12/22 Zeke PMPS 131;+1.5=92;+2.5=50;+4.25 = 71

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MrZ

MrZ

Member Since 2013
Good Morning LL

Zeke is doing well - we're so :-D :-D :-D :-D

We thought we were going to see a bounce today as at +1.25 he'd risen to 144 (the last couple of cycles he's actually dropped during the first hour). Much to our surprise, when we tested at +3 the meter registered a 65. Since he's on a lower dose, we're gonna try and not resort to the HC gravy see instead if we can guide with a 7% or 11%. Keeping fingers and paws crossed this approach will work.
 
Re: 12/22 Zeke AMPS 119;+3 = 65

Laura,
Much nicer:-)
This is what a "typical" cycle is supposed to look like. A slight increase around +1 from eating, then a decrease as the insulin onsets around +2 to +3.
 
Re: 12/22 Zeke AMPS 119;+3 = 65

But let's give him another cycle to really know how he is doing on this dose. The s2u dose can affect up to six subsequent cycles....especially as full as it was. Paws crossed.
 
Re: 12/22 Zeke AMPS 119;+3 = 65

Thank you so much for visiting Champ's condo and wishing him well. Because of you and all the others praying for him, he's HOME!!!
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

This is crazy! I gave him 1T of 13% food and 1/4t 17% gravy after the 1.5 reading. I thought that should slow him down. I just gave him 1t of 20% gravy. I can't believe the depot is still full. What on earth would I be dealing with if I had just done the reducie to 1.75u?
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

He's up a little to 56 - or I guess that's probably considered flat, huh? Just fed him 12% food 1/2t. I think the gravy is a little slow in registering. I plan to test again in 45 minutes since +3.5 of 56.
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

He's on a mission. I wasn't sure if he had snapped the other night but now I believe he might have. It Is still possible this can be depot; I've had it happen to Gracie but I actually think he might have snapped and his liver has given up the fight :-D

If so, that means he could come down the dosing scale fast and you might see a lot of cycles like this. As he does this, it is OK if you skip a shot to catch your breath and some sleep and also drain the depot.
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

Marje and Gracie said:
He's on a mission. I wasn't sure if he had snapped the other night but now I believe he might have. It Is still possible this can be depot; I've had it happen to Gracie but I actually think he might have snapped and his liver has given up the fight :-D

If so, that means he could come down the dosing scale fast and you might see a lot of cycles like this. As he does this, it is OK if you skip a shot to catch your breath and some sleep and also drain the depot.
Click to expand...

I'm sorry Marje, I don't understand. Please explain what you mean.
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

When the liver becomes accustomed to normal numbers and kitty quits bouncing, we say they have "snapped". They start spending more and more time in normal numbers and the amount of insulin needle decreases....and sometimes quickly.

One of the neatest examples I've seen is Mochas SS. She bounced for almost two years and then suddenly snapped and went OTJ in three weeks. That was a fast trip down the dosing scale for Devon and Mocha.

So Zeke looks like he's on a mission to stay in nice numbers :-D
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

I don't know what this means in terms of dosage. How do I know when I'm supposed to adjust and by how much, and for how long I should hold? I thought normal numbers were only upto 120. He's going higher than that - 171 AMPS 12/21, 130's tonight and last, and a spike to 144 this morning.

What should I do tomorrow morning? Is it ok to be giving MC & HC?
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

Just stick with the protocol. You are watching the nadir to determine the dose so if he falls below 50, decrease the dose just as you always have.

Of course, as we said the other night, if you are fighting like crazy by feeding alot to keep his numbers up, you can reduce the dose.

If he's coming down really fast or he drops below 50, you need to use whatever works best to keep him safe.
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

So Phase 4 of the Protocol says:

when the cat regularly (every day for at least one week), has its lowest blood glucose concentration in the normal range of a healthy cat, and stays under 100 mg/dL overall, reduce dose by 0.25.

So, I would understand that to mean I need to hold this dose until Zeke is not going above 100 (unless of course he earns the reduction by going below 50). Is that correct?
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

Personally, I would reduce in the morning to 1.25u. He dropped like rock in one hour even with a ton of carbs consumed. And only came up 6 points. I'd call this "fighting to keep his numbers up". Just my opinion.
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

I was actually thinking about this following question today. I believe one of the advisors on the board commented that basically all numbers are "shootable" (or maybe it was in one of the stickies) unless of course you're faced with a 50 at preshot. Here's my question: As I've been having to guide a lot with food to keep him above 50, is there a preshot number that I might want to consider not shooting?
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

Carl & Bob (GA) said:
Personally, I would reduce in the morning to 1.25u. He dropped like rock in one hour even with a ton of carbs consumed. And only came up 6 points. I'd call this "fighting to keep his numbers up".
Click to expand...

I did do something different tonight. I only feed him 1T at shot time. I usually feed him 2T or more if he's still acting like he's hungry. I did this because I've been having trouble getting him to eat later in the cycle when I need him to go up. At PS, he only ate 4%. It wasn't until I saw the lower +1.5 that I feed him 17% gravy/13% food 1T. Is this considered a lot of carbs? If so, then yes, these HCs did not prevent him from dropping to 50 @ +2.5.
 
Re: 12/22 Zeke PMPS 131;+1.5 = 92; +2.5 = 50

Many of us shoot 50. The things you need to consider are:

---is it a dropping number
---does he get food spikes
---how does he react to food mgmt
---do you have supplies and can you test

As far as whether you reduce tomorrow, if he were my cat, I wouldn't. Yes, he dropped, you gave him higher carb food, he came up. But you hold the syringe and if a CG tells me they think they need to reduce, then you should.

Yes...if his nadirs stay green but above 50, you would hold the dose until he earns the reduction by going below 50 or if he stays in numbers between 50-100 for seven days. Often the PSs are the last numbers to come down so don't worry about them.

And again...the caveat. At any time you feel you are fighting the numbers, you can reduce.
 
I definitely want to keep him safe but I have to admit, I'm terrified at the idea of reducing too quickly and being faced with another failed reduction. Since it could take up to six cycles to clear the depot effect of previous higher dose, we could still be seeing the effects of the s2.0. Is it prudent to reduce again before holding for the six cycles (at a minimum)? To clarify - I want to keep him safe but I'm scared of rushing the reductions - I consider this as a very critical phase. Am I totally off base?
 
I think that unless you know for certain that Zeke's depot affects six cycles, you should just look at four subsequent cycles and keep him safe that way. KWIM? If you get a number below 50 and reduce and then five cycles later get another one, I'd reduce again and see what he does. You have to have safety as a bigger priority over losing momentum. For cats that are truly headed down the dosing scale fast, they just keep earning reductions.

I know with Gracie that I need to give her six cycles after a reduction to see if the reduction holds but if on cycle 5 or cycle 6 after the reduction, she goes Into the 30s, I reduce.

I hope this is helpful. We just need to take it a cycle at a time and see where he is. I know that's nerve wracking but we really don't know exactly what Zeke is up to.

Since he's at a safe number, I need to get to bed. I think LBG has plans for me being up tonight :mrgreen:

If you have more questions, just post and I'll check in tomorrow. Hope you get some sleep.
 
Marje said:
As far as whether you reduce tomorrow, if he were my cat, I wouldn't. Yes, he dropped, you gave him higher carb food, he came up. But you hold the syringe and if a CG tells me they think they need to reduce, then you should.
Click to expand...

That's the cool thing about peer review, which is why we keep all our advice out here in public. :lol:

Laura, honestly, if you look at my dose suggestions or advice, you'll see that I'm more conservative than Marje or anyone who has used Lantus/Lev. That's just me. I am the opposite if the insulin is Prozinc/PZI. More aggressive than most people. That's because I used PZI agressively with Bob, and it worked really great for him. And when I see a cat who seems to respond to PZI like Bob did, I usually suggest the caregiver be aggressive. But since I didn't use Lantus, I don't have the degree of confidence that just about everyone else who advises in the this forum does. No 1st hand experience. Come to think of it, I'm probably just about the only person who gives advice here who never used one of the L insulins. :lol:

I'm just happy to help if and when I can. You hold the syringe, which you already understand.
 
Thanks Carl. I so respect your advice. You've helped me and Zeke so much - Thank you. There are still quite a few hours to go for this cycle. I will see what happens tonight and decide tomorrow morning what to do.
 
And I want to add that I also respect Carls thoughts because he does come in from a different aspect and he's a good balancer :lol: :lol:

I do tend to be a little more aggressive when a CG tests a lot and knows their cat as long as it keeps the kitty safe. I think it is good for CGs to sometimes hear different opinions, weigh those opinions with what they see and know about their cat, and make a decision. Remember, we are only seeing numbers....you are seeing Zeke and you know how much effort you are putting into it...and how exhausted you might be getting or if he needs a break.

So it's a wise thing to hear the thoughts of those you trust and then make your decision.
 
Yes Marje, I agree wholeheartedly. I decided to stick with the 1.5U and see how he continues to do on it. Thank you too for your advice, perspective and offering me the benefit of your experience. Very much appreciated.

thank-you-dancing-frogs-ag1.gif
 
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