1/23 Eddie PMPS = 303, +5 = 185, +6 = 150

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Jen&Eddie

Jen&Eddie

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Yesterday's condo: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=112365

AMPS = 318 (1.4u)
+6 = 264/249 (immediately before and immediately after food)
+10 = 269
PMPS = 303
+3 = 229
+4 = 227
+5 = 185 (1/2 can FF)
+6 = 150


I'm not sure how long I should let this dose settle in, or if my approach is totally wrong, or if I'm missing something here. Trying to keep my patience pants on, and my intention is to continue to hold this dose for at least two or three more cycles, unless advised of something that makes more sense.

You can see Eddie got a pretty flat cycle on the first cycle at 1.4u which was 1/20 AM, then he had a nice PM cycle. Following that, the AM cycle of the 1/21 cycle was high and flat, and I think this is reflects a rebound cycle. Then, the PM cycle is good again on the 21st. That's four cycles on 1.4u. Next, on the 1/22 AM cycle it was OK. No blues that I saw, but a nice approx. 50% decrease at nadir. Then PM cycle last night on 1/22 was high and flat again.

Eddie has been known to have at least one flat cycle, and then will precipitously drop generally in the PM, when increasing the dose. He's also been known to have extra long duration from time to time. He seems to need some time to settle into a dose.

This morning we had a lower AMPS but I won't be able to see what Eddie's numbers are until approximately AM +6.

I'm working on a sliding scale and with a "tough love" approach in terms of shooting through the rebounds. My thought process is that at some point, Eddie's liver will stop freaking out when he's seeing relatively normal numbers, and stop rebounding. Given his good response in at least two of the cycles to this dose, I don't think it's a matter of not enough insulin, but I certainly could be wrong. I read somewhere that the "liver panic" not only releases glucagon but also hormones that have the effect of creating temporary insulin resistance. I *think* this is what I'm seeing with his high flat cycles following a good cycle, where it looks like the insulin is having zero effect.

I'm not worried about the pre-shot bounces, but I do worry about the high-flat cycles where the entire cycle, or even day :shock: is a rebound. Thankfully Eddie isn't showing any signs that he's any worse for the wear, but I don't think my "tough love" approach is going to work if I can't get him to normal numbers because he's in a cycle-long rebound every other cycle. I also don't want to set him up for chronic rebound. I'm all for a more aggressive approach, and that's what I'm doing with my current "experimental" protocol, but if it isn't going to work, then I want to try something else.

This morning was cycle 7 at this dose. Looking for thoughts and guidance here. If someone sees something else going on in Eddie's numbers rather than what I'm seeing, I'm definitely open to suggestions.
 
Re: 1/23 Eddie AMPS 318 - Rebounds?

Certainly like today's amps better than yesterdays. :-D and I like the dose. It's what I would have said.

I am wondering whether the night time drops are a delayed reaction or because it is night and the conditions are different (different amounts of food or less activity or?). Last night was certinly different than the previous nights.

Might be time to try a sliding scale and see if he likes that. (you are sort of doing that, shooting through the bounces, but it could mean a little more in the 400-500 range and a little less in the 200s.)

I agree he is hard to figure, but it sounds like he is feeling good and that is a vital part of this. He is not in awful numbers and you are getting drops, so the insulin is working.

One thing that interests me. He seems to rise pretty consistently at +3. And it might be that sets up the cycle a little higher. Does he eat a big breakfast after the shot? Does he get a snack then? Wonder if feeding 2 hours or earlier before the am shot (is that possible?) would make him less hungry in the am and if he would settle for a small snack then and one at nadir? Maybe something to experiment with this weekend. An automatic feeder lets you feed at +9/10 and can move to an empty tray later so the amps is not food influenced. I think Misty tried that for awhile and it smoothed things out for Rumpel.
 
Re: 1/23 Eddie AMPS 318 - Rebounds?

+6 = 264/249 (immediately before and immediately after food)

Thanks Sue!

Would you suggest adding a "scale" to my current sliding scale? I'm currently doing 1.0u for 200 (which we haven't seen in a while) 1.2u for 250ish, and 1.4 for 300+. Would you suggest a 1.5 or 1.6 for over 350 or 400 for the pre-shot?

AM cycles generally seem to be worse than PM cycles, except when and from what I've read, it seems pretty common for cats to go lower during the PM cycle. Should I be using a different scale for the AM?

I have no idea what might be different during the AM. Maybe he sleeps more? He eats the same as during the PM cycle.

I've been wondering about the rises he sometimes gets after PS. You can see this happening even before starting this new dose. I've always assumed it was part of the pre-shot bounces. It seems like this happens when he had a good cycle the previous cycle, and when we have a pretty clear bouncy pre-shot, but in the last couple days, it looks like it's also been happening when we've had a high-flat cycle (which I'm assuming are rebounds). In contrast, on 1/21, when we had a good PM cycle, at +3, he had dropped by 150 points.

From a practical standpoint, I can usually test at +2/3 to see which direction he's going in the PM, but not during the AM, and I'm not seeing a real clear pattern as to which types of cycles and/or pre-shot ranges are going to result in him continuing to rise until +2 or +3. Can you see a pattern that I'm not seeing here to make an educated guess as to when he's going to continue to rise to hit it more aggressively with a smidge more insulin?

In terms of feeding, his pre-shot meals are in fact bigger. He eats about 3 oz. He then gets a "snack" of about 1.5 oz. at roughly +6 in the AM, and depending on what his PM cycle is doing, another 1.5 oz. at +5 or so in the PM. He also gets no carb treats with every test. He weighs just over 12 pounds, up from about 10.5 at diagnosis, and down from around 13 before diagnosis. Should we maybe be feeding more?

We do shots at 6AM/PM, so I don't think it's going to be possible to feed breakfast or a snack (at least by hand) at PM +10. DH and I both out of the house between around 7:00 AM until just after 4:00 PM (when DH gets home usually). We've considered an automatic feeder to try to give "snacks" even more frequently, which was something I was going to try to look into more this weekend. One thing though...with the feeder, how do we get Eddie to eat versus the civilians? I really, really hate the idea of confining him by himself. :sad: He doesn't have to be coaxed to eat, but one of his civilian roommates is a pig and is overweight, so if he finds food available, he will readily hoover it, as will our fatty foster cat.

Ugh. I know that this takes time, but it's so frustrating to see something that seems like it just might work, then two days later, it seems like it doesn't work anymore.
 
Re: 1/23 Eddie AMPS 318 - Rebounds?

bunni9 said:
Would you suggest adding a "scale" to my current sliding scale? I'm currently doing 1.0u for 200 (which we haven't seen in a while) 1.2u for 250ish, and 1.4 for 300+. Would you suggest a 1.5 or 1.6 for over 350 or 400 for the pre-shot?

I think I'd up the dose to 1.5 for the higher ranges. He might bounce or it might be what he needs…..

AM cycles generally seem to be worse than PM cycles, except when and from what I've read, it seems pretty common for cats to go lower during the PM cycle. Should I be using a different scale for the AM?

I'd just shoot the numbers as you get them, using your present scale with the modification for the higher range for both cycles.

I have no idea what might be different during the AM. Maybe he sleeps more? He eats the same as during the PM cycle.

There's something called dawn phenomena (I think that's the name) that happens to human diabetics as well as animals. Sometimes amps are higher.

I've been wondering about the rises he sometimes gets after PS. You can see this happening even before starting this new dose. I've always assumed it was part of the pre-shot bounces. It seems like this happens when he had a good cycle the previous cycle, and when we have a pretty clear bouncy pre-shot, but in the last couple days, it looks like it's also been happening when we've had a high-flat cycle (which I'm assuming are rebounds). In contrast, on 1/21, when we had a good PM cycle, at +3, he had dropped by 150 points.

From a practical standpoint, I can usually test at +2/3 to see which direction he's going in the PM, but not during the AM, and I'm not seeing a real clear pattern as to which types of cycles and/or pre-shot ranges are going to result in him continuing to rise until +2 or +3. Can you see a pattern that I'm not seeing here to make an educated guess as to when he's going to continue to rise to hit it more aggressively with a smidge more insulin?

In terms of feeding, his pre-shot meals are in fact bigger. He eats about 3 oz. He then gets a "snack" of about 1.5 oz. at roughly +6 in the AM, and depending on what his PM cycle is doing, another 1.5 oz. at +5 or so in the PM. He also gets no carb treats with every test. He weighs just over 12 pounds, up from about 10.5 at diagnosis, and down from around 13 before diagnosis. Should we maybe be feeding more?

Not unless he ates like he's starving. I am just wondering if the meal is what causes that rise and if there is any way to minimize it.

We do shots at 6AM/PM, so I don't think it's going to be possible to feed breakfast or a snack (at least by hand) at PM +10. DH and I both out of the house between around 7:00 AM until just after 4:00 PM (when DH gets home usually). We've considered an automatic feeder to try to give "snacks" even more frequently, which was something I was going to try to look into more this weekend. One thing though...with the feeder, how do we get Eddie to eat versus the civilians? I really, really hate the idea of confining him by himself. :sad: He doesn't have to be coaxed to eat, but one of his civilian roommates is a pig and is overweight, so if he finds food available, he will readily hoover it, as will our fatty foster cat.

Probably the only way is to isolate him or make some kind of a system that only he can access. ( think someone put a box together with a door only wide enough for the smaller cat. Ask BJ about this - she loves figuring out this kind of stuff.

Ugh. I know that this takes time, but it's so frustrating to see something that seems like it just might work, then two days later, it seems like it doesn't work anymore.
Click to expand...

I know, 2 steps forward, one step back. It just isn't an exact science. It's a hormone and just like with humans, everyone has a different reaction to them. ( I mean, look at different women going through menopause. :mrgreen: ) But Eddie is feeling good, playing, looking well, eating well, right? Don't forget that stuff is important. We get fixated on the numbers: we lose sight of the big picture. He is in okay ranges. if he's happy, that's what matters. We'll get him figured out.
 
Re: 1/23 Eddie AMPS 318, +6 = 264, +10 = 269

+10 = 269

Thank you Sue.

Will add 1.5u for 350+ PS numbers and see what happens.

I think we try an experiment with smaller, more frequent feedings over the weekend when we can keep piggo civvies at bay and see if it has any effect.

On a brighter note, I was talking to Eddie's grandma bean yesterday about how things are going with him. A little while later, I get an email from her with this for Eddie:



Someone's going to get some more of the fancy-schmantzy foods!
 
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