? 1/8 Silver AMPS 308 - PMPS 320 is this NDW?

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Juliet said:
Isn’t the depot already full? Surely the new dose is just topping it up?
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The depot is probably one of the most confusing parts to Lantus/Levemir. Silver's depot (reserve) is curent filled to the 2.0U does and is filling to the 2.25U does as you continue to shoot.

How long does it take to fill or empty the depot?
Again, from Boulder Medical Center:
Size of subcutaneous depot: The variability in absorption is increased and net absorption is decreased with increasing size (number of units) injected.
Practical experience on FDMB shows that as a generalization, the depot can affect up to 6 cycles. The time tends to be less when a cat is on a smaller dose, and more when a cat is on a larger dose. Other factors can apply as well, but using the generalization of 6 cycles is a good starting point until you have learned your particular cat's patterns.
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The same is true in reverse - so, let's say there was an earned dose decrease - because the depot had been filled (for example 2.25U) the next couple of cycles (after the reduction) the depot will drain from the 2.25U to the new, reduced dose to 2.0U (again, example) and because of that your kitty can still drop low(er) than would be expected once the depot has stabilized to the new dose (2.0U).

It helped me to think about the depot as a "time-relased" pill (it is not, but it is a concept that we are more familiar with).

I hope that someone can give you a better explanation or explain it better -
 
LizzieInTexas said:
The depot is probably one of the most confusing parts to Lantus/Levemir. Silver's depot (reserve) is curent filled to the 2.0U does and is filling to the 2.25U does as you continue to shoot.



The same is true in reverse - so, let's say there was an earned dose decrease - because the depot had been filled (for example 2.25U) the next couple of cycles (after the reduction) the depot will drain from the 2.25U to the new, reduced dose to 2.0U (again, example) and because of that your kitty can still drop low(er) than would be expected once the depot has stabilized to the new dose (2.0U).

It helped me to think about the depot as a "time-relased" pill (it is not, but it is a concept that we are more familiar with).

I hope that someone can give you a better explanation or explain it better -
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Thanks. Yes that is helpful. The depot is confusing for sure. Let’s see what the next few days bring then.
 
Pink all day. Not seen a blue since 12/29.

Is this current high NDW?

Could he have had glucose toxicity on the lower dose?

Feel like we are going backwards not forwards.
 
Did you get other tests during the AM cycle? I checked the SS and didn't see any other tests.

Yes it could be NDW and yes it could be a bit of glucose toxicity but regardless hold the dose and follow the protocol. It could also be bounces of lows you are not getting due to missed tests.
 
LizzieInTexas said:
Did you get other tests during the AM cycle? I checked the SS and didn't see any other tests.

Yes it could be NDW and yes it could be a bit of glucose toxicity but regardless hold the dose and follow the protocol. It could also be bounces of lows you are not getting due to missed tests.
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No. I have a job. Daytime tests not possible. I don’t think he is going low at all. He goes into yellows but that’s not low.
 
Juliet said:
No. I have a job. Daytime tests not possible.
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I understand! So she could have dipped down-who knows how low. I know it s frustrating not seeing anything but pinks but that doesn't mean there isn't yellows or possibly blues though the day. :bighug: I am in a similar situation, just grab tests whenever you can and remember this is a marathon, not a sprint. ;)
 
Juliet said:
Is this current high NDW?
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It's possible. It's also possible he went lower last night and is bouncing. I don't see any tests lasts night, so it's just a guessing game. Can't tell much with just PS data. Since you can get PM data, I encourage you to try to get at least a before bed test each night.
 
Wendy&Neko said:
It's possible. It's also possible he went lower last night and is bouncing. I don't see any tests lasts night, so it's just a guessing game. Can't tell much with just PS data. Since you can get PM data, I encourage you to try to get at least a before bed test each night.
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I fell asleep last night hence no tests. It is so hard for me to get midweek testing and I do try to get at least a bedtime test. Sometimes I get a +2 but it’s always so high so am guessing food hike.
 
Myagi and Heidi said:
Only too well! If you ever look over Myagi's threads, you'll see some of my melt downs and utter confusion no matter how hard I try to understand. That's why you focus on the basics - so when you're overwhelmed, you can still function for Luci's care.
You're already doing great! :bighug:
"If one spends the time to learn the basics...
Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose,
Peak/Nadir - the lowest point in the cycle,
Duration - the length of time insulin continues to lower blood glucose,
observes kitty's response to food, and understands the reasoning behind the choices... rather than immediately stressing over a choice between TR or SLGS and having someone tell you every move to make... things tends to fall into place."
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@Myagi and Heidi I pulled this over from another condo as I didn’t want to hijack it. I understand nadir and I think I understand onset - that’s when the numbers begin to go down right? I think with Silver it’s at +3 as his +2 is always higher due to food hike. But how do you find out the duration? Is that from onset to nadir?
 
Juliet said:
@Myagi and Heidi I pulled this over from another condo as I didn’t want to hijack it. I understand nadir and I think I understand onset - that’s when the numbers begin to go down right? I think with Silver it’s at +3 as his +2 is always higher due to food hike. But how do you find out the duration? Is that from onset to nadir?
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Yes. That's pretty much my understanding of duration. When they start to talk about overlap and the depot I get a little lost, but that's why the basics help!
I copied it from this thread and put this thread on my ss for easy reference. Also texted myself that sub quote.
http://www.felinediabetes.com/FDMB/...combining-merging-protocols-good-idea.111088/
 
Juliet said:
@Myagi and Heidi I pulled this over from another condo as I didn’t want to hijack it. I understand nadir and I think I understand onset - that’s when the numbers begin to go down right? I think with Silver it’s at +3 as his +2 is always higher due to food hike. But how do you find out the duration? Is that from onset to nadir?
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But one thing I've learned in the last couple of days is onset is often earlier than we think! You said "food hike". Right. Lol. Thanks to @Marje and Gracie and @Gill & George not letting me skate on my "too close to see the forest for the trees" reasons for insisting his onset was +3ish, i started +2 testing and learned his onset is earlier! Because also our kitties change things up - especially as they start to heal.
Hope this helps! :bighug:
 
Myagi and Heidi said:
But one thing I've learned in the last couple of days is onset is often earlier than we think! You said "food hike". Right. Lol. Thanks to @Marje and Gracie and @Gill & George not letting me skate on my "too close to see the forest for the trees" reasons for insisting his onset was +3ish, i started +2 testing and learned his onset is earlier! Because also our kitties change things up - especially as they start to heal.
Hope this helps! :bighug:
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Thanks! I have been getting some +2’s after someone said they are a good idea. He does jump quite high tho. His PMPS was 320 and 382 at +2. I’ll be getting a +4 soon.
 
Juliet said:
Thanks! I have been getting some +2’s after someone said they are a good idea. He does jump quite high tho. His PMPS was 320 and 382 at +2. I’ll be getting a +4 soon.
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Marje said something really cool about the insight of the +2. Lemme find it and bring it here. Also, lots of seniors have been lovingly asking all along fur +2 testing, I just could only handle what I could at the time and the more I've learned, the more receptive I am to learning. I live in the desert and the ground has to be wet to absorb the rain.... know what I mean?! ;)
 
Juliet said:
Thanks. I’m feeling soooo discouraged actually. I seem to be getting nowhere and we are three months in now and nowhere close to good numbers anymore.
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You are getting somewhere as you are not letting Silver's diabetes to its own devices and you are collecting info about this the very best you can.

Myagi and Heidi said:
Yes. That's pretty much my understanding of duration. When they start to talk about overlap and the depot I get a little lost, but that's why the basics help
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That's what I think too . From onset to nadir.
Because everyone talked of a long lasting insulin I took that literally to start with thinking it lasted the 12 hours cycle . Erms. A big fat nopes.

We three are all in the classroom together. :bighug:
 
PussCatPrince said:
You are getting somewhere as you are not letting Silver's diabetes to its own devices and you are collecting info about this the very best you can.



That's what I think too . From onset to nadir.
Because everyone talked of a long lasting insulin I took that literally to start with thinking it lasted the 12 hours cycle . Erms. A big fat nopes.

We three are all in the classroom together. :bighug:
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Dumb question - if it doesn’t last 12 hrs - and we know it doesn’t - why do we only dose at 12 hr intervals?
 
Juliet said:
Dumb question - if it doesn’t last 12 hrs - and we know it doesn’t - why do we only dose at 12 hr intervals?
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Because of the depot. Early shots act like an increase. Ha! I did learn something!

And there are no dumb questions! (From the girl spending hours trying to figure out of you can average carbs! Lol)
 
Juliet said:
Dumb question - if it doesn’t last 12 hrs - and we know it doesn’t - why do we only dose at 12 hr intervals?
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Good question as it happens.

Myagi&Heidi said:
Because of the depot
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I'm still struggling with the depot thought. Nearest me and him have got is a rain water tank on a trickle feed. Top up the tank every 12 hours . Don't let it run totally dry as it will always be trickling away but you want that water to grow healthy plants so try and control the trickle.[
 
Me - I'm still trying to understand why I get good numbers and then lose them again with no rhyme nor reason. We were getting quite a few blues now nothing but pinks and yellows again. I seriously doubt he is currently getting into blues during the day as it was all yellow on the last two curves.
 
Juliet said:
@Myagi and Heidi I pulled this over from another condo as I didn’t want to hijack it. I understand nadir and I think I understand onset - that’s when the numbers begin to go down right? I think with Silver it’s at +3 as his +2 is always higher due to food hike. But how do you find out the duration? Is that from onset to nadir?
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Duration isn't onset to nadir, duration isn't a set time at all, it's however long the insulin carries. This can vary by cycle or you might see a pattern that, say, your kitty loses duration at +10 and spikes before preshot or your kitty has a long duration that runs over into the next cycle (that would be overlap, and it's a great thing because as one cycle's insulin wanes, the onset of the next cycle's insulin gets passed the baton and keeps going on that groove).

Sometimes if you feed your cat after nadir, you will see numbers rise and continue to rise (not usually a bounce), sometimes food can put the breaks on a cycle, and that's why in some cases, its best not to feed after nadir...you want the most duration possible. We say the insulin lasts for 12 hours, but it's an approximation, for some it lasts 8 hours, or 10 hours or even 14 hours and beyond. Many factors play in to the duration you get: absorption, food, exercise, where the shot is injected (in a skinny part vs fatty part or accidentally a muscle, etc.) the list goes on.
 
Stacy & Asia said:
Duration isn't onset to nadir, duration isn't a set time at all, it's however long the insulin carries. This can vary by cycle or you might see a pattern that, say, your kitty loses duration at +10 and spikes before preshot or your kitty has a long duration that runs over into the next cycle (that would be overlap, and it's a great thing because as one cycle's insulin wanes, the onset of the next cycle's insulin gets passed the baton and keeps going on that groove).
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I'll be honest here.

"it's however long the insulin carries" and " your kitty loses duration at +10"

I don't understand. :p:(
 
Juliet said:
Isn’t the depot already full? Surely the new dose is just topping it up?
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Yes, it is topping it up - with some of the insulin injected. So when increasing .25u, part of that will go to the depot and part into circulation.
It takes several cycles before the depot matches up with the new dose. Giving an increase time to settle in is important. Only then can you make a proper evaluation.
 
Stacy & Asia said:
Duration isn't onset to nadir, duration isn't a set time at all, it's however long the insulin carries. This can vary by cycle or you might see a pattern that, say, your kitty loses duration at +10 and spikes before preshot or your kitty has a long duration that runs over into the next cycle (that would be overlap, and it's a great thing because as one cycle's insulin wanes, the onset of the next cycle's insulin gets passed the baton and keeps going on that groove).

Sometimes if you feed your cat after nadir, you will see numbers rise and continue to rise (not usually a bounce), sometimes food can put the breaks on a cycle, and that's why in some cases, its best not to feed after nadir...you want the most duration possible. We say the insulin lasts for 12 hours, but it's an approximation, for some it lasts 8 hours, or 10 hours or even 14 hours and beyond. Many factors play in to the duration you get: absorption, food, exercise, where the shot is injected (in a skinny part vs fatty part or accidentally a muscle, etc.) the list goes on.
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Now I’m totally confused. How can duration be that long? Isn’t duration for as long as numbers are decreasing? Once they start increasing without food influence, surely that’s the end of the duration eg using Silver as example. His onset is +3. Nadir +7 and upwards after that. My logic tells me duration is from +3 to +7?

Heading to bed. It’s late here.
 
Juliet said:
Yup. Me neither.
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@Juliet

Just found this on the 'net. It seems to say that the duration clock starts ticking from the time of injection . You look at the blood glucose number at that point.
The numbers go up/down but when they reach about the same point as when the injection was given then that is the end of the duration. Something like that I think. :confused:

http://petdiabetes.wikia.com said:
.....there is no actual hard time when duration has ended -- it's a matter of degree. The usual time used for reference is either whatever the manufacturer claims, or the time when blood glucose levels have reached the same point they were at shot time. Any residual effect of the insulin beyond that time is carryover.
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Juliet said:
Dumb question - if it doesn’t last 12 hrs - and we know it doesn’t - why do we only dose at 12 hr intervals?
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Because most of the time, it does last 12 hours and sometimes longer.

Sometimes it’s shorter because the absorption of that particular shot is less, we overfeed carbs, or we feed too late in the cycle this putting the brakes on duration.

Even if a particular shot has shorter duration, the depot is still at play.
 
Juliet said:
Now I’m totally confused. How can duration be that long? Isn’t duration for as long as numbers are decreasing? Once they start increasing without food influence, surely that’s the end of the duration eg using Silver as example. His onset is +3. Nadir +7 and upwards after that. My logic tells me duration is from +3 to +7?

Heading to bed. It’s late here.
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No...duration is the entire cycle:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
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Loss of duration is very difficult for most to pick out.
 
Juliet said:
Now I’m totally confused. How can duration be that long? Isn’t duration for as long as numbers are decreasing? Once they start increasing without food influence, surely that’s the end of the duration eg using Silver as example. His onset is +3. Nadir +7 and upwards after that. My logic tells me duration is from +3 to +7?

Heading to bed. It’s late here.
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As long as the numbers are decreasing is when it peaks, but it is still working after that. Certainly the depot probably gives a hand in some of this too, but if think of it this way:

Have you ever used an electric toothbrush and forgot to recharge it? They still work, but they slow down and don't work as well as they do on a full charge until finally they just quit until you charge it back up again. The insulin is like that, if it just stopped working shy of the 12 hours, you'd probably have some pretty terrible numbers, similar to what you would see with skipping some shots but it still works, (keep in mind, the depot, makes this tricky to illustrate), but that's the general idea. It works, it just works less well as time goes on, and if you're lucky, you have onset from the next shot before it gets out of hand.
 
Ok girls. This duration thing just went completely over my head! :banghead: when he's flat Myagi's would be almost 12 hours. But when he's dropping/ improving (which is what's wanted), he doesn't go back as high as that shot number. So what's the duration?

@Juliet @PussCatPrince
So it turns out the +2 pearls of wisdom were spread out over many conversations. The gist was it's our best time/tool for seeing where our kid is likely to go on the cycle. You directly compare +2 to pre shot as an indicator (not a guarantee) of the cycle. These notes were specifically for Myagi so I deleted what wasn't relevant to the generic explanation for us.

"By and large, if his +2 is less than his PS, he’s going to have a pretty active cycle. If you look on 1/5 when you didn’t test until +3, he took a substantial drop. Most likely, he was dropping by +2 but you want to try and catch the drop early enough to just slow it down a bit and flatten him out.
  • Controlling the drop with LC food can also allow you to hold the dose longer.....keep the nadir up a bit. Keeping the nadir = holding the dose (if it gets him into green) = healing pancreas
  • A very good technique is “getting them on a surfboard”. We want to teach the liver to like green numbers. To do that, at the first green number, be sure and feed him a couple tsp of LC food and see if he will get on that surfboard and stay on it for longer periods of time. You don’t have to overfeed him but the goal is to teach the liver that “green is good” . This goes back to bullet 2 above.
  • Like many FD cats, a flat yellow cycle, often is followed by a bounce break."
 
From the New to the Group Sticky Note: Duration - the length of time insulin continues to lower blood glucose. At the peak or nadir, it is the lowest it lowers the blood glucose. Later on, the insulin isn't as strong, so it's not lowering it as much. Ideally you'd get a nice gentle curve where the insulin starts to lower insulin, builds, lowers it some more, peaks, then continues to lower blood sugar from where it would be with no insulin, but it's weaker, so it's not lowering it as much.

Think of a car and momentum. In the first part of the cycle, the foot is on the gas and the car moves faster and faster. Finally it meets the peak, and the foot switches to the brakes. Think of the brakes gently on as the part of the cycle where the insulin is waning. Brakes slow down the car, but it's still moving forward for a while. When the car finally stops moving, that the end of the duration of the forward momentum of the car.
 
Myagi and Heidi said:
So why is it important for us to understand duration if we can't even figure what it truly is or it's too subtle for us to ascertain?
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It’s important so you can figure out if kitty is bouncing or if he’s lost duration and is going to come right back down after the next shot.

It’s also important if the kitty has extended duration so you can tell if he/she is getting carryover and/or overlap.

Let’s say kitty is 60 at +5 but was fed a lot of HC food and so at +8, is at 285. The BG climbs a little more until the end of the cycle and is at 300 at PMPS. But at +2, kitty onsets from the next shot and drops to 175 and proceeds to have a green cycle. That’s indicative of loss of duration but most members would say it was a bounce that cleared fast.

Why is that important? Because the CG thinks kitty is bouncing and so no test is needed after PMPS until +4 before bed and guess what? Kitty is at 60!!!!

It’s also important because the CG thinks the kitty is bouncing instead of surfing but he can’t surf because of the loss of duration. The CG might think, “well this dose is barely getting him to green for very long” but it could be the HC putting the brakes on the duration.

It’s also important to know if the kitty has a longer duration. Gracie could nadir at +15 from the previous dose on Levemir which would be +3 from the current dose. And then she would onset at +4. I had to be prepared that she was going to likely take a big drop at onset.

While longer or shorter duration might be hard to spot, it can be done with a little practice, learning, asking questions. However, because so many members never learned to spot it, they tell others that it’s a bounce when numbers go up. Sometimes it is a bounce, sometimes it’s just the normal rise at the end of a cycle, sometimes it’s loss of duration.
 
Wendy&Neko said:
From the New to the Group Sticky Note: Duration - the length of time insulin continues to lower blood glucose. At the peak or nadir, it is the lowest it lowers the blood glucose. Later on, the insulin isn't as strong, so it's not lowering it as much. Ideally you'd get a nice gentle curve where the insulin starts to lower insulin, builds, lowers it some more, peaks, then continues to lower blood sugar from where it would be with no insulin, but it's weaker, so it's not lowering it as much.

Think of a car and momentum. In the first part of the cycle, the foot is on the gas and the car moves faster and faster. Finally it meets the peak, and the foot switches to the brakes. Think of the brakes gently on as the part of the cycle where the insulin is waning. Brakes slow down the car, but it's still moving forward for a while. When the car finally stops moving, that the end of the duration of the forward momentum of the car.
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So you would rarely see the car stop (insulin duration end point) unless you over carb because the foot is back on the gas at the next shot?
 
Marje and Gracie said:
It’s important so you can figure out if kitty is bouncing or if he’s lost duration and is going to come right back down after the next shot.

It’s also important if the kitty has extended duration so you can tell if he/she is getting carryover and/or overlap.

Let’s say kitty is 60 at +5 but was fed a lot of HC food and so at +8, is at 285. The BG climbs a little more until the end of the cycle and is at 300 at PMPS. But at +2, kitty onsets from the next shot and drops to 175 and proceeds to have a green cycle. That’s indicative of loss of duration but most members would say it was a bounce that cleared fast.

Why is that important? Because the CG thinks kitty is bouncing and so no test is needed after PMPS until +4 before bed and guess what? Kitty is at 60!!!!

It’s also important because the CG thinks the kitty is bouncing instead of surfing but he can’t surf because of the loss of duration. The CG might think, “well this dose is barely getting him to green for very long” but it could be the HC putting the brakes on the duration.

It’s also important to know if the kitty has a longer duration. Gracie could nadir at +15 from the previous dose on Levemir which would be +3 from the current dose. And then she would onset at +4. I had to be prepared that she was going to likely take a big drop at onset.

While longer or shorter duration might be hard to spot, it can be done with a little practice, learning, asking questions. However, because so many members never learned to spot it, they tell others that it’s a bounce when numbers go up. Sometimes it is a bounce, sometimes it’s just the normal rise at the end of a cycle, sometimes it’s loss of duration.
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Ok! Copying - thanks! Love it when it makes sense. Still not sure how to figure it out, but at least I get why it's important!
 
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