10/25 Jenks AMPS 58 +1 49 +2 66 +4 129 PMPS 236 +6 190 +10 199

[AZJenks]

10/24

Jenks had an eventful night last night. He's either getting too much insulin all of a sudden, or alternatively has too big of a depot. I'm not sure how to distinguish between the two. What I have seen are two days where he gets a reduced shot in the AM without issue, followed by full dose in the PM which leads to an overactive night cycle.

Today we're going to drain his depot with back-to-back half doses of 6U.

Now, the question is what dose to we select for tomorrow's AM?

Do we return to 12U to see how he behaves after the depot is drained? There's a concern that he'll just pick right up where we left off, and that maybe there's a depot so large that even a full day of reductions may not do much.

Or, might we need to select something even less, like 9 or 10 now that he's getting all of this activity so suddenly? If it turns out that we overestimate the reduction, it would take a week or two to get back up to the 12U we're at currently.

Are there any guidelines for making that decision? Or because we're dealing with Jenks (to whom the rules often don't apply), do we just wing it?

 

[Wendy&Neko]

I wouldn't shoot 13 again any time soon, that 38 told you it's too much. Last night's 40 was probably the 13.0 unit depot still talking. The larger depots can influence more than 6 cycles after a reduction. I think I'd try 12 now. If 12.0 units still isn't quite enough, you may want to try going up to 12.5 units next time. The only "guidelines" I'm using are the TR protocol, and Jenks situation (high dose cat, over a year on insulin, loves to keep you up at night and/or give OH a heart attack in the morning) and your ability to monitor. If he's zooming up by PMPS tonight, you may not need to shoot another reduced 6.0 unit shot.

 

[AZJenks]

Hey @Wendy&Neko thanks for dropping by with your insight!

I've got to give him another half-dose tonight no matter what his numbers are (they'll probably be high) because otherwise we won't drain the depot.

You can see what happened when we tried this on the 22nd. He got a 7U dose in the AM, and went up to 295. Then he got a full 13U dose in the PM, and dropped 233 points to a 62 which was 3 hours beyond the next day's AMPS. Admittedly, the fact that he was breaking a bounce to 295 probably means this isn't very useful from a decision-making perspective.

Another data point from the 24th. A reduced shot of 9U in the AM, then a 12U dose in the PM still took him to 40. Preceding that was a 12U cycle, then two before that at 13U, then the 7U.I have to assume that there was some influence from those two 13U doses on the 22nd and 23rd.

If I give him another 12U after only one half-dose, I have a feeling we'll go deep again.

If we're going to revisit a big dose like 12U, I'd like to make sure the tank is empty first. That may be the only way to tell if it's the depot versus the dose. It's not ideal, but I don't have any other suggestions for how to figure out the culprit.

 

[julie & punkin (ga)]

He's either getting too much insulin all of a sudden, or alternatively has too big of a depot.

Or his body has changed.

I think I'd see how the numbers are tonight after the 6u shot, then try 11 in the morning. Or 12, depending on if you can monitor.

If it turns out that we overestimate the reduction, it would take a week or two to get back up to the 12U we're at currently.

When one is going up the dosing ladder, you have to take your time going up (per TRP or SLGS) to make sure you don't miss the right dose. However, once you have been at a good dose and Jenks has earned a reduction, so you drop to a lower dose, that dosing ladder no longer applies. You would consider it a "failed reduction" and can go right back to the last good dose.

For example, if you reduce to 11u in the morning, and see the greens disappear, then you could go right back to 12u as soon as you decided that 11u wasn't enough. Or back to 12.5u. I wouldn't go to 13u anytime soon because it got Jenks into the 30's. Gotta respect that.

 

[AZJenks]

Or his body has changed.

That's something that I considered but didn't mention. It was kind of implicit in my discussion of possibly picking a dose several units lower to see what happens. I know that at least once we had to race down the dose ladder and essentially cut the dose in half overnight, after which he held nice numbers for quite some time, so his body does have the capacity to suddenly need less, even if it leaves us at a loss for an explanation.

PMPS is 236. Not great. But we'll deal with it. I gave him another 6U. I'll also be minimizing the amount of carbs he gets tonight. I think the 9 Lives Real Chicken he just got is less than 3%. I too am interested to see how he performs tonight at 6U. Whether he comes down on that dose or not, it will be instructive.

The tips on the failed reduction were new to me. I'm glad to see that I don't have to wait out 6 cycles before taking him back up if whatever lower dose I pick doesn't appear to be working.

There have been times when he's performed differently at a dose after the tank has been drained. So 12U is still on the table as a consideration because it's possible that dose might be just right once we remove the influence of depot action. At this point though it's anyone's guess. That's the FD life though, putting your heads together and doing the best you can

 

[julie & punkin (ga)]

The tips on the failed reduction were new to me. I'm glad to see that I don't have to wait out 6 cycles before taking him back up if whatever lower dose I pick doesn't appear to be working.

Here is the quote from the Tight Regulation Protocol sticky:

• If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose

After Punkin's SRT we called it "Dialing for Doses." Stand in front of the insulin, syringe in hand, and my DH and I would talk about the pros and cons of what dose to try next. It was crazy. All you can do is use your best judgment, based upon what you know about Jenks.

 

[AZJenks]

We got nearly 50 points worth of action out of the 6U dose, which is much more than I expected. After a full day of half-doses, it's time to return to a full dose for the morning.

I think we're going to pick 11U and see how he does.