4/26 Pumbaa AMPS/388 +3/345 +6/321

[Pumbaa]

No ketones when I tested him yesterday afternoon. Yea!!!

Pumbaa was racing around the house and tearing across the bed and generally acting like a kitten again this morning. Yea!!!!

Last night, when I went to inject him (while his face was buried in the food dish), just as I was starting to depress the plunger, Beck (the drooler) let out very loud bark right next to me, causing me to jump and the needle to pull out before the full dose went it. <--*insert the "F" word several times here* There was a tiny damp spot on Pumbaa's skin (I had shaved two injection areas to make it easier for me to see), but at least he got some of the dose. I swear, I have more of a chance winning the lottery than having Beck bark again, right at the instant! :roll:

I'm encouraged by Pumbaa's slowly dropping numbers. Maybe there is a reason I shouldn't be encouraged, but I am. He hasn't had a red since yesterday's AMPS, and no blacks since 4/21. That is encouraging, in itself.

Still waiting to hear back from Trader Joe's about the carb content of their Tuna for Cats, since the last ingredient listed is "rice flower...as a carrier".

 

[PeterDevonMocha]

Re: 4/26 Pumbaa AMPS/388

Hi guys ... bummer on the barking at the right exact moment, but yay on negative ketones, yay on a happy energetic kitty and yay on lowering numbers! All things to be thankful for! Have a great day guys!

 

[Blue]

Re: 4/26 Pumbaa AMPS/388

No ketones when I tested him yesterday afternoon. Yea!!!

Pumbaa was racing around the house and tearing across the bed and generally acting like a kitten again this morning. Yea!!!!

Last night, when I went to inject him (while his face was buried in the food dish), just as I was starting to depress the plunger, Beck (the drooler) let out very loud bark right next to me, causing me to jump and the needle to pull out before the full dose went it. <--*insert the "F" word several times here* There was a tiny damp spot on Pumbaa's skin (I had shaved two injection areas to make it easier for me to see), but at least he got some of the dose. I swear, I have more of a chance winning the lottery than having Beck bark again, right at the instant! :roll:

I'm encouraged by Pumbaa's slowly dropping numbers. Maybe there is a reason I shouldn't be encouraged, but I am. He hasn't had a red since yesterday's AMPS, and no blacks since 4/21. That is encouraging, in itself.

Still waiting to hear back from Trader Joe's about the carb content of their Tuna for Cats, since the last ingredient listed is "rice flower...as a carrier".

Well, it sounds like you and Pumbaa are making great progress! Sure, some may say wow 388 is high, BUT you know that you are looking at some gruesomely higher numbers not too long ago, plus you have a happy and energetic Pumbaa back. Slowly but surely, you will get those numbers down.

About the sounds startling him when you are giving shots, maybe you can try to hold him a bit more securely, say have your thigh against his side for holding more in case he moves or change so that the inside of your forearm is against his side when scruffing, and the syringe holding hand can rest the forearm against the side of his body.... I know the fur shots cause us grief but over time, we each learn how best to hold our cats so that odds of successful shots increase. When we are securely resting on the cat or our own self, there are less chances of pulling out the needle.... once you find a way to keep your own arms and hands stationary, you should have no more of the fur shots.

Pats for Pumbaa, that is if he stops tearing around the place long enough to pat!

 

[Pumbaa]

Re: 4/26 Pumbaa AMPS/388

Gayle: It wasn't Pumbaa that jumped last night when Beck barked, it was me! *LOL* Wanna come over and hold me steady while I inject? Hahahahaha!

Pumbaa was being a wiggle-butt when I was feeding him and trying to inject him on the cat feeding table, so I now let him eat on the kitchen counter when it's injection time, because he doesn't have any room to wiggle and dance around to avoid me up there. It seems to be working. And this morning, I made sure Beck was outside during our injection routine.

 

[julie & punkin (ga)]

Re: 4/26 Pumbaa AMPS/388

suze, i read the rest of your condo from yesterday and this morning - i want to clarify something for you. the protocol is data-driven. yes, every cat is different, but in following the protocol, the numbers tell us what to do. it's not feelings, it's fact. does that make sense? that means that yes, unless you learn by data that you need to increase or decrease by less than .25u or .5u (which dose change one uses is based upon data), then you increase or decrease by those quarter or half units, based upon following the protocol. "Know your own cat" is not the same as trying to know how your cat is feeling - know what i mean? it means knowing how your cat responds to insulin, based upon the data you gather following the protocol.

There is only one published Tight Regulation Protocol, so i'm not sure what other ones you are referring to. It's in the link here. You'll see 3 versions of it, but it's basically the same. the Rand/Roomp Protocol, published in the Journal of Feline Medicine, and the Tilly Protocol are slightly different wordings, based on the same study. the General Guidelines, which i'm quoting below, is based upon those with some suggestions based upon experience of the thousands of cats who have come through here.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
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.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.

You are in the increasing the dose phase - so you would hold the dose for the number of cycles indicated above based upon the low points in the cycles since a dose was changed. a fur shot resets the count. that happens to everyone and we don't worry about it. so start counting cycles with tonight's shot and after 6 consecutive cycles at .75, then look at the nadirs and see if you should increase or not. if a cat goes below 50, that calls for a decrease and starting counting again.

we don't worry about individually high numbers - we're looking at overall cycles and trends. lantus is slower acting (think timed release) and we just have to be patient while it does its thing.

sounds like you've got a new plan for shooting - awesome. just keep asking questions & we'll try to teach you what you need to know to help pumbaa.

 

[Pumbaa]

Re: 4/26 Pumbaa AMPS/388

suze, i read the rest of your condo from yesterday and this morning - i want to clarify something for you. the protocol is data-driven. yes, every cat is different, but in following the protocol, the numbers tell us what to do. it's not feelings, it's fact. does that make sense? that means that yes, unless you learn by data that you need to increase or decrease by less than .25u or .5u (which dose change one uses is based upon data), then you increase or decrease by those quarter or half units, based upon following the protocol. "Know your own cat" is not the same as trying to know how your cat is feeling - know what i mean? it means knowing how your cat responds to insulin, based upon the data you gather following the protocol.

Julie, thank you, and yes, that is why I am trying hard to learn how to interpret the data. Especially from Pumbaa's past history, to learn how he is responding to the insulin. What is difficult is that the same data can be interpreted different ways. I'm trying to learn how to interpret it based on how Pumbaa responds, not how other cats respond.

There is only one published Tight Regulation Protocol, so i'm not sure what other ones you are referring to.

They were all versions of the above, worded differently. I didn't bookmark them all, but I was reading up when people were suggesting I start following the tight regulation protocol.

"General" Guidelines:

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
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.

The above is what I was referring to. The above says 3-5 days, Tilly's states 5-10 days, and many people here seem to use a flat 3 days as the cutoff.

I now understand that a fur shot resets the count, but I've also been told that you never increase the dose based on data until a bounce has cleared, which can take 72 hours. And since I've been given different interpretations of what constitutes a bounce, there is part of my confusion. I still consider that 400 reading on 4/16 as a bounce, coming off the 288 reading, and probably should not have increased Pumbaa the next day. Also, he got a partial fur shot a.m. 4/21, and I should not have increased his dose on 4/23.

sounds like you've got a new plan for shooting - awesome. just keep asking questions & we'll try to teach you what you need to know to help pumbaa.

Thank you, and hopefully I can maintain the stable yet dropping numbers, and get Pumbaa off this roller coaster, other than an occasional bounce.

 

[julie & punkin (ga)]

Re: 4/26 Pumbaa AMPS/388

what most new people do is look at their cat's ss, look at the protocol dosing guidelines, think about what they *think* will be the answer, and then post asking for dose advice before they make a dose change. then you've got experienced eyes giving you the interpretation and people will tell you what they are seeing so you can learn it. that way you're not changing a dose and then having people tell you that it wasn't time yet.

it took me a full 6 months to be able to see a bounce - i don't know if i was a slow learner, or what, but it did take me a long time! :lol:

the difference between holding 6-10 cycles is based upon the numbers. so if you have nadirs consistently of 180-190ish, we likely would suggest an increase after 6 cycles. if you're seeing nadirs of 100, we're going to suggest you wait the full 10 cycles.

does that make sense?

 

[Pumbaa]

Re: 4/26 Pumbaa AMPS/388

what most new people do is look at their cat's ss, look at the protocol dosing guidelines, think about what they *think* will be the answer, and then post asking for dose advice before they make a dose change. then you've got experienced eyes giving you the interpretation and people will tell you what they are seeing so you can learn it. that way you're not changing a dose and then having people tell you that it wasn't time yet.

The funny part is that I've been encouraged/nudged into doing dose changes when I wasn't comfortable doing it yet/wanting to be more patient, only to find out later that I should have waited. That's the problem...everyone interprets things differently.

it took me a full 6 months to be able to see a bounce - i don't know if i was a slow learner, or what, but it did take me a long time! :lol:

So do you think 4/16 was a bounce or not a bounce, and why? I'm interested in your interpretation. Truly! That's the only way I'm going to learn.

the difference between holding 6-10 cycles is based upon the numbers. so if you have nadirs consistently of 180-190ish, we likely would suggest an increase after 6 cycles. if you're seeing nadirs of 100, we're going to suggest you wait the full 10 cycles.

does that make sense?

Yes. But what about waiting for a bounce to clear? Does that affect when a dose increase would take place? And is the nadir for the cycle always the lowest point on the curve (as per the definition of "nadir"), or is it assumed to be the number that appeared at the +6 point? Yesterday, Pumbaa's lowest reading was at his PMPS and was within +/- 20% of his +5 reading, but not his +6 reading.

Julie, thank you for your patience with all of my questions!

 

[julie & punkin (ga)]

marje was the one who said she saw a strong bounce in there - i would definitely say there is a bounce from the 140 on the night of 4/18 to the 522 the next morning.

maybe another one the night of 4/12 182 to the next morning's 452.

*might* be a small one on 4/20 from the 200 to the pmps of 575.

i'm not the expert on this though - there are others better at it than me, and i would defer to them on reading it. Libby has said that some cats have a delayed bounce response - so the bounce doesn't show up for a day after the event that triggered it. i haven't been able to see that yet on anyone's ss.

what his spreadsheet looks like to me is overall not enough insulin. i'll see if someone who is better at reading it can take a look.

 

[Libby and Lucy]

Hi Suze! I don't think I have said hello to you yet. Haven't been around much the past few weeks.

First, hooray for no ketones and for the great WCR (Whole Cat Report). Good news! Keep up the ketone testing, especially since you reduced his dose.

A few things I wanted to address:

Julie said:

we don't worry about individually high numbers - we're looking at overall cycles and trends. lantus is slower acting (think timed release) and we just have to be patient while it does its thing.

This is sooooooooooooooooooooooo important! Pumbaa has been on Lantus for about 2 weeks. He is doing FINE. :thumbup

You said:

The above is what I was referring to. The above says 3-5 days, Tilly's states 5-10 days, and many people here seem to use a flat 3 days as the cutoff.

Very true. We encourage a slightly modified version of the German Tight Regulation Protocol here. The sticky gives our modifications. Essentially, we hold doses for at least 3 days when the numbers are higher. Once the cat starts seeing blue numbers, we slow down to 10 cycles, or even more depending on the cat. There are also some situations where we will encourage moving faster. You'll see in the protocol that if cats are running high/flat, increases can be done in 24-48 hours. Since you decreased his dose, I would hold the 0.75u BID dose at least through tomorrow's daytime cycle. If he is still running high/flat, you might consider going ahead and doing the next increase then. Wait and see what the numbers are, though.

You asked about bouncing, but I don't think Pumbaa is bouncing. I think he just hasn't hit his good dose yet (not surprising, since he has been on Lantus for such a short time!). You're testing a lot and I am confident that you have not missed any significant lows. What we usually see with Lantus kitties is that their numbers don't do much of anything. You raise the dose, raise it again, keep raising it and the numbers look the same or worse. Then one day they all of a sudden hit the right dose and BAM! There's a green number out of nowhere. Then usually lots more green numbers, and they usually start earning dose reductions shortly after. There are a few cats that will show a response immediately, but most do it all of a sudden. Hang in there!

 

[Pumbaa]

Julie, I guess it's going to take me forever to figure out what constitutes a bounce via the numbers. *sigh*

Yes, on the not enough insulin yet, but we're going low and slow and trying to prevent those huge differences in numbers now. Hope that helps the little guy feel better than he has been.

 

[Pumbaa]

Hi Suze! I don't think I have said hello to you yet. Haven't been around much the past few weeks.


You asked about bouncing, but I don't think Pumbaa is bouncing. I think he just hasn't hit his good dose yet (not surprising, since he has been on Lantus for such a short time!). You're testing a lot and I am confident that you have not missed any significant lows. What we usually see with Lantus kitties is that their numbers don't do much of anything. You raise the dose, raise it again, keep raising it and the numbers look the same or worse. Then one day they all of a sudden hit the right dose and BAM! There's a green number out of nowhere. Then usually lots more green numbers, and they usually start earning dose reductions shortly after. There are a few cats that will show a response immediately, but most do it all of a sudden. Hang in there!

Hi Libby!

Thank you for the "hang in there"!

So what Pumbaa was going through (numbers going up, up, up, into the blacks) was normal and I shouldn't have been as worried as I was? ohmygod_smile I've looked at sooooooo many spreadsheets to compare and see what is "normal" (even though I know ECID) and only saw a few that were exhibiting the same trend that Pumbaa was going through. That's why those 500's scared me. That and how Pumbaa was acting as the numbers continued to climb.

Well, hopefully, now, by going low and slow, his high numbers won't get so high while we hunt for his purrfect dose! (From my keyboard to God's ear!)