1/30, Bell, AMPS 81 +2 67 +4 56 +5 58 +6 56 +7 57 +9 61 PMPS 68 +2 85

bluesunshine

bluesunshine

Very Active Member
Yesterday

Not much to say except Bell just keep having beautiful cycles. 6 in a row without a bounce. A little lower today than previous. She seems really flat and consistent, I'm going to have to really think on what to do when I have to be at work or out and about. Even though she is low, she seem predictable and is eating well. I'm wondering if she would do ok with me being gone for, say, 3 hours at a time when she is in the low 60s. I'm not quite sure how drastic the IAA breakthrough will be, but she doesn't have a whole lot of breathing room on this dosage, but I'd hate to scale her back now...

She seems good otherwise too. Following me around for a warm lap or warm spot :cat:

I am slowly getting a bit better. Worked a full day (remotely) and am pretty tired now but I feel more "normal".
 
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Heike & BInie said:
Hi Seth,

so happy Bell is in such good numbers again! :D:D:D You needed so much patience and it all paid out. I honestly don't understand how you manage all this with having Covid. I was already a wreck testing at night when I had a simple cold.

Do you have to go back to office next week? Somehow I missed how it all turned out. You are driving home during the day to test?

Hope you continue to improve and Bell continues to show you all these good numbers. :bighug::bighug::bighug:
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@Heike & BInie: It sounded like you had way more than a simple cold when you were dealing with that. You sounded really sick! It was not easy, but I figured I wasn't sleeping well anyway so I pushed on through.

I just tested again and have a super strong positive line, so I'm guessing I'll be at home at least for the start of the week. But yeah, back in office mandate starts next week. Still not sure what I'm doing :D. I was maybe going to see how going in for ~2-3 hours in the morning, coming home during the +5 to +6.5/7 period, and then heading back for 2-3 hours after that. But with Bell's numbers so low, I want to make sure that would be ok... Really dumb situation!!

:bighug::bighug:
 
So steady and green. This is the dream. Next step is the breakthrough and some reductions right? I wonder when that’ll happen and how. Either way I’m sure you’ll be there and ready :)
 
Yeah I am really not sure what the next step is here.

Let's assume she still has some juice left in her pancreas and it heals up and starts producing more insulin. Would that drive her numbers lower? Would that happen gradually or quickly (prolly ECID)? From what I understand from Wendy, the auto-antibodies only attack the injected insulin, so I would imagine if I keep shooting the same dose and she starts producing more insulin on her own, her numbers would go lower?

But then again, I'm not sure her pancreas would produce more insulin if the injected insulin is regulating her well already. So maybe a drop in the dosage would be required to see the pancreas help kick in?

I am a ball of questions lol.

@Tim & Pookey: Pookey seems to be in a similar boat (minus the IAA). Are you using a modified TR protocol to decide on reduction points? I was thinking Bell needed a week entirely under 100 to try a reduction (assuming nothing below 50). It is so cool to see his numbers stand firm as you slowly decrease his dosage. Sending all my good vibes your way that it continues.
 
I don’t blame you about the questions. Have you dug into Black Kitty that Wendy mentioned? Their spreadsheet is interesting when they worked down from like 13 units.

For Pookey we just follow TR and have been using the 7 day reduction criteria. Good vibes right back to you two!
 
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Yeah I have! It is super neat to see Black Kitty run down the dosage ladder.

Oh I guess I was referring to this point:

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I was thinking Bell needed to be under 100 for the entire cycles throughout that week. I see Pookey still has preshots above 100. Btw, not a critique AT ALL, just making sure I’m understanding the protocol. What you are doing is certainly working for Pookey
 

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bluesunshine said:
so I would imagine if I keep shooting the same dose and she starts producing more insulin on her own, her numbers would go lower?
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Yes, that is what happens in cats with no IAA as well. The pancreas is taking over more of the job. But it can be sporadic at first. We used to joke about beta cells coming back from their holiday but getting tired and taking another break. What makes it trickier for you is two things. One is the size of the depot. The second is the antibodies, and how they react to less injected insulin. Do they suddenly release some of the injected insulin they've grabbed?

Regarding reduction on a week in green, here is more information:
Where to go from here is a good question. At some point, I'd like to see a 0.25 unit reduction, to see if you can nudge up the nadirs without disturbing the "all in green". Some cats are sensitive to smaller reductions (Neko was) some aren't. We don't know that about Bell yet. It'd be good to have another tool to keep her safer while you are at work. When the IAA breaks (multiple back to back reductions earned), you go for the big reductions instead of the small ones to keep her safe - due to the depot. It's a fine dance.
 
Yes, you’re right and no offense taken at all! We’re using some judgement on the “100 overall” term I guess. I look at Bell’s last 7 days and that looks pretty nicely under 100 to me outside of that 1/27 morning. Definitely not advice tho just talking.
 
Wendy&Neko said:
Yes, that is what happens in cats with no IAA as well. The pancreas is taking over more of the job. But it can be sporadic at first. We used to joke about beta cells coming back from their holiday but getting tired and taking another break. What makes it trickier for you is two things. One is the size of the depot. The second is the antibodies, and how they react to less injected insulin. Do they suddenly release some of the injected insulin they've grabbed?

Regarding reduction on a week in green, here is more information:
Where to go from here is a good question. At some point, I'd like to see a 0.25 unit reduction, to see if you can nudge up the nadirs without disturbing the "all in green". Some cats are sensitive to smaller reductions (Neko was) some aren't. We don't know that about Bell yet. It'd be good to have another tool to keep her safer while you are at work. When the IAA breaks (multiple back to back reductions earned), you go for the big reductions instead of the small ones to keep her safe - due to the depot. It's a fine dance.
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Thanks so much for all this Wendy.

Just to repeat for my own clarification: even if the injected insulin is keeping Bell tightly regulated, her (potentially) healed pancreas would still produce some insulin? I was (stupidly) picturing her pancreas with a built-in glucose meter, which shuts off insulin production when not needed ( :rolleyes: at me).

When do you think is a good time to try the 0.25 reduction? I could start tomorrow if you think it is time… Or if you’re not comfortable answering that, I can make the call (probably would try it Friday or Saturday night)
 
Tim & Pookey said:
Yes, you’re right and no offense taken at all! We’re using some judgement on the “100 overall” term I guess. I look at Bell’s last 7 days and that looks pretty nicely under 100 to me outside of that 1/27 morning. Definitely not advice tho just talking.
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No, I totally agree. She’s never been this flat. It is a wonderful thing… Your judgement is looking great right now for Pookey. You are a true student of FD :)
 
Timing of the 0.25 change is up to you. Did you want to wait a week at this dose? Or try it earlier and see if it's a technique to keep her safer when you go back in the office?

In spite of having IAA, Bell is still what we'd call a regular type 2 diabetic. Just like Pookey, though maybe greener. :D. And some added complications from the antibodies.

A quote from Sandy:
A massive depot is one element to consider. There are 2 additional unpredictable variables to consider. The first is that when resistance breaks, previously bound insulin is released back into circulation. How much and when is anybody’s guess. The second variable is that spending more and more time in the healing numbers (50-120) with a little luck can result in the pancreas healing and a returning to the job of producing insulin. So you have contributions from the depot, previously bound insulin that’s been released and maybe the pancreas starting to sputter.
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Thank you, Wendy. I think it makes sense to do a trial before I have to be in office. If tonight doesn’t end up in a bounce, I may start that tomorrow.

I think what I’m struggling understanding is that a non-diabetic cat has to have some form of internal regulation, since cats without external insulin don’t normally go hypo. So the pancreas must know when it has released enough insulin for a non-diabetic cat. I’m trying to understand if a working pancreas would have any “awareness” of the injected insulin and limit its insulin production. I may not be making a whole lot of sense because I don’t understand what i am talking about :p.

My main takeaway from your response is that, yes, even in a cat who is well regulated with injected insulin can still add its own insulin to the mix. And on top of that I need to think about all the built up insulin the auto-antibodies may or may not release. AKA: be cautious :D
 
This thread was very helpful to me too. Thank you. Good luck on the timing decision Seth. That slow but steady inch downward leaving less and less buffer is what triggered me to go for a reduction even tho we didn’t meet the criteria perfectly (plus that the feeding was over the top). But I really struggled with the reaction to such a percentage based “tiny” reduction when seeing the big number jumps after being mostly in green for a while. Yet now at the reduced dose we saw green again … it’s such a simultaneously frustrating AND fascinating disease to manage. I will be watching and learning as well as rooting for you and Bell. Good luck friends.
 
You’re doing such a wonderful job managing Bell’s care, Seth. She is in the best hands possible and you are certainly asking all the right questions and studying to make educated decisions.
Keep up the good work Ivy and I wish you all the best of luck in your diligent care of sweet Bell :)
And hoping you feel so much better quickly :bighug::cat::bighug:
 
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