12/7 Pumbaa +12.25/86 AMPS/89

[Pumbaa]

NOTE: Pumbaa's SS is in reverse order, with the most current data at the top.

I just raised Pumbaa to 3.0U last night for the PM cycle.

He dropped down to 46 at PM +9.5. Right now, at PM+12.25 he's at 86 and I'm stalling.

The 46 could not have come from the increased dose of 3.0U. The 46 technically earned him a dose reduction. Should I keep him at the 3.0U, take him back down to 2.75U or what? (After his numbers start going up. I'll test him again in about 5 more minutes.)

I will admit that I was impatient due to his high numbers that last couple of days, and might have raised him too soon.

Suze

UPDATE: I waited until PM +12.75 when Pumbaa went up to 89, then shot the full 3.0U. nailbite_smile And I'm praying with all of my might that the 3.0U is what he needs to stop those wide swings he's famous for.

 

[hmjohnston]

Wow! Pumbaa! You went low!

Hopefully you won't swing up and bounce high- leave the swinging to the kids and you just enjoy a nice lazy ramble up to the low 100's for mommy, okay?

 

[Sheila & Beau GA & Jeddie GA]

Well, you are here now, so see what happens. If he drops low again, then you can reduce the dose (but not on a high bounce PS).

I think that you have the evidence in your SS that he is responding immediately to the dose increase. Remember my prediction for blues or greens "tonight or tomorrow night" on Weds.? I almost added, "especially if you increase the dose", but I actually thought he would get there on his own without an increase. And he might have. He did on the 27th and 28th on 2.5u.

To me, if the numbers are still dropping, the cat is still settling. Pumbaa always has a "bobble" into the 300s, but then he comes down again a little or a lot. That's hard to find in his SS because you usually raise the dose on those first 300s, but on the last dose you didn't. You waited 27 hrs and then raised him so you can see that he was coming down on his own already. Add the increase and it pushed him further down.

He is very sensitive to the insulin and it's changes (dose). I think that Mel, yesterday, suggested you fine tune at this point. That's what I was saying when I suggested going to 2.35 (between 2.25 and 2.5) if you got lows on 2.5 again. Same thing here. You might want to consider going to 2.85 (between 2.75 and 3) if you decide to decrease.

He has plenty of greens on doses in the 2.25 to 2.75 range and I have to believe that if he can get there on those doses, he doesn't need more, but that it is a matter of waiting through a long settle time to let him find his equilibrium on the dose.

 

[Pumbaa]

I think that you have the evidence in your SS that he is responding immediately to the dose increase.

With what Pumbaa did last night and today so far, I have got to think that he responded immediately to the dose increase, based on what he had been doing at the 2.75U dose. I don't think that Chippendale's and Carl will agree, and there is no way to prove that he wouldn't have done just what he did had I not increased his dose, but I think the dose increase truly did affect him quickly/immediately.

Remember my prediction for blues or greens "tonight or tomorrow night" on Weds.? I almost added, "especially if you increase the dose", but I actually thought he would get there on his own without an increase. And he might have. He did on the 27th and 28th on 2.5u.

He might have gone green last night without the dose increase, but I don't think there is a snowball's chance in hell that he would have had the beautiful numbers he has had so far today. I think he would have bounced by mid-AM cycle.

To me, if the numbers are still dropping, the cat is still settling. Pumbaa always has a "bobble" into the 300s, but then he comes down again a little or a lot. That's hard to find in his SS because you usually raise the dose on those first 300s, but on the last dose you didn't. You waited 27 hrs and then raised him so you can see that he was coming down on his own already. Add the increase and it pushed him further down.

I see what you're saying about how he was coming down, and I might have increased too soon, but I'm still glad I did the increase. He was simply spending way too much time over 250. And I really didn't like his pattern of going up during the AM cycle, then going down at night. So far today, I am really, really, really pleased with his numbers! *knock on wood*

(It's Friday night, so heaven knows what Pumbaa will pull out of his sleeve for entertainment! Hahahahaha!)

He is very sensitive to the insulin and it's changes (dose). I think that Mel, yesterday, suggested you fine tune at this point. That's what I was saying when I suggested going to 2.35 (between 2.25 and 2.5) if you got lows on 2.5 again. Same thing here. You might want to consider going to 2.85 (between 2.75 and 3) if you decide to decrease.

Sheila, some day could you explain to me why you think he's so sensitive to insulin and its changes? I'm just not seeing/understanding what you are seeing. I don't mean to be obtuse, and I've looked for this, but I'm just not seeing what you see. While I really think Pumbaa needed this jolt up to 3.0U, I do agree that any future dose increases/decreases should be done in smaller than .25U increments, to make sure that they hold/don't cause problems. I am so praying that Pumbaa will finally stop this yo-yo action, and calm down in his numbers. An occasional blip up over 250 won't bother me, but it will bother me if he still spends a good part of the day that high.

He has plenty of greens on doses in the 2.25 to 2.75 range and I have to believe that if he can get there on those doses, he doesn't need more, but that it is a matter of waiting through a long settle time to let him find his equilibrium on the dose.

I understand what you are saying, and wish I had the patience to have let him settle longer into some of those doses. But I was worried about IR developing, as well as the too frequent higher than 250 numbers.

I'm actually looking forward to testing Pumbaa again, ever since last night! I'm not anticipating disappointment, but, instead, anticipating good results! He was a trouper last night, eating when his numbers were dropping. (Okay, so I bribed him with Stella & Chewy's sprinkled on his food, but still, I didn't have to force feed him.) And I didn't even break a sweat at the 46.

 

[Carl & Polly & Bob (GA)]

Hi Suze,
I think I'd drop him back down to 2.75u. Until last week he never showed a quick response to an increase. Now he's done it twice in a row. And I agree with you, that this increase was not due to the one increased dose. I just don't believe he'd go from never showing quick response, to all of a sudden doing so. I think this is more likely a "slowing down" of things. Like it took him this many cycles to realize he was on 2.75, and pow, a green. Same thing happened on 2.50. He took days to show you a green, and it just happened to be on the cycle you increased? To me, that says both the 2.5 and the 2.75 were about to show you a result.

And not doubting what Mel is saying about fine tuning. But I don't subscribe to the belief that .1u increments do anything. Not when a cat is in the 2.5 - 3.0u dose range. If he's down to less than a unit, then .1 might matter, because it would be 10% or more of a difference in his dose. What's .1u, 3 drops? It's 3% of his current dose. I think any fluctuation you see in his numbers from changing by a couple of drops right now is more likely "something else" than the difference in dose. Heck, meter variance can give you a lot more fluctuation than a couple drops of insulin can.

Thinking it's too much thinking...

Carl

 

[Pumbaa]

Carl, do you think it would be a problem/dangerous to keep Pumbaa at 3.0U? To try to get him over the days of inverse curves in the AM cycle, and try to flatten him out?

You know I respect your opinion.

When I raised him to 2.75U, I did not assume that the dose increase was what caused his greens that cycle. I assumed that those numbers were caused by the shed.

Suze

 

[Carl & Polly & Bob (GA)]

When I raised him to 2.75U, I did not assume that the dose increase was what caused his greens that cycle. I assumed that those numbers were caused by the shed.

I agree. Likewise, I think the latest greens were caused by the shed from the 2.75, and not by the increase to 3.0u.

Carl, do you think it would be a problem/dangerous to keep Pumbaa at 3.0U? To try to get him over the days of inverse curves in the AM cycle, and try to flatten him out?

.
Dangerous? No. I just didn't think it was needed, because I thought that the 2.75 had finally caused a drop to greens like you wanted. A little better than you wanted really, with the 46.

IF the 46 was from the shed of 2.75 and not from the increase to 3u, THEN it would mean a reduction back to 2.5u, right? In ANY case, the 46 means a reduction was earned. So I'm saying take the reduction down to 2.75. A compromise, if you like. If the 46 was from the 2.75 shed, then you know that dose is working, even if it took 10 cycles to do so.

If 3 is too much, he'll earn a reduction. If 2.75 is too much, he'll earn a reduction. Either could be his "breakthrough" dose. That would be awesome.

Did you ever read Marje's great condo about reductions, and making sure you don't miss one?
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=81242
Getting back to dangerous... again, no. Have you ever looked at the statistics that indicate that hypos on Lantus are rare? I don't know about the study that resulted in the protocol used here. I have looked, however, at the study where Lantus, PZI, and Humulin were tested against each other. 24 cats, 8 with each type of insulin. All the Lantus cats went OTJ. None experienced a hypo. Two H cats hypo'd, one PZI cat hypo'd. If I remember correctly, a couple of the PZI cats went OTJ, none of the H cats did. My point is that the chances of a Lantus cat going hypo are pretty low especially if you're following a protocol and testing regularly. I realize you're using Lev, but I'm going on the theory that they are different, but work the same way when it comes to protocol.

Carl

 

[Pumbaa]

If 3 is too much, he'll earn a reduction. If 2.75 is too much, he'll earn a reduction. Either could be his "breakthrough" dose. That would be awesome.

That WOULD be awesome!!!!

Thank you for the link to Marje's Reduction post! That makes sense how the shed got ahead of her. I hope that doesn't happen with Pumbaa, and I really pray that this dose increase jolts him out of his weird pattern of going up during the AM cycle and down during the PM cycle, so that he has regular curves again.

Did it make me want to take Pumbaa back down to 2.75U yet? No. *LOL* I have 4 boxes of unopened test strips standing by, and will be picking up some higher carbed food today, to try and steer Pumbaa's lows. I've got Dr. Lisa's food chart open, and am making a shopping list now.

I'm much less worried about Pumbaa going hypo now than I was initially, especially since he's gone as low at 38 (on Lantus) without showing any signs of going hypo. And, since I always leave food out for both cats, and Pumbaa instinctively eats more when his numbers are low, that is a relief to me, too. As is my frequent testing, and attempting to steer his numbers with food.

Carl, I am just so excited testing Pumbaa again, due to much better numbers, and instead of dreading seeing another high yellow or a pink. *knock on wood*

Suze