10/28 Crushy pmps 455

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Michele M

Michele M

Member Since 2013
previous: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=106995&p=1134378#p1134378

I need a little clarification on the dosing protocol:

He has been on one unit since 10/22 but on 10/25 his am shot was an hour late so I started the count over again. So today's am cycle makes 7 cycles that he has been on 1 unit.

He hit some nice low blue numbers yesterday. Is 109 considered a "normal" BG # ? and if he is hitting normal #s am I supposed to keep him at this dose?

this is the part Im confused on:

Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
Click to expand...


He bounces into the 400s pretty regularly and those are definitely not normal #s. But if he is reaching the normal #s at his nadir (when he's not bouncing) would I still keep the dose and decrease it after 7 days? Just ignore the daily bounces?

all I have done is go up and down the dose ladder so far...I havent actually just held a dose yet and I just wanted to be sure.

It seems like if I go higher I risk him going too low and a lower dose would not be enough. And he is still super bouncy.

I was still going to give this dose another day or two regardless but I thought Id ask this question early.....

all Ps in place btw. He seems pretty good.
 
Re: 10/28 Crushy amps 359 dose question

this is the part Im confused on:

Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
Click to expand...

What this means is if Crushy were to stay in normal numbers (50-120) for seven days (pre-shot and nadirs) on 1 unit, then you'd reduce to .75 and start the 7 day clock again. If he stayed within normal numbers for another week, he'd go down to .5...etc. etc....down to .1 unit then OTJ

His numbers are still too high, but I think it's a good idea for you to hold the 1 unit dose a little longer first. It looks like he bounced off the 100's yesterday so you don't really know how the 1 unit dose is going to work yet.

One pair of patience pants, on it's way to you!! You pick the color!
Ladies_pants_open_cuff.png
 
Re: 10/28 Crushy amps 359 dose question

that makes sense, but what do you do if he gets into normal numbers at nadir but not at preshot?
 
Re: 10/28 Crushy amps 359 dose question

Lantus dosage is based on the nadir number with only a little consideration on the pre-shot numbers.

That being said, if Crushy were my cat, I'd like to see some lower blues and a lot more greens throughout the cycle, with the pre-shot numbers being in the "normal" range too. Right now, Crushy isn't' doing that and while a couple of his mid-cycle tests are in the "normal" range, there are a lot of them that are still too high

What you're hoping for is that his pre-shots are "normal", and his mid-cycle tests are also in the "normal" range...Not too high, not too low

Example:
AMPS 108
+2 102
+4 84
+6 61
+8 79
+10 88
PMPS 101
 
Re: 10/28 Crushy amps 359 dose question

well yes Chris Id love to see all those things too!

my question is what do I do with the dose if I DONT see those things?

you said
What this means is if Crushy were to stay in normal numbers (50-120) for seven days (pre-shot and nadirs) on 1 unit, then you'd reduce to .75 and start the 7 day clock again.
Click to expand...

his pre shot numbers are not in the normal range, but his nadirs are. So what do I do with the dose in that case?
 
Re: 10/28 Crushy amps 359 dose question

It looks like he's going to need to go back up to 1.25. The numbers he's getting at mid-cycle have a lot of room to go even lower (and still be safe) while hopefully bringing down his pre-shots...but what concerns me is that it looks like he's bouncing off those 100's from yesterday, so I'd stick with the 1 unit awhile longer to see what happens

The protocol says this:

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
Click to expand...

Hopefully some of the others will chime in with some idea's before your PMPS time. Considering how low he went on the 1.25, I can see how that might concern you. Maybe just a "fat" 1 unit, but let's see if other more experienced eyes have to say
 
Re: 10/28 Crushy amps 359 dose question

Hi Michele,

I asked the same question about "normal range for 7 days before further reducing a few days ago, too!

Here's what Wendy & Neko said - plus she gave me a great SS link for an example:
Wendy & Neko said:
To answer the questions: maintaining numbers in normal range means 50-120. If you take a look at the SS of an OTJ cat like Lucky you'll see his last few reductions were all because he spent 7 days in normal numbers. Lucky was bouncy at first, but at some point he stopped bouncing. I've seen other cats go OTJ by earning reductions by going under 50 all the way to zero.
Click to expand...

Oops - Lucky's SS didn't load the first time - I think it'll work now.


I hope that helps!
 
Re: 10/28 Crushy amps 359 dose question

I agree with Chris. I think Crushy could go back up to 1.25 units. When you reduce, if they don't get into good numbers after the bounce has cleared, then you can take him back up. I wouldn't use the fat or skinny increases at this point. I use those when you want to fine tune the green nadirs, but Crushy is only getting blue nadirs.
 
Re: 10/28 Crushy amps 359 dose question

It may help to ask yourself, "Are the nadirs where I want them to be almost all the time?" If the answer is "no," then it may be time to increase the dose. If the answer is, "Yes." then you need to look at the pre-shot numbers. Are they where you want them? It may be a matter of waiting longer at a particular dose to see if the pre-shot numbers come down, it could be changing how you're feeding, or it may be that you need to give a little bit more insulin.
 
Re: 10/28 Crushy amps 359 dose question

thank you Chris, Suzanne, Wendy, and Sienne!

I decided to go ahead and raise his dose back up to 1.25

His numbers were pretty yucky today.....
 
Sorry about the yucky numbers. :YMSIGH: I think raising it back to 1.25 as suggested is a smart move.

He sure doesn't make it easy on you sometime. You'll find the right dose. Maybe it will turn out to be somewhere in between. I just hope he feels good in the meantime. His happy keeps you happy. ;-)

Good luck with the new dose.
 
thanks Betty!

Im wondering if moving UP to 1.25 units as opposed to moving down to 1.25 units from 1.5 will make any difference. I know he had some momentum going there....

I dont know, maybe your right and Ill end up between 1 and 1.25 if he dips low again...
 
Who knows...the wondering just keeps you wondering. Crushy is an enigma sometimes.

The good news with him is just as soon as you worry about one thing...he does something completely different. He's sick... he's not sick. He's high, high..then has you up all night with lows. Until he decides to do his lows during the day. :? He definitely has a mind of his own.

But he never seems to throw you a wrench you can't figure out how to handle. He leads the dance and you follow.
I don't think you can do anything but go with the flow (his flow)
 
I think it's likely that the 1.25u dose was not going to hold and the low numbers you saw might have been depot from the higher dose but we don't like to take chances when a kitty is in the 30s so it was safest to have you reduce to 1u.

You might see some good response or you might find he will have to go higher then 1.25u.
 
oh you are so right Betty!
He has definitely kept me on my toes thats for sure....
He's pretty happy and purry tonight so *fingers crossed* for an eventless night ;-)

and thanks Marje for your input! always appreicated!
 
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