19 Dec | Girlie AMPS 371; +4:30 = 142

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AMPS: 371 gave 8% food pre-shot and left 13% and 15% food out
AM+4:30 = 142
Left 8% food out and back to work.

:-)
 
Bronx's dad said:
So sorry you had to cancel. Sometimes the stress of leaving a diabetic cat is not worth all the benefits of going away.
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Well, it was a combination: I can't get over this flu (probably because I'm way too sleep-deprived), and there isn't much point in making a 24 hour door-to-door flight - with two transfers on the way - and ending up exhausted and probably feeling worse and quite cranky when I land at the other end. I wouldn't exactly be a joyful person to be around, I don't think! I'll book a flight for next year when I'm hopefully feeling okay and Girlie is a bit more on the stable side. That's the plan, at least! :rolleyes:
 
Osha said:
I am so sorry you had to cancel your flight. :bighug:

Girlie, try to be less of a mystery please!
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I told her what you said. She yawned and gave me that look that only a cat can, as if to say, "Haven't you realised yet that this is my job? I'm a cat!" ... sigh... :rolleyes:
 
Marje and Gracie said:
Sorry I missed you yesterday. This darn junk I have is hanging on and now I have laryngitis to boot.

I’m glad you held the dose. I would say if she has an active cycle like last night and you test at +10.5 and she’s above 300, shoot early to get back on schedule.

I had Gracie do this same thing to me many times. The first time, it was just a few months after she was dx and everyone thought she was headed for remission. But she wasn’t and the dose went back up.

While I don’t have any scientific evidence, my gut tells me there are four possible reasons why cats come down the dosing scale fast:
  • They hit a reallly good dose, the shots are cumulative, the depot overfills and they start a race down until the depot stabilizes more. That’s why we’ve learned to try and spread out the reductions....too many have raced down to a much lower dose too fast, the depot stabilized, the dose had to go back up. Let me know if you want to see some examples. I don’t believe there is enough time in green for the pancreas to really be healing. Asia is in this category. As a side point, we have seen a few kitties where the depot affected +10 subsequent cycles after a reduction.
  • When they hit a stretch of many, many cycles in green, I believe the beta cells start to heal. But they are still fragile and so if the dose comes down too fast and they aren’t getting enough support from the exogenous insulin, the beta cells are too fragile to carry the load. Numbers go back up. This happened to Gracie many, many times.
  • They just needed some support from exogenous insulin long enough for any minor damage to the beta cells and pancreas to heal and then they zip down and right off the insulin. This often happens with dry food cats who are switched to wet food.
  • Some types of cancer cause a race down the scale. I can also show you an example of this if you like. Asia’s SS does not look like this. It has a pretty clear pattern.
That’s just “racing down the scale according to Marje”. No scientific research...just observations from all the cats I’ve seen here and my own.
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@Marje and Gracie , I read your comment above on @Stacy & Asia 's post today, and it made me think a lot. This is the second time I've reduced to 0.25 (first time was 9 December), and I really hesitated this time, especially because of all of the yellow starts and the smatterings of pink. But it really took HC and high MC food to keep her in blues and greens, so I wasn't sure. I wonder if it would be better for her to go back up to 0.5 and for me to hold her in greens there as long as possible - regardless of the carb % food I need to do that.

Because I'm not going home for the holidays, I'll have two weeks to really rigorously monitor her, although I really do have to get some decent sleep as often as I can, as well.

I know you're not feeling well either - poor you! - laryngitis and a bad cough are a vicious circle, not to mention painful and annoying. I hope you get better soon.

I so hate to bother you, but what you wrote about Asia really struck me and made me think.

Take good care, Marje!
 
My money is on still bouncing. 67 on the AM cycle of the 17th was the lowest she has seen since the 12th of Dec. She is wobbling around and I think you will see her break this bounce by the PM cycle.

It is not uncommon that they dance around a dose for a few times. I don't think you can call this a failed reduction yet. If she doesn't see green by Dec 20 th AM cycle, I would take her back up. All in all, she is looking really good.
 
I agree with Bobbe. While it might be depot giving you these blues and greens, I wouldn’t jump the gun on a dose increase.

When we say it might be worth it to feed a higher carb food to get more insulin into them safely, we are usually talking about something in the 8-10% range and not HC.

If you have to work to keep the numbers in a safe range, it’s smartest to reduce the dose. Bobbe isn’t also right that sometimes a kitty goes up and down around a dose quite a few times before it works. I’ve had that happen many times. However, you have to resist the urge to rush into dose changes. We need to give her time to see if these numbers are due to depot. Six cycles and you should be able to see what the 0.25u will do for her.

And, just to be clear, the six cycles is because the depot can influence up to six subsequent cycles after the reduction. If kitty bounces after a reduction, clears it in four cycles but does not get back to green, it’s a failed reduction. If kitty is getting into green within the first four cycles of a reduction, it’s best to hold it six just to see if she continues to get to green.

Make sense?
 
Marje and Gracie said:
I agree with Bobbe. While it might be depot giving you these blues and greens, I wouldn’t jump the gun on a dose increase.

When we say it might be worth it to feed a higher carb food to get more insulin into them safely, we are usually talking about something in the 8-10% range and not HC.

If you have to work to keep the numbers in a safe range, it’s smartest to reduce the dose. Bobbe isn’t also right that sometimes a kitty goes up and down around a dose quite a few times before it works. I’ve had that happen many times. However, you have to resist the urge to rush into dose changes. We need to give her time to see if these numbers are due to depot. Six cycles and you should be able to see what the 0.25u will do for her.

And, just to be clear, the six cycles is because the depot can influence up to six subsequent cycles after the reduction. If kitty bounces after a reduction, clears it in four cycles but does not get back to green, it’s a failed reduction. If kitty is getting into green within the first four cycles of a reduction, it’s best to hold it six just to see if she continues to get to green.

Make sense?
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@Bobbie And Bubba and Marje - thank you so much. That really helps clarify things for me and also gets at one of my nagging concerns: having to use such HC food to keep her in safe blues and greens. 20% carb food on a regular basis seemed like a bit much...

I understand now, Marje, what you mean about the six cycles and then noting a failed reduction. I was just confused by the sticky that I'd read, but I see what you mean. I'll be home starting tomorrow during most of the day, so I won't have to guestimate with what carb food to give for her +4: I'll check her at +2 or +2.5 and see if I can catch her fall as it starts and before it becomes a huge dive.

The yellow AMPS and the pinks and yellows that are creeping in now before the PMPS are making me a bit cranky, but I guess those are a result of the dives she's taking before her AM+4, is that right? So I really have to catch her before she dives...

Thank you both!
 
Girlie's mom said:
@Bobbie And Bubba and Marje - thank you so much. That really helps clarify things for me and also gets at one of my nagging concerns: having to use such HC food to keep her in safe blues and greens. 20% carb food on a regular basis seemed like a bit much...

I understand now, Marje, what you mean about the six cycles and then noting a failed reduction. I was just confused by the sticky that I'd read, but I see what you mean. I'll be home starting tomorrow during most of the day, so I won't have to guestimate with what carb food to give for her +4: I'll check her at +2 or +2.5 and see if I can catch her fall as it starts and before it becomes a huge dive.

The yellow AMPS and the pinks and yellows that are creeping in now before the PMPS are making me a bit cranky, but I guess those are a result of the dives she's taking before her AM+4, is that right? So I really have to catch her before she dives...

Thank you both!
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What part of that sticky? There’s a bunch of info in it. If know where specifically, I can explain it.

Her jump into pink and yellow yesterday and last night looks totally like lack of duration...or big insulin poop out. You were feeding 13% foods. As the dose goes lower, it “can” take less carbs to manage the numbers and using a 13% food can certainly nip her duration if it isn’t needed. I understand that you fed or left it because of work and I get it. But I wanted to explain why she went up.
 
Marje and Gracie said:
What part of that sticky? There’s a bunch of info in it. If know where specifically, I can explain it.

Her jump into pink and yellow yesterday and last night looks totally like lack of duration...or big insulin poop out. You were feeding 13% foods. As the dose goes lower, it “can” take less carbs to manage the numbers and using a 13% food can certainly nip her duration if it isn’t needed. I understand that you fed or left it because of work and I get it. But I wanted to explain why she went up.
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Ah - okay: so "big insulin poop out" (love that! :-) ) because of the carbs, or perhaps because the insulin did get affected by my flatmate leaving the fridge door open all night? I assume the former, but if it could be the fridge door thing, I'll just go get a new supply of insulin. To be honest, I'm so tired (and with being sick, still), that I'm on automatic pilot; looking back at her SS I've wondered why - at times - I've fed her so late, much less fed her the carbs I've fed her! The exception is having to leave food in the morning to potentially compensate for a deep dive before I can get home again by her +4.

When she's doing her dives before +3 or +4, an 8% carb food won't slow her down if she starts at yellow or above for her pre-shot. This is where it gets interesting with Levemir: she goes up at +2, so I don't think I want to give her a higher carb food at pre-shot; but then between +2 and +3 - 0r sometimes it waits until +4 - she does a deep dive that the 13 - 15% just barely stalls, if it does stall it. Perhaps over the holidays I can try to give her LC food but give her a tiny bit of glucose syrup at +2.5 rather than MC food as the glucose syrup wouldn't have as long a hold as the MC food. Do you think that would be worth trying?

I'm just stuck with how to stop the quick dive between +2 and +3 or +4 when she starts at yellow or above - and it is a quick dive that's hard to catch!
 
Marje and Gracie said:
What part of that sticky? There’s a bunch of info in it. If know where specifically, I can explain it.
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Re: the sticky: here are the two that confused me a bit.
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/ "If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose."

And: http://www.felinediabetes.com/FDMB/threads/new-dose-wonkiness-ndw-and-failed-reductions.46012/ "
  • There is no "NDW" following a dose reduction nor do we hold a reduced dose 6 cycles (as done with dose increases) to "fill the insulin depot".
  • "Settling time" does not apply to dose reductions. We don't wait for a reduction to "settle".

But then in post#25, Jill and Alex writes:
You'll want to hold the dose:
  • until Rudy falls below 90 and earns another reduction, or
  • unless the reduction has failed (if you see his BG numbers trending upwards after any bounce clears... you'll want to take the dose up, or
  • if nadirs are greater than 90, but less than 149.

The "immediately" seems to be contradicted by post#25, which is what confused me... :confused:
 
Hey Darrah, it is confusing. I think the confusion lie with whether or not she clears the bounce and then starts to trend back up after any bounce clears.
That is where it gets tricky and hard to know whether it's a failed reduction or not.
 
Sorry you cancelled your plans. I completely understand it though. I sure hope you can get over the flu. Sucks that it is hanging on. :bighug:
 
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