1/18 Ole +10.5 391 +11 542 PMPS HI +3 332 +8 247 +10 449

[Rebekah]

Good Morning!

viewtopic.php?f=9&t=112062

Last Night:

PMPS 223
+2 273
+4 332
+7.5 317

Well, those lower numbers of yesterday were sure pleasant and I hope Ole thought so too and he clears this bounce quickly.

Some thoughts about yesterday, thank you all again for your input. It is so appreciated, even though sometimes I don't quite get why I should do things that way or this way. The information and your patient explanations are invaluable. I never mean to be critical, I just need to ask questions and get explanations. So, Thank you, Thank you!

Here's a couple of questions...hahaha Firstly, Could you explain why the timing of yesterday's R wasn't ideal, because I thought it worked great. I've given Ole 3 .1uR now, and all of them have been after sustained HI numbers where L wasn't seeming to budge him anymore. In all 3 circumstances, Ole was able to move down, visiting lower numbers and feeling better. Yes, he did rebound back up, but there is always the chance he won't this time. Could you suggest a better way to use R, or a better way to time the dosage? I also liked the +10 dose because I felt it helped with BIPO, and I was able to monitor/regulate closely yesterday. I know that there was big movement, but if he is HI, a 50-100 pt movement will only get him into red. I admit though that I had hoped that he would stay in pink and yellow for the day because I would of course like to stabilize him in that range before moving into yellow and blues. Your thoughts on what might have been better would be appreciated to help me understand R and how it can be used.

I tried to clarify Ole's SS. I am pretty awful with spread sheets, so any advise and techniques would be helpful, hahaha

Sandy, your Father's 3 P's? Ole has them in spades when it comes to food, except for the patience one. He was not like this prior to FD, so I hope it is a symptom that will dissipate at his decease becomes regulated. Ole is a cat that is overflowing with personality which we love so much, as we love all of our cats past and present.

Any way, enjoy your Saturday. I'll be back to inform you about K's and poos and all of that other good stuff. Right now Ole is sleeping at the end of the bed with A as he reads the paper. O and A have a close relationship, they're buddies for sure.

Thanks again!
Rebekah

 

[Rebekah]

Re: 1/18 Ole AMPS 539 +3 358

Oh yeah,

We all fell back to sleep and I awoke in a bright and warming sunbeam with my 2 furry companions curled up against me putting me in a cat cuddle trap. Love it!

Ole tested neg for K this morning and his lb is well used with #1 and #poo.

Enjoy your day! and we will too.

Rebekah

 

[Chris & China (GA)]

Re: 1/18 Ole AMPS 539 +3 358

No help from me on the "R" question, but just had to say Good Morning and that's a pretty significant drop for Ole in 3 hrs time. He might be headed down even further too. Those big fast drops can lead to another bounce though, so although it's nice to see him out of the black, dropping almost 200 points in 3 hours could set him up for another bounce later, so don't be surprised if he goes HI again

Hopefully he won't, but just wanted to give you a "heads up" that it very well could. We'll just have to see.

I love to see the magical pull of a sunbeam! It's neat to watch our furkids follow the sunbeam around as it moves across the floor/bed/couch..whatever :lol:
[youtube]yq-gSL3o4iQ[/youtube]

Hope you and Ole have a great day Rebekah!

 

[Anne & Zener GA]

Re: 1/18 Ole AMPS 539 +3 358

You're doing a great job, Rebekah. Ole is a tough kitty to treat. Maybe he could joint the LantusLand Sliders Curling Club? It's a great place to work on sliding skills (as opposed to diving). :lol: :lol:
Liz

 

[Marje and Gracie]

Re: 1/18 Ole AMPS 539 +3 358 +5 313

You're right that the R worked great yesterday. Our input was just that you have to be really careful if you are using it other than when a bounce first starts. The goal is to keep the bounce from going into the stratosphere. I have made the mistake of using it after the bounce started and she was well into it but numbers were staying higher than I wanted. The result was her flying down at too fast of a rate. When that happens, you risk a huge bounce back up that could take longer to clear than if you hadn't given the R in the first place.

I've seen R used in three different ways:
1. for IAA kitties like BK
2. for kitties with DKA to bring the numbers down
3. for bouncy kitties whether they are acro or not

I haven't seen it used in the situation where the insulin poops out early. I'm not saying it's not possible to use it at that time but it's not the way I was taught.....which is to give it at the very beginning of a bounce.

I know that Ole's numbers have been really high and you want to get him to safe numbers; he's not had a lot of bouncing yet because he hasn't had a lot of lower numbers. It's possible the high number you saw this morning could be a bounce from yesterday; sometimes the bounces are delayed. Or it could have been the high before the break. I would have given him R when he started that bounce last night in the hopes that he would not hit 500 this morning.

There might be other R users who can help you decide whether you should/could use it to help with the lack of duration.

eta: I thought of one other thing to tell you.
--sometimes kitties will start a bounce, come down a little bit like they might be clearing the bounce, shoot way up again, and then clear. That high number is known as the "high before the break". It is very, very tempting to shoot R in a scenario where you think the bounce is clearing and then you get a really high number. It can result in numbers coming down quickly.

 

[Sandy and Black Kitty]

Re: 1/18 Ole AMPS 539 +3 358

Good Morning
Good to see that Ole decided to return from his visit to the 5th floor penthouse in short order this morning.

Firstly, Could you explain why the timing of yesterday's R wasn't ideal,

An R bolus has a couple uses. One is to help a kitty prone to ketones quickly get enough insulin to prevent trace ketones from developing to critical levels.

Another is to try and keep a kitty with crazy high numbers safe while trying to find the right basal insulin dose. Part of this process is taking the edge off bounces.

Ole falls into the second category. It's' important to know that non matter which category a kitty falls under, decisions around dosing and timings are extremely situational and fluid. You are truly flying by the seat of your pants, no two ways about it.

R is powerful stuff. If a CG gives R as a bounce is breaking, the power of R combined with the drop that naturally occurs when a bounce breaks could result in a deep dive. That deep dive could trigger another bounce and potential for and endless loop of highs and lows begins. If a CG gets stuck in such a loop it can be really tough to get out of it. Same applies for timing R if high numbers are a result of the 'high before the break" that can sometimes occur with NDW

The other night was really tough. Was he clearing a bounce? Was he experiencing NDW? Was it 'the high before the break' of NDW ? The full moon? What's with these meter readings??? Is the meter malfunctioning ? Are the strips bad? Just A and C? All of the above?

You really could not be absolutely certain of any of that. Any one of us, myself included would have had difficultly had we been faced with the same situation so early in the game. Speaking for myself, even providing guidance under those circumstances is daunting.

One thing was for sure - test after test he was off the charts. Using the R provided relief to Ole and to you and Alex. Knowing how high he was and having been advised of the potential risks you made a decision, and you had a plan. Based on knowing that Ole likes to eat, you were confident you could slow him down if he was dropping too quickly and you were prepared to whip out the HC if it looked like he was heading to the cellar. You were available to test and prepared to take action.

It may not have been perfect timing however all things considered you handled things well and expanded your knowledge.


Well Done!

Oles numbers are very erratic. As you approach the right dose this will likely improve and the day will come when you won't have to worry about R decisions.

sometimes I don't quite get why I should do things that way or this way.

There is a whole lot to 'get'. I don't find you the least bit critical. A big part of getting the 'why' is to ask 'Why not?'

Personally, I find that reading about FD - a feeding method, protocol guidelines, bounciness etc. is one thing - theoretical.
So you apply the concepts to your situation and begin the process. The more you apply those concepts to Ole, observe and document the outcomes (whether desirable or less than desirable), the more you will get the 'why'. You may not get everything right away - that's OK. There are experienced folks here to guide you.

And remember even if you do 'get' things, Ole may have other ideas.

 

[Jill & Alex (GA)]

Re: 1/18 Ole AMPS 539 +3 358 +5 313

thank you, sandy.

i really appreciate how sandy pulled yesterday's condo together with her last post of the evening in that thread. i know it feels good when everyone tells you you're doing great, but it won't keep your cat safe under circumstances which *could* be considered questionable. it's much better to discuss the possibilities. sandy's explanation today goes into more detail. details which i hope you will find helpful.

has anyone provided you with the basics of R use yet?

• you never want the nadirs of the basal and bolus insulin to coincide.

• you have to be very careful to not give R at a time in the cycle when the nadirs for R and lantus/levemir might overlap, OR when both insulins are working hard at the same time. if you have R pulling him down at the same time the lantus or levemir joins in and starts pulling down even harder, then you can get into a situation where it is hard to control the drop.

• start with a tiny dose of R. we suggest no more than 0.1 unit. it won't take long to find out if Ole requires more than 0.1u R.

• test every hour for the first 4 - 5 hours after giving R. you'll want to learn when onset and nadir occur as well as how much duration Ole gets from R. this data will will eventually help you develop a sliding scale for R (if necessary).

• all we're looking for is a drop of 50 - 100 points from a shot of R. anything more than that will usually set up another bounce... not what we want to happen.

rebekah, the learning curve is steep. i admire and applaud how you've been asking questions.
you'll end up with a better understanding than most...

have a good day!




btw, yet another way to use R:
using R to pull numbers down enough for lantus or lev to "grab onto" appears to have been a forgotten technique in this group as of late. it's a method which is not restricted to high dose kitties. jojo, my mentor here on the FDMB, likened R to walking into a jungle and using the R as a machete to cut through the dense undergrowth. this will allow the lantus or levemir an easy entry into the dense jungle of high numbers. it's a method i've used and used successfully to pull alex's numbers down when she's sick or when i've had to skip shots for one reason or another. well documented examples can be seen on her spreadsheet over the last couple of years.

 

[julie & punkin (ga)]

Re: 1/18 Ole AMPS 539 +3 358 +5 313

first, you're not even a little bit difficult or critical, rebekah. you're questioning and analyzing and trying to understand. that's a wonderful quality. don't worry at all about it. i love to see people trying to wrap their heads around the whole thing!

secondly, we can tell you what worked for our cats, or what we've seen work in other cats, or what works in most cats, and we can observe how we see Ole' responding to what you do. but your job is to sort through this and notice what does and doesn't work in Ole'. you're doing a very good job at that. you don't have to take our advice, especially when you've really considered everything and feel confident about what you are seeing. the more experience you gain, the more you'll see our comments as guidelines or things to consider, and hopefully, the more accurate and confident you'll become about what you see and what works in Ole'.

third, (hehehe i teach and love to use outlines!) an ideal time to use R is when you're seeing the beginning of a rapid rise, say 100pts in an hour, or you see several tests that are pointing to a rise coming ahead. for example, say Ole' has several tests over 3 or so hours that are all going up, he's passed 200, passed 250, maybe onto 300, and you look back in time and see a low number. that's very reasonable to think that this rise is a bounce from the low number. that becomes an ideal time - at the phase he's in right now - to give a little touch of R.

Later, as he gets used to lower numbers, he will clear bounces more and more quickly. when he reaches that phase, you will want to restrain from using R if you think the bounce will be short.

lastly, pulling him down 50-100 points is really ideal. or cutting a bounce off at the knees so he just doesn't go as he otherwise might have. Lantus works great on the lower ranges of numbers. by keeping the overall range down, you've given a boost to how well the Lantus will work. that is very worthwhile!

hope you're enjoying your Caturday!!

 

[Rebekah]

Re: 1/18 Ole AMPS 539 +3 358 +5 313 +8 303 +10.5 391

Ole has had a pink surf today, and he seems to be climbing...Bounce?...BIPO? I guess figuring that out is the challenge. My intuition tells me that the high AMPS was BIPO, and that he is on track to do the same thing this evening, which I would like to avoid. I feel it is BIPO because he stayed in the pink all day long.

Thank you for everything. So much very helpful information today. Processing....processing.... I stepped out this afternoon because A was home and I needed some me time that I wasn't working or taking care of Ole. I'm refreshed!

Thank you!

Rebekah

 

[Rebekah]

Re: 1/18 Ole AMPS 539 +3 358 +5 313 +8 303 +10.5 391 +11 542

Yes, I tested twice, so he is definitely climbing and will be HI by PMPS Should I shoot R? I feel I should as I don't feel this is a bounce but BIPO. He has been cruising in pink all day. We are home all night and able to monitor.

This is an edit, but I think I wish I would have shot R at +10.5-+11, at the beginning of the bounce/BIPO. I don't think it matters which upward movement it was, just to get it at the onset. I believe that the use of R for Ole is to latch on at the bell ends of his current daily curve to pull them down to a flatter kitty. Oh well, live and learn. I'm sure he will give me another opportunity soon.

Coming soon, I have a few questions about bounces that I'll ask a bit later.


Thanks!
Rebekah

 

[Rachel & Chyna (GA)]

Re: 1/18 Ole AMPS 539 +3 358 +5 313 +8 303 +10.5 391 +11 542

Sorry to not have an answer, I just wanted to pop in to say hello! I hope Ole slides back down in the other direction for you tonight. I'm glad you got some "me" time, we all need that! Have a good rest of your Caturday

 

[Rebekah]

Re: 1/18 Ole +5 313 +8 303 +10.5 391 +11 542 PMPS HI

Well, I'm not surprised that Ole hit HI this evening, it looks as though the climb began at about +10 I don't believe that it matters whether it is a BIPO or a bounce, but perhaps I am wrong.

Ole is doing well, we were out side for a while this evening. Ole loves to explore the great out doors so I like to take him out and watch him sniff around the back yard. I have to keep a close eye on him because if I don't, than it's up and over the fence he goes, and who knows what's on the other side of the fence!

My questions regarding bounces, do they usually occur on the same day, or can Ole bounce off something that happened a day ago, or several days ago, or last week? How do you tell a bounce from a regular climb? In our situation, Ole can have some significant climbs, especially towards the end of the cycle, are they all bounces? If I understand, clearing a bounce is when the cat comes down off of a high number. This morning, Ole was clearing his bounce by +3, is that right, or did the insulin become effective. Bounces are baffling!

I feel that Ole is somewhat reactive to his insulin, within a certain range. I don't know what happens when he won't budge out of sky hi. But, there was movement with the last couple of doses. He also sees movement with .1uR. I can't imagine what it was like for Sandy to be giving BK those huge doses! It's mind boggling, and bold action indeed!

Any way, we solder on, I ask and learn along the way until Ole sees fit to become regulated. I hope then to carry forward the things that I am learning through this remarkable experience.

Thanks, as always, now let's see what this evening will bring us!
Rebekah

 

[julie & punkin (ga)]

Re: 1/18 Ole +5 313 +8 303 +10.5 391 +11 542 PMPS HI

i think one of the things you're seeing is that we haven't gotten to a good dose for him yet. the R pulled him down into blues yesterday, but we want the Lantus to get him there.

my guess is that this is still a bounce from yesterday's blue numbers. sometimes when the bounce occurs, there will be a wobble around in high numbers, some lower, but not back to what they were before. i don't think he was clearing the bounce this morning, i think the numbers were just bobbling around, but he's still in the middle of a bounce and that's why he's so high tonight.

yes, a bounce can start a day later after the low numbers "event." no, i don't think it would begin a week later. the cat's body is responding by releasing stored sugars and hormones and i doubt it would initiate more than a day or so later. i haven't seen it, at least.

yesterday morning, when he went from 396 to 304 in an hour - that speed of a drop, 92 pts in one hour, is fast enough that it alone can set up a bounce to follow. i think you just need to wait this one out, and it can take up to 3 days for a bounce to clear.

 

[Chris & China (GA)]

Re: 1/18 Ole +5 313 +8 303 +10.5 391 +11 542 PMPS HI

On bouncing, the best answer I can give you is "almost all of the above". Yes, they can bounce during the same cycle, the next cycle, and for a few cycles after a low their body isn't used to or a fast drop in the numbers. They can also bounce up, start to come down, and bounce right back up. Bounces are VERY frustrating, but they're part of this dance we have little control over.

If I had to guess (which I am), I'd say today was a bounce off the fast drop this morning. He went from 539 to 358 in 3 hours. That's a pretty significant drop and can cause a bounce just like a low can.

As for using the R, I have absolutely no experience, but from reading along with your condo, I think it might have been a good time to use it if the idea is to use it to slow down a bounce, but again, I've never used it, so I really have no idea.

Hopefully one of the more experienced people will be along soon to help answer your questions.

 

[Sienne and Gabby (GA)]

Re: 1/18 Ole +5 313 +8 303 +10.5 391 +11 542 PMPS HI

My questions regarding bounces, do they usually occur on the same day, or can Ole bounce off something that happened a day ago, or several days ago, or last week? How do you tell a bounce from a regular climb? In our situation, Ole can have some significant climbs, especially towards the end of the cycle, are they all bounces? If I understand, clearing a bounce is when the cat comes down off of a high number. This morning, Ole was clearing his bounce by +3, is that right, or did the insulin become effective. Bounces are baffling!

How I tend to look at bounces is in relation to the other numbers. Was there a low number? Was there an unusually low number for your particular cat -- a number in a range that your kitty isn't used to spending time in? Was there a fast drop? All of these things can trigger a bounce. Then, what happens with the numbers that follow? In some cases, there's a gradual rise that can peak during the next cycle (or two cycles later) and the kitty stays in these higher numbers for a while. Other times, the numbers quickly spike upward. A bounce can last for roughly 72 hours or in some cases, they clear quickly (e.g., after one cycle).

I don't think you're seeing BIPO. I think what you're seeing are bounces. A drop from the 500s to the 300s is a still a big drop even though it's not a drop into what we would consider "low" numbers. Those fast drops like on 1/16 where Ole went from 597 to 273 at +4 was both a big and fast drop. The bounce back to 600 wasn't wholly unexpected. The bounce then cleared the next AM cycle and Ole was in the blues. His numbers then slowly bounced into the 500s this morning.

 

[Rebekah]

Re: 1/18 Ole +10.5 391 +11 542 PMPS HI +3 332

Uff-da...bounces.

Boinging all over the place, but Ole is as happy as a clam because we're making pizza!

I'll continue collecting data and we'll keep doing what we can to help our funny little kitty.

Thanks again!
Rebekah

 

[Wendy&Neko]

Re: 1/18 Ole +10.5 391 +11 542 PMPS HI +3 332

Ooh pizza. Got any stray bits of cheese or meat? Yummy. Neko will be right over there. :lol:

Collecting data on Ole' is what you have to do. There's a good chance of a bounce from tonight's free fall. Another data collection opportunity. I discovered that Neko has the highest part of her bounce typically the beginning of the third cycle after the low event. But it took a while to figure it out, cause it's not what she always does. :roll: Once Ole' starts regularly getting more colors in his SS, the bounces will be easier to detect.

Have a good evening!

 

[Jill & Alex (GA)]

Re: 1/18 Ole +10.5 391 +11 542 PMPS HI +3 332

if BIPO cannot be seen on Ole's ss, one does not understand BIPO and how it manifests itself on a spreadsheet. a classic sign of BIPO is the insulin losing it's effectiveness towards the end of the cycle... almost every cycle... day after day. the solution = safely and methodically taking the dose up until the dose is enough to provide adequate duration.

that's not to say Ole is not bouncing. he is. he's bouncing every time his body drops into numbers he's not accustomed to being in. for years we've been saying bounces can last up to 72 hours. however, we've since learned bounces *can* actually last longer... not usually, but it *can* happen.

some kitties will begin a bounce during the same cycle where a drop to a low or a fast drop is seen. some kitties will begin a bounce in the cycle immediately following the cycle where a low or fast drop was seen. and then we've seen kitties have what we've called a "delayed bounce"... a bounce which doesn't start until a couple of cycles after a drop into lower numbers than kitty is accustomed or a fast drop.

some kitties will experience all of these types of bounces at one time or another. the goal is to keep showing kitty the green until their body no longer panics. this can take weeks, months, or years to happen... and it's also possible kitty will never stop bouncing due to other issues. however, my personal feeling is if a caregiver doesn't have kitty where they want them within 6 months to a year... it's time to try another insulin. after all "the best insulin" is the insulin that works for YOUR cat. chances are if some thing's not working well after a year... it's not gonna happen. :mrgreen:

i think one of the things you're seeing is that we haven't gotten to a good dose for him yet. the R pulled him down into blues yesterday, but we want the Lantus to get him there.

my guess is that this is still a bounce from yesterday's blue numbers. sometimes when the bounce occurs, there will be a wobble around in high numbers, some lower, but not back to what they were before. i don't think he was clearing the bounce this morning, i think the numbers were just bobbling around, but he's still in the middle of a bounce and that's why he's so high tonight.

yes, a bounce can start a day later after the low numbers "event." no, i don't think it would begin a week later. the cat's body is responding by releasing stored sugars and hormones and i doubt it would initiate more than a day or so later. i haven't seen it, at least.

yesterday morning, when he went from 396 to 304 in an hour - that speed of a drop, 92 pts in one hour, is fast enough that it alone can set up a bounce to follow. i think you just need to wait this one out, and it can take up to 3 days for a bounce to clear.

i wholeheartedly agree with julie's thoughts.



getting back to the last shot of R...
hindsight is the best sight. wish what we learn after the fact would show itself beforehand. wouldn't that be nice?
the good news is even when seen in hindsight: we're learning. every bit of data collected in every circumstance is a learning experience.

there were hints on Ole's ss that he could have been clearing a bounce at the same time R was administered. marje recognized the possibility when on 01/16 she said:

I also think this could be NDW. I can understand why you would want to use R because those numbers are very stressful.

If you decide to give it at +10, please monitor closely because if it is NDW, it could break. The other thing, tonight is six cycles since he got some blue so he could also be in a bit of a bounce. (emphasis mine)

fwiw, i don't understand the NDW part of her comment. in all the years i've been here i've not heard of NDW and the use of R in the same sentence. however, after the fact, it became obvious R was administered as the bounce was clearing. in this particular case it didn't make any diference because the numbers were so high. however, it bears discussion because there will come a time when the timing of R will become an issue and we want to make sure Ole is kept safe.


getting back to BIPO...
rebekah, do you have any flexibility in your schedule? one of the fastest ways to overcome BIPO while gradually and methodically increasing the dose in a safe manner is to shoot on the rise (as early as +10, but any time between +10 and +12). the thinking is when kitty is already rising why wait to shoot the next lantus/levemir shot at +12 when he'll be even higher? personally, i don't recommend shooting early in back to back cycles until/unless you have the data to support your decision.

if you were too shoot at let's say +10... the next shot would be due 12 hours later. this technique doesn't work with many caregivers schedules, but if you have the flexibility... this method helps increase duration sooner than later.



just a few thoughts for your consideration...

 

[Sandy and Black Kitty]

Re: 1/18 Ole +5 313 +8 303 +10.5 391 +11 542 PMPS HI

Hi there

I'm not the person to offer meaningful insights into bounces. Plenty of others with first hand experience to help you get your mind around them.
BK was mostly what we used to refer to as 'Flaaaaaaaaaaaaaaat'

I want to add my voice to something Jill said earlier:

rebekah, the learning curve is steep.

It is indeed a steep learning curve.

I can't imagine what it was like for Sandy to be giving BK those huge doses! It's mind boggling,

I was very fortunate to have the guidance of what we (the 'class of 2008-2009' ) affectionately referred to as 'The J Team' - Jojo and Jill.

I believe BK was the first kitty to be tested for IAA. We were all in uncharted waters, without a map, navigating the best we could, many times flying by the seat of our pants.

I was also fortunate that figuring out BKs 'patterns' was very simple. He had pretty much one - consistently high and flat numbers, in spite of huge doses of R. The numbers didn't budge. While in the thick of it, the doses didn't seem extreme, it was what BK needed so I did what needed to be done. It was not however without a good deal of nailbite_smile on everyones part.

Figuring out Oles patterns is key to treating his FD. It''s a tall order, however you are clearly up for the challenge and on your way.

Ole and BK are different in many ways, however I am noticing one thing they have in common - they are both very entertaining characters. :lol:

 

[Jill & Alex (GA)]

Re: 1/18 Ole +5 313 +8 303 +10.5 391 +11 542 PMPS HI

I believe BK was the first kitty to be tested for IAA. We were all in uncharted waters, without a map, navigating the best we could, many times flying by the seat of our pants.

OFTEN flying by the seat of our pants! :lol:
without having been there i don't know if others can appreciate the full extent of all that went on with BK.
to sum it up in one word: groundbreaking!

 

[Marje and Gracie]

wiw, i don't understand the NDW part of her comment. in all the years i've been here i've not heard of NDW and the use of R in the same sentence.

:lol: :lol: probably because I wasn't clear in what I meant. He was still within that time period where we "can" see NDW plus he was also within six cycles of the blue numbers. So my thoughts were that he could have NDW or he could be bouncing or I'm assuming they can do both at the same time. We can't really know. I was worried about Rebekah using R because the bounce could break but also, if he had NDW, it could also start "clearing" and I use that word because I'm not sure what other words best applies when the NDW is no longer a factor.

To tie all that in together, there was a cycle when I wanted to use R with Gracie and Libby told me she wouldn't because she thought it was NDW, not the beginning of a bounce. Thus I made the connection that one probably does not went to use R to lower NDW numbers. If this is incorrect, I'd be appreciative to know and why Libby wouldn't have wanted me to shoot R with what she thought was NDW. FD continues to offer opportunities to learn no matter how long you've been doing it.

 

[Jill & Alex (GA)]

marje:

it's impossible for me to comment or put words in libby's mouth without specifics... knowing not only the exact circumstances as well as the context in which the comment was made. very often someone analyzing a spreadsheet will have their reasons for making a suggestion based on that individual cat... or their caregiver.

all i can speak to is what i said... i've not heard NDW and the use of R in the same sentence...

 

[Libby and Lucy]

Marje - like Jill, I can't say for sure what I meant that day without going back to that day. Remember, though, that any dosing advice given for Gracie is for Gracie. Gracie will dive whenever she wants to, so the only safe time to use R with her is at the beginning of a bounce. That's the only time you can be somewhat sure she isn't planning to dive on her own anyway. If whatever I saw on her spreadsheet indicated that the high numbers were probably not the beginning of a bounce, I would have recommended not using R. But that's Gracie, not Ole. ;-)

For everyone - when you are using R for your cat, you need to understand your cat's Lantus or Levemir patterns (meaning not just the 12 hour cycle, when his nadir is, etc. but also his typical patterns for NDW, bounces, etc.). Then you need to understand his R cycles. Then you lay the R cycle on top of the Lantus/Lev cycle to determine how to safely use R in YOUR cat. That will likely be different than what will work for someone else's cat. It might even be different than what used to work for your own cat! Gather lots and lots of data, then learn how to use the data. Not easy, but it's VERY important for you to understand how the insulins are working together in your cat.

I don't think using R at +10 is a problem on its own, especially if you know your cat will zoom up before PS or if you know your cat will have a big food spike after PS, and if you know the R will be gone before Lantus onset. What CAN create a problem (as Jill said) is giving R when a bounce is due to clear. Then you can get the downward momentum from the R, added to the downward momentum from the bounce clearing, and that can take the cat much lower (and faster) than he would normally go. So yes, you have to learn to predict the future a little bit. :lol: Most cats DO have some consistent patterns, but sometimes it can take quite a bit of study to figure them out.

 

[Marje and Gracie]

Thank you both. Obviously, I completely understand that any advice given is taking into account the specific cat and the caregiver.

And I understand quite well the limitations on giving Gracie R and that that is specific to Gracie. I can only tell you, Libby, that you said you wouldn't give R to her in that specific cycle because it looked like NDW. Therefore, I made a correlation between R and not giving it if it appears the cat is experiencing NDW.

Because there are some very general guidelines about giving R, as Jill listed for Rebekah, I wondered if that also was one. But apparently not.

However, since there might be "some" cases and "some" cats where a CG would want to be careful using R if NDW is occurring, it seems just wise that, particularly when a new member is using R, one should be aware to be cautious.