4/18 Gizzy AMPS 400, +3.75 329, +8 420 Dosing Question
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Harley and Pattie
Member Since 2010
Re: 4/18 Gizzy AMPS 400 Dosing Question
Hi Lori,
I looked at Gizzy's ss and you are always starting in the red, which could be a bounce from action at night. I don't lower my dose during a bounce but it seems like Gizzy can't get out of it. If I were to change dose, I would go down. I think that he is going low enough at night that the liver is dumping glucose into the system, causing the high AM/PM number. I wish you could get a few more tests during the 12 hours to tell.
Anyway to get a curve done? Even a mini one of every 3 hours would give you great information. Every 2 hours would be better.
Hopefully someone else will weigh in here.
Pattie
Hi Lori,
I looked at Gizzy's ss and you are always starting in the red, which could be a bounce from action at night. I don't lower my dose during a bounce but it seems like Gizzy can't get out of it. If I were to change dose, I would go down. I think that he is going low enough at night that the liver is dumping glucose into the system, causing the high AM/PM number. I wish you could get a few more tests during the 12 hours to tell.
Anyway to get a curve done? Even a mini one of every 3 hours would give you great information. Every 2 hours would be better.
Hopefully someone else will weigh in here.
Pattie
Harley and Pattie
Member Since 2010
Re: 4/18 Gizzy AMPS 400 Dosing Question
I would also change the way I am feeding him. This is what I have done with Harley:
1/2 can FF at +12
1/4 at +2
1/4 can FF at +4
1/4 at +6
1/4-1/2 can FF at +8
1/2 can FF at +12
spreads it out more evenly – if the AM/PM feeding is not enough, add a little of your cooked chicken to bulk it up.
I think you are feeding a little heavy at the AM/PM feeding and it needs to be a little more even.
Pattie
I would also change the way I am feeding him. This is what I have done with Harley:
1/2 can FF at +12
1/4 at +2
1/4 can FF at +4
1/4 at +6
1/4-1/2 can FF at +8
1/2 can FF at +12
spreads it out more evenly – if the AM/PM feeding is not enough, add a little of your cooked chicken to bulk it up.
I think you are feeding a little heavy at the AM/PM feeding and it needs to be a little more even.
Pattie
Re: 4/18 Gizzy AMPS 400 Dosing Question
Just to confuse you, I'm not sure I agree with all of Pattie's suggestions. What I do agree with is getting some additional spot checks so you have a clearer picture with respect to whether there are some lower mid-cycle numbers. The days when you've seen Gizzy drop from reds to blues do trigger bounces. This cycle would be 72 hours from when the last bounce started. So, it's good you held the dose. If you can get a spot check this cycle, you may be in a position to increase the dose tonight.
As for food, spreading food out is a good idea if it's possible. However, I would not feed past nadir. If you are feeding later in the cycle, there's less insulin available to offset the effect of the food on BG. It can result in higher numbers later in the cycle and into the pre-shot time. Getting a curve, like Pattie suggested, will give you a better sense of where Gizzy's nadir generally falls so you can think strategically about when to feed. Just a sidebar on food -- if you change Gizzy's feeding schedule, don't expect immediate results. Feeding schedules are largely trial and error and it takes several weeks or more to see the effect.
As a general rule, I don't suggest decreasing a dose with a cat that's bouncing. All the dose reduction does is leave the cat in high numbers and then you've got to increase the dose anyway. The strategy that we've typically used is to wait until the bounce clears and increase the dose. While the high numbers are nail biters, the more time your cat spends in lower numbers, the more her body will become accustomed to those lower numbers and the bouncing will eventually level out.
Just to confuse you, I'm not sure I agree with all of Pattie's suggestions. What I do agree with is getting some additional spot checks so you have a clearer picture with respect to whether there are some lower mid-cycle numbers. The days when you've seen Gizzy drop from reds to blues do trigger bounces. This cycle would be 72 hours from when the last bounce started. So, it's good you held the dose. If you can get a spot check this cycle, you may be in a position to increase the dose tonight.
As for food, spreading food out is a good idea if it's possible. However, I would not feed past nadir. If you are feeding later in the cycle, there's less insulin available to offset the effect of the food on BG. It can result in higher numbers later in the cycle and into the pre-shot time. Getting a curve, like Pattie suggested, will give you a better sense of where Gizzy's nadir generally falls so you can think strategically about when to feed. Just a sidebar on food -- if you change Gizzy's feeding schedule, don't expect immediate results. Feeding schedules are largely trial and error and it takes several weeks or more to see the effect.
As a general rule, I don't suggest decreasing a dose with a cat that's bouncing. All the dose reduction does is leave the cat in high numbers and then you've got to increase the dose anyway. The strategy that we've typically used is to wait until the bounce clears and increase the dose. While the high numbers are nail biters, the more time your cat spends in lower numbers, the more her body will become accustomed to those lower numbers and the bouncing will eventually level out.
Re: 4/18 Gizzy AMPS 400 Dosing Question
Lori, I may not know alot but here’s what I see in the numbers on your ss.
Since start of April, the dose 2.5u looks too high.
End of March, you were bounces, like 3/29 with amps 413 and +6 133, then back up 301 for pmps. Then on 3/30, amps was 366 and +10 was only 164, so what happened in the earlier part of the cycle, plus pmps was up to 443 – a jump in less than 2 hrs... I think, whoa what happened there? And the bounce began. On 3/31, the am cycle was pretty much a write off, clearing through the bounce, but in the pm cycle, you were down to blue with a +5 167, so without any further tests in the pm, I would have to guess that you got some much lower numbers because the amps for 4/1 was 401... something happened to get that high by morn. Again, you have a write off cycle till that bounce clears, and also no tests for that pm cycle, so we are guessing again for 4/2 numbers. On 4/2, you start the day with an increase from 2.25u to 2.5u on the amps of 308. I am not sure why the increase, but you can pretty much know what more insulin is going to do.... make bigger bounces. And that is exactly what happened.
If you look at 4/2, amps is 308, you increase by .25u. Look at the numbers you have for that one cycle.... it is straight down – 308 283 250 229. When I see a steady drop like that I think the drop is going to continue, but till when? And sure enough by +4 you dropped from 229 pmps to 99 at +4.5 and no tests after that 99. Again you can pretty much guess what happened overnite because the morn delivered 4/3 amps 306 and still rising with a 400 at +4. The cycle finished off with a nice high of 433 and by +4 again you had dropped to 210. Another straight line down from pmps 433 to amps 176. At this point, after 3 cycles of 2.5u as a dose, I think I would have said, back we go to 2.25u because that bounce is worse than on 2.25u. Of course, on 4/4 amps was 176 and that cycle was another straight up to pmps of 331.
On 4/6, you have amps 426 and pmps 406 with nothing in the middle for numbers BUT guessing how the past few days have gone and then how you dropped from the 406 down to 73 at +5 and feeding HC did not bring up the number by +7 which had dropped more down to 60, I would have pulled back for sure which is what you did but by only a drop?
By 4/10, on the 2.35u dose, pmps was 373 and dropped to green 90 at +5 and stayed green for most of that cycle including that 33 at +7.5. For sure, I would have dropped the dose, which you did and that is good. You would have had some shed to dump and you would have shed to settle in the new dose, and bounce to clear, so the next couple days showed maybe a dose of less than 2u was not quite enough, but without numbers in mid cycle we can’t know.
On 4/12 and 4/13, you have ps numbers of 409/410 and 410/359. You may think all is staying high and want to raise the dose, but you can’t base dosing on the ps numbers. Just look at 4/13 pmps 359 and you got a drop to 184 by +5, so with no other pm cycle numbers, you have to guess the numbers were lower because the 4/14 amps was 573. I am not clear why you increased the dose at that time, just for one cycle.
With frequent dose adjustments, you are going to see strange numbers as dose is settling, draining or filling, and fast changes are not helpful for smooth numbers.
On 4/15, you see a drop from amps of 431 to 175 at +5... big drop, and then back up to pmps of 471 followed by more bouncing.
I think I’d try the 2u dose and leave it for at least 3 days, no fat or skinny 2’s, just the same dose and let it settle.
For feeding, with those big drops in the front of the cycles, I would think you will get much better results by feeding hourly in the front half of the cycle and make the portions smaller. Instead of feeding at ps and +4, divide those 2 meal amounts into 5 portions.... you want to have slow, small and steady flow of foods to try and slow down the big drops.
Without seeing what’s going on in the middle of many cycles, it’s hard to say what to do as much is going to be based on assumptions, but I you try a lower dose and stick with it, then once the bounce stops, you can see where you need to go.
Lori, I may not know alot but here’s what I see in the numbers on your ss.
Since start of April, the dose 2.5u looks too high.
End of March, you were bounces, like 3/29 with amps 413 and +6 133, then back up 301 for pmps. Then on 3/30, amps was 366 and +10 was only 164, so what happened in the earlier part of the cycle, plus pmps was up to 443 – a jump in less than 2 hrs... I think, whoa what happened there? And the bounce began. On 3/31, the am cycle was pretty much a write off, clearing through the bounce, but in the pm cycle, you were down to blue with a +5 167, so without any further tests in the pm, I would have to guess that you got some much lower numbers because the amps for 4/1 was 401... something happened to get that high by morn. Again, you have a write off cycle till that bounce clears, and also no tests for that pm cycle, so we are guessing again for 4/2 numbers. On 4/2, you start the day with an increase from 2.25u to 2.5u on the amps of 308. I am not sure why the increase, but you can pretty much know what more insulin is going to do.... make bigger bounces. And that is exactly what happened.
If you look at 4/2, amps is 308, you increase by .25u. Look at the numbers you have for that one cycle.... it is straight down – 308 283 250 229. When I see a steady drop like that I think the drop is going to continue, but till when? And sure enough by +4 you dropped from 229 pmps to 99 at +4.5 and no tests after that 99. Again you can pretty much guess what happened overnite because the morn delivered 4/3 amps 306 and still rising with a 400 at +4. The cycle finished off with a nice high of 433 and by +4 again you had dropped to 210. Another straight line down from pmps 433 to amps 176. At this point, after 3 cycles of 2.5u as a dose, I think I would have said, back we go to 2.25u because that bounce is worse than on 2.25u. Of course, on 4/4 amps was 176 and that cycle was another straight up to pmps of 331.
On 4/6, you have amps 426 and pmps 406 with nothing in the middle for numbers BUT guessing how the past few days have gone and then how you dropped from the 406 down to 73 at +5 and feeding HC did not bring up the number by +7 which had dropped more down to 60, I would have pulled back for sure which is what you did but by only a drop?
By 4/10, on the 2.35u dose, pmps was 373 and dropped to green 90 at +5 and stayed green for most of that cycle including that 33 at +7.5. For sure, I would have dropped the dose, which you did and that is good. You would have had some shed to dump and you would have shed to settle in the new dose, and bounce to clear, so the next couple days showed maybe a dose of less than 2u was not quite enough, but without numbers in mid cycle we can’t know.
On 4/12 and 4/13, you have ps numbers of 409/410 and 410/359. You may think all is staying high and want to raise the dose, but you can’t base dosing on the ps numbers. Just look at 4/13 pmps 359 and you got a drop to 184 by +5, so with no other pm cycle numbers, you have to guess the numbers were lower because the 4/14 amps was 573. I am not clear why you increased the dose at that time, just for one cycle.
With frequent dose adjustments, you are going to see strange numbers as dose is settling, draining or filling, and fast changes are not helpful for smooth numbers.
On 4/15, you see a drop from amps of 431 to 175 at +5... big drop, and then back up to pmps of 471 followed by more bouncing.
I think I’d try the 2u dose and leave it for at least 3 days, no fat or skinny 2’s, just the same dose and let it settle.
For feeding, with those big drops in the front of the cycles, I would think you will get much better results by feeding hourly in the front half of the cycle and make the portions smaller. Instead of feeding at ps and +4, divide those 2 meal amounts into 5 portions.... you want to have slow, small and steady flow of foods to try and slow down the big drops.
Without seeing what’s going on in the middle of many cycles, it’s hard to say what to do as much is going to be based on assumptions, but I you try a lower dose and stick with it, then once the bounce stops, you can see where you need to go.
PeterDevonMocha
Member Since 2009
Re: 4/18 Gizzy AMPS 400 Dosing Question
Hi guys .. no dosing advice from me, but fingers and paws crossed here that gizzy decides to come down for you .. have a great day!
Hi guys .. no dosing advice from me, but fingers and paws crossed here that gizzy decides to come down for you .. have a great day!
julie & punkin (ga)
Member Since 2011
Re: 4/18 Gizzy AMPS 400 Dosing Question
hi lori! hey, i can see why you don't know what to do. gizzy's kinda all over the place.
i can't tell from your ss - why are you giving Bupe? your notes say that everything was normal, but i'm wondering if the bupe is responsible for the random greens on the 10th & the blues in the past week. are you dosing bupe am/pm or just pm?
it does look like there was a bounce from the blue on the 13th pm cycle and another one from 15th am cycle. 72 hours for the one on the 15th to clear would be today.
hi lori! hey, i can see why you don't know what to do. gizzy's kinda all over the place.
i can't tell from your ss - why are you giving Bupe? your notes say that everything was normal, but i'm wondering if the bupe is responsible for the random greens on the 10th & the blues in the past week. are you dosing bupe am/pm or just pm?
it does look like there was a bounce from the blue on the 13th pm cycle and another one from 15th am cycle. 72 hours for the one on the 15th to clear would be today.
pistull
Member Since 2011
There is no doubt in my mind that the wonky #'s are from 2 things:
1. He needs a dental. I had the dentist look at him and he said he definitely suspects something going on in his mouth. Everything else checks out so the lip smacking, frequent yawning and marking would concur with that.
2. He has joint pain from arthritis and severe neuropathy. He is starting acupuncture on Friday to try and relieve some of the pain.
I have stopped buprenex a week ago - just gets him wired (was giving it to take the edge off the joint pain)
If I do see some results with the acupuncture to relieve pain, then I will schedule the dental. My question is with fasting before anesthesia and no shot in the morning....what the heck is going to happen to these already high #'s??? Scares the hell out of me to put him under, but without it I have a feeling the #'s will never regulate. If the #'s don't regulate, then the neuropathy will never have a chance to get better, etc. It's a VICIOUS cycle. Truly the dental is the only thing left that we haven't checked. I'm trying to have faith that it will solve all of Gizzy's issues....but I know it will get worse before it gets better.
So the consensuses is to drop him to 2u tonight? Correct??
Poor Gizzy. This is making me sick to my stomach watching him go thru this.
1. He needs a dental. I had the dentist look at him and he said he definitely suspects something going on in his mouth. Everything else checks out so the lip smacking, frequent yawning and marking would concur with that.
2. He has joint pain from arthritis and severe neuropathy. He is starting acupuncture on Friday to try and relieve some of the pain.
I have stopped buprenex a week ago - just gets him wired (was giving it to take the edge off the joint pain)
If I do see some results with the acupuncture to relieve pain, then I will schedule the dental. My question is with fasting before anesthesia and no shot in the morning....what the heck is going to happen to these already high #'s??? Scares the hell out of me to put him under, but without it I have a feeling the #'s will never regulate. If the #'s don't regulate, then the neuropathy will never have a chance to get better, etc. It's a VICIOUS cycle. Truly the dental is the only thing left that we haven't checked. I'm trying to have faith that it will solve all of Gizzy's issues....but I know it will get worse before it gets better.
So the consensuses is to drop him to 2u tonight? Correct??
Poor Gizzy. This is making me sick to my stomach watching him go thru this.
julie & punkin (ga)
Member Since 2011
you just divide however much you were going to give in that cycle up into multiple small portions an hour or so apart. most people feed between the shot and 3-4ish hours later. repeat again in the evening.
you don't change the amount you're feeding, you just divide it up.
i suspect you're going to see a lot of improvement after the dental. you don't really have to worry about high numbers with the dental - you're not going to feed that morning, so no carbs going in, and anesthesia tends to lower their numbers. punkin's had several anesthesias and that's the same process - the numbers haven't been a problem.
we've had great success with improvement in punkin's mobility with the acupuncture. took him once a week for a month, then backed off to every other week. we tried to go to once a month but it didn't "hold" so i'm back to taking him every other week again.
you don't change the amount you're feeding, you just divide it up.
i suspect you're going to see a lot of improvement after the dental. you don't really have to worry about high numbers with the dental - you're not going to feed that morning, so no carbs going in, and anesthesia tends to lower their numbers. punkin's had several anesthesias and that's the same process - the numbers haven't been a problem.
we've had great success with improvement in punkin's mobility with the acupuncture. took him once a week for a month, then backed off to every other week. we tried to go to once a month but it didn't "hold" so i'm back to taking him every other week again.
Harley and Pattie
Member Since 2010
So, what was Gizzy's AMPS today. Waiting to hear.
pattie
pattie
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