12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, repeat

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Pumbaa

Pumbaa

Member Since 2012
I have half an hour to decide if I am going to go against my instincts/gut feelings and increase Pumbaa's dose to try to get him out of this bounce/dive/bounce/dive cycle.

I am hesitant for several reasons:

• He has dropped below 50 twice (that I caught) on this dose, but I didn't take a reduction, something that Carl thinks I should have done;

• I caught a 68 last night, but he most likely dropped lower before that (total cell phone sound failure);

• Once you put the insulin in, you can't take it out;

• He hasn't cleared his bounce yet, and it's not even 72 hours since the first bounce;

• Pumbaa has a history of diving, and, even though he has gone as low at 38 without showing signs of going hypo, I still worry;

• Several months back, when Pumbaa was also in a pattern like this, and still on Lantus, I reduced his dose and his pattern changed.

So, do I reduce him, increase him, or keep him on the same dose until his bounces clear, if they ever clear?

I know most people here in TR land are going to say to increase him. And that scares me a lot, even if 3.25U could be Pumbaa's breakthrough dose and stop all of this bouncing and diving. I'd be much more comfortable increasing him if he wasn't bouncing/diving and had flattened out to blues and some greens.

I so wish this was easier. :YMSIGH:

Suze
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

No advice from me, but have you read Marje's lesson on reductions. Good info. On why you should take a reduction when it is earned.

Good luck, I hope you find the perfect dose for Pumbaa.
Kathie

Ps. I so wish this was easier too!
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Thank you, Kathie!

Yes, I have read Marje's reductions post. But, looking at Pumbaa's good numbers (when he's not bouncing on this dose), it didn't appear that I was having a problem staying ahead of the shed. What concerns me is that he may have (most likely did) dropped below 50 more than the two times I caught on this dose.

Too much conflicting information, even when you are trying to follow a protocol. Some people say that a cat on insulin as long as Pumbaa has been have to drop below 40 for a dose decrease. Others say that, since he hasn't been on insulin over a year, the cutoff is still below 50.

I need to go test/feed/shoot now. I think I am am raising his dose. nailbite_smile

Suze
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Agreed... Lots of info, lots of conflicting info at times, and lots of people with different opinions. You just have to follow your heart and do what you think is best for Pumbaa. Good luck with the increase. nailbite_smile

Kathie
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Well, I increased Pumbaa to 3.25U tonight. I pray that that was the right move.

Kathie, thank you again for the good luck wishes! We need them! (((HUGS)))

What made you switch Zeus to Levemir recently, and how is he reacting (other than his numbers, which I saw on your SS) overall to the change from Lantus? He's still quite the diver/bouncer, too. Even with the continued diving/bouncing, I'm still pleased with Pumbaa's overall reaction to Levemir.

Suze

ps: sorry for misspelling your name earlier.
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Suze

If you look at Gracie's SS from 4/28 for the next month, you'll see I was aggressive on bounces.....and got them stopped. I took her dose up, feeding the low points with higher low carb food to keep more insulin in her. If she earned a reduction but then bounced, I took her back up. This is only a technique for experienced caregivers who know their cats well. I'm not suggesting that you want to do this with Pumbaa because of your schedule and you said you don't have that much time and I understand. But it's the best example of what I was trying to tell you. Even if she had been in the 40s, if she bounced, I increased. Again, just for the general audience that might be reading this, it is not a technique for new, inexperienced caregivers or ones who cannot test much or spend time managing the curve with LC food.

Also, you'll see that I've got her a little more stable and flatter now and since I'm not getting those blue frames on either side of green, I edged her up just a tiny bit tonight even though she was in the high 40s yesterday morning.

On your comments yesterday to my comments, perhaps part of the problem is free feeding him instead of managing his curve with food and feeding him at the appropriate times. I know that I could not put down 1/2 can of food for Gracie in the morning and have any consistency in her curve; I have to feed it at certain times in certain amounts and make sure she eats consistently.

And the last thing I want to mention, when you say he goes high right before he dives, that is what we call the "high before the break". I know when Gracie does that, I need to be more vigilant with her tests so I catch it when she breaks and I feed the curve coming down to slow it. Sometimes I miss it.....even very experienced CGs can miss it. But if you know he does it, start being super vigilant and testing more after those high numbers so you can catch the drop and start to feed it early.
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

• Several months back, when Pumbaa was also in a pattern like this, and still on Lantus, I reduced his dose and his pattern changed.
Click to expand...

Suze,
I wish I had seen this earlier because I would have asked you to be more specific. How did his pattern change when you reduced?


Question for the crowd. On "breakthru dose".
When you get to that dose, what are the changes? Other than you can eventually start stepping down the dose ladder. Do cats still bounce? Do they still dive? Is it, at least for a while, the same sort of stuff, only on lower doses?

I'm familiar with the progress of going down from a small dose, to a smaller dose, to a mini then a micro dose, because I've "watched" that a few times. And I still saw low numbers, which meant a reduction, and I watched the late night drops and steering the "hypo", and the excitement of seeing the 40 nadir with the 100 preshots. It was actually "fun" to watch and to feel a part of.

What I haven't seen, other than with Bob, was the kitty who starts at 1u, goes all the way to 4u, and then back to zero, but that was on PZI, not Lantus or Lev.

So what's "typical" once the breakthru dose is reached? Can you suggest a SS or two for me to look at?

Thanks!
Carl
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Marje and Gracie said:
Suze

If you look at Gracie's SS from 4/28 for the next month, you'll see I was aggressive on bounces.....and got them stopped. I took her dose up, feeding the low points with higher low carb food to keep more insulin in her. If she earned a reduction but then bounced, I took her back up. This is only a technique for experienced caregivers who know their cats well. I'm not suggesting that you want to do this with Pumbaa because of your schedule and you said you don't have that much time and I understand. But it's the best example of what I was trying to tell you. Even if she had been in the 40s, if she bounced, I increased. Again, just for the general audience that might be reading this, it is not a technique for new, inexperienced caregivers or ones who cannot test much or spend time managing the curve with LC food.
Click to expand...
Marje, are you talking 4/28/12? I adore you, but if you are, there is no comparison to Pumbaa here because Gracie was already in regulated numbers and her bounces at that time were 190 max. And she was already in a fine-tuning dose. Maybe you meant around 5/9 instead, when she started bouncing up to the mid 200's after a dose reduction? Or did you mean 11/28 instead of 4/28? But seriously, and not to be disrespectful, I really don't see the correlation to Pumbaa hitting greens at night but bouncing up to pinks in the daytime @ a dose of 3.0U. Plus, I'm confused because on 5/9/12, even though Gracie had bounced up to 225, you decreased her dose. I'm missing something here and I don't know what it is. But I want to learn, and can't if I am confused.

Marje and Gracie said:
Also, you'll see that I've got her a little more stable and flatter now and since I'm not getting those blue frames on either side of green, I edged her up just a tiny bit tonight even though she was in the high 40s yesterday morning.
Click to expand...
I would love to have Pumbaa at that low of a dose. But yes, now that I am on the right spot in the SS, I can see what you did. But, what is a c1u? I get that an f1U is a fat 1.0U dose. But I don't understand the c or the c+.


Marje and Gracie said:
On your comments yesterday to my comments, perhaps part of the problem is free feeding him instead of managing his curve with food and feeding him at the appropriate times. I know that I could not put down 1/2 can of food for Gracie in the morning and have any consistency in her curve; I have to feed it at certain times in certain amounts and make sure she eats consistently.
Click to expand...
Pumbaa and Larry have always been free-feeders, and once Pumbaa was on the insulin for a bit, he got back to grazing instead of devouring any food that was out there. Same with Larry...they both graze as needed throughout the day, which is great for me! And, the best thing is that Pumbaa knows that he always has food available if he starts to drop, and instinctively knows that he needs more food when he is dropping low. He woke me up at PM +10 last night because he went to go eat since he had dropped to 68. I test Pumbaa at the feeding table, and, depending on his numbers, he will either eat if he is low, or ignore the food if he is high. This is a major blessing that I am thankful for! But, what I can do to help Pumbaa's numbers, is to feed him slightly higher (9%) food when he is dropping too low, and would normally eat anyway. That's what I have meant by "steering" his numbers.

Marje and Gracie said:
And the last thing I want to mention, when you say he goes high right before he dives, that is what we call the "high before the break". I know when Gracie does that, I need to be more vigilant with her tests so I catch it when she breaks and I feed the curve coming down to slow it. Sometimes I miss it.....even very experienced CGs can miss it. But if you know he does it, start being super vigilant and testing more after those high numbers so you can catch the drop and start to feed it early.
Click to expand...
That will be happening tonight. And I have been trying to test more after the bounces, because I know that the dives are bound to take place. Unfortunately, this always seems to take place at night, and even though I seldom sleep in my bed anymore, and just nap on the sofa with my cell phone alarm set to wake me up and test Pumbaa, sometimes I'm just too exhausted to have the alarm wake me up enough to test him and feed the lows. I hate napping on the sofa instead of sleeping in my bed. And...if anyone remembers...I tried changing my work schedule over to work nights a few months ago, and then Pumbaa decided to have his lows during the day when I should have been sleeping! :roll: He's not the most cooperative little guy, let me tell you!

Thank you, Marje. So...when do yours sisters arrive for the wonderful visit?

Suze
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Carl & Bob said:
]Suze,
I wish I had seen this earlier because I would have asked you to be more specific. How did his pattern change when you reduced?
Click to expand...
This was somewhere around June maybe? I'm still hunting for the info/dates, since my SS didn't always reflect what was stated in the daily threads. But this all had to do with Somoygi Rebound, which some people here think is fictitious and others think is a true entity. But I do remember that Pumbaa stopped the diving/bouncing he was doing, especially on Friday nights. I know you remember his cycles of diving on Friday nights for some odd reason. But, I never knew if the reducing the dose had the same effect that increasing the dose would have, other than being safer for Pumbaa, overall. Since you can't remove insulin once it is injected.

Carl & Bob said:
Question for the crowd. On "breakthru dose".
When you get to that dose, what are the changes? Other than you can eventually start stepping down the dose ladder. Do cats still bounce? Do they still dive? Is it, at least for a while, the same sort of stuff, only on lower doses?
Click to expand...
Excellent question. From what I have seen, in spreadsheets vs. daily posts, the breakthrough dose isn't evident immediately. There are still bounces and dives, but eventually the cat settles down into numbers which allow the pancreas to heal. Then starts requiring less and less insulin due to this healing process. Another reason I was hesitant to increase Pumbaa tonight.

Carl & Bob said:
I'm familiar with the progress of going down from a small dose, to a smaller dose, to a mini then a micro dose, because I've "watched" that a few times. And I still saw low numbers, which meant a reduction, and I watched the late night drops and steering the "hypo", and the excitement of seeing the 40 nadir with the 100 preshots. It was actually "fun" to watch and to feel a part of.

What I haven't seen, other than with Bob, was the kitty who starts at 1u, goes all the way to 4u, and then back to zero, but that was on PZI, not Lantus or Lev.

So what's "typical" once the breakthru dose is reached? Can you suggest a SS or two for me to look at?
Click to expand...
I've looked at many of these, including MommaDale's Max SS. Every time a cat goes OTJ, I study that SS to see what occurred and to see if there is anything I can learn for treating Pumbaa. And I'm still confused. :lol:

Suze
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Yes...I am referring to that timeframe. But I wasn't comparing Gracie to Pumbaa. I was using it as an example of how to manage the curve to flatten it and taking the dose up to smooth out the bounces. Gracie was bouncing into pinks in Feb and then I started taking her up and she flattened out. But, again, I referred you to that just as an example of what I meant.

On 5/9, I took her down because the night of 5/8 was one of the most difficult ones we've had due to a missed reduction and a depot that got ahead of me. It's the same cycle I referred to in the condo I did on reductions. Ad even though she bounced from those 20s, I took her down again to drain the depot. Once I felt it had drained, I took her back up.

I have to really microdose her so I have a dose in between 1u and f1u that I call a chubby 1u or c1u :lol: I added just a bit of fat to it today but not enough to make it a f1u so I just added a + to the c1u.

Carl...the best example I know (although there are others), is Randi's Max's SS.
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Marje:

Love the C for chubby vs. F for fat!

Your dosing around 5/8 (and after) still makes more sense to me, and I can see better how you managed the increases and decreases, as well as adjusting the % carbs of food Gracie got throughout the day to attempt to steer her numbers. You sure had your hands full those days! Honestly, there is no way I could feed like that and still work and attempt to take care of my house and yard and mom's house and errands, etc.

The reduction at the 5/9 PM dose threw me for a loop initially because it came after the bounce and not immediately after the cycle with all of those 20 and 30 numbers. I noticed a couple of times you didn't immediately take the reduction the next shot cycle if Gracie was going up at the PS time, but instead you waited a cycle. I know you wouldn't do it if you didn't have a good reason for it, but I'm curious about that, especially if the shed is what is controlling the current dose.

Suze
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Pumbaa said:
Love the C for chubby vs. F for fat!
Click to expand...

Well, one must be creative when dancing with Miss Gracie! :lol:

Pumbaa said:
The reduction at the 5/9 PM dose threw me for a loop initially because it came after the bounce and not immediately after the cycle with all of those 20 and 30 numbers. I noticed a couple of times you didn't immediately take the reduction the next shot cycle if Gracie was going up at the PS time, but instead you waited a cycle. I know you wouldn't do it if you didn't have a good reason for it, but I'm curious about that, especially if the shed is what is controlling the current dose.
Click to expand...

On the delayed reduction on 5/9, I had intended to reduce her again on the morning of 5/9 due to the 5/8 PM cycle but she was headed up fast so I shot through the bounce and then took the reduction that night. Shooting through the bounce is a very common practice. I haven't looked through Pumbaa's SS to see if you've ever done it but it can help keep a little extra insulin in them when they start those big bounces and that, hopefully, keeps them from going so high. While the depot does control the current dose, sometimes the bounce is too much even for the depot so by keeping a little extra insulin in the game during the bounce, it helps.

I'll take a look through Pumbaa's SS today and see if you've been taking advantage of that little technique. Sometimes it works, sometimes it's hard to tell. But anytime you see that I did not take a reduction right away because she was going up, it's because I was shooting through the bounce.
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Marje, I knew you'd have a good reason to do that...and it's something I'm going to keep in mind. I've never done that to date...not intentionally, anyway.

Pumbaa is down to 70 at AM +4.5. I just gave him some 9% carbs food, hoping to slow down this drop since he has a long time to go to nadir. It's going to be an interesting day...
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Example of when you could have shot through the bounce:

He got into the 40s on the PM cycle of 11/2 and earned a reduction. He started the bounce on the A.M. cycle of 11/3. You reduced then to 2.0u. You could have shot the 2.25u that cycle and then reduced the 11/3 P.M. cycle.

Shooting through the bounce is for when they earn a reduction and then bounce at the beginning of the next cycle by the PS. You can shoot the higher dose that earned the reduction for the cycle where the bounce initiates and then take the reduction the next cycle.
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

I see it. And maybe doing that would have cleared the bounce quicker, or at least have had it not go up to 335.
 
Re: 12/14 Pumbaa - dive/bounce/dive/bounce lather, rinse, re

Marje: See, I'm not totally obtuse about this stuff all the time! haha_smiley
 
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