4/16 Aria

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Hope and Aria

Hope and Aria

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We made it almost 22 hours before a number I could shoot. I'm lowballing at 1.2 units. She didn't start coming up until after midnight. Sometime around 5 am I woke up and she was at 132. Gave her the shot at 231 (+21.75.) It was a nice and slow and steady path once she finally started dropping, so no major bouncing after the high and tight of 300 for the first 7 hours post shot. Our vet tech called to check on her yesterday afternoon and said she would teach me how to do SubQ's next time I come in.

I need a nap. I-)

ETA - +1 is already dropping. We've never seen that! Now I'm wondering if I should have waited a 1/2 hour after the 7:45 am test to test again before shooting. But after almost 24 hours and a long night, it never occurred to me.
 
Just another perspective. My theories change often so whatever it's worth.

Buddha has had curves like Aria's yesterday ... at least starting out, he's never had the duration you've seen.

The way I've started interpreting this type of curve:
BG is going up at ps time,
shot is given,
BG continues to rise for +1 and +2
BG starts to drop around +3
and by +4 is coming back down, but still lower then pmps

and since the insulin is working slowly and gently, no fast/hard drops that's why the much longer duration? This part I haven't figured out yet. But dose reductions have not worked for me.

What's weird for us is sometimes after +12/ps check, Buddha zooms from 200s to 400s (in the +1-+2 hours) and sometimes he coasts along at 200s. So it's hard to know how much insulin to give. So I've been wondering if it would be safe to to check at +2 or so, see if he's gone up since ps check, and if it's much higher to give a bolus dose of insulin ...
 
Donna - sounds like Ari and Buddha are littermates - She rises on +1, is about the same at +2 then slowly settles down to a nice nadir around +6. Then, before TID, she would putz out at +10 and zoom from 200's to 400's in those last 2 hours. That was the whole reason we went to TID. If it took 2 hours before she saw any results and at +10 she's start zooming, it seemed that an 8 hour shot was perfect.

This whole falling on +1 after almost a full day between shots is baffling. We always have an increase at +1 and +2. We've never not had an increase in the 4 months I've been testing constantly nor in the last year when I would spot test.

As for the bolus shot, IMHO, I wouldn't recommend it after such a short time (remember I'm on sleep deprivation brain, so that may not even remotely be what you're suggesting.) When we started TID, that was my original thought. That I could catch her at +6 and give her a mini shot to help her hold out until +12. I could never get the numbers quite right, so then I went to TID in the hopes that some tighter control would be beneficial. Now I'm a mushy brained Mama in need of some caffeine ~O)

ETA - Update - At +5, she's at 40 again. So! I'm going to guess that means we're lowering the dose again. I'm thinking maybe I'll skip 1 and go to .8 and see how that does? Maybe?
 
With PZI, onset is somewhere around +2, so the pattern of a rise in the early hours, leveling out around +2 or +3-ish, and then a moderate drop after that IMO is what anyone would generally expect to see, though of course nadirs can vary quite a bit, and onset has some variation as well. I don't think that pattern in and of itself would lead to longer duration, since that is the "default" PZI pattern, so to speak. A sharp drop though anywhere in there can trigger rebound, so a less gentle curve can lead to a lack of duration.

From what I have seen, duration improves with liver-training, and with pancreas healing. There may be other explanations as well - it seems fairly typical that cats starting out on PZI poop-out around +10, but then once they spend more time in good #s, will get duration til +12 or longer. Bix went from +12 to around +16, then to around +24, then to anyone's guess. I'm not sure where the mark is where it's clearly pancreas and not PZI. I would suppose there has to be a certain point where it's just impossible that it's from the PZI any longer, but I do think some small amount remains in their system for well past the 12 hour mark. Just guessing on that though.

A drop by +1 from what I have seen usually means the dose is too high. I don't think I have ever seen that on a late shot though, I associate it with really good overlap, which you wouldn't have at something like +22. I don't see any reason to have waited another 1/2 hour though and retested unless you wanted to give her food and see if she would bring the #s down on her own...? I probably wouldn't try that though once over 200 - in my view it's more of something you do at 150 or so and hold off shooting for a bit.

Looks like she wants you on your toes with more dose reductions! Pretty cool! :mrgreen:

Donna - with Buddha's variable zoom rate, have you had success pinpointing it from something like a +11 test and then the +12 test, or is that not reliable with him? Personally I wouldn't do the bolus dose. I've done something like that a couple times, and it gets really confusing what to do with the next shot, when you know there is still some insulin in their system that won't have worn off yet. Plus I never got much in the way of results, at best just holding the #s from going really high.

Some people do more of a rising # test than I have ever done - 2 tests 10 or maybe 20 minutes apart as part of your PS process. Something like that (maybe 15 min before PS time and then regular PS time?) might help you assess the zoom rate, and then have a sliding scale for dosing a high zoom vs. a coaster....? Just a thought - I have never done something like that more than occasionally, and don't know if it would really be useful or not...
 
Wowsa! Quite some action today. Aria would definitely NOT need a bolus at +2.

I'm not even sure I using the right term, but it seems if one is
1) using a sliding scale and shoots a dose x at ps y, and if
2) 2 hours later bg has climbed into a higher range on the sliding scale

then shooting the extra amount at +2 (and in my head I'm thinking it would be a .1u or .2u, to make up the difference between what was shot at ps and what one would shoot had the +2 been the actual ps number.)

Else if you have a curve like Aria's today, then I think you are onto something good!

ECID for most, but for mine it seems more like EDID (every day is different.)
 
Donna & Buddha said:
I'm not even sure I using the right term, but it seems if one is
1) using a sliding scale and shoots a dose x at ps y, and if
2) 2 hours later bg has climbed into a higher range on the sliding scale

then shooting the extra amount at +2 (and in my head I'm thinking it would be a .1u or .2u, to make up the difference between what was shot at ps and what one would shoot had the +2 been the actual ps number.)

ECID for most, but for mine it seems more like EDID (every day is different.)
Click to expand...

EDID, I love that!!!!! In theory, the sliding scale based on PS is taking into account the zoom rate, so if you have a cat who isn't in the EDID camp :) then you might know that a 250 PS means 320 at +1, and you know what dose to shoot at 250 that will land you at a nadir of 80 (or whatever). If you had an actual 320 PS and shot more insulin based on your scale, it would be in part because you know that means a 400 at +1, and have already taken that into account.

I think I get what you are saying, like base your scale on a low zoom rate, and then if +1 tells you the zoom rate is higher, pop in a little extra insulin to make up for the difference. In my head, it seems like one of those things that sounds like it might be a good idea, but in reality might drive you nutso, or be ineffective at a low dose, vs. dangerous at a higher dose. I guess since it violates the rules of PZI that I've been taught (for better or worse) it just makes me edgy.

I know people do bolus dosing, but I haven't seen much of it, seems a bit like playing with fire. I did it a couple times when I was panicked, and ended up no better off for it. It can mess with the nadir if you have 2 doses potentially peaking at once, risking unexpected low #s/hypo, and can mess with your following PS - might be lower than it would have been b/c of the bolus, but then might zoom even more after the bolus fully wears off. When ever I did it, my mind all but exploded at the next PS, trying to figure out how much insulin was still in his system for how much longer, etc.

Not to be overly discouraging or anything. :lol: I guess I'm more comfortable with shooting early if the #s are zooming, or doing some kind of "zoom test" and then shooting more/less at the +12 to compensate. Ultimately, you hold the syringe though, and who knows, maybe unconventional methods are just what he needs. I don't know if there is anyone around with bolus expertise, but maybe someone will chime in...
 
Well +11 and 287. Because of the craziness of yesterday, I'm going to wait 15 minutes and test again to make sure she's on the rise and not holding (lord knows with Aria). Was going to go to .8, but with an almost 300 number, I'm not sure that's a good idea. Then again, I never thought I'd get a 40 on 1.2. Heck! She's boggling my brain!! So, I'm debating 1 unit vs .8 unit. Who would think that .2 of a unit would drive me this nutty. I'll update when I get my brain into an actual decision.

ETA - Ok, just because we're all having so much fun here. I just tested Ari 20 minutes after the 287 and she's at 245. Still way too high, but I'm not shooting on a declining number. What the heck is up with my cat?

+12 - 300 - gave 1unit. We'll see what happens.
 
Hope and Aria said:
Well +11 and 287. Because of the craziness of yesterday, I'm going to wait 15 minutes and test again to make sure she's on the rise and not holding (lord knows with Aria). Was going to go to .8, but with an almost 300 number, I'm not sure that's a good idea. Then again, I never thought I'd get a 40 on 1.2. Heck! She's boggling my brain!! So, I'm debating 1 unit vs .8 unit. Who would think that .2 of a unit would drive me this nutty. I'll update when I get my brain into an actual decision.

ETA - Ok, just because we're all having so much fun here. I just tested Ari 20 minutes after the 287 and she's at 245. Still way too high, but I'm not shooting on a declining number. What the heck is up with my cat?
Click to expand...

Could be a little rebound that is now wearing off? Or just natural variation or meter variation, might be just variable coasting readings vs. a true drop. Technically you don't need to do a rising # test if your PS is higher than your nadir - that in and of itself is a rising #. Nothing wrong of course with testing again :). I wouldn't tend to worry about it much at +11 with a number that high, seems pretty shootable to me at that point. I would probably shoot light for a couple days - if this last one did trigger a little rebound, that will be wearing off so you may see better results again in a couple cycles.

I think your shooting choices come down to what your short-term goal is. If you are intent on DDs or are worried about ketones you shoot more, feed when needed, and live with possible rebound. Not sure if more food earlier in the cycle might offset the rebound effect, or if the liver does its thing regardless of food intake. I want to say that eating is their first line of defense, and if they can't keep their BG high enough with that, then the liver kicks in. But I can't recall if I read that somewhere, of if I made it up, lol! ohmygod_smile

Alternately, if your goals are to avoid possible rebound and low #s, even if she may go a bit higher til you get the dose worked out, you shoot a little less and see where you are. Since she has been repeatedly hitting some lows, if it were me I would probably try backing off a little further to get my bearings. I've had a couple runs with Bix where it was hard to keep up with the dose reductions - in hindsight I wish I had reduced faster at times.

No right answers, just an endless stream of confusing choices. :lol: The good part is that she seems to be doing really well, and you are doing a great job walking the FD tightrope! I have not seen anyone who never overshoots or undershoots - it's a guessing game a lot of the time, so don't overstress yourself with it. She is getting awesome results, and if she is feeling fine, I'd shoot doses for a couple days that will let you catch up on your sleep! :-D
 
Those numbers you have the past few days look familiar! Looks like a mix of rebound and Aria's system trying to sort things out. Keeping in mind my noobness, it looks like Aria needs less insulin as those high numbers are most probably the liver kicking in from those fairly low numbers (from too high a dose) and it will take a few cycles to level out.

I think keeping a fairly low dose (<.8) over the next few cycles would be the way to go and see where she settles w/o risking any more possible rebound. Looks like a dose reduction is needed. She's been needing less insulin every day so that is awesome. The trend just looks to be continuing IMHO.

edit: I think at first read I agree with what J&B said above. She just beat me to it and said it better. :lol:

edit2: Oh, and H&A - what you said in the other thread (didn't want to hijack it) about 2009: I feel very lucky to have found this site when I did and to find it a bit late is much better than never! Your kitty looks to be getting closer and closer. Thanks for keeping an eye on us too. :smile:
 
Joanna - yeah, Ari is prone to ketones so I dislike keeping her in the high numbers.

She also tends to inappropriately pee on things any time she gets over 250. Not that there's any appropriate way to pee on things, but you know what I mean. That's not so much fun. Because of the ketones, I'm trying to slowly drop the dose so she'll stay away from them. I'm figuring once I hit a nadir that's in the 60's instead of the 40's, I'll be calm. Every time I've reduced the dose I'm always sure "This'll be it!" Then she hits 40 again. Hey, best case scenario, we can keep up the pattern all the way into remission. Here's to hopin'!

Well, I'm heading to get a few hours sleep. I want to catch her at +5 to see what her "close to nadir" number is to see how she does on 1 unit. I'm thinking because of the too high doses, we'll probably end up finally undershooting and have to work our way up.

Night all! I-)

ETA - So I woke up a bit ago (+4.25) and took a reading - 53, down from 300. Usually it goes a bit lower, so I'm going to have to say we're due for another reduction for tomorrow mornings shot.
 
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