4/15 Rocky PMPS 254 +2 284 +4 138 +6.5 150

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Tina & Rocky

Tina & Rocky

Member Since 2013
Good morning, ~O)

viewtopic.php?f=9&t=117231&p=1230664#p1230664

Rocky starts the morning in a sunny yellow number. He is coming down from a high of 313 at PMPS +2 last night which I guess means he bounced from the few green numbers in his AM cycle?

He is getting a 'skinny' 2.25u. Last night I made it a bit skinnier than his yesterday morning shot. I am going to keep and hold this skinner dose the best that I can manage to try and keep it at a constant.

Right now I believe that Rocky's system is sensitive around that 2.25u dose mark. I thought maybe what I should do is give him the skinny 2.25u for a few cycles. If Rocky cannot seem to surf blue or green at that dose then I will slightly increase his dose to a flat 2.25u. If he still cannot surf at the flat 2.25u I would further increase it to the fat 2.25u.

I am not sure how many cycles to hold each one of those slightly increased doses to see if it is having a different effect on his BG.

If there is no surfing and I need to keep slightly increasing his dose, do you think I should I hold each dose for 6 cycles or 10 cycles before the slight increase?

Or, do you think this is a bad idea?

Any other thoughts?

Thank you! :YMHUG:

Rocky recap of yesterday:
AMPS 251 +2 117 +4 51 +4.5 47 +5 75 +6 92 +8 186 +10 275
PMPS 244 +2 316 +6 285 +8 264 +11 244
 
Re: Cycle question - 4/15 Rocky AMPS 220

He actually earned a reduction with that 47. I think you should have, at least, shaved the dose a little more than you did to maybe a f2u. He is bouncing and so it's very difficult to make dosing decisions during a bounce.

But to answer your question regarding increases, when I do increases, I try and follow the protocol and hold them six cycles at a minimum and see what Gracie does. She is a slow responder and usually needs 10-13 cycles on an increase to really get going but I know if in the first six cycles, she's not seeing some blue or green, she needs to go up more. These are the things you will have to learn about Rocky. Does he get NDW? How long? If he does and it takes 24 hours to kick in and lasts 24 hours than that's four cycles right there. If he's bouncing, you'll need to wait for the bounce to clear until you get to the point where you are very familiar with his onset, nadir, and duration and know that you can increase during the bounce (experienced CGs can and do increase during a bounce but are careful to not do it if it is apparent the bounce is clearing or is due to clear).

It's hard to know how much insulin you are actually increasing by with doses like skinny and a little skinnier than skinny and flat and fat ;-) ;-) If you are just increasing by .05u, it is likely not enough. Typically we find that better response is gained if you do larger increases up to 0.25u and smaller decreases (unless they drop below 40). So I don't know if you will see much difference in the doses you are talking about. Also, I find with cats that get NDW, you are "losing cycles" every time you increase by having to wait out the NDW. Why not just raise by a little more (no more than 0.25u) and get the NDW over with? Sometimes they only need a cycle or two at a higher dose to kickstart them.

You might want to study some of the experienced members' SSs and see how they handle micro dosing and how their cats respond. ECID yes but you might see patterns that you can then spot on Rocky's SS.
 
Re: More Cycle question - 4/15 Rocky AMPS 220 +2 129

Thank you Marje,

I really appreciate that detailed answer. You know, he was at the 2.25u and 2.50u before and he did so well in the green and blue numbers. That 2.0u is not working for him. He always sees more pinks and reds than blues or greens with a 2.0u.

The reason I am thinking of doing the skinny, flat, fat with the 2.25u is because Rocky doesn't seem to settle into a "flat" dose of say 2.0u, 2.25u, or 2.50u. From his SS chart, it appears he either needs a tad bit more, or a tad bit less.

There is some point in time when a cat must have (3) below 50 numbers before he earns a reducie, is that correct? :roll: How is that determined and why is that so? Also, isn't it possible that a 47 could have just been a meter variance?

Thanks Marje!
 
Re: More info pls - 4/15 Rocky AMPS 220 +2 129 +3 94 +3.5 10

You're welcome.

There is some point in time when a cat must have (3) below 50 numbers before he earns a reducie, is that correct? :roll: How is that determined and why is that so?
Click to expand...

No, this is not true. Some newly dx cats become tightly regulated or go into remission by the CG just reducing when the cat when the BG goes below 50 once or when the kitty has been in normal numbers (primarily 50-100) for a week. The three times between 40-50 is for cats that don't hold reductions and if a CG uses that method, they should not shave the dose but take a full 0.25u reduction when it is earned. Using the three times between 40-50 is an aggressive method of reduction. If you believe Rocky is not holding reductions, then you can either shave for a singular drop between 40-50 or you can use the three times between 40-50 with a 0.25u reduction when earned. But please don't mix and match.

The CG determines if the kitty is not holding reductions and what is the most appropriate method. Consider also that if the kitty is not holding reductions, perhaps the CG needs to manage the curve a little more to prevent the reduction. That doesn't mean feeding a lot of HC food all day. It means to feed the kitty's regular portion of LC food at appropriate times to teach the liver to surf. However, I have noticed with Gracie that when she is ready for a reduction, she earns it regardless of my efforts to get her to surf.

Also, isn't it possible that a 47 could have just been a meter variance?
Click to expand...
I understand your concerns but, no, I wouldn't agree that you shouldn't take a reduction because you think it is meter variance. If you were going to think that, then what keeps the 47 from being 40 because meter variance works both ways. If you haven't read my post on Reductions, you might want to or if you have, perhaps a refresher read? We got into the same hesitance that many CG's get into......kitty is doing well and staying blue/green and we think a reduction will put them back into yellow numbers so we delay. The night I reference was the scariest night we've ever had and now we are cautious. We can always go back up. Respect for the depot is a healthy one to have. If you check out Gracie's SS, you'll see she recently gave us a 34 so we reduced but we didn't reduce enough and she got into the 20s on a subsequent cycle so then we took another reduction. I've had to take her back up but I'd rather keep her safe.

Does that help?
 
Re: More info pls - 4/15 Rocky AMPS 220 +2 129 +3 94

Hi Tina,
I microdose with Rusty, by 1-drop increments, but I always follow the rest of the protocol: he has to have 3 numbers under 50 before getting a 1-drop reduction; and I always hold the new dose for at least 6 cycles so that he has a chance to settle in. If it looks like a failed reduction, I put the drop back on. As Marje suggests, it is important to be able to accurately determine those drops. The formula I use can be illustrated by this example (counting down from 2 units): 1 drop less = skinny 2 units; 2 drops less = fat 1.75 units; 3 drops less = straight 1.75 units; 4 drops less = skinny 1.75 units; 5 drops less = fat 1.5 units; 6 drops less = straight 1.5 units; 7 drops less = skinny 1.5 units; 8 drops less = fat 1.25 units; 9 drops less = straight 1.25 units; 10 drops less = skinny 1.25 units; 11 drops less = fat 1 unit; 12 drops less = 1 unit.

The only accurate way to do this is to use digital calipers. I use the Terumo syringes and figure 11 or 12 drops in a unit, so I figure that each drop = .11mm on the calipers. It doesn't matter what you wind up "calling" a dose, as long as you are consistent in your own knowledge of what the dose is and are measuring it accurately. Rusty's current dose is 2.22mm on the digital calipers, Terumo syringe. I "call" it a straight 1.5 units but that is just to put words to it.

Sorry to go into all this weird detail, but you wanted to know!! This "formula" omly works with Terumo syringes. All brands of syringe have different barrel dimensions, so you would have to count drops to figure out how many are in a unit with whatever syringe you use.

Good luck!

Ella & Rusty
 
Re: More info pls - 4/15 Rocky AMPS 220 +2 129 +3 94 +3.5 10

Hi Ella and Marje,

Thank you both for that detailed information on cycles and dosing. Yes, it makes sense.

I do think that Rocky does not settle into reductions even after 10 cycles, going back to that 2.0u dose again.

I believe that I am going to need to take that "drop-by-drop" method with him. However, I do not have calipers.

Marje, I forgot to update Rocky's SS. I did in fact shave TWO DROPS off of Rocky's dose last night after he had that BG of 47 during his 04/14 AM cycle. I would say that the AMPS shot on 4/14 was a "straight" 2.25u rather than a skinny. I will go back and correct that on my SS because right now I see how you might think that I did not give Rocky a reducie. He did receive that reducie right away on his PM cycle last night, and it is also the same reducie insulin dose that he got this morning. \M/

I am using the Relion syringes and not the Terumo. I believe all syringes to be inaccurate. Frankly, if that is the case then the calipers don't do any good either. The only way one could accurately measure would be to somehow get the withdrawn AM or PM insulin dose into a separate container, and THEN count the exact number of drops one needs, which would then be drawn up into the syringe.

Thanks again! :thumbup
 
Re: 4/15 Rocky AMPS 220 +2 129 +3 94 +3.5 105 +4.5 150

You have to find a "perfect syringe and use that as your model. The top edge of the plunger should line up with the zero line. Marje did all of the work for us using scientific instruments leant by MJ. You can read the thread on dosing with calipers and determine whether this method is something you want to do. Here's a link. There are more posts in the discussion, but I can't find them at the moment.
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=79851

Ella

p.s. here's another link: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=75126
 
Re: 4/15 Rocky AMPS 220 +2 129 +3 94 +3.5 105 +4.5 150 +7 26

Thanks Ella! Well, for me it comes down to cost and convenience right now. I have to rely on the Relion syringes because they are cheap and available for me.

I know what you mean bout the the "perfect" syringe though, I think. I've seen some in my bag that look lopsided. :?
 
Re: 4/15 Rocky AMPS 220 +2 129 +3 94 +3.5 105 +4.5 150 +7 26

Why do you think the calipers won't be accurate? I just ordered some. I have a whole box of monoject that I need to use up before I switch to the terumo. I'll read the post referenced but am sure I will have lots of questions once the calipers arrive. I don't know if the variance is what is causing Rocky and Max to be so hard to regulate but I hope it is a contributing factor. Then something can at least be done about it. I don't see how you can add or decrease by a drop though. When I first had to dose .25 and .75 I practiced with food coloring and water but it was not easy for me to be consistent. I sure hope the calipers help and aren't too difficult to learn to use. I'll let you know how I do after I get them Tina.
 
Re: 4/15 Rocky AMPS 220 +2 129 +3 94 +4.5 150 +7 266 +11 276

Just a couple things...

there is no settling in with reductions. They settle into increases but not reductions. The reductions either hold or they don't. If you reduce, they bounce, clear the bounce, and come right back into green, then the reduction is holding.

The calipers are accurate. I'm a scientist and I conducted the experiments using calipers and a micropippetor which is the most accurate way to determine small volumes. The calipers are only $15 and sometimes you can get them on sale. I have two and one of them I got for $7.
 
Re: 4/15 Rocky PMPS 254

I never thought that calipers were an inaccurate tool. I said it was the syringes which are so because they vary in size, so I could not see how one could use the calipers on them because one syringe might vary slightly from another.

However, if the CG is choosing the measured amount of insulin they want to give their cat using the calipers it wouldn't matter what size the syringe is as long as the measured amount stays constant.

I'm not sure how a CG could tell the difference between settling into a dose increase vs. a reduction causing a bounce that then clears into green numbers. I guess with a "settling in" a CG might not see any higher numbers at all after an increase, but instead they would see just a slow and steady decrease in their cat's BG number? If the CG does see a rise in the BG number with a 'settling in', then it's all too confusing to me. 'Settling in' and 'bounce clearing' seem too similar to be able to differentiate between them. confused_cat
 
Re: 4/15 Rocky PMPS 254

the inaccuracies with the syringes from one to another within the same brand is in the markings, not in the plastic barrel or working parts. if you line up a bunch of syringes from the same brand, same box and compare the markings, they will vary. you set the calipers to work with one brand, and then it can be used on all the syringes of that brand. if you switch brands, you'd have to figure it out again.

i think a significant point here in the discussion is that it works better to increase by larger increments. In Rocky's case, I would increase by 0.25u and then after you've gotten into good numbers, decrease by smaller increments.

when a dose is increased, some cats experience "new dose wonkiness" that causes their BGs to rise for a day or less, then the better numbers come. that's when you can see what a dose increase will do. that's the reason for holding a dose long enough to evaluate it. when you are fine-tuning a dose, which is what you're doing, you want to always allow at least 6 cycles to evaluate an increase.

when you decrease a dose following green numbers, you want to see those green numbers hold. if they don't hold, we call it a failed reduction and you'd go back up to the last good dose asap. there is no set amount of time to hold a dose before deciding it's a failed reduction. you don't have to let it settle in - either it holds or it doesn't.

when you've got higher numbers and a possible bounce involved, it just takes experience to decide what's going on. the difference between settling in and bouncing can be seen.

does that answer your question at all?
 
dosecrease in AM? Re: 4/15 Rocky PMPS 254 +2 284

Hi Julie, I believe that Rocky failed a reduction to 2.0u that started on 04/09.

I thought Sienna was advising me to NOT increase his dose back up to 2.25u for at least 10 cycles. Did I misinterpret her? :roll:

Yesterday, 04/14, I increased his morning dose back up to a "straight" 2.25u. At AMPS +4 his BG was 51 so I fed him 1/4 can of FF Classic Chicken and then tested him 15 minutes later. He was at 47. I decided to feed him another 1/4 of the FF Classic Chicken. I believe that 47 could have even been a meter variance because I did not re-check it immediately. I should have.. I then waited 1/2 hour before testing him again. He was at what I believe was a food influenced 75 and his BG just kept going up from there.

Anyway, it did not take me hours and hours of work to get his BG to go back up. His BG went up 20 points in 1/2 hour after eating 1/2 can of FFCC. Marje told me that he had "earned a reduction of .25u" because of that BG of 47-- that one number below 50. I did not want to decrease Rocky's insulin dose back down to 2.0u after he had so many pink numbers on that dose, and he had been on it for 5 days. To me, it was not a reduction that held. His numbers did not stay in green, or blue. I do not believe that the 2.0u is the correct dose for Rocky at this time.

Should I have not waited 5 days before increasing his dose? On which day would you have increased his dose back up to 2.25u?

You said:

when you decrease a dose following green numbers, you want to see those green numbers hold. if they don't hold, we call it a failed reduction and you'd go back up to the last good dose asap. there is no set amount of time to hold a dose before deciding it's a failed reduction. you don't have to let it settle in - either it holds or it doesn't
Click to expand...
.

So, I DID give Rocky a reducie at his PMPS shot on 04/14 because of that 47... But, I did not decrease his dose by .25u, back down to 2.0u, again. I decided I would try to give him a "skinny" 2.25u.

Now--- Julie, if Rocky were your cat, and he did not have one green number in his PMPS cycle tonight, would you increase his insulin dose to 2.50u in the morning? Or, would you try to do more fine-tuning with the 2.25u dose? :?:

I always feel like you are encouraging me to increase his dose sooner rather then later, and I always feel like Marje and Sienna are suggesting that I "decrease and hold."
 
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