3/21 Rocky PMPS (?) +2 267 +3 175 +4 181 +5 194 +9 361

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Tina & Rocky

Tina & Rocky

Member Since 2013
Good afternoon,

viewtopic.php?f=9&t=115801&p=1217992#p1217992

Not much to say. Rocky is still surfing pink numbers after a very short run of only 3 hours of green numbers on 3/18. I feel like I am going to kill him with all of these pink numbers. If he was at the vet, they would have definitely increased his insulin dose by now. It doesn't make any sense to me to keep him in numbers ABOVE 300 for nearly 4 days. (Rocky went into the pinks, with numbers above 350 -- and the reds -- at 7PM on 3/18)

Rocky's recap of yesterday:
AMPS 340 +2 306 +4 303 +6 352 +8 314 +11 370
PMPS 383 +2 323 +4 315 +9 397
 
Re: 3/21 Rocky AMPS 397 +2 319 +4 347

Tina

You hold the syringe. But here's what I said in last night's condo:
if he doesn't clear tomorrow, you could take him up but I'd only increase 0.25u so his new dose is 2u.
Click to expand...

It doesn't look like he's going to clear the bounce today so I would increase his dose tonight.
 
dosecrease? Re: 3/21 Rocky AMPS 397 +2 319 +4 347 +6 285

Hi Marje,

Well, he went to 285 at +6 (3pm), but maybe that is as low as his BG will go in this AM cycle. I'm not sure whether to increase the dose or not this evening if he manages to stay in yellow numbers from now through his PMPS test (9pm).

If Rocky is able to stay in the yellows for the next six hours, should I raise the dose by .25u anyway? I know I should increase if he goes back up to the 300s.

Worried.. that this 62 point drop from 347 to 285 will already start another bounce. :cry:

Thank you! :YMHUG:
 
Re: dosecrease? Re: 3/21 Rocky AMPS 397 +2 319 +4 347 +6 285

Worried.. that this 62 point drop from 347 to 285 will already start another bounce
Click to expand...
Those 62 points could easily be meter variance. There's a 20% variance around any number that a meter produces. It's the allowable measurement error. That kind of drop from where Rocky started is not really significant.

You'll have to see where Rocky takes his numbers at PMPS.
 
Re: 3/21 Rocky AMPS 397 +2 319 +4 347 +6 285 +8 333

Thank you Sienna. I thought maybe it was a meter variance and I should have retested Rocky right then. But I did not.

Instead, I fed Rocky (1)tsp of his zero carb NVIV. I don't know if it does any good to feed a cat that has already dropped more than 50 points to keep them from bouncing though, if it is a "real" drop?
 
Re: Why increase tonight's dose by only .25u? - Rocky

Because you had nadirs under 100 just 6 cycles ago.

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.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

Lantus doesn't work well as a hammer.
 
Re: Why increase tonight's dose by only .25u? - Rocky

Rocky did not have nadirs under 200.. he had a cycle with with only 3 green numbers. All of his nadirs have been 300 or greater.

I think maybe you have seen this?

http://www.tillydiabetes.net/en_6_protocol2.htm

It says that
However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU.
Click to expand...

About the bounces:

Be aware that experimental studies in human diabetics over the last 15-20 have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia.
Click to expand...
 
Re: Why increase tonight's dose by only .25u? - Rocky

Rocky did not have nadirs under 200.. he had a cycle with with on 3 green numbers. All of his nadirs have been 300 or greater.
Click to expand...

Tina, on the AM cycle on 3/18, Rocky's "nadir" was 83....the nadir is the lowest point in the cycle, so Rocky has seen a nadir under 100. That's why we're suggesting either holding the dose a little longer (as the protocol states) or only taking the .25 increase.

The protocol used here is a modified version that's even slightly more aggressive than the original TR protocol.

That all being said, you hold the syringe. You have to make the final decision
 
Re: Shot 2.0u 3/21 Rocky PMPS (?)

I forgot to take Rocky's PMBG... ohmygod_smile I was working on another project and then looked at the time, and that it was nearly "Rocky time." I fed him and just gave him his shot with the dosecrease to 2.0u.

I will make sure to test at PMPS +1, before I feed him his mini-meal.

I think the word here that I fear is not being heard, seen, or realized by the advise givers is continuously. Rocky does NOT continuously have nadirs in the 80s, or lower. His SS from the beginning in January is more pink than it is green or blue.

What happens is Rocky will have a few hours in the green numbers, I then lower his insulin dose, and then his BG goes straight up again. Is it really from a bounce, or is this happening because his depot is actually drained and he really needs more insulin? :roll:

Yes, Rocky had a nadir in the 80s three days ago, for ONLY three hours. I would not call that a continuously low BG.

Please, someone examine Rocky's SS chart and tell me honestly if you believe that Rocky has had continuously low numbers.. I don't think we can really say that about him. They are more hit and miss, or once in awhile.

And at what point in time do we stop saying that a "cat is new to diabetes?" Rocky was diagnosed with Diabetes in December 2013. It is likely that he had it since Oct. 2013, maybe even before that..

What constitutes being "old" to diabetes?
 
Re: Shot 2.0u 3/21 Rocky PMPS (?)

We really do understand your frustration Tina! It's hard to see those high numbers and not feel like you should be doing SOMETHING!

But the protocol has these "recommendations" for a reason, and that's because of the number of cats who've been successfully controlled or able to achieve remission
1. if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
2. when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

Rocky is new to numbers under 200 at nadir, and he also just saw a nadir under 100 on 3/18

Our number 1 rule here is to be safe..that's why we get a little shaky about increasing the dose when we see numbers that could be a bounce.

Let's hope the new 2 unit dose will show you some MUCH better numbers! Then everyone is happy :-D

Come on Rocky!! Work that juice!!

Edited to add...."old" diabetics are ones that have been diagnosed for at least a year. I'm not sure why you're referencing "continuously low numbers" though. No, Rocky hasn't had "continuous low numbers", but he has dropped under 100 several times. (and under 50 several times too)

Is it really from a bounce, or is this happening because his depot is actually drained and he really needs more insulin? :roll:
Click to expand...

As for this, if we had a crystal ball, we'd ALL save ourselves a lot of worry and get a lot more sleep!....LOL
The only answer I can give you is that the protocol here has been so successful with so many cats, you just kind of have to "trust the process" and that the people who've been dealing with this disease and reading the spreadsheets the longest (and have the most experience), are suggesting what they think is best for Rocky.
 
Re: Shot 2.0u 3/21 Rocky PMPS (?)

I think it's ok that you took him up as long as you keep a close eye on his numbers.

I don't think I would classify him as new to numbers under 200 (or 100). I think you've been around long enough now to have increased after waiting to let the bounce clear. But you have to be sure you stay on top of the numbers especially because you forgot the PS.
 
Re: 3/21 Rocky PMPS (?) +1 351

My concern is that Rocky is edging past the point of possible remission because maybe I have not increased his dose fast enough.

I do understand the concern here that he could go hypo, but so far even when he was at 29 that one time he was acting completely normal, in fact, a if he had even more energy.

But again, what Rocky has continuously showed me is numbers above 300, and nadirs above 300. I feel like I am not raising his dose fast enough.

The other thing is that Tilly's page doesn't believe in the 'bounce' and thinks that doses should be raised in two to three days. I've been waiting for 3 days each time before I raise Rocky's dose, instead of 2 days, as she suggests.

The other thing is, when Rocky had those numbers of 50, if I had been able to catch them in time, I could have fed him HC or LC food and he would not have gone below 50.. that means that I would not have had to lower his dose at all.

In other words, I am causing his dose to be lowered and than raised back up again because I have not tested at the right time.
 
Re: dosecrease 3/21 Rocky PMPS (?) +1 351

There were times when you've just fattened the dose. I wouldn't do that. Adding fat or skinnying the dose helps with fine tuning but you should be doing the prescribed 0.25u increases and decreases.

I'd recommend you look at other SSs. I've seen cats stay in a lot worse numbers than Rocky for a lot longer time and they went into remission. We can't predict who will or won't go into remission but your immediate goal is just to get him into remission.
 
Re: dosecrease 3/21 Rocky PMPS (?) +1 351

OK.. no more fat or skinny doses. Yes, that could have messed things up. As could have skipping shots and moving the shot times. All of that has happened.

Sure, I would love for Rocky to go into remission, but to even get him regulated on any insulin dose would seem like a milestone was reached.
 
Re: dosecrease 3/21 Rocky PMPS (?) +1 351 +2 267

That's a pretty good drop at +2. If he's clearing a bounce this cycle and he's now got a little extra insulin, he might drop more or be active tonight.
 
Re: 3/21 Rocky PMPS (?) +1 351 +2 267 +3 175 +4 181 +5 194

i'm going to go ahead and post here since i'm online now and you don't have a condo open yet for saturday.

i just want to encourage you to try to keep Rocky from getting a reduction at the 2.0 dose. we talked about it a few days ago - holding up the low numbers allows you to give enough insulin to hopefully bring down the higher range of numbers. Give more carbs if you see him heading down - yes, you can prevent him from getting into blues or greens if you want. how you implement it is up to you. you may have to do some tinkering to figure out what works for Rocky.

The goal is simply to be able to continue giving enough insulin to bring down the higher BGs.
 
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