10/25/10 Buddy AMPS 325 PMPS 361 +1 322 +3 220 +7 281

[Mad Scientist and Buddy]

Yesterday 10/24/2010

Morning all!
Not much to say today. I fell asleep on the couch last night and woke up at some point before 3:30 to find a purring, cuddly Buddy under my arm. Felt nice. Probably happened because of a nice blue number that I happened to catch when the little devils woke me up for food in the wee hours. . . .
Pee
Poop - still lots and lots
Purrs
Preen

Tony and Buddy

 

[Pat+Raja+Shadow (GA)]

Re: 10/25/10 Buddy AMPS 325

Morning Tony. Any news on your auto feeder? Wondering if you gave any thought to what Sienne suggested the other day:

If you're able to get some mid-cycle checks tomorrow, you may be able to increase Buddy's dose in the evening. He may have bounced yesterday so it will be helpful to know what his AM cycle looks like.

Maybe if you can manage some PM checks...but I understand falling asleep...believe me I do...one of these days though...if you could do some checks at night...

 

[Sienne and Gabby (GA)]

Re: 10/25/10 Buddy AMPS 325

Ditto on what Pat said. I think you're seeing that Buddy may run lower at night. It will be helpful if you can work some additional checks in, especially since you're gone during the day.

 

[Mad Scientist and Buddy]

Re: 10/25/10 Buddy AMPS 325

Pat,

I work Saturdays as well. Sunday is the only day to get a curve. I did get a +9 in the wee hours of the morning, wish I had a +6 or +7 as well. He was at 166. I believe you said it best, that you think he is hanging lower in the evening/night time cycle, then just bounces up during the day. Seems to be the pattern for him. That's why I suggested a while ago it might be beneficial to increase his morning dose ever so slightly to help control the bounce better (say a fat 0.5) and leave his evening dose the same for now. If he's bounceing from a 166 (and probably a bit lower even at nadir - I know I gotta wake up and get that data) wouldn't increasing his dose just make it worse? Or is the hope that the increased insulin will control the bounce better. Vet is suggesting perhaps a once daily morning shot since it seems like evenings he doesn't need as much insulin anyway. Not ready to try it yet till I exhaust other ideas, but her argument is pretty compelling based on the data I've seen. I know you all have had great things to say about BID, but everyone is always talking about ECID, and well, my Buddy just might be one of the "special" ones. Like I said, not ready to try this route, but thinking long and hard about dosing amounts/schedules.

Tony

 

[Mad Scientist and Buddy]

Re: 10/25/10 Buddy AMPS 325

PS. Feeder works well for during the day - food is gone when I get home. Feeder not so well during the night - he wakes me up and I have to show him that food is out for him. Maybe he'll catch on.
So, no extra sleep for the Bean, but I'm happy to know that food is available for more hours of the day while I'm gone (cause he just eats the kitty pop frozen after my GF puts it out for him - I believe this was one trigger for the pukus - he's been puke free since Friday, longest run so far. And he is more manageable when I walk through the door at 6pm (less frantic for food and easier testing/shooting).

 

[Mad Scientist and Buddy]

Re: 10/25/10 Buddy AMPS 325

Ok, so I've done some reading today (workload light this Monday) and looked hard at Buddy's SS again. I forgot what I read 2mos. ago about the Dawn Phenomenon and was reminded reading some other people's posts, Pat's included. I wonder if what I'm seeing isn't a bounce, but just dawn counterregualtory hormones. I've kinda been thinking about each morning's high as a bounce to the evening's low, but it may be something indicative in Buddy's hormone profile. I thought a bit and part of the problem may be that his AMPS and shot are so early in the morning, the insulin is wearing off when he needs it the most. Question is: What to do about it?
1) Keep dose the same, inject in the shoulder in the AM and scruff (for slower absorption and longer lasting) in the PM
2) Increase only the evening dose just a little ( I know "Lantus likes consistency" but my cat isn't responding consistently).
3) Move PM dose later by a bit say 1 hour to move profile for more insulin in the AM.
4) Keep dosing times the same but increase the dose to somewhere between 0.5 and 0.75 say a super fat 0.5.
5) Increase the dose and move PM back by 1 hour.
6) Any additional ideas you may have or combinations of the above.

I know a lot of thoughts here. Just want to overcome the highs we see in the morning, without him going too low in the evening.

Tony

 

[Pat+Raja+Shadow (GA)]

Re: 10/25/10 Buddy AMPS 325

I appreciate the time you are putting into the research and whatnot, Tony. ECID for sure, in a lot of ways.

1.) You could certasinly try shooting in different locations and keep a record of your findings.
2.) I don't think the different doses is wise. Here on this forum we follow the protocol and have seen many kitties have a rough start and while the dose is being adjusted, the numbers are cause for the Beans' concern. However, we all follow the Protocol here and I pulled this from the Tilly Page.... http://www.tillydiabetes.net/en_6_protocol2.htm

Under Phase 2: Increasing the dose.....
"Try to find a way to dose as consistently as possible, time-wise and dose-wise: sliding scales don't work. Don't skip shots. Fluctuations are very common in this phase before BGs start to stabilize under consistent dosing: a typical curve of cat over the first 1.5 months on Lantus can be seen here."

3.) If you wanted to change the times, again, that is up to you. But you need to leave the 12 hours between shots....you could see if that makes a difference. We move the shot times by 15 minutes at a shot, or one half hour per day....

4.) Increasing the dose would be a good plan, yes. We usually go up the dosing ladder in increments of .25u. Sometimes when a kitty has shown that they don't hold the reductions well, we shave the dose on the way down the dosing ladder.
However, you will need to get more PM spot checks in if you increase the dose, okay?
Moving the PM dose back so that there is longer than 12 hours between shots is not recommended, if that's what you meant there...

5.) Some people have success with giving a late snack at night....somewhere around +8 or +9 and then have no food available from that lat snack up until preshot time. If they eat anywhere within 2 hours of their preshot, the food will show a rise in the preshot number. It is good that you read about the Dawn Phenomenon. It just IS. Not much one can do about that.

Have faith that as you move along and go up the dosing ladder, you will start seeing better numbers. Your work hours are a fact and we just have to utilize the time that you are available, right? so make use to the night times and then maybe the dose can be increase....You are doing a good job! You raise lots of good points and I know you really want this to be better. It is one of the most frustrating things....sigh. But for myself, I am glad that we do have the guidelines to follow. They have proven to be successful and I have faith that in following them we are doing the best that we can.
And I am not going to talk about patience here...cause that is what everyone says. So I won't tell you to BE patient!
Okay? but I will ask that you try to fill in some of the blanks by testing when you can.... :mrgreen:

 

[Mad Scientist and Buddy]

Re: 10/25/10 Buddy AMPS 325

Pat,

Yeah, I need to get more nighttime checks. What times do you recommend. +6 is too close to bedtime and on 2 occasions when I tried setting the alarm, I just slept right through them. So high quality times? +4 +8 +10? These are the most doable as are +1-3, but I don't want to over check and cause more stress on the guy. Also, last time we were at 0.75, I woke up to a 98. Not overly concerned, but would getting data say PM +1-3 help in determining if it was safe to shoot the 98? It seems like the only data worth a damn is PM other than an AMPS to see if it is safe to shoot. He just rides high all morning most of the time. I'm thinking about increasing his dose to between 0.5 and 0.75. I'm a little nervous about him hypoing over night since he rides significantly lower in this time frame than in the morning. All that talk about moving the PM dose a little later was to keep a higher amount of insulin in him in the wee hours of the morn to control the AM BG's, not move both doses. I wonder ( and I'm not questioning the wisdom of Tilly's Protocol or Queensland) but how many cats were they shooting at 6am and 6pm? My schedule just does not allow for 8am 8pm dosing. But I would love to see what it would do for Buddy to have the nadir of his dose be present during the critical dawn phenom times, instead of wearing off. Once he goes high, he doesn't come down till after the PM dose. Remember that the counterreg hormones confer a certain amount of insulin resistance. Sticking with the plan though. Increase the dose, check more often. Interested to see what you think are the highest priority times for me to check. Just not possible to get them all.

Tony