1/19 Ole +10 457 early PMPS +2 396 +3 377 +5 346 +10.5 449

[Rebekah]

Good Morning!

viewtopic.php?f=9&t=112118

It's early, but I have to continue yesterday's condo. Sorry I wasn't here as much last night, but A and I were having a in house "date night" catching up with each others crazy life.

Last Night's recap:
PMPS HI
+3 337
+5 319
+8 247
+10 449

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.

I do have flexibility in my schedule, but I don't have consistency. Meaning, what might work one day might not work the next . I have a lot of job site meetings (I'm an interior designer/ architectural illustrator). I think shooting the rise was what I was trying to get at yesterday, but I was thinking of shooting the rise with R, not L. If I shoot L early back to back, do I then again shoot at +12 the following day? Or, at some point does +10 become the new +12. I am willing to try anything because these end of cycle high rise numbers have to stop. I lean towards shooting the rise with R as needed/able and shooting L at +12. I believe there will be a time, shortly, that the need to shoot the rise and R use will be over as we get to the right dose. It's just that it's hard to find that dose when Ole is bouncing and BIPOing all over the place.

Sorry about the quote thing. I don't know how to use the function. This is the first message board that I've been involved with and I'm not as computer savvy as I should be!

This morning will be the 4th cycle since Ole has seen blue, which was after his R shot on the AM of 1/17.

Getting close to AMPS, I'll be back!

Enjoy, and thanks again.

Rebekah

 

[Dyana]

Re: 1/19 Ole +10 449

To use the Quote, you can highlight the line or paragraph that you want and then click on the Quote buttom above /\ and then just copy and paste from the first [ to the last ].

To answer your +10 question: If you normally shoot at 9:00am and 9:00pm for instance, and you decide to shoot at +10 in the evening which would be your 7:00pm, then yes your next dose would be due 12 hours later at 7:00am.
Your schedule would have to move with the new shot times.

 

[Rebekah]

Re: 1/19 Ole AMPS 467

To use the Quote, you can highlight the line or paragraph that you want and then click on the Quote buttom above /\ and then just copy and paste from the first [ to the last ].

Thanks Dyana!

I did it, two times!

Oh, and yesterday was our 1 month anniversary on FDMB! Yay

 

[Jill & Alex (GA)]

Re: 1/19 Ole AMPS 467

I do have flexibility in my schedule, but I don't have consistency. Meaning, what might work one day might not work the next . I have a lot of job site meetings (I'm an interior designer/ architectural illustrator). I think shooting the rise was what I was trying to get at yesterday, but I was thinking of shooting the rise with R, not L. If I shoot L early back to back, do I then again shoot at +12 the following day? Or, at some point does +10 become the new +12. I am willing to try anything because these end of cycle high rise numbers have to stop. I lean towards shooting the rise with R as needed/able and shooting L at +12. I believe there will be a time, shortly, that the need to shoot the rise and R use will be over as we get to the right dose. It's just that it's hard to find that dose when Ole is bouncing and BIPOing all over the place.

flexibility works. this is probably one of the few instances you'll find consistency isn't important because you do not want to shoot early every single cycle. shooting early too often (in back-to-back cycles) could end up back-firing on you because you can inadvertently build up too much overlap/carryover.

take a look at alex's spreadsheets. i've tried to remember to record the +hours of shot times over the last few years, but when looking at her spreadsheets, keep in mind alex is on levemir which has a later onset than lantus (+4). i often shoot her PM shot at +11 and AM shot at +13 for very different reasons than what i'm suggesting for Ole. i try not to shoot early in back-to-back cycles. the shot times are not consistent. they pretty much follow my work schedule and sleeping patterns. what i'm trying to get at is sometimes you'll be shooting on a 12/12 schedule... probably mostly shooting on a 12/12 schedule with some exceptions. those exceptions being when you see Ole heading upwards and see no reason for him to go any higher before giving him more insulin (his next lantus shot). and yes, like dyana said, if you shoot early at for instance +10... the next lantus shot is *due* 12 hours later. now if you need to get back on schedule because of work you can always shoot that next shot at +13 or +14.... which would bring you right back to your normal shot time. lantus and levemir are more flexible than we used to think years ago.

i understand this can be confusing. if you have questions, continue asking. sometimes it just takes another way of explaining the same thing for everything to fall into place in one's mind.

subjects worth reviewing because of their relevance to shooting early:

Carryover - insulin effects lasting past the insulin's official duration
Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
Insulin Depot - "spare tank" of insulin, which has yet to be used by the body
LANTUS & LEVEMIR: WHAT IS THE INSULIN DEPOT?


there are a few of "rules" when shooting early/shooting on the rise... rules designed to keep kitty safe:

• in the interest of safety, we usually do not recommend shooting any earlier than +10 and only when you know your kitty is definitely headed upwards.

• don't shoot early when a bounce is breaking

• using R and shooting early are two separate techniques. please don't combine them.

• initially, careful monitoring is required any time one strays from the guidelines listed in the TR protocol. eventually, you will accumulate enough data to know when you can comfortably back off on monitoring, but this only comes with time, experience, and "knowing thy cat".

i'll be in and out a lot today... mostly out... but will check in when i can to see if you have any questions. i'm sure others will also be around today.
have a great day! :mrgreen:

 

[Ella & Rusty & Stu(GA)]

Re: 1/19 Ole AMPS 467 +2 450

This is a very interesting discussion. Thanks, guys.
Good luck with your schedule, Rebekah!

Ella & Rusty

 

[Rebekah]

Re: 1/19 Ole AMPS 467 +2 450

Hi!

Wowser! Shooting early on the rise...

flexibility works. this is probably one of the few instances you'll find consistency isn't important because you do not want to shoot early every single cycle. shooting early too often (in back-to-back cycles) could end up back-firing on you because you can inadvertently build up too much overlap/carryover.

take a look at alex's spreadsheets. i've tried to remember to record the +hours of shot times over the last few years, but when looking at her spreadsheets, keep in mind alex is on levemir which has a later onset than lantus (+4). i often shoot her PM shot at +11 and AM shot at +13 for very different reasons than what i'm suggesting for Ole. i try not to shoot early in back-to-back cycles. the shot times are not consistent. they pretty much follow my work schedule and sleeping patterns. what i'm trying to get at is sometimes you'll be shooting on a 12/12 schedule... probably mostly shooting on a 12/12 schedule with some exceptions. those exceptions being when you see Ole heading upwards and see no reason for him to go any higher before giving him more insulin (his next lantus shot). and yes, like dyana said, if you shoot early at for instance +10... the next lantus shot is due 12 hours later. now if you need to get back on schedule because of work you can always shoot that next shot at +13 or +14.... which would bring you right back to your normal shot time. lantus and levemir are more flexible than we used to think years ago.

i understand this can be confusing. if you have questions, continue asking. sometimes it just takes another way of explaining the same thing for everything to fall into place in one's mind.

Let me break this down as I under stand it, in true life story form. Our usual PS is 6:00am and 6:00pm MST.

Ole is rising at AM+10 this evening, and because of his pattern of steep rises at the end of his cycle, I give him 6uL at +10 tonight. I monitor him through PMPS and the PM cycle. I then administer 6uL at PM+10 tomorrow morning. I continue monitoring, and if there is no rise, I shoot Monday's PM dose at, in this case +14, which is back at my normal dosing time of 6:00pm. What happens if there is a rise on that second day? Also, what happens if there is an increase of dose?

I'll study Alex's SS in earnest, but I'm just trying to wrap my head around this treatment, I also want to make sure it is the best option for Ole. I do believe I could work it into my schedule though.

Thanks again. More questions to come...

Rebekah

 

[Rebekah]

Re: 1/19 Ole AMPS 467 +2 450

Hi!

Not to hark back to R all of the time, but what about this?

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.

Isn't BIPO a jungle? It sure is in my eyes! Right now reading bounces, what does Ole's bounce look like as it is clearing etc, is still pretty grey and foggy and unclear. He is so bouncy I don't know one bounce from the other! I think that what you're all telling me is that because of Ole's erratic BP's, R isn't the safest option.

My second senario:

Ole begins his end of cycle rise at +10 this evening. I give him .1uR at that point. Monitor him at +1R. At PMPS (+2R), I also administer 6uL. Continue monitoring for +3,4 & 5R. Able to regulate with food because Ole is ravenous all of the time. I try to keep his numbers as steady as possible. I do this as needed to flatten out the BIPO. As we are able to find Ole's correct dose, we do not need to use R anymore because Ole's cycle has flattened. We all live happily ever after. Hahaha

Thanks again! I really appreciate everybody's patience and input. You're all awesome.

Rebekah

 

[carfurby (GA)]

Re: 1/19 Ole AMPS 467 +2 450

Good luck making adjustments to Ole's shot time. It's nice that your schedule allows you to do that.

 

[Rebekah]

Re: 1/19 Ole AMPS 467 +2 450

Hi all,

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.

Even though I have only been with FDMB 1 month and a day, the pattern I see the most clearly is that Lantus loses potency at the beginning and end of Ole's cycle. Ole also experiences a food spike. His mid da/ night tests are generally much lower than his early/late tests. I see an exception on 1/11 when he bounced into HI after seeing green on the 10th.

Thanks again. Though I seem to be pleading a case for R use, as needed for Ole, I am just trying to understand why/if shooting early would be a better option

Sunday=Funday so enjoy yours!

Rebekah

 

[Sandy and Black Kitty]

Re: 1/19 Ole AMPS 467 +2 450 +4 424

Hi there

I'm just catching up and want to make sure you understand an important aspect of the technique Jill describes:

Let me break this down as I under stand it, in true life story form. Our usual PS is 6:00am and 6:00pm MST.

Ole is rising at AM+10 this evening, and because of his pattern of steep rises at the end of his cycle, I give him 6uL at +10 tonight. I monitor him through PMPS and the PM cycle. I then administer 6uL at PM+10 tomorrow morning.

My understanding of what you are describing here is shooting 2 hours early, twice (2 cycles) in a row...

and yes, like dyana said, if you shoot early at for instance +10... the next lantus shot is *due* 12 hours later. now if you need to get back on schedule because of work you can always shoot that next shot at +13 or +14.... which would bring you right back to your normal shot time.

Think of shooting early as a slight increase. Shooting early 2 cycles in a row (back to back) is yet another slight increase and could result in an unexpected dive in BGs. (I'll see if I can find an example of that on BKs ss. . . )

That's why, in most cases, back to back early shots are not recommended. There may be times/circumstances when it's OK to do that. However if you are considering testing this technique, I recommend you take it one step at a time for starters and see what 1 early shot in a 24 hour period does.

For example:
4:00pm MST - It's +10 and Ole has clearly pressed the elevators 'up' button. . .
>>You shoot his regular dose of Lantus at +10, which is 2 hours early
4:00am MST - It's +12 and you shoot his regular dose of Lantus.

I do have a question for Jill - being that Ole still working on finding a dose that works for him, would the TR protocol guidelines for increasing apply or are there other considerations due to the potential effects of this technique ?

BBL
(edited to correct typos. . .and once again for clarity)

 

[Sienne and Gabby (GA)]

Re: 1/19 Ole AMPS 467 +2 450 +4 424

Shooting early acts like a dose increase because you are maximizing the overlap between the previous and current dose. I don't think anyone is saying that shooting early is a better option than R. My read is that you can use either option depending on what the situation dictates.

Let me also point out that what you're describing, higher numbers at pre-shot times vs. mid-cycle is normal until your cat becomes better regulated. The nadir is the lowest point in the cycle. That difference between pre-shot and nadir can be hundreds of points or the "curve" can be flat. The ideal Lantus (and Lev) curve is flat but it is not the case early on or for all kitties. I still think Ole is bouncing vs. the insulin "pooping out."

I also want to clarify a point. If your usual shot time is at 6:00 and you see that numbers are rising at +10 (4:00) and shoot, then the 4:00 time is your new pre-shot time. If you refer to it at your +10, it will be confusing. The clock starts every time you shoot.

 

[Rebekah]

Re: 1/19 Ole AMPS 467 +2 450 +4 424

Hello!

and yes, like dyana said, if you shoot early at for instance +10... the next lantus shot is *due* 12 hours later. now if you need to get back on schedule because of work you can always shoot that next shot at +13 or +14.... which would bring you right back to your normal shot time. lantus and levemir are more flexible than we used to think years ago.

The way I read Jill's statement is that I don't necessarily need to shoot at 12 hours apart because of the flexibility of Lantus, I can shoot at +13 or +14. 4am shooting is doable, but 4pm would be clipping my work day too much and I wouldn't be employed for very long. I love my job! It is difficult for me to get home before 5:30, except for Fridays which is reserved for my in house studio work.

She is of course able to clarify upon her return.

This is an edit because I am confused and trying to figure this out...

4am is 2 hours early and to have the 12 hour dose, my new PMPS is at 4pm. Because that would be impossible for me to maintain, I shoot at 6:00pm or +14, which is 2 hours late, but also my current PS. Is that correct?

Uff-da! Oy Vey! Mercy!

 

[julie & punkin (ga)]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393

while you're getting clarification, let's add how a dose increase fits into this discussion. i think he needs more Lantus. i'd increase by 0.5u.

however, i don't think you would increase the dose AND shoot early.

You're getting a lot of information Rebekah. It's gotta be a bit confusing. Keep asking questions.

and forgive me for asking again, but i don't remember where you are on the status of getting him tested for a high dose condition. Is that something being planned?

 

[Rebekah]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393

Hello again!

while you're getting clarification, let's add how a dose increase fits into this discussion. i think he needs more Lantus. i'd increase by 0.5u.

Yes, I feel he needs more Lantus too. I do not believe that 6uL is his correct dose.

I know I am not suppose to look at the past, but I do feel that the fact that he did come down off needing a high dose at 8uL in August needs to be considered. Whether he was truly OTJ remains up for conjecture, but his BG's did significantly drop at 8 units. I would like to hold off on high dose testing until I see what happens nearer to that dose.

I am not quite at saturation point, but there is a lot to consider here on how to safely get Ole to the right dose while trying to flatten out his curve. For myself, at this point I feel more comfortable with using a drop of R to help L do its job that I feel about shooting the rise. Perhaps I'm timid about trying a new treatment when I know he needs more juice too.

Thanks again!

Oh, I am terribly sorry I haven't told Chris, but the sunbeam vid was brilliant. Thanks for sharing it with us!

 

[Jill & Alex (GA)]

Re: 1/19 Ole AMPS 467 +2 450

Let me break this down as I under stand it, in true life story form. Our usual PS is 6:00am and 6:00pm MST.

Ole is rising at AM+10 this evening, and because of his pattern of steep rises at the end of his cycle, I give him 6uL at +10 tonight. I monitor him through PMPS and the PM cycle. I then administer 6uL at PM+10 tomorrow morning. I continue monitoring, and if there is no rise, I shoot Monday's PM dose at, in this case +14, which is back at my normal dosing time of 6:00pm. What happens if there is a rise on that second day? Also, what happens if there is an increase of dose?

real life example:
6am - amps 539 (6u lantus)
9am - +3 358
11am - +5 318
2pm - +8 303
4:30pm - +10.5 393
5:00pm - +11 542
6pm - pmps 600 (6u lantus)

using the numbers from yesterday and understanding these givens:

• Ole's ss provides data which illustrates a lack of duration.

• Ole dropped into the blues 24 hours earlier. at this stage of the game, he wasn't going to clear the inevitable bounce from the drop to blues for at least another few cycles.

back to the data...

6am - amps 539 (6u lantus)
9am - +3 358
11am - +5 318
2pm - +8 303
4:30pm - +10.5 393 <----------- there's the rise. because of Ole's history, we know he's going nowhere but up from here. why not shoot to get a jump on the numbers before they get any higher?
5:00pm - +11 542 <------------ note for the doubters: if this 542 taken 30 minutes after the 393 doesn't scream BIPO!... i don't know what would. the action of the insulin is done and gone!
6pm - pmps 600 (6u lantus) <------------ wouldn't it have made more sense to shoot his regular dose into a 393 rather than waiting til he's 600 or more?

the next morning...

ole's shot is *due* 12 hours after whatever time you shot last. say you did shoot early... at +10.5 (4:30pm). that makes the next shot *due* at 4:30am. i don't know about you, but getting up at 4:30am to shoot the cat doesn't work for me. however, if you're an early morning person and getting up that early doesn't pose a problem... go for it.

personally, under these circumstances, i'd hold off on shooting the morning shot until + 13.5 which brings you to 6am... your regular shot time. voila! you're right back on schedule!

i'm not sure if this is being lost in the shuffle, but in case it is i'd like to reiterate... this is a technique which is not to be used every cycle. to do so will run the risk of accumulating too much overlap/carryover. it's also not a technique to be used in tandem with a bolus of R.




have to take care of my kitties, but will be back to address some of the points brought up by others including dosing strategy.

 

[Sandy and Black Kitty]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393

The way I read Jill's statement is that I don't necessarily need to shoot at 12 hours apart because of the flexibility of Lantus, I can shoot at +13 or +14. 4am shooting is doable, but 4pm would be clipping my work day too much and I wouldn't be employed for very long

Keeping in mind that I have no personal experience using this technique (however am very interested in this discussion), if I am understanding what Jill describes,the desired effect is to enhance overlap.

So. . .Assuming you have been shooting every 12 hours as per the TR guidelines you decide to try this. You shoot at +10 on one cycle creating an overlap, in time (and hopefully in available insulin in circulation), of 2 hours: the time between your +10 shot and the end of the previous cycle (+12). To nail it down, the next shot must be 12 hours later. It seems to me that waiting until +14 to get back to schedule at this point would 'wash out ' the desired effect.

In summary:
cycle 1 - shoot at +10 from the previous shot -2 hour overlap created
cycle 2 - shoot at +12 from the previous shot -2 hour overlap maintained
cycle 3 - shoot at +14 from the previous shot - gets you back to schedule (and reduces the risk of unemployment)

That's my take on it. Jill will let us know if that's not the case.
And for convenience I'll put my previous question here:

I do have a question for Jill - being that Ole still working on finding a dose that works for him, would the TR protocol guidelines for increasing apply or are there other considerations due to the potential effects of this technique ?

eta - Rat's! posting at the same time as Jill. . .

 

[Rebekah]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393

Thank you Jill!

Your last post is brilliant! I would like to do something for Ole when he is out of insulin, but a 4am shot time is not conducive to my lifestyle. Believe me, 6am has been a big enough adjustment! Without being able to shoot at 6:00am, I can see the situation snowballing to where I was shooting at the 2:00's!

Jill, your clarification makes shooting the rise seem much less daunting.

My back and forth between R and Shooting the Rise is because I am trying to discern which treatment would work best for our family, not because I expect to use both.

Thank you!

Rebekah

 

[Wendy&Neko]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393

Happy Sunday Rebekah. I'm happy to hear you had a date night last night. Taking care of the beans during this crazy FD dance is a very important part of the puzzle.

I'd like to second Julie's suggestion on increasing the dose. This has been a fascinating discussion on how to get rid of the end of cycle rises, but I think we've all agreed Ole' needs more Lantus.

A question for others and it's something I struggled with when Neko's SS looked a lot like Ole's does now. How can Rebekah tell that the bounce is broken and it's OK to increase? Neko had a similar looking SS and I seem to remember we kept going up as long as the PS was not too high (low red or lower) and/or counted 6 cycles from the low. Now I hear that bounces can last longer than 6 cycles. :?

 

[Jill & Alex (GA)]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393

The way I read Jill's statement is that I don't necessarily need to shoot at 12 hours apart because of the flexibility of Lantus, I can shoot at +13 or +14. 4am shooting is doable, but 4pm would be clipping my work day too much and I wouldn't be employed for very long

Keeping in mind that I have no personal experience using this technique (however am very interested in this discussion), if I am understanding what Jill describes,the desired effect is to enhance overlap.

So. . .Assuming you have been shooting every 12 hours as per the TR guidelines you decide to try this. You shoot at +10 on one cycle creating an overlap, in time (and hopefully in available insulin in circulation), of 2 hours: the time between your +10 shot and the end of the previous cycle (+12). To nail it down, the next shot must be 12 hours later. It seems to me that waiting until +14 to get back to schedule at this point would 'wash out ' the desired effect.

sandy, you're absolutely correct and if we lived in a world which required no sleep, didn't have any responsibilities, no jobs to go to, or could clone ourselves... shooting around the clock would be optimal. however, that's not real life. we not only need our sleep, but having a diabetic cat should not define or limit our lives. lantus and levemir have been given a bum wrap. while shooting every 12 hours is nice... it's a way of evening out treatment as well as making it easier to plan our lives... there's a depot and the depot helps in situations like this. heck, it helps in any situation when a shot may be late because you want to go to that concert or order dessert after a dinner out. you kwim. so we get real. we adjust shot times to the best of our ability.

now, having said that... i've shot around the clock and it's something i don't think i'd ever do again. it's too rough a schedule.
take a look at D and Noisy's spreadsheet: https://spreadsheets.google.com/pub?key=pJL61t5A7A9N2bqwcn0PfJA. D often shot Noisy early AND round the clock. noisy did not live on the premises and d was lucky to have a night time caregiver who stepped in for the night time cycles.

-----------> rebekah: noisy's ss is the ss you want to study as far as shooting early with lantus.

I do have a question for Jill - being that Ole still working on finding a dose that works for him, would the TR protocol guidelines for increasing apply or are there other considerations due to the potential effects of this technique ?

as with ALL techniques that deviate from the norm... we have to let the numbers as well as the individual cat's response to insulin be our guide.

at this point in time, if Ole were mine i would continue following the guidelines for increasing the dose suggested in the TR protocol and i'd shoot early (on a definite rise) whenever i could.

those of you who are making dosing recommendations have to juggle the use of R with results from using R in your dosing decisions. for instance, ole saw R induced blue numbers yesterday. by protocol standards, you'd hold this dose for now or at the very best... increase by 0.25 unit. julie's calling for an increase of 0.5 unit. careful thought will have to be given when increasing the dose while using R and in absence of a confirmed high dose condition.

 

[Jill & Alex (GA)]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393

while you're getting clarification, let's add how a dose increase fits into this discussion. i think he needs more Lantus. i'd increase by 0.5u.

however, i don't think you would increase the dose AND shoot early.

whether you could increase the dose and shoot early depends on what is happening. we talk about "waves of action". where is the cat in this 3 day wave of action? everyone wants rules, but they're very difficult to make. an accurate assessment & understanding of the insulin used and that kitty's response as well as what is going on at the time is how you figure out what you can and/or want to do.

make sense?

 

[Jill & Alex (GA)]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393

I am not quite at saturation point, but there is a lot to consider here on how to safely get Ole to the right dose while trying to flatten out his curve. For myself, at this point I feel more comfortable with using a drop of R to help L do its job that I feel about shooting the rise. Perhaps I'm timid about trying a new treatment when I know he needs more juice too.

your comfort level is very, very important.

 

[Jill & Alex (GA)]

Re: 1/19 Ole AMPS 467 +2 450

Hi!

Not to hark back to R all of the time, but what about this?

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.

yep. it's another option. contrary to current belief, there's more than one way to use insulins to bring down numbers.
that's pretty much the whole point to this discussion. :mrgreen:

 

[Rebekah]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393 +403

Oh my!

I need some guidance here as it is coming up on +10 for Ole. I've been studying Noisey's SS as well as Ole's. When I look at Ole's I see columns of high numbers and the middle ground full of less high numbers with a streak of R induced rainbow. I was leaning towards grabbing the L with R, but with not having to shoot at 4pm and 4am, I am not as afraid of shooting the Rise as I once was. I am also not sure of the dose increase. Tonight will be the 6th cycle since Ole's blue. Should I shoot early at the same dose, then monitor quite closely to gather data? Should I shoot early with a dose increase? Should I shoot R with or without a dose increase? All I know is that I want wo help Ole as he climbs. I can tell he has begun to climb as he is searching for food. I can tell the difference between behavior in lower numbers and climbing behavior, there is tension in poor Ole.

Thank you,

Rebekah

 

[Rebekah]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393 +403 +10 457 ???

I went ahead and gave Ole an early shot of Lantus to help him with his BIPO. I gave him 6.25uL, but unfortunately my fingers smell a little bit like insulin, even though I didn't feel any insulin on them, so a wee bit might have leaked out, it wouldn't have been much though. I'm so sorry, I have only missed a shot one time before and that was before FDMB. Aaaargggghhh!

I also fed him 1/2 of his meal (2.75oz lc FF) and I plan to give him the other half when I feed Loki so they can eat together. I didn't know what to do about the food.

Wish us luck. My only hope is that Ole is able to keep his numbers out of the penthouse.

Thank you,

Rebekah

 

[Suzanne & Cobb(GA)]

Re: 1/19 Ole AMPS 467 +2 450 +4 424 +6 393 +403 +10 457 ???

I went ahead and gave Ole an early shot of Lantus to help him with his BIPO. I gave him 6.25uL, but unfortunately my fingers smell a little bit like insulin, even though I didn't feel any insulin on them, so a wee bit might have leaked out, it wouldn't have been much though. I'm so sorry, I have only missed a shot one time before and that was before FDMB. Aaaargggghhh!

You may be surprised. Matt had the same thing happen and it was the first time Cobb saw green.

 

[Wendy&Neko]

Re: 1/19 Ole +2 450 +4 424 +6 393 +403 +10 457 shot the rise

Paws crossed Ole' hangs onto the lower floor a while. Sorry about the possible furshot, but sometimes you get a little insulin on your fingers when you are squeezing out the excess to get the right dose. I've done way more furshots than I wish to count, and some on dose increases too. :roll: I usually sniff Neko around the injection site to confirm whether or not it's a true furshot.

 

[Sienne and Gabby (GA)]

Re: 1/19 Ole +2 450 +4 424 +6 393 +403 +10 457 shot the rise

Good shooting!! I suspect that Julie's suggestion of raising the dose was not meant to imply that you shoot early AND increase.

There may have been a little bit of Lantus on the syringe and that's what you noticed.

FWIW, Jill and I are going to have to agree to disagree about duration. I find it difficult to differentiate between a drop of 200+ points causing a bounce versus lack of duration. The bottom line, however, is that the strategy of shooting early (or in other instances using R) is still a good strategy.

 

[Rebekah]

Re: 1/19 Ole +10 457 early PMPS +2 396

Hi!

I gave Ole the sniff test and I didn't smell anything except Ole, but who knows, I'm kind of nervous. I'm also having issues about how to document a early shot on the SS. I believe I should leave the PMPS square blank and put his +2 in the +2 box. I am really a spread sheet block head.

It was really awesome to see Ole napping up until 5:45 MST (+1.75 today). Usually his manic search for food begins at 4:00 or so and he'll beg for 2 or more hours straight if we are here. I believe all of that stress can't be good for him either. I split his meal, the first half of 2.75oz to support the insulin and the other half so he could eat with Loki.

at this point in time, if Ole were mine i would continue following the guidelines for increasing the dose suggested in the TR protocol and i'd shoot early (on a definite rise) whenever i could.

I did take Jill's suggestion to follow the protocol and raised Ole's dose by .25uL. I hope I have done no harm, and I might have lost a bit on the shot. All I want, and I know you do too, is to help my little fella safely and effectively.

Edit: oh no! I miss counted cycles and tonight was only the 5th cycle after blue, am I right? I got mixed up and thought it was the 6th. My brain, what's wrong! I'll keep a close eye on him tonight, I'm so sorry.

Keeping our fingers and paws crossed that Ole finds relief.

Thanks again!

Rebekah

 

[Libby and Lucy]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377

nice shooting, and it seems to be working. :mrgreen:

There are different ways you can notate early shots. If you look at my KK's spreadsheet, you can see how I did it on 5/6/13 (ignore the fact that I gave two early shots that day - he was on PZI at the time and there isn't as much overlap to worry about with that insulin. Shooting early is a common technique with PZI).

 

[Libby and Lucy]

Re: 1/19 Ole +10 457 early PMPS +2 396

Edit: oh no! I miss counted cycles and tonight was only the 5th cycle after blue, am I right? I got mixed up and thought it was the 6th. My brain, what's wrong! I'll keep a close eye on him tonight, I'm so sorry.

I wouldn't worry too much. He has been on 6 units for 7 cycles, and his only blue was R-induced. I agree that he needed a dose increase.

 

[Blue]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377

You may want to fast track your dosing. Holding for a full 6 shots at one dose is giving the resistance a chance to set in. You can hold a dose for only 5 shots, going up on the 6th shot.

If you look at the 17th, the blues were the result of too much R. You would want to set up a sliding scale for your R use, and give R dose at the same time as your basal insulin, and then if your testing shows the BG rising again by +5, you would be good to give 1/2 the dose of R you gave at shot time.

If you give 4uR at amps, then you should be good to give 2uR at +6. Another thing you can watch is that some cats show some more reaction to R on a later cycle.

Once you hit 10u for your basal insulin, your increases need to be increased to 1u. .... hold 10u for 5 shots then up the dose to 11u.

Gayle

 

[julie & punkin (ga)]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377

um, Gayle, she gave a 0.1u dose of R. that's one drop. not sure how she's going to give half of that.

You've done great, Rebekah. This is a lot of info to wrap one's head around. We're all cheering for you and Ole'! I hope tonight brings him into some better numbers.

 

[Jill & Alex (GA)]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377

hi rebekah. good job shooting early! regardless of this being this 5th cycle after seeing blue... i would have increased the dose, too. like libby mentioned, that blue was R induced.

your spreadsheet...
it would help any one who is actually interpreting your spreadsheet to go ahead and put the actual preshot number in the PMPS column. if you look at alex's spreadsheet you'll see i shot at +11 tonight. i left the AM+11 cell blank and then recorded her preshot number in the PMPS cell like this:

81 ** @+11.

that way you can see exactly when she was shot. people have different ways of doing it. i've just found this particular method to work well because the majority of the shots i give are early or late. gasp! :lol:


have a good evening!

 

[Jill & Alex (GA)]

Re: 1/19 Ole +2 450 +4 424 +6 393 +403 +10 457 shot the rise

I find it difficult to differentiate between a drop of 200+ points causing a bounce versus lack of duration.

sigh... i'm not surprised you're finding it difficult to differentiate between bouncing and a lack of duration especially when you're basing your conclusion on a single snapshot in time. ole IS bouncing, but if you look beyond the one cycle you can see the BIPO pattern is repetitive. look at the cycles over several weeks... sometimes even several months when faced with the possibility of BIPO and it'll be easier to recognize. iirc, you've never identified or even assisted a caregiver whose kitty has been experiencing a lack of duration. i understand where you're coming from...

 

[Jill & Alex (GA)]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377

If you give 4uR at amps, then you should be good to give 2uR at +6.

ai-yi-yi!

 

[Rebekah]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377 +5 346

Oh, I am so glad that you are all cheering for us and that I didn't make too many major gaffes!

Let me ask you quickly about tomorrow morning. I trust that I will be shooting him at +13 or +14, to put him back at his normal PS. There is a chance that he will wake me at +12 for food. Usually when this happens, I put him is the garage for a time out. He loves it out there and part of me feels that he wakes me up not so much for food, but to get into the garage!...no, it's all about the food... I could test and shoot him then, but I don't want 4am/pm to be his normal PS time. I can do it tomorrow because it is a holiday and I don't have meetings all afternoon, just 1 in the morning. Should I shoot at +12 tomorrow am so I could possibly shoot early if needed in the pm (not back to back), or should I bring back the PS to +14?

Thank you again for your guidance and your encouragement. I'll need a bunch as we figure out how to use this method as well as finding a good dose for Ole. Ole seems to be having a nice slow drift down the pinks, lovely.

Rebekah

 

[Jill & Alex (GA)]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377 +5 346

rebekah, do whatever feels right in the morning. go with the flow.
if you're awake and want to test him at +12 and he's high... go ahead and shoot him at +12... if you want.
if your bed is feeling nice and warm and you could use another hour or two of sleep... shoot at +13 or +14.
it's up to you... :mrgreen:

 

[Sandy and Black Kitty]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377 +5 346

Just popping in for a quick visit
(I'll be back later after with some ruminating of the days events)

Well done!
regarding documentation of early or late shots, fwiw I did mine as below:

looks like I after that PM+2 of 43 on the first day in this example I skipped the AM shot and decided it was time to resume after 18.5 hours

Regarding the morning. . .from the discussion today it sounds like you have the latitude to pick a time between +12 and +14 that's best for you.

BBL

 

[Grayson & Lu]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377 +5 346

Hi Rebekah -

I'm Lu-Ann and my guy Grayson used to be "flat as a pancake" (which ended up being known as "hanging out at the IHOP") or "Swimming in a sea of pinks" for months, despite high doses of ProZinc and even TID dosing (that about killed me!!!). We had the tests run for Acro and IAA (insulin resistance), and turned out he was both. As I was going to be traveling, and G was left with sitters, we postponed his switch to Levemir until I returned.

What we didn't realize, and what I didn't get a handle on for quite some time, was an ear infection that he'd had. His ears had always been kinda cruddy, but until we had them cultured (C&S), the antibiotics weren't cutting it. Once the ear was under control, his numbers started moving. Is there any chance that Ole has something going like that going on? Ear? Teeth? Anal gland? I've seen each of these really wreak havoc on a kitty's BGs.

You're brave to be using R this early in the game. I was very reluctant to use it, but eventually it grew on me. It's good that Ole is responding to such small quantities of it. G rarely moves for anything less than 2u; usually 3. So it's good that you're comfortable with it, and that he's responding. Some kitties only need a sniff! I know there are many different ways to use R - most people use it with the Lantus/Lev. I rarely use it mid-cycle, since G nadirs so late, but I have a couple of times - to take the edge off for his Levemir. Since Lantus usually nadirs earlier, I wonder if it would help as soon as he's well on his way to a rise to use it... like around +9 or +10. Using it to jumpstart the Lantus. Has anyone here used R like that?

Once I had test results, I knew it would take aggressive dosing to break the resistance we were experiencing. With the "normal" 1-2 unit doses, increases are usually .25 or .5u, which equates to about a 25% increase. Much to a LOT of peoples' freaking out, I continued that philosophy as I increased Grayson. For an Acro, it's not uncommon to reach doses like 20 or 30u... which translates to 5u increases. Most others tend to increase by 1 or 2u at a time. But when you're barely seeing movement, and they're staying red and/or pink, you realize that you have to be aggressive. I would recommend, however, that you NOT use the R while you're increasing his Lantus. And some kitties tend to take a cycle or more to respond to either - if Ole is one of them, then you need to hold your doses longer.

You mentioned that he's ravenous, and that you're giving him 2.75 ounces FF half at a time. Grayson wasn't just ravenous, he was impossible. He could remove lids from 2 different types of Tupperware cannisters, rip open a bag of kibble (dog or cat food) in seconds, and one time I even caught him in my pantry, laying on top of cans & boxes eating egg noodles from a torn-open bag! I purchased a PetSafe 5 automatic feeder ($49 Petco on-line ad - printed out & took to PetSmart & they matched the price). Grayson gets a can with his shot, and 1/4 can at +2, +4, +6, and +8. This has helped tremendously!!! I'm usually home by +10, so he might get another little bit then as well. At one time, however, he was eating a LOT more than that! The expression for Acros is "Feed the Beast!"

I personally, would hold to your 12/12 schedule. When I get off, it's hard on me and it's hard on him. ProZinc worked okay for crazy scheduling... but the L's not so much. The other thing you might want to do, is adjust your time from when you first wake up to when you're headed out the door. So say you leave for work at 8 am and return at 5:30. By then (you're awake or you're home) and you could see if he's climbing and maybe head that off with some R... For me, switching from 6:30 am/pm shot times (ProZinc) to 10:00 am/pm (Levemir) made all the difference - and I can sleep or be at work while he's still climbing (he has a very late nadir).

Good luck - happy to answer any questions you have, but I'm an east coaster and heading to bed shortly.

Lu-Ann

 

[Blue]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377

um, Gayle, she gave a 0.1u dose of R. that's one drop. not sure how she's going to give half of that.

You've done great, Rebekah. This is a lot of info to wrap one's head around. We're all cheering for you and Ole'! I hope tonight brings him into some better numbers.

um, Julie, beg pardon on the misread. If you look at the mention of R at +10.5 on the prev pm cycle(1/16 to the 496) and then again at the amps..... one may get the feeling of R having been given twice. (Suggest adjusting the recording to make ss clear?)

My post was to state what is done with R when it brings down the numbers in the first half of the cycle then the numbers begin to rise again.

To suggest that R be given at such a late point in a cycle, at +10.5, should also let the owner know that the R, even if only a 0.1u shot of R, is going to skew your amps.

The best times for giving R would be at ps times and at mid-cycle because any later will skew your ps numbers.

Gayle

 

[Sandy and Black Kitty]

Re: 1/19 Ole +10 457 early PMPS +2 396 +3 377 +5 346

Hello Again

your spreadsheet...
it would help any one who is actually interpreting your spreadsheet to go ahead and put the actual preshot number in the PMPS column.

I'm here to confirm that - I just peeked at Oles ss and gasped - at first glance it appears you did not give him a PM shot!
My brain immediately started to try and figure out why. . . :? then I remembered. . . .

You are testing this technique!
Fingers crossed for a good result. Looking good so far. . .

Should I shoot at +12 tomorrow am so I could possibly shoot early if needed in the pm (not back to back), or should I bring back the PS to +14?

If you shoot at +12 tomorrow AM, and then shoot early if needed in the PM, the only caveat I see is that it would put your schedule even further off .

for example:
4pm/4am (12 hours)
3pm/???? (assuming you shoot 1 hour early ) you would then be 3 hours off from your 6p/6p routine.

Regarding the possible fur shot - They happen.
I wish I had a dollar for every one I did. . .I've even had them happen back to back cycles :evil:
Don't forget to make a notation on the ss that you think tonight's shot may have been a fur shot. ;-)

Keep things simple right now -One dose at a time, one new technique at a time , observe, document ,
know thy cat - It's a solid foundation to build on.