Ok...here we go!!!
Marjorie and Gracie wrote:
I notice that you say she did not "earn" the reduction to 2u and you are correct. However, the numbers she gave you last night would not have been influenced by 2.25u given on pm cycle 12/21 especially since you drained the shed a little with that 1u shot on a.m. cycle 12/22.
Hi Marje, I'm just keeping track of the details. I need to "see" all of it so I can wrap my head around it. I do realize that the 12/23 dive would not have been influenced by shooting 2.25u on 12/21...but she was already 3 cycles in, on the 2.0u "unearned" decreased dose (4 cycles, if you count the 1.0u "BCS" dose), when she took her 12/23 dive. I kept asking questions about "real" numbers a while ago. They are mixed-in on various past condos...too hard to locate. Here is a quote by me, when I explained it to Sienne when she PM'd me a few days back, "This is why I was questioning "real" low numbers regarding any particular dose. If all low numbers are "real" to a dose, then Marilyn showed a "real" 116 on 1.5 units. This is why I ask questions like this. Otherwise, her data is useless to me...just a series of bounces, dose increases, and more bounces. Those "real" numbers mean something to me."
I apparently have a tendency to go against advice. I based my decision to decrease her 2.25u, back to 2.0u, on that 116 on 1.5u from 12/10/11. The increase to 2.25u, on 12/20, went against my gut feeling...however, I realize that the decisions are mine to make, and I ultimately went ahead with the increase to 2.25u. Anyway, it's hard to understand the data when typing it like this...it probably reads as blah, blah, blabity, blah.
Decreasing, per the protocol, is usually based on the kitty earning a reduction....and newly diagnosed kitties earn a reduction when they go below 50. Marilyn should have stayed on 2.25u until she earned the reduction on pm cycle 12/23 by going to 46. It is your decision as you hold the syringe but, IMHO, the increase to 2.25u was warranted. Sometimes we just need to give them a little extra for a short time to see a difference. She might very well have earned a reduction earlier if you had shot the full dose on the a.m. cycle of 12/22...who knows? ;-) That was a very shootable number and I know it followed the stressful evening you had. But we'd like to encourage you to not feed, post, and ask for help on shooting....that way we can help you get more comfortable shooting lower numbers.
I guess my point is, after Marilyn's two closely spaced "dives", I'm realizing that I'm not following TR Protocol. I first realized it when my decision to decrease her from 2.25u, back to 2.0u, was described as her "not earning" the decrease, I suppose because I didn't let her drop to lower numbers, before feeding carbs.
I am not aware of anywhere in the TR protocol where it says to let her drop to lower numbers before feeding carbs. That's where food management of the curve comes in to play. There are several folks who know their kitties well enuff now that they know when they will "typically" get those dives. That's when they know to give food in order to help soften the dives.....so they are feeding before the drop comes. It does not have to be an increase in carbs...it's ECID. When Gracie was on lantus, if she gave me a low PS, I fed her a little higher LC food (6% instead of 4%) because I knew she was a diver. That's what you need to really look at and figure out WHEN to feed Marilyn to soften the dives so you aren't scrambling to get her up.
It all looks nice and regimented on the stickies. I like specific "rules & procedures"...when "A" happens, do "B", and your result should equal "C". In reality, it appears, when push comes to shove, the stickies are the furthest thing from my mind, in regards to dosing, and feeding carbs during dives. This is how I look at things...I wanted to give Karo a half-hour earlier on 12/23. Now I wonder if I had given it sooner...and had kept her away from 50, and below, if she wouldn't have bounced quite so high on 12/24. However, had I kept her away from 50 & below...she wouldn't have earned a dose decrease...right? Not saying I wouldn't have given one...but she wouldn't have earned one.
I think we would all love it if A+B=C all the time. FD is not like that and it's one of the great lessons to learn...flexibility. Know thy cat but know the cat might decide to do something different. Have you printed the stickies so they are close at hand? Many of us do but you can always post and ask for help. The one thing that you
know is that if she is below 40, you need to get her up....so feed her a
little HC gravy with
"maybe" a drop of karo (.1 ml). If Marilyn responds really well and quickly to HC gravy...you don't need the karo. So for any number above 40, you have time to post and ask for help. Your point is well taken....there is no need for you to keep her away from 50....you want to give her the chance to earn reductions. Feeding the curve (keeping her from diving) is not the same as keeping her away from 50. Feeding the curve is just trying to flatten her out early.
This is the type of thing that makes me realize she may not be a TR kitty, or actually, her "Mom" may not be a TR person. I don't know that I'll ever be comfortable with her hanging around 50; only time will tell. It looks like I started going "rogue" on 12/22/11...and I don't want you folks to feel like your time, and advice, is wasted on me.
IMHO, I think it is too soon to say that Marilyn might not be a TR kitty. I think you are correct in your assessment that
you are not comfy with TR. And that is a decision only you can make. If you let us help you with each lower PS number, you'll learn to shoot lower and feel more comfy. You have TONS of data and that is GREAT. And she is giving you more every single cycle. The one thing I would suggest if you have time (and I know you are crazy busy).....study her SS. Look for trends. Ask questions about those trends. That will help you know her and learn how to feel comfy with her numbers.
Marjorie and Gracie wrote:
I know you have alot going on with lots of sweet babies and it may be difficult to feed one cat differently than the others but food management does make a difference in the curve and also in helping the pancreas. For diabetic kitties, it is much better to feed them multiple small meals than to feed them their portions in one or two large meals. Many lantus kitties get their allotted food portioned out at PS, +1, +2, +3; several are front-loaded at PS and +1 to minimize dives.
Right now, it looks like Marilyn falls between 8 small meals, and 4 "front-loaded" meals. The difficulty with feeding Marilyn 8 meals per day, doesn't pertain to feeding her differently from the others. She is already fed differently from the others. It pertains more to how much care I am physically able to handle.
I'm not sure what you mean by the first part about Marilyn falls between 8 small meals and 4 front loaded meals. Maybe she can do fine with six minimeals a day....you just need to look at her SS, see when she likes to dive, and then try to adust her feeding appropriately
for her. But I would say that even when Gracie was not FD, we fed many small meals all through the day...that's the way we've always fed our cats.
Marjorie and Gracie wrote:
Marilyn does not appear to be an early diver so it might be fine to evenly proportion her food over four hours but from looking at her SS (and you have lots of great data but she hasn't gone low that much yet so this is just a thought), perhaps she might like to have PS, +1, +3, +4 as both low cycles she dropped more between +4 and +5.
Your assessment might be right on target. But...and I hate to keep thinking this way, especially since she is finally making some progress on Lantus...but, would an insulin like ProZinc, require this much food management? I honestly can't handle 8 mini-meals, and 2 snacks, per day...I think I discussed this with you early on. Right now, Marilyn receives 4 canned meals per day, with a token offering of DM dry for "overnights" in her AM cycle. She doesn't always eat/finish the DM dry...it's just there if she "needs" it...otherwise, I couldn't sleep at all.
I apologize but I don't know anything about PZI and food management but it is insulin and so I think food management has to come into play. She IS making progress and I, personally, would be very reticent to change her insulin at this time. IMHO. I'm not sure what to tell you about feeding the dry DM....except I wouldn't. Cats can adjust to changes in their feeding schedules....I had to change Gracie from eating small meals all day to eating at specific times. A long time ago (long before Gracie), we left dry food out overnight for our grazers but as we learned the pitfalls of dry food, we put less and less down until we pulled it entirely and those cats all adjusted fine. Might she wake you the first few nights? Perhaps. But I do think she'll get used to it...esp if you can feed her a snack right before you go to bed.
Marilyn takes her time with meals. She's been caged for 7 years during feedings. Otherwise, the others in her "group" would've eaten everything before she even had a chance. This made is easy to switch her to canned food post-FD dx. I'll see what I can do to tweek her meals...but I would prefer to find a dose, that isn't so food driven, that she will dive without many small meals. Maybe such a dose doesn't exist with Lantus?
I don't know a response to that thought because ECID and I'm sure there are people not feeding 6-8 minimeals. I also don't have that coveted crystal ball that would let us all figure out that "perfect" dose ;-)
Marjorie and Gracie wrote:
Kitties who are OTJ also receive many small meals throughout the day to keep their pancreas working properly.
Clarky receives 1/2 can Friskies Pate TID...with a token offering of DM Dry for "overnights" in his AM cycle...well, it's not really a "cycle" since he's been OTJ. Hopefully, I'm not doing the wrong thing with him, but again, I can't fit in many more special feedings with these two kitties...they are only 2 of 12.
I won't continue to pound away too much more on the dry food issue but.....well, you know how most of us feel about dry food and dry DM is not much better than any dry food. It still has more carbs than I would want any of my cats having..not just Gracie.
I hope this helps....please ask questions and let me know where I have left gaps or not made it clear.
