11/13 Pumbaa +12/87 stalling - +12.5/89 - shot 2.0U

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Pumbaa

Pumbaa

Member Since 2012
Stalling again. Hopefully he'll start to go up after 15 minutes.
+11/103
+12/87
+12.5/89 = new shot time = 9:00

I did reduce Pumbaa's dose to 2.0U at Sheila's suggestion, to hopefully stop the wide swings in numbers. If it doesn't work, he can always go back up to 2.25U.

I also updated the spreadsheet link, so now people should be able to see my notes by mousing over any cell that has a black triangle in the upper right corner, rather than having to scroll to the bottom to view all of the notes. Let me know if this works for you.

Suze
 
Re: 11/13 Pumbaa +12/87 stalling the AM shot again

Pumbaa - 87 at AMPS? What's THAT for? U been visitin' KT again? Wish you 2 would settle down and SURF instead of dive and zoom climb! Us beans would have a few less gray hairs... :roll:

HUGS Suze!
 
Re: 11/13 Pumbaa +12/87 stalling the AM shot again

I think this qualifies for "no chicken shots, skipped shots or fur shots" so I think I'd shoot the full 2.25 for the sake of stability.

If he's not rising by :15 I think I'd go ahead and feed him and stall for 1 to 2 hours until he's heading up. You already know that drill.

A second alternative is to feed the cat, wait 1 to 2 hours, test again, and when the BGs start rising, give the normal dose.
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That's a direct quote from Tilly and it's what I've done with great success.

If he's dropping like a rock, I'd feed now before he gets to 45 to help prevent the next bounce. You already know your true nadirs so there is no problem there.
 
Pumbaa said:
I did reduce Pumbaa's dose to 2.0U at Sheila's suggestion, to hopefully stop the wide swings in numbers. If it doesn't work, he can always go back up to 2.25U.


Suze
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Isn't that essentially what you just did last week?

Maybe you are making 2 steps forward and only 1 step back instead of the other way around.

We can always hope for the best. ;-)
 
Chippendale's: Actually, last week Pumbaa had earned the dose reduction by staying at 45 for about an hour and a half. :)

I'm still waiting for Sheila to explain how reducing can help prevent the swings. Or maybe I missed the explanation somewhere. I trust Sheila for knowing what she's doing. I trust you, too. The hard part is that I can't do both things when suggestions conflict. *LOL* I know Sheila had mentioned that I could have kept Pumbaa at 2.0U longer, since he probably hadn't settled into that dose.

I'm also coming up to another round of excruciatingly tight deadlines again, so getting Pumbaa to settle down would be wonderful. Never a dull moment around here, eh?

Suze
 
Hey don't trust me, I don't have a clue what I'm doing. Just doing basic Tilly. If you want to trust anything, trust Tilly cause I strongly suspect it works. Should know more in a few weeks/months.

You can always do both. Go ahead and hold the reduction for at least 6 cycles, or as long as you want. You never know maybe some kind of miracle will happen.

But if not Tilly will surely always be there if you ever want to get more serious about it. ;-)
 
Hi Suze,
I'm still waiting for Sheila to explain how reducing can help prevent the swings.
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I'm guessing you are referring to this from another of your condos?

OK - the bounce is from last night as he was already going high based on that +2. He might clear it over night or tomorrow during the day. Then I think you should back off the dose to 2u to stop the swing. I'd do that on the next low PS, not on a 300.
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I don't want to put words in Sheila's mouth, but I am thinking "if/then"? If you lower the dose, then the drop wouldn't be as deep, the bounces would lessen, and the wild swings would stop? I'm not sure on the "do that on the next low PS, not on a 300" part though. Not sure why that would apply.

Carl
 
Carl, basically, that IS what I mean/think. The bounce is caused by the low. The low is caused by the dose, so backing off the dose a tiny bit should cause lows that aren't as low and take the momentum out of the swing.

The reason I suggest dropping the dose on a low PS and not a high (bounce) PS is that the 300s caused by the bounce need the larger dose to bring them down.

I don't think you want to feed and shoot the food-rising number as if it is an end of duration rising number. It is a "false" rising number. You set yourself up for having to hyper-monitor and feed lows all the time, because if the dose is too high, once the food is absorbed then the BG will drop again, maybe even lower. The simpler solution is to lower the dose. We use insulin in amounts to handle the food eaten, not the other way around.

I think Pumbaa will need a longer settle time than 3 days on the lower dose. He tends to bubble on day 2 or 3. Doses should not be raised on one high number.
 
Okay, Sheila. Thank you. That makes sense. I think. *LOL*

Pumbaa did have higher bounces on the 2.25U than he did on the 2.0U.

More later...
 
This is a question for everyone, but especially for Chippendale's:

It seems like my cats (and Beck) are on more of a biological eating schedule, than just 12 hours after the last time they were fed.

Pumbaa's testing/feeding/shooting time is now 2 hours off from where it was on Saturday, due to a late shot on Sunday, and stalling Pumbaa's shots a couple of days in a row. It's not working out for any of us.

I can see the reasons for not shifting back, incrementally, but at the same time, I wonder if having Pumbaa's biological clock and insulin peak times no longer in sync is causing any problems. It's only been in the last two days that Pumbaa's nadirs were at his AMPS time.

Any comments/conversation will be appreciated. I'm just throwing this out for discussion. (Yes, I probably should have started a new thread, even in Health, but thought I'd toss this out here first.)

Suze
 
Carl, click on Pumbaa's SS link now, and tell me what you think. The mouseover notes should still be visible, and the SS is now in reverse order, with the most recent date at the top. :)

Can your brain function in reverse and read the data in reverse, so that any time you view any SS, you get the most current data at the top?

Want to start a revolution with me? ;)

Suze
 
I suspect that having meals times and shot times out of sync will effect things. I am having a bit of an issue with that with Cami because of being gone late several evenings in one week.

The solution is to reduce the dose before and then the dose moved early. You are off 2 hrs now? Shoot maybe 1.75u at a +12 and then 1.5u or 1.75u at +10 on the next shot. Just be aware that doing this will always cause some number wonkiness that you will have to wait out.
 
Sheila, I think we already have dose wonkiness with these extended shot times, so seeing more wonkiness as I move the shot times back won't feel funny to me, and I think Pumbaa is going to react better having his biological clock more in tune to his Levemir clock.

Sorry, Chippendale's. I love that you and Chip have been dealing with a 13 hour Levemir clock, but it just seems like Pumbaa is more set to biological/feeding time than by insulin time. Just from what I have observed in the last few days.
 
Chip's not on a 13 hour Levimir cycle. Sorry I didn't take the time to explain that better. I only stall when he is too low to shoot (below 70 or 75) and right now it's about one stalled hour out of every 4 cycles, so it averages to 12 hours 15 minutes per cycle.

I started doing that because I knew I didn't want any skipped shots or chicken shots because of the havoc they wreck for days and it seems to work well for Chip. Other than having to keep track of the musical shot times, or having to be alert enough to draw a dose at 3:00AM or 4:00AM. I was already pretty much testing all those times.

I agree with Sheila on everything here except perhaps Tilly. I used to be skeptical about the aggressive "tight" regulation dosing because I didn't think it was necessary for Chip after my experiences taking him OTJ from NPH. I thought Tilly was overkill. But after the Lantus *adventure* and reboot to Levimir and the nightmare of the Somogyi like flat high numbers and all the bouncing, I finally started to figure out that Tilly is a tool to specifically manage those particular drawbacks to depot insulin's.

It's apparently working for Chip and is likely the only way to stop his so called "rebounding" and retrain his liver short of taking him off human depot insulin. The problem with trying to reduce the dose to "stop the swing" is the depot. It just keeps coming for days and keeps the swinging up long enough for increased GT/IR and then when the level falls enough to not cause bouncing, it's not enough to overcome the increased GT/IR or clear the bounce. The solution seems to be to bring the numbers down and hold them down until the body adjusts and heals. Without pancreas the most expedient way to do that is with sufficient dose. I suspect Tilly is the best way to manage the delicate balance safely.

BTW now is a great time to move the shot times back to normal, during the reduction when things aren't on a knife's edge.
 
Chippendale's:

Can't argue that Chip has responded much better when you've religiously followed Tilly. And it also makes sense what you said about not reducing to try and control the swings.

I reduced Pumbaa this morning so that I can shoot him at +10 and get him back on his regular injection schedule. Tomorrow morning, I'll take him back up to 2.0U, and then go from there. Hopefully he won't be too wonky after these changes.

Suze
 
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