2/8 Buddha

[Donna & Buddha]

I shot Buddha a couple of hours later than usual last night, due to a personal life (of sorts.) His pmps was HI (ouch!) and he was full o'carbs, but I reduced the dose from the (more or less usual) 2u to 1u. He seemed to feel so much better last night. He went upstairs in the evening, he stopped by my room for a cuddle, he was purry and happy and this morning socks were EVERYWHERE. That's his hobby, moving socks around. Anyway. So this morning's amps were 417, not great at all. He did drink some water this morning, haven't seen that in a long time, but then again he had dry food (yum, yum) yesterday. Gave him 1u again, it was a couple hours early, cause of his late shot last night. Lower doses, so I'm crossing my fingers that the overlap will work in our favor.

I don't understand liver training. I haven't run across that concept outside of this board, unless its called something else too.

I do have a civvie cat I could test to check my meter but ... I think I would need a restraining device to do it. Lemur is very affectionate and outgoing, but not keen on being held and not shy about using his claws if necessary. Does the clothes pin trick really work?

 

[Ele & Blackie (GA)]

Sorry for those high numbers. I didn't remember that you were starting over at 1 unit. If that is the case you may see high numbers for at least a few days until Buddha adjusts to the new dose. I have never used the clothes pin trick myself, but Judy & Squamee used it and I think Sarah & Buzz.

I hope that overlap carries over to a better pmps. Funny about the socks! -- That sounds cute.

 

[Joanna & Bix (GA)]

Hopefully that PS is still reflecting the dry food, and will come down some on its own tonight. I'd probably go ahead and bump up to 1.5u or even back to 2u if you don't get a good PS tonight. The higher dose worked well to bring the #s down, and then maybe back off to 1.5u or 1.8u when you get back to good PSs. Sometimes it takes a little extra insulin to get them in good #s, but then not quite as much to keep them there.

No need to stress yourself over the liver training thing. We've gotten on a kick of discussing that lately, but really, usually we don't talk about it much at all!!! It's just something that explains why sometimes after a round of good #s, they'll run higher for a while as their liver overreacts to the good #s. It can also be a reason why a dose like 2.0 or 2.2 works perfectly one cycle as you saw, but then is too much in a couple more cycles. Could be that his liver was protesting and that's why you needed that dose to get anywhere, but then once the liver settles down you don't end up needing that much insulin.

More than anything else, I think it's just good to be aware that sometimes you need a little higher dose to get to good #s, and then as they settle into that there can be a dose reduction path. So you just keep an eye on the #s and when you see improvement like you did with those 50s, then you know it's dose reduction time! dancing_cat

With Bix, I found reductions of more than 0.2u were usually too much and he would go high. But I felt it was safer to try that and be sure, than to accidentally give him too much insulin. Once I discovered that larger dose reductions were too little insulin for him, then that helped me get a feel for how much to reduce by.

 

[Sarah and Buzz]

The clothespin trick is one of 2 or 3 things that REALLY turned the tide for me on home testing. I had a very difficult time with testing at first and I was constantly in tears and stressed. I swear by this trick and while I can't say it works for every cat, it certainly works for the ones I have heard of, as well as my own. Clothespins are so cheap that it's worth it to try out. You can test it first by using your hand to do what the clothespins would do. It should make Buddha lay down almost instantly.

I hope it works for you guys.

 

[Donna & Buddha]

My rationalizations for cutting dose from 2u to 1u.

On the "start low, go slow" page it says:
If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.

And treating hypo page says:
"Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a low number (40 – 60mg/dL or 2.2 – 3.3mmol/L) give food or treats until the blood glucose numbers rise to an acceptable level."

I had 45 and 50 as the test and retest bg at +3 and +3.5 (and thought the meter was stuck on 45 and 50 and tested a volunteer in the house who'd just eaten lunch, 114.) I think I have to trust my meter. Otherwise I have to start questioning ALL tests and not just the ones that don't fit my current theory.

further down on the hypo page:
"After a hypoglycemic episode cats may be more sensitive to insulin, so a reduction in dosage is generally required, especially considering too much insulin"

So, perhaps cutting back to 1u was too drastic, but I look at Buddha's ss and there are low +3s that can be explained as test errors, but could also be explained this way: Buddha's numbers at +3 aren't hypo numbers, but could have dropped into hypo range between +3 and the next test, which is often really high and represents a rebound. But if there is another interpretation that's called "liver training" then I have 3 options to choose from, and my headache today is preventing me from thinking clearly.

I want a nice low, flat curve like the ideal cat on PZI has. It seems that Buddha's PZIR curves look a lot like a Vetsulin kind of curve.

And Buddha's never had a dose much lower than 2u. What if his poor body has been freaking out all this time since the switch to wet food in November, reacting to too much insulin with off the chart bgs? Is there an example curve for that situation?

Ele and Joanna, thanks for the advice. I'll probably move the dose up tonight, but maybe try 1.2u or 1.4u for a couple of days, depending on pmps. BTW, even with the 1/2u marked on the syringe, it's still tricky drawing spot on the correct dose. I can usually get a fat or a skinny but rarely exactly on the mark.

 

[Joanna & Bix (GA)]

So, perhaps cutting back to 1u was too drastic

Not at all, and my apologies if any of my posts have sounded critical. I didn't mean the advice that way, just trying to give you the benefit of what I have learned at times the hard way. OMG with Bix I dropped the dose down a lot many times. For me, I felt like "better safe than sorry", and he's always been a cat who has tolerated higher #s fairly well. What I did was drop the dose way down, and then he'd go high. Then the next time in the same position I'd drop the dose not quite as far down, he'd go high. Then next time I'd drop it a little less, and he'd STILL go high. So by about the 5th time I felt comfortable only dropping it a tiny bit, and then that worked perfectly. LOL.

No one's said it in awhile, but people like to say "you hold the syringe". And with that, you *have* to pick the dose that *you* think is right, no matter what anyone else says, because you are the one who has to live with the consequences!

I want a nice low, flat curve like the ideal cat on PZI has. It seems that Buddha's PZIR curves look a lot like a Vetsulin kind of curve.

PZI can still give a pretty strong curve, but ideally the drop isn't as sharp and the duration is longer than Vetsulin. ECID in any case, some who have come through here get huge drops, Bix on the whole seems a little shallower. You had such great #s for those couple days before he started heading low, I think you will get back in a good place soon.

 

[Joanna & Bix (GA)]

And Buddha's never had a dose much lower than 2u. What if his poor body has been freaking out all this time since the switch to wet food in November, reacting to too much insulin with off the chart bgs? Is there an example curve for that situation?

I think you are ok, because you have some nice curves along the way. When the dose is too high, some possible signs are (not a comprehensive list, just what is coming to me at the moment, and these patterns can also be caused by other factors such as high carb food mid-cycle, for instance):

* high flat #s throughout the cycle
* inverse curve - #s go up mid-cycle and come down again at the end
* flat #s through most of the cycle and then a drop at the end

If you look back at Buddha's #s, you have spots where you can see that the insulin was too little or too much, but still showing a nice U-curve. For instance, the day at the top of the SS with 195 at +7 and then #s rising gently after that. So that looks like a good insulin response. And then on 1/13 you have a 212 PS and 46 nadir. It's a nice curve (followed by either rebound or response to HC, or mix of the two, but the 1st half of the cycle at least starts the U-curve), but the dose was too high. If his body was totally freaked out by the dose I don't think you would get curves like that, you'd either get high #s, and/or you'd be seeing more scary low #s.

The PM cycle on 2/5 is picture-perfect IMHO. 217 down to 95 and back to 227. It's about a 56% drop which is ideal. I suspect if you can get back to something similar to that and hold it for a few cycles, you may find the PSs come down a little bit if there is liver-training involved. It's just finessing the dose from this point. I know it may feel all upside-down right now, but I think you are very close.

I don't know if it would help you, but if you are interested, you can check out Bix's spreadsheet starting around 7/15. 7/20 was when he popped into good #s, and from there you can see I had to keep nudging the dose down (and sometimes back up a bit) to hold the #s where I wanted them. Unless there is something else going on with Buddha (like he wasn't eating 2/7 and that's why you got those 50s), I would guess it is something similar, that as his body gets used to better #s he won't need as much insulin to stay in them. Of course ECID, and I am just guessing based on what happened with Bix.

 

[Donna & Buddha]

Not at all, and my apologies if any of my posts have sounded critical. I didn't mean the advice that way, just trying to give you the benefit of what I have learned at times the hard way

Your posts have been very helpful! It really touches me that someone out there is thinking about my cat at 2 am. Thank you for your patience.

For instance, the day at the top of the SS with 195 at +7 and then #s rising gently after that.

Ha! That was the curve they did at the vets. Buddha had a hypo (36?) the day before--Thanksgiving-- on 5u of Vetsulin (that much scared me, but the vet said "do it" and as she'd just saved him from his dka, I went along). So he hadn't had any insulin the night before and I think that was a day or two before he went entirely onto the fancy feast diet. And that was his first day on PZIR.

The PM cycle on 2/5 is picture-perfect IMHO. 217 down to 95 and back to 227. It's about a 56% drop which is ideal. I suspect if you can get back to something similar to that and hold it for a few cycles, you may find the PSs come down a little bit if there is liver-training involved. It's just finessing the dose from this point. I know it may feel all upside-down right now, but I think you are very close.

I would be very satisfied with recurring curves like this one. Wish I could just order it out of a catalog and be done with it.

I'd probably go ahead and bump up to 1.5u or even back to 2u if you don't get a good PS tonight. The higher dose worked well to bring the #s down, and then maybe back off to 1.5u or 1.8u when you get back to good PSs. Sometimes it takes a little extra insulin to get them in good #s, but then not quite as much to keep them there.

Sounds like a good plan. But I'd like to be able to keep a good eye on him, so I might wait another few days.