Re: 1/1 Gracie AMPS 119 +2 269 +4 329 HAPPY NEW YEAR!!
I'm going to take a few of these for now, because there are a million other condos I want to visit while I'm still feeling some energy. Sorry, I'm too impatient to get all the quotes into the right places so I hope you can still follow me.
Libby said:
It wasn’t until she got to the next breakthrough that I understood what had happened
Just out of curiousity...what was that?
I took too many reductions in too fast succession, and Lucy was not able to hold those reductions. She went back to pink/yellow and stayed there until I built all the way back up to her original breakthrough dose (4.25 units). Look at her spreadsheet in October 08.
When I got a second chance, I was determined to hold reductions until I saw a number below 40, even if I was fighting to prevent seeing that number below 40. Is that what made Lucy's second run down the dosing scale more successful? I don't know. It might have worked to go down the normal way. Maybe she just wasn't ready the first time, and the second time would have been fine. All I knew was that what I did the first time didn't have the result I wanted, so when she gave me a second chance, I was going to do something different. One VERY important difference here is that Lucy was not a new diabetic. She had been on the juice for over a year, so I knew nothing was going to come easily for her. Also, I was very fortunate that Lucy decided to give me this second chance over the holidays, when I could take more time to work with her. If she had done this while I was working my normal schedule, I wouldn't have been able to pull this off. Then I would have done things the "normal" way and just gone up and down until she decided to stop bouncing. Safety first and you can't ride that close to the edge when you can't monitor around the clock.
Bouncers can have a very long and frustrating trip through LL. Back in "the day" (LOL!) we just waited until the bouncing went away, whether that took a month or a year or three years. Now we have some ideas, like food manipulation, that are helping make that trip faster for some cats. You seem like you want to try to get her to unbounce faster, so we're trying to show you what has worked for some others. Would she unbounce on her own if you follow the "normal" protocol? Probably. When? I don't know.
Basically what we are saying is that a lot of this is up to you. I know that sounds very unfair. What you and Mike are doing is working very well for Gracie, but there is a human cost. I remember feeling frustrated that Jojo or Jill did not tell me "reduce your dose by x.xx" like they did other people. They couldn't. One of the parameters Rebecca has set here is that advice needs to be given based on a set protocol or on experience. I have a little experience with this. Jill has experience because she went through it with me. Both of us have also watched lots of other cats.
Do I know what I would want to do, if this was Lucy and if I felt I was up to it? Yes. But that is not something I can advise you to do. There are risks. If you reduce the dose too much/too fast, there is a risk that she'll lose her progress and you'll be back at square one. If you stay aggressive and hold doses longer, there is a risk that she will go too low and you might have trouble bringing her up.
Libby said:
I’m still “old school” enough to actually want to SEE dose reduction earning numbers though. LOL! I’m positive Gracie would have hit 30s last night without the Karo, but I’m scared to reduce because I’m scared she’ll lose all the progress she is suddenly making.
This is what Mike and I have been wondering. The protocol doesn't say to lower the dose when a newly dx cat gets below 50
after doing everything the caregiver can to keep them up (i.e. making them earn a reduction). As Libby said, we have to feed her to get her up but I think she would have been already reduced at the 1.25u and the sk1.25u after the first low cycle because without us controlling her, she would have gone lower.
Right. Gracie has a hard time holding reductions. In the past, she has proven that if you reduce by 0.25 after she goes below 50, she won't hold the reduction. Has that changed for her now? Maybe. There is only one way to find out, and that is to try. It's your decision!
Questions:
1. Perhaps I'm not seeing this with unbiased eyes but when I look at other kitties' SS, I see the same kind of bouncing so I don't see that Gracie's is worse than many of the other cats.
right, there are lots of other cats who bounce a lot. You seem to want to get her into better numbers faster, so by suggesting food manipulation we're trying to give you ideas that might help. Most cats do unbounce after a while. I think your food management is probably helping Gracie get through it faster, but she would probably still unbounce on her own at some point. As Jill said in one of her emails, most likely your food manipulation has moved Gracie a couple of months farther along in LTS than she might have otherwise gotten.
2. I also see other caregivers using alot of HC foods to manage their curves and some of them don't respond any more quickly than Gracie and I see them surfing 50s over a few hours.
Yes, there are other caregivers using a lot of HC food to manage curves. I think some of them might be overthinking things, too. :mrgreen: Each person has to make their own decisions, especially when they start stepping outside the normal protocol. Also, a lot of the cats you are watching are long-term diabetics. Once they have been at this a while, the chances that they will unbounce on their own are reduced. I don't know why, but we do see that. I also remember that Jojo's theory was that cats who had spent a while on Vetsulin or PZI were harder to make stop bouncing than the ones who had started on Lantus or Levemir. Gracie is still new, so there is a good chance her liver with "get it" on its own.
4. Where does this leave us? Do we get aggressive again and bump her back up? Do we see what she does with this TINY reduction? Is it possible that it will help if we take her down a drop at a time, see if she will get back into healing numbers and maybe stop bouncing so much and then continue slowly down the scale a drop at a time instead of .25u at a time?
It's very possible. With Lucy, I decided "losing it" again was less preferable than seeing low numbers.
It is also important to note that the time Lucy "lost it," it was not because I was taking shaves. I took a lot of reductions in quick succession. At the stage you are, I don't think taking shaves will hurt. I would just hate to tell you "it's ok to take shaves" and then have Gracie lose it. I hate giving advice that results in setbacks, even though there is no way to know in advance if there will be a setback. I've seen it matter, in some cats.
6. Mike and I just aren't experienced enough with this to make the decision.....if Libby has a hard time with it because Gracie's SS looks like Lucy's, then can you imagine how we feel?? We're novices and we're trying to make objective decisions about our baby without having the knowledge or the unbias.
I have a hard time not projecting my fears about Lucy onto Gracie. It's not fair for me to do that, because they really are different cats (old diabetic vs. new, carb sensitive vs. not, cat who had a pancreas that I thought was damaged beyond repair, etc.). Also, I wasn't experienced at the time. I had been in LL maybe 8 months, but hadn't been studying other spreadsheets the way I do now. To this day, Jill teases me because I wanted to hold onto my doses longer than anybody she has ever seen here. :lol: It's why you will often see me step aside when a cat is going into a fast dose reduction phase. It's stressful for me to watch people taking fast reductions and hoping they will hold!
7. Would levemir be an option....I see Tess and Gracie as very similar altho Gracie doesn't peak as early as Tess but she certainly drops fast at the beginning like Tess does...do these drops decrease on lev because the nadir is further out or does it just push the drop out further to +4 or 5 instead of 2 or 3?
Maybe. It seems like most of the time we don't see the drops reduce with Lev, but we see the whole cycle move around. You might find Putty's spreadsheet to be helpful. With Jazzy, I'm finding Lev a little frustrating only because it pushes her onset so late that if I do a +4 before bed, it tells me absolutely nothing about what number I'm going to wake up to in the morning. She likes Lev and is nice and flat on it, but I wonder if Lantus would be a safer choice for Jazzy just because it's not possible for me to do later tests at night. ECID, though.
