3/31 Silver AMPS 250 +4=266 +6=254 +8=257 +10=232 PMPS 193 +2=317 +4=256

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Juliet

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http://www.felinediabetes.com/FDMB/...-2-293-5-344-why-so-high.193343/#post-2160920

So I think Silver is bouncing - that pink last night was awful. First pink since changing to the Freestyle. And now a high yellow for AMPS. So what should I do about this dose for this upcoming week? I will do a curve today but really - he is going to be high all day. I would hope he would come down for PMPS but it doesnt look good. This dose has been awful for him all week. The highest AMPS I've ever seen plus high PMPS as well. It was NOT this high on 3.75. Should I drop back to that last good dose? Should I increase even though I am presuming these highs are bounces - he did get a 126 on Thursday night. The lowest number on this dose and I think he may have gone lower that night given he only increased to 164 instead of his usual high food hike.

Thoughts? What do I do? Need dosing help here.
 
Remember dosing is based on the nadir, not the highest numbers you see. Per SLGS, you would hold the dose.
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
 
Juliet said:
I dont understand why you say he is not used to those low blue numbers - look at his ss - he is often low blue - March 17th, 19th, 20th, 22nd, 26th, 27th, 29th - all within one point of each other - I am looking on his Canadian ss so thats 4.4; 6.8; 8.8; 8.7. 5.7; 8 all around the same as that 7 you are talking about on the 29th. So I am a little confused. I do think he likely did touch green that 29th but even when he does touch green - he doesnt usually bounce into pink. And every AMPS has been high yellow on this dose which he hasnt been at for a while. Its all been low yellows. So can it ALL just be bouncing? for the whole week?
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When I say low blue numbers, I mean 120 or below. He has touched a few of those, and may have been lower, but he is not consistently staying in those numbers in order to get used to them. Of course, Silver may just be a bouncy cat.

Yes, they can bounce any time they get into a lower number than they are used to or have a fast drop. It is possible to see bouncing every day.
 
Should I drop back to that last good dose?
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This only applies to a failed dose reduction. Reducing because numbers are high (or bouncing) is generally ineffective.

My best guess is that Silver went low during the AM cycle and you saw a bounce yesterday. From the high of 344 to an AMPS of 250, numbers were dropping. Your next test was at AM +8 was 214. I think it's very likely that Silver's numbers dropped between AMPS and +8. This may be atypical for your cat but cat's numbers are not always predictable.

My other guess is that Silver likes the high blue-low yellow zone. It may be that following SLGS where you are holding doses for a week may not be enough of a push to get him into lower numbers.


 
carfurby said:
Remember dosing is based on the nadir, not the highest numbers you see. Per SLGS, you would hold the dose.
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
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Yes I know that re the nadir. BUT if he's bouncing then it's not accurate. His nadir today won't be between 5 and 8.2. It does not say if his nadirs are between 5 and 8.2 over the last several days. The sticky says run a curve and if nadirs are between 5 and 8.2 hold the dose but that doesn't make sense if he is bouncing. That's my point.
 
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Sienne and Gabby (GA) said:
This only applies to a failed dose reduction. Reducing because numbers are high (or bouncing) is generally ineffective.

My best guess is that Silver went low during the AM cycle and you saw a bounce yesterday. From the high of 344 to an AMPS of 250, numbers were dropping. Your next test was at AM +8 was 214. I think it's very likely that Silver's numbers dropped between AMPS and +8. This may be atypical for your cat but cat's numbers are not always predictable.

My other guess is that Silver likes the high blue-low yellow zone. It may be that following SLGS where you are holding doses for a week may not be enough of a push to get him into lower numbers.

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Ok. So should not hold the 4u this week again then? I held the 3.75 after advice but if that's making things worse - his numbers are much higher on this dose - do I increase again? My main concern is the numbers trending upwards after the increase to 4u.
 
266! Why is he still climbing at +4 and what can I do?? This is scaring me - he doesn't normally go higher this late after food - the insulin starts to bring him down by now.
@carfurby @Sienne and Gabby (GA) is this normal - to keep going up? I checked the insulin - its good - and its still bringing him down to that low blue the night before last - but I just looked over his ss for the whole of this year and I've never seen a +4 higher than the +2. Oh wait - he did - 24th Feb in the daytime cycle. Okay but its unusual to do that. I'm getting worried on this dose. Its been awful.
 
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Fundamentally, there is no difference between 250 and 266. They are within the 20% variance attributable to your meter.

The challenge is that there's no way to know what's doing on during the AM cycle if you are unable to get spot checks. If you are concerned about Silver's numbers, increase the dose but if it were me, I would do everything possible to get tests in during the AM cycle on any days that you can so you have some idea what's happening with your kitty's numbers.

I'd also encourage you to take a hard look at your spreadsheet and decide if your approach to dosing is helping you to achieve your goals for Silver. I'm not remembering if you're hoping to get Silver back OTJ or tightly regulated. In addition, it may help to remember that a dose that was good last week may not continue to be effective. A cat's insulin needs can change -- either up or down. It's what makes this process so challenging.
 
Sienne and Gabby (GA) said:
Fundamentally, there is no difference between 250 and 266. They are within the 20% variance attributable to your meter.

The challenge is that there's no way to know what's doing on during the AM cycle if you are unable to get spot checks. If you are concerned about Silver's numbers, increase the dose but if it were me, I would do everything possible to get tests in during the AM cycle on any days that you can so you have some idea what's happening with your kitty's numbers.

I'd also encourage you to take a hard look at your spreadsheet and decide if your approach to dosing is helping you to achieve your goals for Silver. I'm not remembering if you're hoping to get Silver back OTJ or tightly regulated. In addition, it may help to remember that a dose that was good last week may not continue to be effective. A cat's insulin needs can change -- either up or down. It's what makes this process so challenging.
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My goal initially was remission but I don't think that will happen. I do want him out of the yellows.
I do get spot checks in every weekend and holiday in the am cycle but I do work a two hour commute away so if it's a working day then that's unfortunately not at all possible no matter how much I want to. So I should hold dose then? I do worry that if I hold too long he will get comfortable at too high a number.

My approach to dosing is the SLGS approach. I don't have any other option as not being able to get mid cycle tests in disallows me from doing TR as @Jill & Alex (GA) said. So I have no choice but to keep the same approach. Right?
 
If it was me, I'd hold the dose and see if the flat yellows mean lower numbers tonight or tomorrow. When deciding whether to change the dose, you should look at the overall numbers for the past week, not just on curve day. The lowest number you saw was in the range to hold the dose.
 
carfurby said:
If it was me, I'd hold the dose and see if the flat yellows mean lower numbers tonight or tomorrow. When deciding whether to change the dose, you should look at the overall numbers for the past week, not just on curve day. The lowest number you saw was in the range to hold the dose.
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Thanks. I'll hold. Does that mean I need to hold for a whole week or see what the next couple days do? Sienne earlier said that perhaps holding was causing him to become comfortable at a higher dose so I find decision making confusing.
 
@Sienne and Gabby (GA)
Juliet said:
I don't have any other option as not being able to get mid cycle tests in disallows me from doing TR as @Jill & Alex (GA) said.
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That's part of it, but more importantly is the fact that Silver doesn't have any access to food during the day or night to help bring her numbers up on her own... when Juliet is sleeping or at work and not able to monitor. In other words, there is no safety net. Given the circumstances, even wishing to see greens may be risky.
 
Jill & Alex (GA) said:
@Sienne and Gabby (GA)

That's part of it, but more importantly is the fact that Silver doesn't have any access to food during the day or night to help bring her numbers up on her own... when Juliet is sleeping or at work and not able to monitor. In other words, there is no safety net. Given the circumstances, even wishing to see greens may be risky.
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Silver is a he. I could easily leave food out - but I have no guarantee which of my cats would be eating it. Silver is a horse and anything I put on the floor would be eaten the minute I put it down. A timed feeder - sure - but I would not know which cat was eating what. So its not an inability to leave food out - but rather ineffective.

Obviously the aim is greens in order to get him in remission or at least tightly regulated. This IS possible. I had Silver in nothing but greens the first time around - greens ALL day. Yet the situation was the same. I was not home during the day and, like most people, sleep at night. From the several condos I've read over the past few months it seems some people err on the side of caution and say stay in higher numbers - and others encourage more risks. I am not the only one on the board that doesn't leave food out - not by a long shot.
 
Juliet said:
Silver is a he. I could easily leave food out - but I have no guarantee which of my cats would be eating it. Silver is a horse and anything I put on the floor would be eaten the minute I put it down. A timed feeder - sure - but I would not know which cat was eating what. So its not an inability to leave food out - but rather ineffective.
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Oops, sorry! Alex was a she. Couldn't tell you how many people made that mistake! No harm. I just got used to it.

About feeding... yes, I remember your circumstances. I was addressing the requisites of the TR Protocol... reasons why following TR is not a safe option for Silver.
 
Juliet said:
Obviously the aim is greens in order to get him in remission or at least tightly regulated. This IS possible. I had Silver in nothing but greens the first time around - greens ALL day. Yet the situation was the same. I was not home during the day and, like most people, sleep at night. From the several condos I've read over the past few months it seems some people err on the side of caution and say stay in higher numbers - and others encourage more risks. I am not the only one on the board that doesn't leave food out - not by a long shot.
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Sorry, I forgot this part of your post...

What happened the first time Silver was on the juice was then. This is now and obviously this time it's different. Comparing the two times on insulin will only give you a headache.

As far as how much risk you want to take with Silver's treatment... that's up to you. You hold the syringe. I took risks with Alex that others wouldn't take with their cats, but I was there to see it through... to keep her out of danger. That said, it's not right for others to encourage you to take risks that have the potential of doing harm... which is why I brought up the special circumstances you're dealing with. If you recall, I've said on more than one occasion, given the circumstances, you may have to resign yourself to running Silver in higher numbers than you'd like.

I have to get off the computer now. If you have questions/comments for me I'll try to get back on later.
 
Jill & Alex (GA) said:
Oops, sorry! Alex was a she. Couldn't tell you how many people made that mistake! No harm. I just got used to it.

About feeding... yes, I remember your circumstances. I was addressing the requisites of the TR Protocol... reasons why following TR is not a safe option for Silver.
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Got it. Yes, I don't know why people keep encouraging TR for Silver but there you go.

I have resigned myself to the fact that Silver likely won't get a second remission but I do want him below renal threshhold or I will then be looking at other problems down the line. That I believe, would be getting him in mostly blues. But we aren't there yet so I have no choice but to continue SLGS until we get him in mostly blue numbers. I am presuming following the method is safe. Silver does do inverted curves or remains flat from every curve I have done, so I don't have the same worries about him going low when I am at work as others might. His lowest is usually around +10 or preshot and I am home by then.

I know I can't keep comparing - but crumbs, everyone else does. They constantly look back at how Silver has responded in the past for today's recommendations and at some level, we do have to do that. Even the SLGS method says to do the same. I have got comfortable enough over the past six months to know how Silver responds both to food and insulin to continue following the SLGS method set out in this forum, however the last few increases have done little good and I am wondering whether it is wise to keep increasing to no effect. There must be a limit at some point.
 
Fundamentally, any cat needs as much insulin as that cat needs. The dose that was was wonderful last week can be as effective as water this week. Yes, we do look for trends but it's with the understanding that it is a cat's nature to be unpredictable and some cats are more unpredictable than others.

On the whole, Silver's numbers aren't bad. If your goal is keeping her under renal threshold, one possibility is to fatten the dose. You might want to consider doing so on a Friday night so you will have the entire weekend to keep an eye on Silver's numbers. As Jill noted, you hold the syringe and are best aware of you situation and how Silver behaves.
 
Sienne and Gabby (GA) said:
Fundamentally, any cat needs as much insulin as that cat needs. The dose that was was wonderful last week can be as effective as water this week. Yes, we do look for trends but it's with the understanding that it is a cat's nature to be unpredictable and some cats are more unpredictable than others.

On the whole, Silver's numbers aren't bad. If your goal is keeping her under renal threshold, one possibility is to fatten the dose. You might want to consider doing so on a Friday night so you will have the entire weekend to keep an eye on Silver's numbers. As Jill noted, you hold the syringe and are best aware of you situation and how Silver behaves.
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Thanks. What does fatten the dose mean?

I just tested him now at PMPS and here we go it's lowest in the cycle. I don't know why he does that. Flat all day. Maybe he is coming out of a bounce? But now he's had his dinner so when I test at +2 he will have gone back up into yellows again. :banghead::arghh:
 
For some cats, a flat yellow cycle is a signal that there's going to be an active cycle. It's almost like they are gathering up their energy and numbers will start to come down. Again, your PMPS is not that big of a difference from your +10. It just looks "bigger" because you are in a different color zone.

In Silver's case, a "fat" dose would be between 4.0 and 4.25u. It's adding a smidgen more insulin. The hard part is figuring out how to consistently measure that amount. Calipers can be very helpful.
 
Sienne and Gabby (GA) said:
For some cats, a flat yellow cycle is a signal that there's going to be an active cycle. It's almost like they are gathering up their energy and numbers will start to come down. Again, your PMPS is not that big of a difference from your +10. It just looks "bigger" because you are in a different color zone.

In Silver's case, a "fat" dose would be between 4.0 and 4.25u. It's adding a smidgen more insulin. The hard part is figuring out how to consistently measure that amount. Calipers can be very helpful.
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@Stacy & Asia sent me calipers but I just cant figure out how to use them. I've looked at video after video but I just can't get it. I have resorted to counting drops. There seems to be - with my syringes - four fat drops to a unit. So when I get to 4.25 I fill to 4.5 and squeeze out a drop. Not sure how I get half way between the two?
 
Not a good day at all. Not understanding the suddenly much higher numbers since the dose increase last weekend.
 
Juliet said:
Not a good day at all.
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Poo! It is rotten when one feels like that, especially when a lot of work has gone into trying to achieve something. Know that feeling all too well.

I was going to post a little bit of the mischievous & will still do so in the hope of turning a :arghh: into maybe a little wry :rolleyes:.

Take a look at Ty' s sparse SS numbers for today. I'dgive you those numbers for young Silver but you wouldn't want the diarrhea that came with that. :woot:
 
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