Jane & Jack & Karre the Emperor
Member Since 2009
Good Morning LL! (And Good Afternoon and Good Evening for those of you on the other side of the world!) Happy Caturday!
Karre's 13th July Condo
So, Karre's fourth day on his favourite AMPS
Pretty and green. Here's the overview:
13th July
AMPS 4.7/85 --- Shot 0.5u
(+1) 5.0/90
(+2) 4.8/86
(+3) 4.6/83
(+6) 5.4/97
(+10) 5.0/90
(+11) 5.3/95
PMPS 4.8/86 --- Shot 0.5u --- Lowest PM pre-shot so far.
(+2) 4.7/85
14th July
AMPS 4.7/85
(+2) 4.4/79
Something to think about:
Quoting LIBBY of Libby and Lucy on Thursday, 12th July:
"Verra nice cycling, Karre. :smile: I don't think you need to change his dose. It doesn't matter if he is low green or high green, it's the green that matters. That one number last night, just ignore it unless it becomes a pattern. I would probably hold onto this dose for a couple more days just for good measure, then if he stays under 120 overall try a reduction."
I've been going over his SS and analyzing his dose reduction history the first time he was here on LL, in 2008. Here is an overview of that reduction history:
***************************************************************************************************************************************************************************************
KARRE'S DOSING REDUCTION HISTORY
21-10-08
AM+3 --- Lowest ever BG (2.9/52.2).
Earned dose reduction due to lowest BG so far from 1.25u to 1.0u after 14 cycles (7 days), despite 1 or more blue BGs above 6.7/120 daily.
31-10-08
Earned dose reduction due to Tilly Protocol rules (“When the cat regularly, i.e. every day, has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall, attempt to reduce the dose. Alternatively, if the cat goes below 50 mg/dl, try lowering the dose.” Quoted from protocol by Jill of Jill &Alex) and Jill’s interpretation of Karre’s consistency.
Reduction from 1.0u to skinny1.0u as advised by Jill, after 19 cycles (almost 10 days). Occasional blue BGs persist.
Karre’s response: Inverted curve, indicative of too much insulin. (Jill advised reducing for that PM-cycle, but we’d already shot by the time we saw her post.)
01-11-08
Earned dose reduction due to inverted curve indicative of too much insulin.
Reduction from s1.0u to 0.75u (with Jill’s suggestion even a fat 0.5u might have been fine, but it’s no problem to ease down through smaller reductions) after only 2 cycles (1 day) on the higher dose.
Jill emphasized that she expects dose reduction to come in quick succession from this point on.
Karre’s response: Another inverted curve. Indicative of too much insulin (i.e. readying himself for next dose reduction). Jill added that Karre will still have had residual action from previous (slightly higher) dose, so as the shed empties, “we'll either see a flatter curve or we'll see the need for another dose reduction. the need for another dose reduction can manifest itself either by numbers dropping lower than we'd like to see OR another inverted curve.”
05-11-08
Earned dose reduction due to low dip very early in cycle (3.2/58) and also repeat of slightly inverted curve.
Jojo’s assessment: “Watch this cycle: dipping to 50's early, on a flat green cycle type of cat (or as it is known now a karre-cycle type of cat), might be our sign that a dose reduction is needed.”
Reduction from 0.75u to 0.5u, after 8 cycle (4 days) on higher dose.
07-11-08
Earned dose reduction due to low pre-shot (3.4/61, which we stalled on for 20 minutes and fed, to get PMPS of 3.8/68).
Jojo remarked that Karre’s pancreas was definitely kicking in, since the new dose only got 4 cycles (2 days) to work, which would most likely not have filled up the shed to the degree that it pushed his numbers down this way.
Reduction from 0.5u to 0.25u.
Karre’s response: Mid-cycle rise that was either inverted-curve effect or simply NDW (new dose wonkiness). We were reminded that Lantus sometimes triggers a little dip at the end of the cycle, and that a pancreas that has healed well will normally kick in if there was a bit of snackus going on, which is most likely what happened.
On his 3rd cycle with the 0.25u new dose, Karre gave us a blue AMPS (6.1/110). But: Jojo reminded us that that’s a perfectly fine number, as long as Karre stays under 6.7/120. And he dropped beautifully right afterwards (+1: 4.9/88 --- +2: 3.1/56). His 2nd day on a new dose generally Karre would show standard signs of a re-filling shed (and hence slightly higher numbers, including one above 6.7/120).
10-11-08
Earned dose reduction due to lowering of numbers especially around and right after shot-time.
Reduced from 0.25u to 0.1u after 6 cycles (3 days) on previous dose.
Held the 0.1u dose for 8 cycles (4 days).
Karre showed us inverted curves in the AM-cycles following the reduction to 0.1u and Jojo as well as Jill noted that as a sign that an OTJ-trial was very near. The occasional blue BGs would fit the inverted-curve pattern we discussed with Team-J & Co. in Karre’s condos at this time – despite tiny dose, body says “too much insulin” so liver kicks in and pushed BG up a bit, then pancreas brings it back down.
On his 8th cycle on 0.1u Karre gave us three low numbers in a row (3.2,3.3,3.2/upper 50s), and he pulled away from us when we gave him his shot. That was the final factor in deciding: OTJ Trial commences! Jill’s final comments on OTJ Trial beginning: “what i'm seeing is the insulin causing the numbers to go up. the numbers are going down as the cycle ends... as the insulin is wearing off. when you look at ss, you'll see one inverted curve after another. "IF" this were happening earlier on in the sugar dance, we would might assume we're dealing with a late nadir cat. or we might assume kitty needs more insulin. however, in this situation we have a cat who has spent the last month in normal or near normal numbers for most of the time. a month of so-called "healing time". we're also talking about 0.1u of insulin. imho, it's time to take the training wheels off... unless someone is seeing something i'm missing. ~ Jill”
14-11-08
OTJ Trial begins. Karre gave us a few blue BGs throughout his OTJ-Trial, but made it through beautifully all the same.
***************************************************************************************************************************************************************************************
So: Karre has been consistently lower than 6.7/120 since 8th July, i.e. for 12 cycles 6 days. (The 1 exception was most likely caused by accidental skinny shot and stress, on 11th July at PM+1).
Karre's dose reductions back then were based on the type of Lantus-Kitty he is (early onset, early nadir, flat curves, inverted when too much insulin). Jojo, Jill, Libby, Greg and some of the others advising us back then would often underline that reduction do NOT always follow the Tilly Protocol to the letter. Progress can (and DID) variously slow and speed up, and the dose reduction followed that pace. Karre's pace. By trusting the advice given to us back then by Jojo, Jill, Libby and others, which adjusted dosing reduction according to BG evidence and progress pace, Karre went OTJ.
Libby: You suggested holding the 0.5u for another couple of days (which we've done) and see if Karre stays green (which he did), and then try a reduction.
Do you still feel we should try to reduce to 0.25u tomorrow, then? Or do you think we should try a skinny 0.5u first?
As long as Karre maintains the numbers he has had the past week, we're not trying to rush him at all. He didn't always ask for reductions in very obvious ways back in 2008. One tell-tale sign was often the inverted curve, and he HAS had several cycle with those mid-cycle rises (inverting the curve) in the past few days. (ALSO: Karre still has two more days of his antibiotics - "Synulox/Noroclav" - and will have his last pill on Monday morning. It may be another option to wait until Monday/Tuesday to reduce, in case the ABs have been keeping his BG higgher than they would normally have been.) He could be ready for 0.25u, we feel. Thoughts?
Jane
Karre's 13th July Condo
So, Karre's fourth day on his favourite AMPS
Pretty and green. Here's the overview:13th July
AMPS 4.7/85 --- Shot 0.5u
(+1) 5.0/90
(+2) 4.8/86
(+3) 4.6/83
(+6) 5.4/97
(+10) 5.0/90
(+11) 5.3/95
PMPS 4.8/86 --- Shot 0.5u --- Lowest PM pre-shot so far.
(+2) 4.7/85
14th July
AMPS 4.7/85
(+2) 4.4/79
Something to think about:
Quoting LIBBY of Libby and Lucy on Thursday, 12th July:
"Verra nice cycling, Karre. :smile: I don't think you need to change his dose. It doesn't matter if he is low green or high green, it's the green that matters. That one number last night, just ignore it unless it becomes a pattern. I would probably hold onto this dose for a couple more days just for good measure, then if he stays under 120 overall try a reduction."
I've been going over his SS and analyzing his dose reduction history the first time he was here on LL, in 2008. Here is an overview of that reduction history:
***************************************************************************************************************************************************************************************
KARRE'S DOSING REDUCTION HISTORY
21-10-08
AM+3 --- Lowest ever BG (2.9/52.2).
Earned dose reduction due to lowest BG so far from 1.25u to 1.0u after 14 cycles (7 days), despite 1 or more blue BGs above 6.7/120 daily.
31-10-08
Earned dose reduction due to Tilly Protocol rules (“When the cat regularly, i.e. every day, has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall, attempt to reduce the dose. Alternatively, if the cat goes below 50 mg/dl, try lowering the dose.” Quoted from protocol by Jill of Jill &Alex) and Jill’s interpretation of Karre’s consistency.
Reduction from 1.0u to skinny1.0u as advised by Jill, after 19 cycles (almost 10 days). Occasional blue BGs persist.
Karre’s response: Inverted curve, indicative of too much insulin. (Jill advised reducing for that PM-cycle, but we’d already shot by the time we saw her post.)
01-11-08
Earned dose reduction due to inverted curve indicative of too much insulin.
Reduction from s1.0u to 0.75u (with Jill’s suggestion even a fat 0.5u might have been fine, but it’s no problem to ease down through smaller reductions) after only 2 cycles (1 day) on the higher dose.
Jill emphasized that she expects dose reduction to come in quick succession from this point on.
Karre’s response: Another inverted curve. Indicative of too much insulin (i.e. readying himself for next dose reduction). Jill added that Karre will still have had residual action from previous (slightly higher) dose, so as the shed empties, “we'll either see a flatter curve or we'll see the need for another dose reduction. the need for another dose reduction can manifest itself either by numbers dropping lower than we'd like to see OR another inverted curve.”
05-11-08
Earned dose reduction due to low dip very early in cycle (3.2/58) and also repeat of slightly inverted curve.
Jojo’s assessment: “Watch this cycle: dipping to 50's early, on a flat green cycle type of cat (or as it is known now a karre-cycle type of cat), might be our sign that a dose reduction is needed.”
Reduction from 0.75u to 0.5u, after 8 cycle (4 days) on higher dose.
07-11-08
Earned dose reduction due to low pre-shot (3.4/61, which we stalled on for 20 minutes and fed, to get PMPS of 3.8/68).
Jojo remarked that Karre’s pancreas was definitely kicking in, since the new dose only got 4 cycles (2 days) to work, which would most likely not have filled up the shed to the degree that it pushed his numbers down this way.
Reduction from 0.5u to 0.25u.
Karre’s response: Mid-cycle rise that was either inverted-curve effect or simply NDW (new dose wonkiness). We were reminded that Lantus sometimes triggers a little dip at the end of the cycle, and that a pancreas that has healed well will normally kick in if there was a bit of snackus going on, which is most likely what happened.
On his 3rd cycle with the 0.25u new dose, Karre gave us a blue AMPS (6.1/110). But: Jojo reminded us that that’s a perfectly fine number, as long as Karre stays under 6.7/120. And he dropped beautifully right afterwards (+1: 4.9/88 --- +2: 3.1/56). His 2nd day on a new dose generally Karre would show standard signs of a re-filling shed (and hence slightly higher numbers, including one above 6.7/120).
10-11-08
Earned dose reduction due to lowering of numbers especially around and right after shot-time.
Reduced from 0.25u to 0.1u after 6 cycles (3 days) on previous dose.
Held the 0.1u dose for 8 cycles (4 days).
Karre showed us inverted curves in the AM-cycles following the reduction to 0.1u and Jojo as well as Jill noted that as a sign that an OTJ-trial was very near. The occasional blue BGs would fit the inverted-curve pattern we discussed with Team-J & Co. in Karre’s condos at this time – despite tiny dose, body says “too much insulin” so liver kicks in and pushed BG up a bit, then pancreas brings it back down.
On his 8th cycle on 0.1u Karre gave us three low numbers in a row (3.2,3.3,3.2/upper 50s), and he pulled away from us when we gave him his shot. That was the final factor in deciding: OTJ Trial commences! Jill’s final comments on OTJ Trial beginning: “what i'm seeing is the insulin causing the numbers to go up. the numbers are going down as the cycle ends... as the insulin is wearing off. when you look at ss, you'll see one inverted curve after another. "IF" this were happening earlier on in the sugar dance, we would might assume we're dealing with a late nadir cat. or we might assume kitty needs more insulin. however, in this situation we have a cat who has spent the last month in normal or near normal numbers for most of the time. a month of so-called "healing time". we're also talking about 0.1u of insulin. imho, it's time to take the training wheels off... unless someone is seeing something i'm missing. ~ Jill”
14-11-08
OTJ Trial begins. Karre gave us a few blue BGs throughout his OTJ-Trial, but made it through beautifully all the same.
***************************************************************************************************************************************************************************************
So: Karre has been consistently lower than 6.7/120 since 8th July, i.e. for 12 cycles 6 days. (The 1 exception was most likely caused by accidental skinny shot and stress, on 11th July at PM+1).
Karre's dose reductions back then were based on the type of Lantus-Kitty he is (early onset, early nadir, flat curves, inverted when too much insulin). Jojo, Jill, Libby, Greg and some of the others advising us back then would often underline that reduction do NOT always follow the Tilly Protocol to the letter. Progress can (and DID) variously slow and speed up, and the dose reduction followed that pace. Karre's pace. By trusting the advice given to us back then by Jojo, Jill, Libby and others, which adjusted dosing reduction according to BG evidence and progress pace, Karre went OTJ.
Libby: You suggested holding the 0.5u for another couple of days (which we've done) and see if Karre stays green (which he did), and then try a reduction.
Do you still feel we should try to reduce to 0.25u tomorrow, then? Or do you think we should try a skinny 0.5u first?
As long as Karre maintains the numbers he has had the past week, we're not trying to rush him at all. He didn't always ask for reductions in very obvious ways back in 2008. One tell-tale sign was often the inverted curve, and he HAS had several cycle with those mid-cycle rises (inverting the curve) in the past few days. (ALSO: Karre still has two more days of his antibiotics - "Synulox/Noroclav" - and will have his last pill on Monday morning. It may be another option to wait until Monday/Tuesday to reduce, in case the ABs have been keeping his BG higgher than they would normally have been.) He could be ready for 0.25u, we feel. Thoughts?
Jane
