1/28 DAVIDSON PMPS 335

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Re: 1/28 DAVIDSON AMPS 324

Hi Shawna,
The 324 is a bounce from the blues you saw yesterday. Normally you wouldn't increase on a bounce because the extra insulin might leave him too low after the bounce clears. (Don't forget that decisions about increasing and decreasing the dose are based on the nadir, with only secondary consideration being given to the pre-shot number.) In any event, be sure to get in your tests today. It will be helpful to see how long it takes Davidson to clear the bounce. It can take up to 72 hours, but the dose increase is sure to play into the equation in this case; also to be considered is that when you increase the dose, the shed has to absorb some of that increase, so all of the dose increase will not be available to work on the blood glucose until the shed "catches up" to the size of the dose. Keep on asking questions! You are doing fine. And so is Davidson.

Have a fine day,

Ella & Rusty
 
Re: 1/28 DAVIDSON AMPS 324

Ella, yesterday she was quoted this part of the protocol..that's where the decision to go ahead and go up .25 came from (Julie if I remember right)

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

My original message this morning mentioned if he was in the 200's this morning and in that case, going ahead and increasing was a sound idea. If I'd seen a 300, I would have probably suggested holding the 2.5 for another cycle or two just to see if he was bouncing off the blues, but it looks like the lowest he got yesterday was 180, which is still a pretty flat number for all day yesterday. Not sure he'd bounce too high from that...of course ECID and we never know what Davidson has in mind!!

I'm glad you're able to be home and get some testing in Shawna!! Yes, I think if your +2 is about the same as your AMPS, a +5 would make sense. Of course there's no such thing as too much data :-D

However if there's more than just a little drop, it's important for you to test more often. Let's see where he's at. You didn't do anything wrong and I'm sure he'll be just fine..You're a wonderful caretaker!!
 
Re: 1/28 DAVIDSON AMPS 324

Hi guys .. no dosing advice from me but I hope davidson clears these pinks soon and surfs some blues for you! have a great day!
 
Re: 1/28 DAVIDSON AMPS 324

Hi again,
Shawna, I'm sorry if I caused you to worry. My post was intended to call your attention to some of the things to take into consideration. I read through your yesterday's condo before I posted and noted all of the advice and agreed with it all. But no one advised what to do today in the event of a bounce. Wow, FD sure is complex, and tricky, too! It's an adventure, for sure. You are doing fine. As Lisa (Do Lou) once observed: "there are many variables in FD, but the biggest variable is FD itself".
Carry on!! :smile:

Ella
 
Re: 1/28 DAVIDSON AMPS 324 +2 317

Hi.........No problem as I am aware of how this is working now, and since I am retired (sort of) and home I can monitor and test him as often as needed.

His +2 was 317, so still high and will test him again at +5 and see where he is at and go from there. BTW - my Vet is getting an Excel spreadsheet each time there is an update and he is well aware of THIS forum and the input and advise I am getting. He has yet to disagree with ANYONE here so that's encouraging.

All good from my end and with my records I can see the high and lows and when the insulin works or starts to fade off.............

Harley, Davidson and I REALLY appreciate the lessons, support and education you have provided........

Yes, ECID and Davidson is such a horse that he just may need a bit more juice then most..........time will tell.

Shawna
 
Re: 1/28 DAVIDSON AMPS 324 +2 317

Not sure if anyone has explained bouncing to you

Bounces - what are they and is my cat doing them?
When a cat isnt regulated, the blood glucose has probably been high for a while.
As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up.
This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

Cats bounce until they don't. Some cats bounce for a few weeks or months and stop and go into remission. Other cats just keep bouncing.

I am not 100% sure it was a bounce. He didn't go much higher than normal, and doesn't look like its lasting that long. Maybe a mini bounce if anything? hard to tell.

Wendy
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275

Thanks Wendy;

UPDATE - BG at +4 is 275, so slowly coming down again. The issue is when someone with "experience" suggests to do something then unless someone else indicates otherwise - I will take my experience with my knowledge (I learn very fast) and that of my latest conversations with my Vet and then make a decision, which will be influenced by the board and/or me at the time of shooting. FYI - you can see my SS and I am taking lots of BG tests so can see the graph of when it's working or idle. I believe I made the right decision as there was little change since even starting the Lantus, and now with the increase we will STAY AT 2.75 for at least 5 full cycles..........please correct me if I am wrong.

The good thing is he is not dropping really fast so no risk as yet of hypo..........I'll do another BG at +8/+9 as this seems to be the nadir for him.

Any comments are always appreciated

Shawna
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275

Shawna, you're doing exactly right. We encourage people to do their own research, listen to more experienced opinions, and then decide for themselves what's best for their cat. Nobody knows your cat as well as you do!!

Not to confuse you anymore, but nadirs can and do change. One day they can be at +6, the next at +4, and the next at +11...although most cats do have an "average" time you can usually expect it....although they also love to be unpredictable....LOL

As you get more and more data, hopefully he'll be one that settles in to an "average" nadir time....although as soon as you figure it out, he'll probably mix it up just to keep you on your toes

You're doing great! You're also very lucky that you have a vet that's open to the protocol and seems to understand the decisions we're helping you to make! That's a very great gift to have!
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275

Hi there :cool:

Below are the guidelines from the TR protocol.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

My $0.02:
You held the 2.5u for 6 cycles.
The lowest you saw during that time was 180 - a high blue. Considering meter reading variance 180 is not that 'blue'

Would this dose have produced lower blues - say 120-160? Hard to say
Is this a big bounce that will be long lasting, short lived? Also hard to say.
True, increasing at the height of a bounce is not recommended since with Lantus you are shooting at a number, that is unknown and will appear 3-4 hours down the road, at onset.
So if onset aligns with the end of a bounce you could encounter an unexpected low later in the cycle and have a very active cycle. Additionally you could trigger another bounce.

That being said-
You are there to monitor and are doing very well monitoring - safety first.
You are prepared to intervene and guide the numbers if needed - you will keep him safe.
You don't hesitate to ask for help when you have questions or concerns.
You are developing your instincts about how it all affects your cat.

The way I see it , putting aside the bounce variable, you did not stray very far from the guidelines for raising the dose.
Maybe not perfect timing for the increase however based on input here today you are aware of potential outcomes.
What you learn from your decision will expand your knowledge of your cats rhythms and responses.

As far as holding this new dose -- 6 full cycles minimum, unless you see a signal to reduce. :cool:
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

Thanks, just came from my Vet as I was in the area and he agreed with the increase and said that the .25 increase is so difficult to read on the syringe that at times I may be giving .30 more or perhaps only .20 more...........they should make narrower tube with longer numbering so that we can see the darn thing LOL. All good, Davidson just dropped a wee bit again to 14.6 at +6 and no abnormal signs.

I respect the protocol and everyone's input, but as they say ECID and knowing the athletic level I am at (National in some sports) each body reacts differently as I can personally attest to that. So I am comfortable with the dose increase, as is my Vet and since as you notice I am home pretty much all day every day until Davidson is "cruising nicely" I will monitor him to the nth degree since he and Harley are my only family and at this point if he wants to spend his inheritance on insulin, lancets and test strips.......then so be it. LOL

He is doing well and we will hold this dose until the weekend is over.

QUESTION: to get someone's attention if I need your advise in odd hours of the night, during work days or very early mornings which icon on the top should I click? Not the 911 since it's not that urgent but sometimes I rely on an answer to a question and respect many are not always around.............trying not to screw up and hope that by increasing the dose I didn't.

THANKS!

Shawna
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

Holding the dose for that long would be ok to do, and some people on here (myself included) tend to hold a dose for a bit longer than the protocol states. By doing that you may see Davidson's #s improve a bit better, too. Only time will tell with that. When the weekend is up, and you don't see an improvement, then perhaps another increase may be required.

In answer to your question about late night questions, I would click on the "?" which is located to the right of the big yellow OTJ, and then type in Question in your subject line.

Hope that helps, and good luck! :smile:
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

GECKO said:
Thanks, just came from my Vet as I was in the area and he agreed with the increase and said that the .25 increase is so difficult to read on the syringe that at times I may be giving .30 more or perhaps only .20 more..
Click to expand...
Personally I would not get too hung up on that. Back in our day, when dosing BK required 0.25u increments one way or the other, I learned from the wise ones of the times that the important thing was to try and be consistent. Whether or not it was precisely 2.75 was less important than aiming for consistency. It was my 2.75 that mattered. You'd be hard pressed to find 2 folks who measure 2.75 (or any dose not on the lines) the same.

BK for most of the journey was very high dose due to IAA and 0.25u changes were not part of the picture - until the slide down.
That;s when I learned about 0.25u increments :cool:
GECKO said:
QUESTION: to get someone's attention if I need your advise in odd hours of the night, during work days or very early mornings which icon on the top should I click? Not the 911 since it's not that urgent but sometimes I rely on an answer to a question and respect many are not always around.............trying not to screw up and hope that by increasing the dose I didn't.
Click to expand...
I'd pick the ? icon and append your subject line with "eyes please". No way to guarantee that anyone is around however.
If you anticipate a situation in advance you feel requires input, try and bring it up in advance while the board is more active. There is generally someone around that is willing to watch out for you.

What time zone are you in?
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

Thanks Sandy.........same time as MD. Agree with you that nobody is going to measure so precisely with the syringes we use, and the main thing is consistency. The Vet I use is wonderful, and FULLY AGREES with the FDMB and is very aware of all the information I get from it. He's never said anything against the advise I've received and encourages me to get as much info as possible from all sources. The main thing for all of us is that it's about our kitties, nothing else. ;-)
(edited for spelling error on 'about')
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

GECKO said:
The Vet I use is wonderful, and FULLY AGREES with the FDMB and is very aware of all the information I get from it. He's never said anything against the advise I've received and encourages me to get as much info as possible from all sources. The main thing for all of us is that it's out our kitties, nothing else. ;-)
Click to expand...

You hit the lotto there - big time! :cool:
So many of us struggled and folks continue to struggle, to find a vet with an attitude even remotely resembling your vets.
I myself was on vet #3 and a hairs width from her not renewing BKs Lantus prescription, due to the high doses I was giving BK at the time.

eta - Dyana/JD is an early bird here in the east and when available is willing to assist other early birds
There are a number of experienced folks in the pacific time zone too, although I'm not sure if any are night owls or insomniacs :cool:
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

I'm currently working on vet #2, as my first vet didn't know nearly as much as this one does, and we butted heads on more than one occasion not just with regards to Blackie, but with the others that have GA recently, too.

Finding a vet, especially a good one that will back up FDMB especially, is hard to find. Good job! :-D
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

There are a couple of us on in the west who tend to be up late, as we have late nadir cats (on Levemir). So depending on whether my kitty is low, I may be up. That ? icon usually catches attention.

Another thing I wanted to mention is that some of us dose with calipers. If you get a pair of digital calipers, you can set it to the dose you want, and with the help of a good light and magnification, you get fairly consistent doses. I find the BD syringes can vary quite a bit if you dose on the lines, often up to .5U out. My hubby got me calipers from his local machine tool store. Here is the model that a number of members here use. But once I've found a dose I like, I can record the number of mm and keep using that to measure the dose.
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

some syringes also have narrower barrels, which spreads out the lines a little more, than others. I liked Terumos thinpro with 0.5u dose markings. yes, consistency to your own dose is what's important. i looked at where the line of the plunger was.

wendy, marje and i are in the west coast time and usually check in throughout the evening. i look first for question marks, although sometimes people put up a question mark in the morning and 12 hrs and 15 responses later it's still up there! the ? icon is a good option, also putting the comment in your subject line. anything that says you have something you want help with works. Most of the time there's someone online who is willing to give dosing advice all except in the middle of the night, and sometimes even then there will be someone online!

we do know that absorption varies from day to day, so while we try to control as many variables as we can - the food, the dose, the timing - the absorption rate is beyond our control. you have to do a lot of just doing the best you can with this disease. you're learning a lot - the first few weeks are an information overload phase, but then it gets easier.

fwiw, i'd have increased today as you did.
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

Great idea on the calibers as I have a digital set and will try it out. It's too bad many Vets don't care nearly about our pets as we do and most unfortunate to hear many of you aren't getting the proper attention. I actually called this Vet and went for a consultation without Davidson and after an hour I felt satisfied he knew my position, what I wanted and that I was seeking advise here. He's a NKOTB (new kid on the block), young and eager to prove himself and I think having someone young is better then those old farts (generalization) as they are fresh off the education and have learnt the newest ways and technologies around. My last Vet admitted he was 'old school' yet wouldn't read the material I printed off here and emailed him. Go figure.

We all have our hearts in the right place and I'm glad I found this site!! Whoever started it is an absolute Saint.........plus all those who contributed and one day I may be able to add something too. :-D
 
Re: 1/28 DAVIDSON AMPS 324 +2 317 +4 275 +6 263

i know i felt like i'd won the lottery when i found it. my vet was in a 3 vet practice, and i'd been with him for ages. absolutely loved him. but there was only 1 diabetic cat in the practice besides punkin and it was with another vet. he started us on ProZinc, which uses u-40 syringes, and when he switched punkin to Lantus after a while he didn't tell me i needed u-100 syringes. the folks here figured out that i wasn't really giving 3.0 units of insulin - it was more like 7 units of insulin. fortunately, in this particular circumstance, having acromegaly probably saved his life. the people here figured it out.

i did change vets and my new vet is wonderful. she had 2 diabetic cats but didn't practice TR or advise it. She was willing to listen to me and i told her of this site, but i doubt she recommends it to any other FD caregivers. She knew i was getting dosing advice here and just left me to do what i needed to do. i consulted her for everything else, but often i got my info here first and then asked her about it.

the people here live and breathe feline diabetes and understand all the associated problems. don't know who started it either, but i am also grateful. this particular website started in 2009 but there was at least one previous version of it and i think i've heard people mention as far back as the late-90's, probably when the internet became common.
 
RECAP: AMPS 324 +2 317 +4 275 +6 263 +8 234 PMPS 335

So, with the increase today he dropped slowly and then rose high again which is what he's been doing. I will do a test at either + 2 or +3, then early morning for a +9

He didn't drop as much as one would have thought with an increase and perhaps it's in the depot, but slow is good.

Looking at Davidson's numbers do I need to do a test in the middle of the night again. Davidson is complaining that he would really like to sleep and not be woken up when he's dreaming of being on a sunny beach! :lol:

Your thoughts? Davidson would like to know.........

Shawna
 
i'd check at +2 or +3, look at the speed of any drop in BGs and predict from that if you need to get up to check him again during the night.
 
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