1/7 Zeke AMPS 203;PMPS 203; Nadir 103. Failed Reduction?

[MrZ]

Good morning LL

Hope everyone is keeping warm. The colder temperatures are certainly affecting the PS routine. Several mornings of late I've had difficulty getting Zekey's ear to bleed - today included. This morning it took me about 10 minutes to finally get a sample. By then I was really rushed to get his syringe ready (only had 3 minutes to stay on schedule). Consequently, I rushed the syringe loading and squeezed out too much insulin, shorting Zeke on his dose (think it might have been a 0.50u). Should have just prepared another syringe but because I was already late, I didn’t. Couldn’t have picked a worse day for a shave! Did you see his AMBG? Well of course you KNOW as soon as I finished the injection I was kicking myself for not just redoing the syringe and giving him the full 0.75u. To add insult to injury, trying to stick with feeding consistency, I gave Zeke 7% (1T), though for his third breakfast (0.5T) I gave him only 4% instead. Now I’m mentally and emotionally preparing myself for a not so pretty cycle this AM plus the potential aftermath of the shaved dose on his future cycles.

I’m exceptionally upset about this shave because honestly, I’ve been wondering if his numbers are starting to trend up (i.e. do we have a failed reduction?). While, Zeke has been seeing blues and greens, he doesn’t have any greens come PS and the green periods during his cycles appear to be shortening. And then today, a 203 AMBG. Now an honest evaluation of this dose is not really possible because of this shave. If I see worsening numbers next cycle or two, is it because 0.75 really wasn’t enough or is it because I drained the depot with this shave?

Your thoughts?

Zeke's Yesterday

 

[Marje and Gracie]

Re: 1/7 Zeke AMPS 203; +1.25 = 240

He was getting nadirs in the 60s on this dose so my thought is to hold it because you weren't having to do massive food management or worry about him when you are working.

Sometimes a kitty doing well as Zeke is will venture into yellow at AMPS and come down. The dawn phenomenon makes it common for AMPS to be higher.

IMHO, I'd give him a cycle or so after this one to see how he recovers from the short shot and then we can reevaluate. If you want a bit more green, you can fatten the dose a bit but you'll have to be religious about the 7% food to try and keep him flatter earlier in the cycle.

I know you said you have a rice sock....maybe you need to make a new one? I pop mind in the microwave for about 30 seconds and it warms her ears quickly.

Try to have a good day.

 

[PeterDevonMocha]

Re: 1/7 Zeke AMPS 203; +1.25 = 240

Hi guys .. no advice from me but I'm crossing fingers it wasn't a failed reduction .. These cold mornings are a real bummer in getting the ears to bleed .. the rice socks definitely help! Have a great day guys!

 

[MrZ]

Re: 1/7 Zeke AMPS 203; +1.25 = 240

If you want a bit more green, you can fatten the dose a. It but you'll have to be religious about the 7% food to try and keep him flatter earlier in the cycle.

Try to have a good day.

Hi Marje, thanks for checking in on us. Am I understanding you correctly to say that I can go ahead and fatten the dose tonight? I think you meant to write "you can fatten the dose a bit but you'll...", is that correct?

"Try". Yes. You know how I am. I will TRY.

Hope you and Gracie HAVE a great day.

Thanks again for the advice. Don't know how I'd do this without you and the others on this board. So very grateful.

Thanks PeterDevonMocha for dropping by and sending us your well wishes. Fingers and paws (tightly) crossed over here that Zekey can continue to work this juice and see his numbers improve soon.

 

[Marje and Gracie]

Re: 1/7 Zeke AMPS 203;+1.25= 240;+3= 178; +5 = 103

Sorry to be unclear. What I meant was first:

IMHO, I'd give him a cycle or so after this one to see how he recovers from the short shot and then we can reevaluate.

then, second (depending on what happens above):

If you want a bit more green, you can fatten the dose a bit but you'll have to be religious about the 7% food to try and keep him flatter earlier in the cycle.

I think it's pretty telling that he's at +5 103 with a partial shot. I really think we need to see how he does when he gets the full dose before you decide to fatten the dose.

Thanks....I think we will have a good day, today.

 

[MrZ]

Re: 1/7 Zeke AMPS 203;+1.25= 240;+3= 178; +5 = 103

OK Marje, thanks for the clarification.

As Sienne has advised me in the past, I will put my hands in mittens and then sit on my hands :lol: :lol: :lol: (thanks Sienne).

Tonight, I'm going to fill the syringe before I take his test (but still let it sit no more than 15 minutes) so that I'm not rushed again should I have trouble drawing blood. We were having issues with one of our heaters. That was fixed today so hopefully his ears won't be as cold as they've been these last couple of weeks.

 

[Carl & Polly & Bob (GA)]

Re: 1/7 Zeke AMPS 203;+1.25= 240;+3= 178; +5 = 103

This is where the designer patience pants become handy...

Focus on the nadirs, not the preshots -

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

.

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

I know, much easier said than done

 

[MrZ]

Re: 1/7 Zeke AMPS 203;+1.25= 240;+3= 178; +5 = 103

But Carl, this is a reduction so aren't the rules a little different? You look to see if there's a rising trend, right?

 

[Carl & Polly & Bob (GA)]

Re: 1/7 Zeke AMPS 203;+1.25= 240;+3= 178; +5 = 103

I wouldn't increase yet, if that's what you are asking. If he continues to have good nadirs, then the dose is working.

 

[MrZ]

Re: 1/7 Zeke AMPS 203;+1.25= 240;+3= 178; +5 = 103

I wouldn't increase yet, if that's what you are asking. If he continues to have good nadirs, then the dose is working.

Sorry, I believe I've asked this before (not necessarily to you however) but not quite sure I've gotten an answer. Would it be best to flatten him out now early in the cycle using 7% even if that means he most likely won't spend much if any time in green? Also, what constitutes flat? Within 20% of the PSBG?

 

[MrZ]

Re: 1/7 Zeke AMPS 203;+5=103; PMPS 203

Yes, the AM & PM were the same - yellow.

 

[MrZ]

Re: 1/7 Zeke AMPS 203;+5=103; PMPS 203

Yes, the AM & PM were the same - yellow.

 

[Carl & Polly & Bob (GA)]

Re: 1/7 Zeke AMPS 203;+1.25= 240;+3= 178; +5 = 103

I wouldn't increase yet, if that's what you are asking. If he continues to have good nadirs, then the dose is working.

Sorry, I believe I've asked this before (not necessarily to you however) but not quite sure I've gotten an answer. Would it be best to flatten him out now early in the cycle using 7% even if that means he most likely won't spend much if any time in green? Also, what constitutes flat? Within 20% of the PSBG?

First, my theory on carb content...
I'll quote Dr. Lisa first -
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=79754&
Read what she says on the % carbs that the food chart states, and "reality". It's cat food. The numbers are not perfect. As far as how this relates to Zeke? The can of food you are feeding that says "7%" may or may not be exactly 7%. Could be more, could be less. Ditto on the 4%. So even if you feed him the same exact brand and flavor (regardless on carb %), any two cans are not equal.

Another way I have had it explained to me (I think Jill was the person who helped me understand this) -
I make a batch of chili. And when I put together a list of ingredients and calculate the carb content, I get (random number) "8% carbs" overall. So I take this big old pot of chili, and freezer containers, and I freeze meal sized portions. As I am ladling it into the tupperware, one scoop contains lots of beans and tomatoes. Another contains lots of beef and not much "veggies". Because of the different mix of ingredients in each container, one of those meals might be 4% carbs, and the other might be 12% carbs. But overall, my recipe calculates out to 8%.

Cat food is not gourmet cooking (as opposed to my chili). It's a big vat of godknowswhatisinit that gets put into cans by a machine. Maybe thousands or hundreds of cans. It isn't likely that all cans are the same. But the vat has 5% carbs, in theory.

I think that what both of the above stress is that, at best, the number on the food chart is an estimate. It's a good ballpark number that we use to classify foods as low, medium, or high carbs. But nobody knows exactly what is packed into each can carbs-wise.

You might see an obvious difference in BG numbers if you feed MC instead of LC, or HC instead of MC. But the difference you might see between his numbers on 4% vs. 7% are probably more due to other things than "% carbs" on the food chart. I think you would be able to better steer a cycle, regardless of exact carb content, by adjusting the timing of meals, and the size of portions, than by deciding between 4%, 7% or 9% based on his preshot numbers.

To me, this sums it up, from Dr. Lisa -

Why am I beating this to death? Because I don't like to see people get so fixated on the carb numbers to the point where they drive themselves nuts.

Also, what constitutes flat? Within 20% of the PSBG?

I think when I look for "flat", I am looking from one test to the next.
Today, from 203 to 240 by +1.5. That's within 20%, but I think I would call it "rising from eating".
But when you consider the next test you got - 178 - I'd say that was a drop. It's within 20% of his AMPS, but it's a drop from the 240 for sure.

And over 12 hours, he was "perfectly flat" if you just look at him having the same exact AMPS and PMPS number. But he dropped at least 100 points somewhere in the middle, so that's a 50% drop or more. Nice cycle, IMHO.

I look back a few days and I see cycles that weren't all that "great" on the f1.0 dose. But he absolutely got much better cycles after that, and eventually he earned a reduction to 1.0u and another to .75u. I think that's where my "patience pants" comment was rooted this morning.

edit - forgot to link to Dr. Lisa's thread...

 

[Marje and Gracie]

Re: 1/7 Zeke AMPS 203;+5=103; PMPS 203

Today could also be a bouncette as Sienne calls them. I want to see what he does tonight and what his AMPS is before I start getting impatient for you ;-)

Of course, I won't be here in the morning when you shoot but I'll check in tonight to see what he does before I go to bed. It is not beyond the realm of possibility that we were still seeing some depot action from the 1u. So hang on and put on some super cosmic patience pants and let's see what tonight looks like.

 

[MrZ]

Re: 1/7 Zeke AMPS 203;+1.25= 240;+3= 178; +5 = 103

Sorry, my post previously submitted in response to the following was done so in error. I actually intended to state the below.

I wouldn't increase yet, if that's what you are asking. If he continues to have good nadirs, then the dose is working.

If the PM plays out like the AM cycle then his nadir today is higher than what it's been last couple of days. He had been spending time below 100 before. At the current pace, it's looking like he might not be seeing south of 100 this entire day. If his nadirs are not as good as they had been before, then is this not a failed reduction? I don't mean to sound like a broken record (but I'm sure I do), I just don't want to hold a dose too long if it's not gonna help him along. It's not that his cycle today was ugly it's just IMHO it's not as good as what Zeke was getting before. These are my observations. Thought I'd just toss this out there now for discussion instead of waiting. If today is a bouncette then at least I have an explanation for this temporary worsening of his numbers and a reason to just sit tight and wait another cycle or day.

I want to see what he does tonight and what his AMPS is before I start getting impatient for you ;-)

Of course, I won't be here in the morning when you shoot but I'll check in tonight to see what he does before I go to bed. It is not beyond the realm of possibility that we were still seeing some depot action from the 1u. So hang on and put on some super cosmic patience pants and let's see what tonight looks like.

I think it's a failed reduction but I will wait to hear what you think.

He only dropped 10 from +2.5 to +3.75. Of late I would be feeding him 1/2T+ of 7% but because he didn't drop much I'm only giving 2%. I saw your post Carl, but at this point I can't change the quantity so I'll play with the carb % even though (like you said) we really don't know if it's 2%. If I don't feed him enough he's gonna be starving later when the insulin won't be at it's peak.

 

[Marje and Gracie]

Re: 1/7 Zeke AMPS 203;+5=103;PMPS 203;+2.5= 155;+4 = 145

One other thing to remember: you gave a partial shot today. It does take a bit of time to refill the depot. So he could have a few things going on:

--less insulin
--bouncette

While we can just tell you what we think we see, you are there and you hold the syringe...

 

[MrZ]

Re: 1/7 Zeke AMPS 203;+5=103;PMPS 203;+2.5= 155;+4 = 145

While we can just tell you what we think we see...

Marje, for that I am forever grateful. I couldn't do this without you and the others that have provided their support and advice. Although I do hold the syringe, I respect and desire the advice of others more experienced than me. He's been pretty flat this cycle and unless he clears a bouncette tonight, I'm expecting another PSBG similar to this morning's :-(

I hope I'm wrong. I know that dosing adjustments are based on the nadir but if his PS tomorrow is similar to today's, I believe that would be an indication that this is a failed reduction - the higher nadirs today weren't just a fluke. I might still hold the dose one more cycle but I don't know. I am definitely still open to hearing what others think. There is also the question of what dose to increase to. Marje, in your earlier post you stated that once I reevaluate this dose, I could consider fattening the 0.75 to try and get more green, correct? But what a fat 0.75 looks like in the syringe, I'm not sure. Or would it be advisable to go back up to the 1.0 as that was the last good dose?

Yesterday wasn't too bad. Yesterday, there was still hope for green. What a difference a day makes.