2/24 Pepper AMPS 458, +6 380, PMPS 430

[Nancy&Pepper (GA)]

yesterday

This is Pepper's 8th cycle on this dose. Yesterday was awesome! Today he is bouncing. Do I wait for the bounce to clear and see how his numbers are before deciding if I need to up his dose? (I'm pretty sure that's what I'm supposed to do, but I just want to make sure. I feel like the slow kid in the class sometimes!)

 

[Sienne and Gabby (GA)]

Re: 2/24 Pepper AMPS 458 - Question?

Given that you're experienced, you have a choice. The issue with waiting for the bounce to clear is directed mostly at new caregivers. If you increase at the time a bounce is breaking, you can end up with the momentum from the bounce breaking plus the momentum of an increase. This can make numbers drop in a scary way, especially if you're new at handling dropping numbers. As a result, we urge new members to wait until a bounce clears.

In Pepper's case, you have a very large depot. It's like trying to steer an ocean liner -- the effect may not be noticed immediately. With a high dose condition, there are two issues. With IAA, you really want to get ahead of the insulin resistance. That would speak to increasing. However, with either IAA or acro, if numbers drop either due to the resistance breaking or the tumor putting out less growth hormone, you may have to work hard to keep numbers from dropping too far or too fast.

In other words, I don't have a definitive answer for you. With a high dose cat, you're the one who knows your cat and how she responds. There's a different rule book.

 

[Libby and Lucy]

Re: 2/24 Pepper AMPS 458 - Question?

that was a nice day yesterday, sorry about the bounce.

This is a good question, and it is one that you will probably find different opinions on depending on who you ask. ;-)

This is a point at which a lot of the high dose parents will say that you need to keep increasing every 4-6 cycles, even though Pepper is hitting green. My opinion is a little different. I think you still need to pay some attention to what the numbers are saying. I would wait and see if the bounce clears before deciding. Notice I say "if" the bounce clears. See how after Pepper's last couple of greens, he bounced but then never really came out of the bounce until you increased again? That is pretty common with insulin resistance. If the bounce doesn't clear, then he'll need an increase to start things moving again. I'm not talking about waiting long, just a couple of days.

I disagree with the people who go ahead and assume that the bounce isn't going to clear, and increase anyway. They are probably right that he will need an increase, but one of these days Pepper will be at a good dose and the bounce WILL clear. If you keep increasing and increasing before that has a chance to happen, then the cat is always seeing NDW and you may never see what a dose can actually do. I understand the concept of getting ahead of the resistance, but I also think it needs to be done with some consideration toward letting the insulin do its job.

Sienne is right that as you go along, you'll want to learn as much as you can about Pepper's patterns. We always say ECID, but that seems to be even more true with the high dose cats. Your job is to become the expert in Pepper. I have a tendency to say that I made a lot of decisions about Jazzy's treatment based on gut instinct, but really it was gut instinct based on my knowledge of how Lantus/Levemir work. You will find that you are doing the same.

 

[Nancy&Pepper (GA)]

Re: 2/24 Pepper AMPS 458 - Question?

Thanks Sienne and Libby. That helps a lot. I'll wait a day or so and then I expect I'll be increasing.