3/2 - Sammy - AMPS 92; +2 69; :6 84; +8 127;PMPS 150; +2 135; Question about Dosing

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Tina & Sammy

Tina & Sammy

Member Since 2010
Yesterday's Condo

Good morning LL,

Yesterday, Sammy and I had a great day, although not much got accomplished because Sammy felt the need to cuddle most of the day. I am not complaining because I did get through about 8 episodes of Blue Bloods that I have been collecting on the DVR.

We are back to work today, and if today's BG plays out anything like yesterday we should have a nice quite day. No fast drops at +1 so we will see.

Hope everyone has a fabulous day.
 
Okay, I might be getting ahead of myself, but I have a question about the phases.

Phase 2: Increase the dose
When the cat first begins to have daily nadirs in the normal range of a healthy cat (50 to 80 mg/dl) and spends significant amounts of time in this range each day, stop increasing the dose and switch to Phase 3.

Phase 3: Holding the dose
Try to keep the cat at a dose where the BGs are in the 50 to 200 mg/dl range for as much of the day as possible. The majority of cats are actually able to achieve consistent BGs in the 50 to <100 mg/dl range with consistent dosing. A well regulated cat looks like this.

Phase 5: Remission
14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible. Test the cat's BGs once per month.


So my question is this. If Sammy's numbers continue the way they have been with a range of 50-120 do I keep holding the dose for a week and then start decreasing, or do we hold the dose for 10 cycles and then increase by a drop or so to push the numbers down to between 50-80? I have seen on some of the other spreadsheets that some people have started OTJ trials with numbers over 100, but the last time Sammy went into remission his numbers were all between the 50-80 range prior to taking him off insulin, and I am just wondering if that is what we should be shooting for.

If we will need to increase, I don't think we have any business increasing at least until Friday, but I just want to know if this is what we should be looking for numbers in 50-80 range, or if we would start decreasing after a week with the numbers the way they are?
 
I am extremely frustrated with tonights PMPS. Yes on Saturday we saw a PMPS of 209, but we could attribute that to a bounce from the rapid drop from the night before, or the food that had been in the refrigerator a bit too long.

BUT WHAT IS THIS? I am really starting to wonder if I need to add a drop to the dose to bring these numbers down a bit more. I will try to post a picture of how I am measuring the dose. I use my phone to magnetize the syringe so that I can see it better and then I take a photo. As I look back at all the doses since Friday PM they all look the same. So even if the dose isn't exactly 1.5 units it is the same amount each time.
 
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As long as your dose is consistent between your shots, that is what counts. And remember that we dose Lantus based on the nadir, with just some consideration to preshots. Sammy hit 57 last night - that's a pretty good nadir so I'd stick with this dose for a while. The other thing, sometimes cats go a little high, before they go low. It's just ONE number. Breathe!
 
@Wendy&Neko Yes, 57 is good, but it was also on a night with fluids, and I know that Sammy tends to go a bit lower with fluids, and just as I wouldn't want to take a reduction if he happens to go below 50 on a fluids night I don't really want to use it to base whether or not I increase either. Does that make sense?
 
I just don't get this. Sammy is only 135 at +2. Every other day Sammy has show good progress at reducing the higher PMPS numbers, but not tonight.

Why is this one different then the others. Is this a sign that I definitely too an unearned reduction?

Sammy has been on this dose for 8 cycles, he hasn't had any lows on this dose, and is also still seeing a lot of blue. I am really wondering if we should be thinking about increasing the dose in the next few days, even if it is only by a drop or two.
 
I think this is one of those "6 of one, 1/2 dozen of the other" kind of situations. Most people would look at Sammy's ss and be thrilled. You want to look at the overall thing - which is pretty great. There is a sea of green there, except that he has some blues around the late afternoon/pmps most days.

If you want to tweak his dose, I'd probably try to get between 1.5u and 1.75u. You're really just fine-tuning at this point. I don't think there's anything wrong with holding the dose either - so it's up to you.
 
Skooter sometimes like to do his cliff diving at +3 instead of +2....perhaps you can try a +3 and see where he is at?

I know the feeling of being frustrated, up until yesterday morning, I was feeling the same way. Skoots didn't seem to want to hit those greens for me at all....I suck at dosing, but just wanted to let you know I share the same frustration :)
 
That looks like 2 units to me, but I don't use that brand of syringe

Each hash mark is .5 unit and I count 4 hash marks

No matter...as long as it's the same, that's the important part! I think he's looking pretty good at this dose myself...and the drop at +2 is 10% which is a pretty decent drop!
 
julie & punkin (ga) said:
I think this is one of those "6 of one, 1/2 dozen of the other" kind of situations. Most people would look at Sammy's ss and be thrilled. You want to look at the overall thing - which is pretty great. There is a sea of green there, except that he has some blues around the late afternoon/pmps most days.

If you want to tweak his dose, I'd probably try to get between 1.5u and 1.75u. You're really just fine-tuning at this point. I don't think there's anything wrong with holding the dose either - so it's up to you.
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@julie & punkin (ga) If I were to tweak the dose a bit, when do you think I should do it? We have been on this dose for 8 cycles, should I wait 10 cycles, or a bit longer?
 
Here is another question about how close to the end of the pen should I go. The pen is currently at around 40 (I think this is units). Should I be able to draw from this pen right up to the last unit?
 
Here are the guidelines on increasing . . . although because you're going down the dosing scale the "hold for this many days" doesn't apply. When you're tweaking like this, I think how long you wait is up to you. I would do it when you can monitor since he's already got nadirs in the 50's-70's. If you think holding it longer might bring those blue numbers down, then i'd hold it longer.

You're not really in a phase that has an exact "step 1, 2, 3" type of directions.

I'll include it anyway, just as a frame of reference. If you were going UP the dosing scale, rather than calling this a failed reduction (from 1.75 to 1.5u), then you would hold for 10 cycles before increasing.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
I can tell you've really got an itchy finger here, and want to increase! ;)
 
ah, ok - i see the 5u mark on the flicker pic.

as wendy said, the important thing is that you are consistent with your own dose, whatever you measure that you call 1.5u, and that you can increase or decrease the dose.
 
julie & punkin (ga) said:
I can tell you've really got an itchy finger here, and want to increase! ;)
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Yes, I do have an itchy finger, but I don't want to do it if everyone thinks I should hold for now. I just think that if we tweak the dose a bit, and add just about a drop to the dose it might be all we need to push these blues out of the equation.

But my earlier question was never answered.

So my question is this. If Sammy's numbers continue the way they have been with a range of 50-120 do I keep holding the dose for a week and then start decreasing, or do we hold the dose for 10 cycles and then increase by a drop or so to push the numbers down to between 50-80? I have seen on some of the other spreadsheets that some people have started OTJ trials with numbers over 100, but the last time Sammy went into remission his numbers were all between the 50-80 range prior to taking him off insulin, and I am just wondering if that is what we should be shooting for.

I just want to know if this is what we should be looking for numbers in 50-80 range, or if we would start decreasing after a week with the numbers between 50-120?

The phases are just a little confusing because some of the phases reference 50-80 while others reference 50-120 or 50-200. What are we looking for to determine when we should be reducing and attempting a OTJ Trial?
 
A week in normal numbers (50-120) and you'd take the reduction, not wait until you have a week at 50-80

Getting 14 cycles below 120 really isn't easy.

I think you might see us telling people to give just a drop more when we're trying to get their nadir down a little more, but as long as all the numbers for 14 cycles are normal, you'd reduce for a week and see if he can stay in normal numbers
 
@Chris & China

But that is just what I am talking about. Tilly's page talks about the normal being between 50-80, but here I am being told that if numbers are under 120 for 7 days that is normal.

I AM SO CONFUSED! Maybe I just need to sleep on it.

But it does sound like I will need to increase a drop if I want to bring down Sammy's overall numbers down a bit more. It doesn't sound like we are possibly going to be reducing if we hold out hoping to have numbers between 50-120 for a week. I will see how the rest of tonight goes and if I don't see a lower AMPS tomorrow morning then I will increase by a drop.

I like the whole taking pictures of the syringe because I can look at the day before to see exactly where the plunger was and duplicate it. It also gives me the opportunity to re check the dose if I think I screwed something up based on the numbers. There are times that I second guess myself wondering if I had the right amount or not. I am sure we have all done that.
 
the goal is to get everything under 120 and MOST BG tests under 100 before a trial is started. I suspect the times you've seen a spreadsheet of a cat on an OTJ trial and there are higher numbers, it's likely that the cat is bouncing still, and is going below 50 in between the bounce cycles.

For dose reductions, there are 2 ways of getting a dose reduction. One is if the cat goes below 50 (regardless of bouncing) and the other if the cat is in normal numbers (50-120 on a human glucometer) for 14 consecutive cycles. In that second scenario, bouncing matters if it sends the BGs over 120. That disqualifies that cycle from being "all normal numbers."

So right now with Sammy having 150 tonight at pmps, that would mean his "14 consecutive cycles of normal numbers" would start AFTER he returns to normal numbers. But every time he goes over 120, that would start the count over.

Does that make sense?
 
julie & punkin (ga) said:
the goal is to get everything under 120 and MOST BG tests under 100 before a trial is started. I suspect the times you've seen a spreadsheet of a cat on an OTJ trial and there are higher numbers, it's likely that the cat is bouncing still, and is going below 50 in between the bounce cycles.

For dose reductions, there are 2 ways of getting a dose reduction. One is if the cat goes below 50 (regardless of bouncing) and the other if the cat is in normal numbers (50-120 on a human glucometer) for 14 consecutive cycles. In that second scenario, bouncing matters if it sends the BGs over 120. That disqualifies that cycle from being "all normal numbers."

So right now with Sammy having 150 tonight at pmps, that would mean his "14 consecutive cycles of normal numbers" would start AFTER he returns to normal numbers. But every time he goes over 120, that would start the count over.

Does that make sense?
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Yes, that makes a lot of sense. I am still not sure why 50-80 is listed as normal but 50-120 is used for determining if reductions can be taken. But I guess that really doesn't matter, because as @Chris & China pointed out it is very difficult to see 14 cycles in a row in this range without going over 120. Like I said I will probably increase by a drop tomorrow and see where that takes us. I know we are seeing some really good numbers and I think increasing by more than just a tiny bit will be too much. And it a drop still isn't enough then we can always increase another drop after 8-10 cycles right. I don't see this happening, but I guess anything is possible.
 
Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs.
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The key word here is "Most"....If Sammy is really ready, you may still see occasional blues under 120 (especially at AMPS) and even occasional numbers a few ticks higher ...what we watch for is the majority to be green, with mainly only pre-shots being blue (if not green!) and under 120
 
BWAHAHAHAAHA @Chris & China ;)

I'd just take it a cycle at a time, Tina. Overall he looks fantastic. I think if you want to tweak by adding a drop it's ok. I'm saying that specific to YOUR situation with Sammy, not about any other cat (said for lurkers.) You do a great job of monitoring and you know what you're doing.
 
Overall, Sammy's looking great. I had some of the exact same questions as you regarding what constitutes "normal" for purposes of a reduction based on normal numbers. I do wonder if PMPS might be just a tiny little bouncette. I have no doubt that Sammy's going to soon be earning those reductions one way or another. :D
 
Tina & Sammy said:
So my question is this. If Sammy's numbers continue the way they have been with a range of 50-120 do I keep holding the dose for a week and then start decreasing, or do we hold the dose for 10 cycles and then increase by a drop or so to push the numbers down to between 50-80?
Click to expand...
FWIW - Our first reduction based on being all in normal numbers was after 27 cycles at 1.25u; we reduced to 1.0u.
It was a very weird feeling.
The balance of BKs reductions were earned that same way.
15 cycles at 1.0u
37 cycles at 0.75u
17 cycles at 0.5u
21 cycles at 0.01u
It took 2 months to go down the last bit of the dosing ladder to OTJ trial.
I caught about a dozen blues throughout those 2 months, the highest of which was 108.
Tina & Sammy said:
Yes, 57 is good, but it was also on a night with fluids, and I know that Sammy tends to go a bit lower with fluids, and just as I wouldn't want to take a reduction if he happens to go below 50 on a fluids night I don't really want to use it to base whether or not I increase either. Does that make sense?
Click to expand...
Yes it makes sense. What you need is to string together a few cycles that are not influenced by anything.
To do that you will need to loosen up on the reins a bit, sit on your hands, observe and keep an open mind. Sammy is leading this dance and it may differ from the last one.
Follow his lead - the numbers will be your guide.
 
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