11/11 Gracie PMPS 260

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Marje and Gracie

Marje and Gracie

Member Since 2010
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Gracie's Yesterday

11/10 Recap:
AMPS: 295
+3: 287
+5.5: 161
+6.5: 126
+7.5: 130
+9: 173
PMPS: 238
+2.75: 129
+3.5: 83
+4: 54
+4.5: 59
+5: 56
+6: 69
+7: 127
+9: 300 :shock: :shock:

Good afternoon and hope Sunday is beautiful where you are. Many thoughts and prayers continuing for Roni and Brad and healing vines to Noni, B, and Reuben. Has anyone heard from Shai lately?

Ugh ugh ugh. That huge dive/bounce last night tells us there is a little too much insulin on board but we already took her down. She is notorious for holding onto doses for six cycles after we reduce so we are waiting for the ship to get back on course and her current dose to tell us what it will do. This morning is her sixth cycle on the reduced dose. She has never done this dive/bouncing on levemir like this. In this instance, we know we can't go up since she was in the 40s so patience and let this dose settle. She has been major Miss Lovey Dovey this morning. We had morning coffee and paper reading in the guest room with all the sun....all three cats and me while Daddy was still asleep. But as the sun moved, she went into one of her favorite winter spots which is the bed in another guest room and proceeded to wad her pink blankie into a big pile. I took my sherpa blanket and laid down with her and she was doing her adorable somersaults onto me and the sherpa and then decided to wad IT up :lol: :lol: :lol: :lol: She's asleep all swathed in sherpa right now
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I could not love this little brown kitten girl any more than I do.

The best way for us to handle the stress of high numbers is activity so we're going hiking. Hope you have a splendid day.
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

No kidding with that ouch! It's about 70 degrees here although, the temp is supposed to drop this evening.
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Yikes! Well, weren't you just mentioning to me about Gracie's response to dose changes? :lol: :lol: :lol: :lol: Get those sunny yellow patience pants on ... you're looking hot ... but I noticed you probably need a little belly button jewelry to make the picture complete :cool:

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Re: 11/11 Gracie AMPS 353 +3 347 ouch

Hope Gracie can get back to some nice numbers sooner than later.
Patience is so hard to do.
Hope you enjoy your hike and can distract yourself ....

Your temperatures must not be like ours .... we have nice cold here, woke up to snow on the ground.
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Oh Gracie. Definitely a double ouch. Settle down little missy!! But how nice you let your beans go for a hike. NOT doing that here today. In the 30's but that windchill has a super bite to it. Yikes. Did some errands after church but am glad to be home now. Fur Ball is burrowed down in the couch cushion.

Lisa, I LOVED the belly button jewelery addition. That will look sweet with those hot yellow patience pants!!!! :lol: :lol:

Have a great afternoon!
Karen
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

My Goodness Gracie, where in the world are you headed? Marje, maybe it was all that rolling around in her PINK blankie, have you thought of replacing it with a BLUE or GREEN one?

Hope you guys enjoy your hike. Have a great day.
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Ai yi yiiiiii! What is with these bouncy girls! They are still little loves though so we know it will pass. Take advantage and get out while you can! I hope the hike is great!
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Marje, I guess Gracie is being generous again with giving permission for you and Mike to take a hike! Lots of kitties started out on the pink floor. Maybe a nice slide by the time you both get home, right Gracie!
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Gracie, my dear... ummm???? I think she just wanted you to feel REALLY comfy about taking a hike.
have great fun
mary and oliver
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Responding to your PM here, hope you don't mind. I hope to see a good discussion get started here. :smile:

Regulation

In LL we sometimes get so focused on dose increases that we can lose sight of what "regulation" means.

From the FDMB FAQ:
Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
Click to expand...

And from Tilly's Diabetes homepage:

Phase 3: Holding the dose
Try to keep the cat at a dose where the BGs are in the 50 to 200 mg/dl range for as much of the day as possible. The majority of cats are actually able to achieve consistent BGs in the 50 to <100 mg/dl range with consistent dosing. A well regulated cat looks like this.

Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way). 200 to 220 mg/dl is approximately the renal threshold for glucose and important for renal health and general recovery. This phase may last a long time (many months). Periodic slight adjustments are necessary in many cases.
Click to expand...
So Gracie is well regulated. She is spending a lot more time below renal threshhold than above it. She is not "tightly regulated" but she is doing fine overall. Don't forget the WCR, which sounds awesome by the way!

Honestly the best way I have seen to get cats more tightly regulated is usually to ignore the bounces and dose to the nadir. But (this is important) - you don't have to dose looking for a low nadir. Lower isn't always better, you want the nadir in a range that is best for that cat.

For Gracie, I can think of three approaches that might be worth a try.

One is to leave things alone, nadirs are good and just wait to see if the bounces disappear on their own. Adjust the dose only if the nadirs require you to.

Another would be to say that maybe she doesn't hold reductions from 40s, and just wait until she gets 30s to reduce. Risky, wouldn't work for most people but you guys monitor around the clock so you could try it (I did that with Lucy, and it drove Jojo and Jill crazy! I didn't fully understand the risks I was taking and I don't think I would do it that way again).

The other would be to try reducing the dose to try to keep her out of 40s, or maybe even try to keep her above 60 because she has been bouncing from 50s recently. I don't know, you have tried running her low, maybe running her high is worth a shot? There's no way to know how whether it would leave the high end of her range too high other than to try it. I think Dyana/J.D. tried a similar approach so she might have some input.
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Libby

Thank you so much for your input. I appreciate the options. The first one is where we are now and our thought was to let her settle more. The second is not an option we want to try. We've done that and it requires too much testing and feeding...it isn't sustainable and Gracie doesn't tend to just leave it at 30....she can quickly slip to the 20s even with us diligently monitoring.

Regarding the third...I took her down to f.5u to try and run her a little higher so she wouldn't bounce and she just went high and flat on me. Perhaps the dose that gets her to nadirs around 60 is one we haven't tried but with the calipers, we could.

I see her bouncing severely more from the dives....like today's bounce. When she's bouncing from low numbers, it's not this bad. It's the dives I need to address and I think if I can get her flatter, she will overall look better. JMHO. :-D
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

FWIW - I vote for option one. It is my approach with Mannie, and have found if given time he will adjust on is own. The others were too risky and it took all i had to keep him in the 50's, and out of the 40's. anyways... just imho, and Mannie being Mannie. If one lets these cats settle, they will, alot on their own. But that does take patience and a close watch on nadir. Wishing you guys much luck! You know Gracie better than anyone, you will make the right choice.
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Marje, you know I don't know nuttin' about this number crunching stuff, I just want you to know I read your condo, with interest, especially when it gets techy.
Scritches to sweet striped baby girl. cat_pet_icon
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Gracie! You're being so sassy with those numbers! I know your mama bean would appreciate more of your normal numbers. You know...those pretty blues and greens. You sure do look lovely in those colors. Hope you come down out of the stinky pinkies and no more big bounces, please.
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

Hi Marje,

I am with you on continuing with option 1. I'm glad that Libby presented those options too, very educational for me! I think Option 3 is another good way to go, and I like to tell people that just because something didn't work in the past, don't assume it can't/won't work in the future. With these sugarkitties, nothing is etched in stone, and they'll decide on a day to day basis what works and what doesn't.

Now, to you little Ms. Gracie.... Look, I'm sorry. It seems that you started showing more pink numbers right around the time I mentioned in passing that Gus was the cutest thing EVER.. I am not afraid to admit when I am wrong. In this case, beyond a doubt, I was mistaken. I am willing to bet that if Mom posted a pic of you snuggled all up in the sherpa blanket, you would be seen as the cutest thing EVER by me and by every one else that is lucky enough to see it! So please, accept my humble apology and lose the pink tint?

Carl

(If Gus reads this, I'm screwed :lol: )
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

a.baa-the-pink-cat.jpg


Hi Marje,

I know it hurts to see those stinky pinkys but I'm sure Gracie is just experimenting with a new look, like other kiteens her age. Sounds like you have gotten some solid advice to get her through this phase. You're such a rebel Missy G!!!!
 
Carl....you crack me up just when I need it the most. I did take some pics of Gracie and will try to post tomorrow. The thing about Gus is (1) he doesn't read the condos (2) he's very forgiving and (3) he isn't FD so if he gets upset about you being fickle, his BG won't skyrocket :lol: :-x :lol: anti jinx.

Tamara....nonononono pink!

The thing that makes me cat(2)_steam is being thankful for a yellow PS :evil: :evil: :lol: :lol: :lol:
 
pillow-fight-smiley-emoticon.gif


Looks like the Little Stinka is fighting back! Get those stinky pinky's Gracie!
 
Carl....you crack me up just when I need it the most
Click to expand...
.

Good! Then I achieved my goal! :lol:

Tamara,
That picture is awesome! Do you have them in blue or green?
And I knew if I hung around here long enough, there would be a pillow fight! :lol:

Carl
 
I'd love a yellow PMPS at this point! OK Gracie, time to work that juice and show your bean that door #1 is the way to go.

Carl, here ya go:
 
aw marje, i'm sorry gracie's blood sugar is giving you grief! glad you got a hike today, though - that's important to get a break from the non-stop monitoring once in a while.

sending you all hugs and encouragement! she'll get there - and in the meantime, she's happy, furry, purry and wrapped in sherpa! :YMHUG:
 
I"m with Julie! Great that you got out on a hike :-D :-D . It's late, so I've got to re-read this condo and Libby's comments tomorrow.

Ni ni,

YOu can come down now, Gracie.

Hugs to you all,

Ella & Rusty
 
What a very fun and very educational condo, and so many great images! Little Gracie, such a princess!! I`m with Carl... a photo would be awesome :-)
 
Re: 11/11 Gracie AMPS 353 +3 347 ouch

I'm bumping yesterday's condo. Sorry, I asked for a discussion then I fall asleep before I come back to it!

Marje and Gracie said:
Regarding the third...I took her down to f.5u to try and run her a little higher so she wouldn't bounce and she just went high and flat on me. Perhaps the dose that gets her to nadirs around 60 is one we haven't tried but with the calipers, we could.
Click to expand...
isn't it Suze/Pumbaa who is constantly repeating "they bounce until they don't?" It's true, there's no secret, they stop when they're ready to stop. I remember being frustrated that Lucy was pink at AMPS almost every single day, even though she went green at night. Jojo told me not to worry about the pink, she was spending more and more time in green so the little bit of pink didn't matter. She finally got to the point where she was pink for just a few hours every morning. One day she just completely stopped bouncing. I didn't do anything to make that happen, it just happened. Then what you're calling "dives," Jojo would say "look, she is racing as fast as she can to get back to those green numbers that she loves." Perspective. ;-) FWIW, I don't really see serious diving going on for Gracie. She's not flat, but it's nothing extreme.

So yes, I would dose to the nadir you want and wait for the numbers to fall into place. If you want nadirs in the 60s (which seems like a good goal), then adjust the dose until the nadirs fall into the 60s. Then STOP. She will eventually start to flatten out. That might take a long time. Once she flattens out, it might be higher than 60s, so you would adjust the dose again to put her back where you want her. If she drops lower than 60s, reduce the dose again to keep her nadirs in that range.

Spend some time studying Mocha's spreadsheet. Devon was good at holding doses once they started doing good things. At one point she held the 3u dose for basically a whole month, with numbers that looked a lot like Gracie's do now. Some other doses on the way down the dosing scale were held about that long because the nadirs were good. Also look at Tuffy - she was on 3.5u for almost 3 months. It took 2 months for her to start to flatten out, but then she headed down the dosing scale.

I see her bouncing severely more from the dives....like today's bounce. When she's bouncing from low numbers, it's not this bad. It's the dives I need to address and I think if I can get her flatter, she will overall look better. JMHO. :-D
Click to expand...
Don't try to minimize them, seriously just ignore them. :cool: :) Another thing the ever-wise Jojo always said is that Lantus (and Lev) are "Zen" insulins. You have to wait for the numbers to come to you. If you are someone who wants to chase numbers, these are not the right insulins for you to use (not "you" individually, but that's what she always said).
 
Love this discussion - hope it continues.
YES:
"they bounce until they don't?" It's true, there's no secret, they stop when they're ready to stop.
Click to expand...
YES:
Another thing the ever-wise Jojo always said is that Lantus (and Lev) are "Zen" insulins. You have to wait for the numbers to come to you. If you are someone who wants to chase numbers, these are not the right insulins for you to use (not "you" individually, but that's what she always said).
Click to expand...

Thanks Libby for posting this. There is ALOT for all of us to learn here. Well said on it all.
 
I agree this is a great discussion. I held doses for long periods of time. The end result was fantastic. Tuffy loved to dive and dive low, she also was a professional bouncer. I too remember jojo saying 'and one day it will stop' and it did.

I also remember on June 12, 2010 when I started the trial. Tuffy was on .1 and in the 30s. Libby posted Barb, she can't surf the 30s. and she suggested we try OTJ. It was 27 1/2 months. But all the support and advice worked. We are back at it because Tuffy stressed out while I was in the hospital. We worked up to 4.5 units. She started at .50 units on August 3. And every 3 days we raised the dose because of the high numbers. She is now coming back down the scale and settling into nice numbers. The bouncing has stopped. This is like a rerun but it is working for a second time.

Thanks for all the input Libby. You 'ROCK".

Good luck Marje.
 
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