12/28 Sam Siam pmps 413 @ +1

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donna & sam siam

Member Since 2011
Went ahead & gave Sam 1.5 again this morning because I may have to give an early pm shot and didn't want it to act like a double increase. Also, I wanted to see if numbers continued to remain about the same on this dose. With that said, any suggestions on my question yesterday as to how much to increase? This mornings shot was his 8th cycle on 1.5

** Thanks for the tip on updating subject line. Just checked at +8 & heading a little back up. Dinner time. Will check between +9 & +10 before we leave. Thinking it looks like I should wait to shoot after we get home. Liking those numbers!

**Update...Ok, just checked Sam at +9.5. He was 163. Great numbers today. It looks like I will be having to shoot late rather than early. Will probably shoot about +1 - +1.5. Any thoughts about shooting a little less tonight since I'm late anyhow, so that I could perhaps shoot earlier tomorrow? Will be gone most of the day tomorrow so would like to try and get in one more test after the amps before I leave. Whadaya think?? Again, thanks IMMENSELY for sticking with me today Laurie!! You have really made a difference. So glad I didn't increase!

Well, all in all it has been a good day for Sam. Looks like he has bounced but I'm ok with it cause I know he is on his way!



http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=59510
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

Hello, I don't think I've visited your condo before...welcome! I haven't been around much lately, but I took a look at Sam Siam's SS. Here's the question from yesterday's condo...I'm sorry you didn't get an answer to your question.

magnachic said:
Best amps in weeks! :-D Come on Sam, you can do it!

***QUESTION...Sam has been on 1.5 for 6 cycles & gave him the same tonight for the 7th cycle. He was in the mid-high 400s yesterday (4th cycle). Today (6th cycle) He was in the 300s all day till pmps 494. From the protocol it looks as if I should increase by .5 but I don't want to do it too fast. Really not sure if he has settled in to the 1.5 since I'm not familiar with reading the ss as a whole.

Hopefully someone will read this before I give him his am shot. Should I give him a couple more cycles on 1.5, should I increase by .25 or .5?? His numbers haven't been all over the place like they were, but I do know that they are still consistently too high. Help please! THANK YOU!!


http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=59438
Click to expand...

There's two separate things to consider when you look at the 1.5u dose and consider an increase. First of all, it looks like Sam bounced from the low blue he saw after you increased to 1.5u....that would be the explanation for the higher numbers you are seeing. They are artificially inflated by hormones...you would not want to increase based on those numbers. You want to wait for the bounce to clear before assessing the 1.5u dose. It can take 72 hours for a bounce to clear, so the usual suggestion is to wait 6 cycles after the bounce starts....that would take you through the AM cycle today. Additionally, since he did see a low blue (and may have gone even lower) before he bounced, the protocol suggests holding the dose for 6-10 cycles before increasing. I would hold the dose for a few more cycles and see how low the 1.5u dose takes him after the bounce clears.

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

I would suggest getting some mid-cycle tests today if possible....I would expect the bounce to be clearing very soon, and you may see some lower numbers that you want to catch. The other suggestion I have relates to the PM cycle....I would encourage you to get at least a before bed test every night if at all possible. Many cats go lower at night, and without the PM tests, you are missing half of your data.

Regarding the early shot tonight...how early are you shooting? Anthing more than 30 minutes early acts like an increase....if you need to shift the schedule more than that, it's better to do it gradually. I have to leave for a few hours, I'll check back later though...what time do you need to shoot?
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

Laurie,
Thanks so much for taking the time to give such detailed information. That is exactly what i was looking for. Everyone has been so helpful and explained a lot about the bounce I might see when increasing. That is why I was so concerned about when and how much to increase. I wasn't sure if the bounce was continuing still or if he had evened out at the high numbers. I'm glad I chose to continue with the 1.5. I will get more frequent numbers today.

As for the time of testing, I had actually been on a pretty good schedule of testing 6:30 am & pm. That is when I was able to get the pm +3 tests in you see on his ss. Unfortunately I got all messed up one day this week because I could not be home and had to test much later. I tested at 8:40 this morning (been on this schedule for a few days) but have to test at 6:30 pm tonight. I know this is way too early so will probably mess him up AGAIN, but I have no choice. The one good thing is that it will put me back on the 6:30 schedule which is usually very easy to be consistent with. Because of this 2 hr mess up tonight, I'm pretty sure his numbers will get crazy again as I know this will count as an increase tonight. Maybe that's a good thing since I was planning on increasing anyway. Does this even make any sense?? :?

Again, thanks so much. I was using the protocol you listed, but wasn't sure which numbers to use. Will be testing in a few minutes so will post again soon.
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

Just exploring the possiblilities....could you possibly shoot late rather than 2 hours early? The only circumstance that I would suggest shooting 2 hours early is if he is zooming up quickly at the beginning of a bounce. He *may* zoom up again from the blues he's seeing today. If he is high pink or red by +10, you could shoot early. Let's see what happens.

I know life happens, schedules get thrown off, and you can't always get all of the tests you would like. We all understand, we've been there! Just try to get a test during each cycle in addition to the PS test if possible....that data will help you see his patterns. With Lantus, the patterns are often measured in days, not hours, so it helps to have data in each cycle to see the whole pattern. It also helps give you an idea if you need to watch that particular cycle more closely....not that our kitties won't surprise us now and then, just because they can! ;-)

Did you get any other tests after +5? He was heading down, so I was curious if he continued down or started back up.
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

I thought the same thing about shooting later & thought that might be better. I could shoot about +1.5 which would be about 10 pm. The only reason I was trying not to was that I want to get back to the 6:30 schedule & that's gonna take a looong time to do if I am shooting @ 10 pm tonight. Also I won't be able to get a reading later than the pmps unless I getup in the night?? Hmmm...I really am not sure what would be the best/worst. I think I will take your advice and see where he is this evening at just before +10. That will mean I will check in about 3 hrs from now. If you are on at that time I would REALLY appreciate your thoughts. I'll be leaving within 1/2 hr. of that time.

Ok, just checked at +6 I still going down (126). I am checking frequently today so hopefully I can see about where his lowest is. Let's hope this is a good pattern and he's not gonna bounce right out again.
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

That's a nice +6, I would get a +6.5 or +7 at the latest...he's still dropping at a fair pace. I bet that he will bounce from these numbers....it's part of the sugar dance. It's frustrating, but the good news is that his liver is doing its job!

Have you fed him since shot time? What is his typical feeding schedule?

I'm on the east coast, but I will still be up in 3 hours and can check in. There are others that are on the west coast who may be around if you need help late.
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

Holy Cow...just tested at a little less than +7 & Sam was 95. Never seen him this low. I have not fed him since amps because I wanted to check often & see what would happen without extra food. I usually feed at amps & pmps & try to give a couple mini meals in between. Maybe I should go ahead & feed him since he is dropping so quickly??
I guess I don't understand the difference between low numbers causing a bounce, and low numbers just because we have the right dose. Could he still bounce & then level out again? Sooo new to this. Thanks for your support!!!
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

I would go ahead and give him a little food, don't overdo it though...just a tsp or two. If he keeps going down, you may need to feed him again and you don't want him to be too full to eat. It looks like he is slowing down, I'm thinking he is near nadir and will be turning around soon. No worries, 95 is a GREAT number! I would check him again by +8.

The lower numbers are an indication that the dose is working good....normal is 50-120. Since he is used to being in higher numbers, his liver reacts to the lower numbers as "too low" even though they are not....as he spends more time in the normal numbers, he will get used to them and (hopefully) stop bouncing. Don't worry overly about the bouncing....the low numbers are what you want to focus on. Dose is adjusted based on the lows...not the highs. This dose is looking very good so far.
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

Ok, sounds good. I am VERY pleased with 95. I'm hoping that even if he bounces that this will be a good dose for him. I'm soooo glad you said what you did..."Dose is based on lows not highs." My poor hubby (a type I diabetic for 40 years) just doesn't get why I am not giving him MORE! He is so used to controlling his human diabetes & I'm trying to help him learn that kitties are different. Such a good guy though, sharing his insulin & all! :smile:

Will check Sam again soon.
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

Donna:

Can you update your subject line as you get new numbers? It let's us keep track of what's going on, tells us you have a new test, and it's a quick way to see whether you need help.
 
Re: 12/28 Sam Siam amps 344 DOSE ? CONTINUED...

I know it seems counter intuitive....why not just give more insulin if his numbers are high? But those "bounce cycles" are not true reflections of how the dose is working....they are artificially inflated numbers, and trying to push them down with more insulin (especially with the depot type insulins like Lantus and Levemir) is not only ineffective, but it can be downright dangerous. If you start out with a dose that is dropping him into the normal range, and you increase the dose during a bounce, then the increase kicks in at the same time as the bounce clears....you can end up fighting to keep the numbers up. Since Lantus is a long acting insulin, those situations can turn into long hypos.....16 hours or longer. That's why you will see the advice given over and over....let the bounce clear, then assess the dose.

Regarding food....many people here feed small meals spread out over the first half of the cycle. Once you get a feel for Sam's typical nadir, I would suggest feeding all of his meals before nadir...feeding after nadir tends to push up the PS numbers. Naturally, if you are dealing with low numbers, that overrides the "no feeding after nadir" suggestion. ;-) Since Lantus is a gentle insulin, feeding small, frequent meals works well to help keep the numbers flat.

My bad....I should have suggested updating the subject line...thank you Sienne!
 
Re: 12/28 Sam Siam amps 344,+6 126,+7 95, +8 109, +9.5 163

I see the 163 @ +9.5....I would not shoot at +10. If your only other option is to shoot at +13.5, that's what I would do. You can work your way back to your original schedule by moving the shot time back 15 minutes on each shot, or 30 minutes once per day. The other option is to skip a shot, and resume shooting on your desired schedule on the next shot.

If you are off schedule and can't test before bed, then try to catch a test whenever you get the chance....if you get up to use the bathroom, when you get up in the morning, or you could set an alarm if you are able to manage that. I was a testaholic when Mr T was on insulin...I also am an insomniac, so testing at all hours was relatively easy for me.....just as ECID, EBID too.
 
Re: 12/28 Sam Siam amps 344,+6 126,+7 95, +8 109, +9.5 163

Hi Donna:

Very nice numbers for Sam today and lots of good information for you! Lots to learn but you're doing great!
 
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