10/17 Pumbaa - nothing to brag about!

[Pumbaa]

Pumbaa finished his sixth cycle at 2.0U as of his PMPS, and it was not very impressive.

He only hit blue once, and that was at +7 right after his first 2.0U dose.

Pumbaa doesn't like being in higher numbers like this, and is much more lethargic and hides from me more often during testing and shooting times. He, obviously, just doesn't feel good when his BG numbers are this high.

The good news is:

• Even though I raised his dose to 2.25U tonight, Pumbaa didn't stop eating or run away when the insulin was injected. No stinging! I am so thankful for this change due to switching to Levemir you have no clue! His trying to hide from me tonight for testing/feeding/shooting obviously was due to his not feeling well due to the high numbers, and not due to any pain I am subjecting him to during the injections.

• It took me a while to get used to the Terumo syringes, especially since I started using them with Lantus (which is much thicker in viscosity than Levemir) and had to change how I held the syringes, but damn, dosing Levemir with the Terumo syringes is an absolute piece of cake! I've been using the Terumo's for a month now (since 9/15/12), and I waste very little insulin, only get a tiny air bubble each time I fill the syringe (which is easy to get rid of), and that slick plunger makes it so easy to get an accurate dose. Also, I've only tossed one syringe so far, in over a month, because the markings were too far off to deal with.

• While Pumbaa may still bounce, he doesn't take dangerous dives anymore. Whew! And insert

.

What I don't understand is how Pumbaa could have better numbers at lower doses of the Levemir, and have higher numbers now, when his insulin dose is higher. Yes, I have read up on glucose toxicity and insulin resistance, and those make sense. But still, my brain says, "more insulin, lower numbers". :roll: This is a problem with me trying to turn very gray areas into black and white/cause and effect issues. That's just how I'm wired. So I really appreciate people here who are more creative in their thinking (and you know who you all are) than I am, and who share their knowledge with the rest of us. Thank you all for that! (I would have listed names, but didn't want to inadvertently leave anyone out and cause hurt feelings, since so many have been blessed with this "creative thinking" and have given me support in the last six months. Even when I didn't want to listen because I wanted common sense to prevail. :roll: )

I'm praying that Pumbaa sees a breakthrough at the 2.25U dose and his numbers drop.

Suze

 

[Dale 'n' Chip]

...But still, my brain says, "more insulin, lower numbers". :roll:

Suze

I think your brain has it figured out. But it's not linear. You have to just keep going up until you reach the breakthrough. You are doing a great job and getting great guidance here, instead of where we were before stumbling around in the dark.

The blind leading the blind? But I have to say I learned a lot from watching Pumbaa on Lantus.

Remember Chip hit 52 on day 4 of 1U of Lantus. He didn't earn a reduction on Levemir until he was on 3.0U for like 13 days. So don't be shocked if it takes a higher dose to stop bouncing, snap green and stay green. And Chip seemed to have NDW with almost every increase, once he got past the constant flat pink. I agree that the persistent flat pink and yellow is temporary resistance likely from all those months unregulated on Lantus.

 

[Pumbaa]

No, my brain still doesn't have it figured out. *LOL* My brain still says an increased dose will = decreased numbers, and that's not always true!

You learned a lot from watching Pumbaa on Lantus? Seriously? Well, then that was a good thing. And I'm sure you are referring to his frequent diving and bouncing on Lantus, and how he got stuck in cycles of this. (Remember those Friday night dives? And the Somoygi rebound?) It caused both of us to change our FD cats over to Levemir, which I don't regret for one second!

Now that Pumbaa is on Levemir, I've frequently gone to Chip's SS to see how he did on the same dose Pumbaa is at now. So I am now learning from you two!

It's interesting that, now that Pumbaa no longer takes dangerous dives (insert

) on Levemir, I am more willing to follow the TR protocols than I was before. Those dangerous dives made all of the difference in how I dosed. I hated the bounces, but the bounces weren't life-threatening as the dangerous and unpredictable dives were. Now that Pumbaa isn't diving like he was on Lantus (insert

), I'm much less afraid of raising him when his numbers are still high after 6 cycles.

I wish I could take some time and decrease the size of the anti-jinx icon and still have the text legible. I'll work on that.

Suze

 

[Sheila & Beau GA & Jeddie GA]

I think that if we had enough data all this would make sense, but we don't so... it is like reinventing the wheel sometimes. One of the toughest concepts is that more insulin does not always = lower numbers, but what is even harder is to figure out when to raise and when to lower when more is equaling higher numbers. :roll: Oy!

 

[Pumbaa]

Sheila:

That's why I love you, because you think think outside of the box and admit that this data doesn't make sense, while you still try to make sense out of it, by thinking in the gray areas and relaying that info to us. Thank you for that! (((HUGS)))

If Pumbaa still doesn't respond well to the 2.25U dose, I might just drop him back down a bit, since Somoygi Rebound has been an issue in the past with him.

Then again, since this is all guesswork, I might increase his dose even further, to 2.50U. And beyond, if necessary. It's such a fine line between overdosing and finding the perfect dose.

I wish is was easier, for all of us!

Suze

 

[Dale 'n' Chip]

...If Pumbaa still doesn't respond well to the 2.25U dose, I might just drop him back down a bit, since Somoygi Rebound has been an issue in the past with him.

Then again, since this is all guesswork, I might increase his dose even further, to 2.50U. And beyond, if necessary. It's such a fine line between overdosing and finding the perfect dose.

Suze

You just can't plan ahead like that or expect something from any given dose. You have to go by the numbers. The pink is not from *rebound* it almost certainly resistance. You never want to start down before you breakthrough, or Pumbaa may end up where he was on Lantus, confused, bouncing. Hold each dose for 6 cycles and then step up. There *should be* plenty of warning before you reach your ideal dose like some dips to green after peeks of increasing yellow and some blues... along with wonky pink.

You don't want to go up faster than every six cycles or you may miss the good dose. But you don't want to linger under dose because it may increase resistance. Just stay on schedule and and keep testing for ketones as long as he is pink/yellow. And of course get spot checks in every cycle so you know what is going on... but you have that down pat. :smile:

Disclaimer: I meant with Chip (looking back) there were signs when he was close/at the breakthrough dose. Notice here Julia came to the same conclusion as Sheila several times here that I could/should have settled 2.5U (the original unearned reductions from too low to shoot) longer to see if it would hold. I don't at all regret taking him up to 3.0U twice because I believe that stopped the bouncing. But anyone else reading this don't try this with your cat. And even with Pumbaa I would go by the book and run it by Sheila or the TR group first before trying anything like this.

 

[Dale 'n' Chip]

Wow do I sound like I'm in the wrong forum or what? Actually I've been having to live this 24/7 for the last month... so I really had to figure out how it works.

You shouldn't have to do that... just ask Sheila since she's doing it too now!

 

[Sheila & Beau GA & Jeddie GA]

You just can't plan ahead like that or expect something from any given dose. You have to go by the numbers. The pink is not from *rebound* it almost certainly resistance. You never want to start down before you breakthrough, or Pumbaa may end up where he was on Lantus, confused, bouncing. Hold each dose for 6 cycles and then step up. There *should be* plenty of warning before you reach your ideal dose like some dips to green after peeks of increasing yellow and some blues... along with wonky pink.

You don't want to go up faster than every six cycles or you may miss the good dose. But you don't want to linger under dose because it may increase resistance. Just stay on schedule and and keep testing for ketones as long as he is pink/yellow. And of course get spot checks in every cycle so you know what is going on... but you have that down pat. :smile:

This is really good advice for anyone in the regulation process - although some kitties do seem to need more settle time and that just has to be something you study the data for on your own cat. Is 6 cycles enough or is 8. Or 10. Actually, I think the closer you are to the best dose the longer the settle time needs to be, but that is just my experience.

And I always let the greens guide my decision making. That is why I thought Chip needed less insulin than he ended up needing. He hit greens at lower doses on Lantus and early with lev (if I am remembering correctly). Now I wonder if an early green or very low blue is a forecast of the future best dose, but you have to GET THERE first by breaking through the GT/IR.

Cami had the 100 on her second cycle, but has not been that low since. I don't think she needs a lot more insulin though. PS this morning was 178 when it was 328 last night. She is clearly still settling on this dose so I won't change it at this point.

 

[hmjohnston]

I will be honest- between Pumbaa and Missy I am so GLAD Sneakers is just an acro-cat

:cry: (for you two).

 

[Pumbaa]

Heather:

Don't be sad for me or Pumbaa. (((HUGS)))

Pumbaa was simply a bouncer/diver on the Lantus. While the bouncing is irritating, and Pumbaa doesn't act like his normal self when his numbers go sky high, on the Levemir he comes down gently, instead of diving unexpectedly like he did on the Lantus. Those dives were the worst part, since I seldom got decent sleep as I never knew when they would occur. (Except for the regular Friday night dive parties. Now that was weird. It was like he kept a calendar or something. *LOL*)

Suze