Hi there, sorry it's taken a while to get back to you, I was asleep, I'm in Spain so it was 2.45am for me.
Looking at your SS this morning it says you shot 1.75u last night oct 23??? I so hope this is a typo, she earned a reduction down to 1.5u, holding onto that 1.75u dose based on the data you have is an extremely risky decision to take.
My advise would be to bring her back to 1.5u at the very next cycle, additionally, please monitor her tonight, though this is probably to late and you have gone to bed.
My fiance has to make decisions on PM doses, and, he barely understands the basics, much less TR, if I don't even get it!
It's great that he is willing to help you, would he be willing to post on the board if he was unsure? It's not unusual for couples to be joint CG, my DH also helped out, he never posted, but he had access to the forum just in case he needed help. My petsitter also had access to the forum should she have needed help.
perhaps he saw the high PS and decided on the 1.75? I'm wondering if the fact that you've come from using Prozinc might be influencing your/his decisions.
I haven't used Prozinc, but from what I understand with that the dosing decisions are somewhat based on PS numbers, that is not the case with lantus, with lantus, it is the nadir (that AT59 on the night of the 22 that governs your dosing decision) If it was just a typo, just ignore the above. Last night his only choice on what to shoot would have been shoot, 1.5u , unless she is too low (you may have to decide on a no shoot number for him or a number where he would ask for help), taking the dose up, was never an option.
I really just came on to reply to your [post, the response to that follows regarding patterns and what I see in the last couple of weeks, which I hope helps you get things a little clearer in your mind.
This is also confusing to me. I did not think she was bouncing or clearing a bounce that day. Is it possible I missed a low number the night before last? Sure. But based on other data I've got, it's also possible (maybe even likely) that she was just running in the pinks, as her normal. Besides, she doesn't typically clear bounces that quickly. So, I'm not seeing the low numbers prior to last night that would have led to a bounce, and then her clearing that bounce yesterday?
OK I'm going to start from first principles as I'm not sure what you do or do not understand with regards to bouncing.
What is a bounce?
Is when we see numbers stay high and flattish for a period of up to 6 cycles. The numbers can bobble about a bit in some kitties.
Why/when do kitties bounce?
When kitties get into BG levels that they are not used to, this can trigger a physiological reaction that essentially results in stored Glucose being dumped into the bloodstream by the liver. Note it doesn't have to be low numbers, for example I remember when George saw his first blue, he didn't hang there for long, he just bounced straight back up.
Another trigger for a bounce can be a sharp fall in numbers, so a kitty might be at say 455 and drop 200pts in 3 hrs to 255, and that could also trigger a bounce back up into the reds.
I like to think of bouncing being a result of a messed up fail safe in the kitties physiology, their bodies have gotten used to being in high numbers and they have come to accept those as being normal, when we take them out of that range, their fail safe, 'thinks' kitty is in danger from a perceived, imminent dangerous low (not an actual low), and that triggers the glucose dump.
Now lets look at Lilys numbers
Starting Oct 19
am cycle she dropped from a pink amps of 322 to a blue 104 at +5 staying flat with a 111 at +6 and then by +7 she was shooting up to yellow (this is the start of a bounce) and was up at 394 at pmps.
pm cycle of 0ct 19 mid cycle test shows she is still high, so bounce ongoing (
cycle one of bounce)
Oct 20
amps 405 +5 311, pmps 386 + 309 oct 21 amps 314 so showing a downward trend over 24 hrs but essentially still high and flat over these two cycles (
cycle 2 and 3 of bounce)
Oct 21
amps 314 +6 293 yellow, but not much different to amps, (could she have gone lower early? and this is her on her way up? possibly... I'd be looking to what she does at the next test to get some indication if she got lower earlier in the cycle) pmps was 359, so looking at those numbers that you got overall the seem flattish, so it doesn't appear to me that she dropped into low numbers which you missed early in the cycle, possible but not probable, though we can't know for sure. No tests in the pm cycle on oct 21 ??? but she was red by morning. That might be another bounce, she may have dropped overnight and you missed it, no way of knowing.
So still bouncing in the morning
(cycle 4 of bounce) and cycle 5 we don' t know if she is still bouncing or if she had an active cycle, we will have to look to the am cycle of Oct 22 to look for clues.
Oct 22
amps 434, back up in red??? hmmm that would start me wondering did she do something naughty last night?? Lets see how the morning pans out... +7 shes 290 (probably didn't go lower than usual last night), approx 150 pt drop from amps, that's a significant (large ) drop, this is cycle 6 so I would be looking for that bounce to finally clear, 207 at pmps, thats 227 pts lower than amps, definitely clearing the bounce, why do I say that, well we are at the end of the cycle, we are at the point of least insulin action, but BG is the lowest it's been all cycle. What could have caused that, could it be that the bounce cycle is over, the liver has stopped over reacting and has decided to stop dumping glucose into the blood stream? (probably)
So to me that 207 was a big sign that the bounce was clearing, not because it was yellow, but just because when you looked at the trend in that preceding cycle she was dropping consistently during the day, her numbers continuing to slide in spite of the insulin action waning.
In contrast to that if we look back to the pmps of oct 4 In the morning she was 398 and at pmps she was 208, why did we not see the same happen on this day, well if we look to the midcycle test we see she is at 182 at +8, so although the 208 is a lot lower than amps we can see that the numbers are trending up or flat at best, so possibly she nadired a bit earlier in that cycle and by pmps was on her way up, starting a bounce, which incidentally cleared 4 cycles later 4 cycles later on am cycle of october 6 where she earned a reduction, she then looked to clear two cycles later with that blue on oct 7th but didn't quite make it, eventually taking a further 4 cycles to clear into green earning another reduction.
One thing to bear in mind is that when you see a bounce clearing at the end of a cycle like that and you shoot they can often gather quite a bit of momentum, it doesn't mean that you shouldn't shoot, (in fact shooting in my opinion was the right choice) it's just important to be aware of what is happening, so you could take appropriate action.
What could you have done different?
When you shoot a PS number, that is falling or flat that can often be a sign of cycle that is going to be active, that is, that we are going to see the BG drop at onset (usually around +2) and continue to drop through to nadir (usually around +5+6) So that is a heads up to pay attention, particularly in a kitty that has shown she has a flare for the dramatic such as Lily.
So on that night if it had been me, I would have got a +1. That would have probably been lower than the PS number, absence of a food spike(flat) at +1, or even more important a drop instead of rise at +1. At that point it would have been possible to attempt to steer the cycle with food, to see if she would level out, this is what Sienne has talked about in her post above. You might have been able to hold on to the dose by simply feeding some LC food in the early part of the cycle, holding on to the dose a little longer may help minimise the yo-yoing with doses, though some kitties just take longer to do so than others.
At +1 food should be impacting BG but the Lantus shot will still not have onset, so we would normally expect numbers to spike a bit, how much depends on the cat, my guy never had much of a food spike, but if he had a significant drop at +1 I knew I was in for a bit of a ride, it took me time to learn this about my kitty, be patient with yourself.
I'm sorry, I'm just so exhausted with this illness and trying to understand it and everything and I feel pretty alone.
I'm sorry you are feeling so low. I think all of us who have dealt with FD have felt like that at some point. For me being on the board really helped, I made new friends all of us sharing a love for our cats, I've rejoiced in their successes and mourned their losses alongside. It takes some time to build relationships on the board, when you do get some rest, if it's something you haven't tried do visit the other condos post a comment or two, it doesn't have to be advice, a hug, an expression of empathy, or a a little joke to make someone smile can be the start to you building a support network on the board.
My kitty is OTJ now, has been for a few years, so I'm not on every day, but I will look for you when you are. If you feel in desperate need of help, and not getting any response after trying Siennes suggestions of how to get more attention. Send me a PM I can't guarantee I will be there quickly, but I will make a special effort to log on and visit your condo as soon as I can.
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