242 at +10! Next move+terminology? (TR long-term diabetic)

[Angel's mommie]

AMPS 159; 53 and 54 between +2 and +3; 91 at +4 after steering with high carb treats and Primal nuggets. Since Angel is a long-term diabetic and thus 57 (on feline glucometer) would be the point at which TR protocol calls for reducing his insulin, I should reduce from .75 to .5? Can I just take it a smush down? I really don't want to see him go back to those yellows again, but also don't want to endanger him. I'm home all of tomorrow so can monitor really closely. Please advise as to my next move. Thank you.

Also, please, could someone explain the following terms or point me to a good place to understand them?

-- "Active Cycle." Is this a good thing or bad or context-dependent? Angel clearly has active cycles, if those are defined by drastically different numbers between AMPS/PMPS and +2.

-- "Bounce" I kinda get what this means from reading other posts, but feel I still don't fully have a handle on this. Are there spots on Angel's SS where one sees a clear bounce? Is this one:
3/9/2017: AMPS 194 +3 = 76 ; +5 = 200

Thank you so very much!

 

[Sienne and Gabby (GA)]

Definitions first....

An active cycle generally refers to numbers dropping into or close to dose reduction range. For example, if your kitty is typically spending lots of time in blues and greens and then has a run of yellow numbers, there could then be an indication (e.g., a fast early drop) that your cat is returning back to greens. Or, when a bounce is breaking, could also be a situation where the cycle is going to be "active." They are active in the sense that you need to be keeping an eye on the numbers.

The AM cycle on 3/11 may be a better example of a bounce. Angel dropped from 139 to 59. By PMPS, the numbers rose to 262. While for many cats, this wouldn't be a big spike in numbers, for Angel, it looks like a bounce. (It would have been clearer if you'd gotten another test or two in the PM cycle.) A bounce occurs if numbers drop low, drop lower than what a cat that's not yet regulated is used to, drop a large amount (e.g,, from the 500s to the 200s in a relatively short period of time), or drop fast. A bounce is the result of the cat's liver and pancreas "panicking." These organs react as if there is a significant danger of hypoglycemia and pump out a stored form of glucose along with counterregulatory hormones to raise the blood glucose level. Bounces are annoying but normal and are, in fact, a protective mechanism.

I'm going to couch my reply to your question about how much to reduce Angel's dose on 2 factors. First, you're new to following TR. Angel may be a long term diabetic and you've clearly done a great job of managing his FD but it sounds like TR is new territory. The other issue is that you are new to us. I would not be comfortable encouraging you to shave the dose without knowing more about your cat's response to insulin and having a lot more data to look at. You may have pages of test data but based on my being able to see only about a month's worth of information, I would not want to coach you to do anything that could potentially put Angel at risk. TR is an aggressive approach to diabetes management. By not taking the full reduction, you are being even more aggressive. Other members may have a different perspective but I would encourage you to take the full 0.25u reduction. The worst that can happen is that you need to increase the dose if the reduction doesn't hold.

 

[Chris/China (GA)/Garfield]

Since Angel is a long-term diabetic and thus 57 (on feline glucometer) would be the point at which TR protocol calls for reducing his insulin, I should reduce from .75 to .5? Can I just take it a smush down?

Another option that a lot of use in long term diabetics (over a year) is to wait until they drop below 68 (on AlphaTrak) a total of three times before taking the reduction, but Sienne has a good point

Until we get to know Angel better, it's always safer to take the full reduction....You can always go back up if it proves to be too much of a reduction

 

[Angel's mommie]

Definitions first....

I'm going to couch my reply to your question about how much to reduce Angel's dose on 2 factors. First, you're new to following TR. Angel may be a long term diabetic and you've clearly done a great job of managing his FD but it sounds like TR is new territory. The other issue is that you are new to us. I would not be comfortable encouraging you to shave the dose without knowing more about your cat's response to insulin and having a lot more data to look at. You may have pages of test data but based on my being able to see only about a month's worth of information, I would not want to coach you to do anything that could potentially put Angel at risk. TR is an aggressive approach to diabetes management. By not taking the full reduction, you are being even more aggressive. Other members may have a different perspective but I would encourage you to take the full 0.25u reduction. The worst that can happen is that you need to increase the dose if the reduction doesn't hold.

This sounds like sane advice, Sienne and Gabby. Thank you. I'll try and load in some more data from the past if I can. I guess the main reason I was wondering about not taking the full reduction was that last night he didn't go low. But still. Better to be safe. Over the years he's been through about 4 hypoglycemic episodes (very mild to moderate, luckily nothing worse) and I would very much like not to risk another, although I know that we might during this TR process -- just not today, maybe. Thank you so very much for taking the time and trouble to explain the terms so well, and respond.

 

[Angel's mommie]

Another option that a lot of use in long term diabetics (over a year) is to wait until they drop below 68 (on AlphaTrak) a total of three times before taking the reduction, but Sienne has a good point

Until we get to know Angel better, it's always safer to take the full reduction....You can always go back up if it proves to be too much of a reduction

Thanks, Chris and China, for the advice -- and for that very useful tip about the 3 times. The 68 is for short-term, right? So shouldn't that be 57 on an alphatrak for long term? (the guidelines say 40 for longterm and 50 for short term on a human glucometer). Or is it 68 'cos it's a THREE-time rule? Really appreciate your checking in!

 

[Marje and Gracie]

Just to let you know....you have two threads going for today. It’s really important to do one thread per cat per day with all of your questions, etc. in that one thread. K? Thank you!!!

 

[Angel's mommie]

Just to let you know....you have two threads going for today. It’s really important to do one thread per cat per day with all of your questions, etc. in that one thread. K? Thank you!!!

But I didn't ! I just began one thread today (this one). I would never break that rule -- someone else had told me about the rule some days ago when I made the newbie mistake of beginning 2 threads on one day. Hmmmm. I did go to my older thread to thank Wendy&Neko for her very useful advice re air bubbles -- did that (just responding to an earlier conversation) make that two threads for one day? Please let me know -- I would NEVER want to break rules or hog the board .

And if so, how does one keep the continuity of a previous conversation if one wants to respond to an earlier post? For instance, how could I have thanked Wendy&Neko for specific advice in this case?

I'm guessing I just basically continue the same thread always, while changing the title each time? Is that what everyone does?

 

[Marje and Gracie]

But I didn't ! I just began one thread today (this one). I would never break that rule -- someone else had told me about the rule some days ago when I made the newbie mistake of beginning 2 threads on one day. Hmmmm. I did go to my older thread to thank Wendy&Neko for her very useful advice re air bubbles -- did that (just responding to an earlier conversation) make that two threads for one day? Please let me know -- I would NEVER want to break rules or hog the board .

And if so, how does one keep the continuity of a previous conversation if one wants to respond to an earlier post? For instance, how could I have thanked Wendy&Neko for specific advice in this case?

I'm guessing I just basically continue the same thread always, while changing the title each time? Is that what everyone does?

My apologies. I saw another one bumped to the top with the title “126 @ +12” and I thought when you posted and it got bumped up, it was today but looks like it was Tuesday. My sincere apologies. You did it correctly. That is still considered to be Tuesday’s condo. I think it would help if you went back to that one, though, and edited the title to have the date.

We do have a set way that we entitle the posts. There are two good reads for posting that are Making the Most of your Lantus/Levemir ISG Experience and Updated Tips for New Members.

Each day, you open a new thread (we call them “condos”) and that’s where you post about Angel and all the questions related to Angel for that day. You update the title per the info in the above posts that I linked. You also link the condo from the previous day. Please let me know if you need info on how to do that.

Again...so sorry. I thought your “126 @ +12” was today. My bad.

 

[Angel's mommie]

My apologies. I saw another one bumped to the top with the title “126 @ +12” and I thought when you posted and it got bumped up, it was today but looks like it was Tuesday. My sincere apologies. You did it correctly. That is still considered to be Tuesday’s condo. I think it would help if you went back to that one, though, and edited the title to have the date.

We do have a set way that we entitle the posts. There are two good reads for posting that are Making the Most of your Lantus/Levemir ISG Experience and Updated Tips for New Members.

Each day, you open a new thread (we call them “condos”) and that’s where you post about Angel and all the questions related to Angel for that day. You update the title per the info in the above posts that I linked. You also link the condo from the previous day. Please let me know if you need info on how to do that.

Again...so sorry. I thought your “126 @ +12” was today. My bad.

No worries, Marje , in the least . You do so much and take care of so many that some mix-ups are bound to happen -- besides my commenting on my previous condo might have caused confusion. I have read those posts for new members but need to do so again more carefully so as to follow tips re titles and also learn to link the condo from the previous day (I'm guessing it's simply a cut and paste of the URL). Again, no worries in the least. Thank you so very much for all you do.

 

[Chris/China (GA)/Garfield]

(I'm guessing it's simply a cut and paste of the URL).

Exactly!!

The 68 is for short-term, right? So shouldn't that be 57 on an alphatrak for long term?

I think it's more of an "either/or".....for long term diabetics that have a history of failed reductions, you'd wait for 3 drops below 68 OR one drop below about 57 (the "below 40" on a human meter)

 

[Angel's mommie]

I think it's more of an "either/or".....for long term diabetics that have a history of failed reductions, you'd wait for 3 drops below 68 OR one drop below about 57 (the "below 40" on a human meter)[/QUOTE]

Got it! Although I guess we don't yet know if he has a history of failed reductions, since I wasn't following any protocols. Still, better safe than sorry. Thank you!!

 

[Angel's mommie]

Argh, so now he's 242 at +10. I'm guessing this is in response to those 8-10 HC treats he had when he was 53 and 54 between +2 and +3?

 

[Chris/China (GA)/Garfield]

I'm guessing this is in response to those 8-10 HC treats he had when he was 53 and 54 between +2 and +3?

Probably more due to his liver starting off a bounce but the treats could have "helped".....that's why we usually use something like the gravy from a "Gravy Lovers" food instead of high carb treats....it tends to get into their bloodstream faster and leave quicker than using high carb treats

Bounces are caused by 1. dropping too low, 2. dropping too fast, 3. dropping into numbers the cats body just isn't used to being at (or any combination of all 3)....the liver releases those stored sugars and hormones to bring them back up quickly

It can take up to 3 days for a bounce to clear, so you just have to wait them out....as he gets used to being in those lower numbers more and more, his body should get used to them and the bounces won't be as high and won't last as long, but we've had cats that bounced their way to OTJ too

 

[Angel's mommie]

Probably more due to his liver starting off a bounce but the treats could have "helped".....that's why we usually use something like the gravy from a "Gravy Lovers" food instead of high carb treats....it tends to get into their bloodstream faster and leave quicker than using high carb treats

Bounces are caused by 1. dropping too low, 2. dropping too fast, 3. dropping into numbers the cats body just isn't used to being at (or any combination of all 3)....the liver releases those stored sugars and hormones to bring them back up quickly

It can take up to 3 days for a bounce to clear, so you just have to wait them out....as he gets used to being in those lower numbers more and more, his body should get used to them and the bounces won't be as high and won't last as long, but we've had cats that bounced their way to OTJ too

Thanks for explaining so clearly, Chris. I still stick to the reduction of .25 tonight, right, and stick to that for 3 days while his bounce clears? Ahhhhhhhh, that promised land of kitties who bounced their way to OTJ Such dreams ! Good to know about the gravy -- will get some tins tomorrow and use that next time.

 

[Wendy&Neko]

I still stick to the reduction of .25 tonight, right, and stick to that for 3 days while his bounce clears?

It may not take 3 days for the bounce to clear. What you are looking for is where the nadirs land when he does clear the bounce. If they aren't in the green, then he's failed the reduction. But paws all crossed here that he holds it.

Glad to hear the bubble trick is working for you. In Canada, BD pretty much has a monopoly on syringes and they are horrid for bubbles, so we get lots of practice clearing them. One thing you can do instead of answering a question on your yesterday's post, is to tag the person in today's post so they still see your answer.

 

[Angel's mommie]

It may not take 3 days for the bounce to clear. What you are looking for is where the nadirs land when he does clear the bounce. If they aren't in the green, then he's failed the reduction. But paws all crossed here that he holds it.

Glad to hear the bubble trick is working for you. In Canada, BD pretty much has a monopoly on syringes and they are horrid for bubbles, so we get lots of practice clearing them. One thing you can do instead of answering a question on your yesterday's post, is to tag the person in today's post so they still see your answer.

Good idea, tagging the person on today's post. I honestly can't believe I've got such a good handle on those bubbles now, lol (shouldn't jinx it tho!!!!!).

Some questions (sorry to be a pest ):
(1) When you say it may not take 3 days for the bounce to clear, do you mean it might take more than 3?
(2) so if the nadirs for the next few days land on blues or yellows, he's failed the reduction?
(3) What happens when kitties fail a reduction? (I guess that depends on the numbers and nadirs, huh)

Thank you, Wendy&Neko (or anyone else who responds)!

 

[Wendy&Neko]

It can take less than 3 days or 6 cycles for a bounce to clear. That's one of the things you to learn about your cat. And as they get more used to normal BG numbers, they won't bounce as high or for as long. Back on 3/11 Angel went low, but 5 cycles later he was back in green, so it doesn't seem he's taking the full 6 cycles to clear a bounce. But there was a possible fur shot and an extra shot in there, so it's not entirely clear what his pattern was that day.

If a kitty doesn't end up with green nadirs after a reduction and the bounce is cleared, then the reduction is deemed to have failed and you go back up to the old dose. But you wait for however long to clear the bounce before deciding if the reduction will hold or fail, and don't worry about the nadirs until the bounce is gone.

 

[Angel's mommie]

Thank you, Wendy&Neko, that definitely helps. I feel so bad pestering you with yet more questions (and please feel free to ignore if you do not have the time; maybe some other kind soul will step in, lol). I'm just trying very hard to do my best here. So:

How will I know when the bounce has cleared? And is the "old dose" .75 in this case?

 

[Wendy&Neko]

Yes, 0.75 will be the old dose after you've done the reduction. And I see the bounce had begun.

Learning about bounces is not easy. When I was new I kept asking about them too. And of course there is an ECID element to them too. For Angel, it looks like when he get down into the mid or so blues for a preshot that he is over his bounce.

 

[Angel's mommie]

Yes, 0.75 will be the old dose after you've done the reduction. And I see the bounce had begun.

Learning about bounces is not easy. When I was new I kept asking about them too. And of course there is an ECID element to them too. For Angel, it looks like when he get down into the mid or so blues for a preshot that he is over his bounce.

Thank you so so so much

 

[Chris/China (GA)/Garfield]

How will I know when the bounce has cleared? And is the "old dose" .75 in this case?

We watch for the next 6 cycles for them to return to "good numbers" ....if (for example) he started to come down into low blue numbers after a few cycles, we'd want to continue watching for another few cycles....but if he only got down into blues and then started back up again without any sign of coming back down, we'd call it a failed reduction. The hard part is that cats can (and do) "wobble" sometimes....they can start to come down, go back up a little and then come back down again without failing the reduction...it just takes time and reading a LOT of other people's spreadsheets to start to learn the difference

 

[Angel's mommie]

We watch for the next 6 cycles for them to return to "good numbers" ....if (for example) he started to come down into low blue numbers after a few cycles, we'd want to continue watching for another few cycles....but if he only got down into blues and then started back up again without any sign of coming back down, we'd call it a failed reduction. The hard part is that cats can (and do) "wobble" sometimes....they can start to come down, go back up a little and then come back down again without failing the reduction...it just takes time and reading a LOT of other people's spreadsheets to start to learn the difference

Thank you for all these additional explanations, Chris & China. You are all such a big help negotiating the many complexities here.