thought our tentative numbers came from what we were reading, being a little more conservative for Zener's CH. And I understand completely about shooting the same dose at the same time, and how not doing so can cause some of the ups and downs. I don't think I probably appreciate yet how one dose can have an effect for three days. We read the protocol and think we have it, then we lose it. Read it again, think we get it, then it slips away.

when following the tight regulation protocol, theoretically you'd shoot the same dose every 12 hours as long as the preshot number is over 50 (human meter) or 80 (alphatrak meter). the idea is to take advantage of overlap and carryover to cover the expected food spike and the time before the new shot kicks in (onset). onset *usually* occurs around +2 with lantus.

take a look at alex's spreadsheet. when alex went back on insulin in 2009 i purposely tested her a lot in order to illustrate what happens when shooting full doses on lower numbers. click on the 2009 tab at the top of her spreadsheet page to view.

however, we have to be a little more careful because of the CH. that's why i think it's a good idea to gradually lower the number you're feeling comfortable shooting a full dose on.

We are around to monitor this week and next so testing more and shooting lower is possible, then we will be back at school and our time at home during the day will be very limited and our schedules pretty inflexible. Also, our time up at night for testing will be more limited too. And stalling during the week will be very difficult to impossible. We are trying to work our schedule so that one of us can come home mid-day or early afternoon to do checks and make sure he is eating. But there will be several weeks where I will be out of the country and Liz will be Zener's only caregiver and her schedule is a little less flexible than mine. So, we are starting to worry a little about going back to work and upcoming travel and how we can make it work best for Zener and us. I am sure there are lots of people on the board who are balancing these sorts of things and even more!

make the most of the time you have left before you return to work. take naps when you can in case you'll be up that night. get to bed at a decent time when zener bounces. initially, regulating a cat is hard work, but there comes a time when you know enough about how your cat responds to insulin and food that it'll become much, much easier. i can sleep test alex while she's sleeping in my bed by the light of a night light if i have to.

many people adjust their shot times so they can get a +1 or +2 before going out the door. those early spot checks will often give you a clue where he's headed for the day. those in the door spot checks will give you an idea of the rate of the rise or descent into pmps. "sleep tests"... setting your alarm to grab a night time spot check will sometimes be needed (depending on the +1, +2, or before bed spot check). in the early days i used to drink a tall glass of water right before going to bed to help wake me up in a few hours! :lol:

He has been at the 1.5u now for 6 cycles and his numbers are better. Should we be thinking about a dose increase and if so, when? Any other insight you see from his data would be great, this is all very helpful. Thanks so much!

see how things go tonight. if zener remains high you might want to fatten the dose rather than taking it up a full quarter unit or you could take the dose up a quarter unit if your schedule allows you to monitor carefully over the next few days.

hope this helps...

 

[Anne & Zener GA]

Re: 08/08 Zener PMPS 221 ATrak

Yes Jill, a great help! I especially like the big glass of water before bedtime alarm! I've been drinking a lot of green tea as part of my post surgery recovery and it works too. I like the water idea even better, no caffeine.

Thanks for the examples of Alex's spreadsheet. I like homework!

 

[Jill & Alex (GA)]

Re: 08/08 Zener PMPS 221 ATrak

if you have any questions, please ask.
i have an early morning so i'm headed to bed, but i'll catch up to you tomorrow.

 

[Anne & Zener GA]

Re: 08/08 Zener PMPS 221 ATrak

Thanks Jill! We'll post his numbers tonight and in the morning. Hope you get a good night's sleep.
I-)

 

[Anne & Zener GA]

Yikes, I completely lost track of the time.

08/08/11 Zener Alpha Trak
AMPS 338, 6th cycle @ 1.5 u, fed FDCK, 2 t. 11%
+1 fed 2t 10%
+3 229, fed 2t. 10%
+5, fed 3t 10%
+6 171, fed 2t 10%
+10 168, fed 2t 10%
PMPS 221, 7th cycle @ 1.5 u, fed 3t. 10%
+2.5 261, fed 2t 10%

I'm going to try for an early bedtime tonight and use Jill's large glass of water alarm! :mrgreen: