4/5 Merlin AMPS 505

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Merlin

Merlin

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I was sure hoping for a lower number this am. I will plan to go .08 this am according to the plan. 505 is lower than yesterday morning and according to the data, if I keep with the plan, it should keep on going down each am and pm. Hopefully I can get a ketone test in today.

4/5
AlphaTrak2
AMPS - 505; .8
 
Well, darn on that AMPS.

The good thing is, it looks like Merlin "clears" those high pre-shot numbers pretty easily. To my eye, he looks like a bouncy little boy. There's a couple different "schools" of thought on "bouncing." Basically, you can try to back off the dose which results in a less drastic swing from pre-shot to nadir, and theoretically, less bouncing. The downside is, of course, that kitty spends more time in numbers that are above renal threshold (approx. 250 or so).

The other approach is the "liver training" approach. Basically, you keep aiming for good numbers at nadir regardless of the bouncing, and eventually, kitty's body adjusts to those lower healthy numbers and stops panicking and you get a flatter overall cycle with less bouncing. Some cats "get with the program" fairly quickly, and others bounce and bounce and bounce, until they don't.

Generally speaking, I think most people follow the "liver training" approach, but there are definitely some kitties that do respond better to backing off the dose and taking them down more gradually. One of those pesky every-cat-is-different things. :-D

How is Merlin feeling overall?
 
Interesting on the bouncing effect. Also didn't know that I was doing the "liver training." I will have to read up more on those subjects. I don't completely understand the bouncing part but can definitely see he is doing it i.e going way up around shot time and then going down, correct? I went ahead and gave him .8 this morning. I think that just before I messed up on the fur shot and him eating a few dog food kibbles all in 24 hours, he was going in a good direction. Maybe with him it will take a little longer to get back to where he was. What did you mean that he "clears" his bounce numbers pretty good? At what point do I consider the other alternative that you mentioned like reducing his dose down?

Here are some things that I have noticed "huge" improvements on:
* his coat is much more soft and not so rough and greasy
* he is much more alert
* purring more
* Merlin is a talker and he is talking quite a bit more

Here are some things that I have noticed "minimal" improvements on:
* his gait seems to be a little stronger (neuropathy) and he doesn't seem to be as weak (been taking Methyl B12 since 3/16)
* he jumps with more confidence
* he is sleeping better i.e. he stretches out and is more comfortable
* doesn't drink as much; mostly after each meal
* is moving around the house more i.e. come out the family room with us

So I think overall and especially since I got on this forum and with your advice, in a short time, I have seen some improvements.

Oh, one more thing, should I be testing his BG at any specific intervals that would be helpful to know today?

Thanks, Cindi
 
That's a wonderful "Whole Cat Report" Cindi. :-D Often times, we see big improvements in the clinical symptoms before the BG levels look really good.

"Clearing" a bounce basically means that the steep spike in BG due to the release of glucose comes down quickly. A cat can also release counter-regulatory hormones that cause temporary insulin resistance, meaning that as a self-protective measure (either "legit" self-protection due to a number that's too low, or "panicking" due to healthy numbers that they simply aren't used to), those hormones prevent the insulin from really lowering the BG. This can look like high numbers that hang around for a few hours and don't seem to budge downwards even with insulin, or the bounces can even last for a whole cycle, where the numbers are high and flat despite insulin. My guy Eddie would have both high pre-shot "bounces" and high flat cycles that were bounces. "Liver training" as used around here, basically just refers to "aiming" for good numbers at nadir and ignoring the bounces, with the idea that eventually the kitty gets used to those healthy numbers and stops bouncing. If the bounce is due to a number that's too low, you will want to reduce, but if you follow the "liver training" school of thought, you don't reduce simply because kitty is bouncing. That said, there's no hard and fast rule here. :-D

Particularly since Merlin is on such a small dose, you can certainly experiment with continuing to shoot for nadirs that are in the healthy range, despite his bouncing, and see if his bounces will settle down, or you could experiment with a decrease and see if his pre-shots come down a bit. There's not a specific time frame to try one approach or another. With ProZinc the nice thing is, you can tweak as needed. :-D

It's totally up to you if you'd like to try a reduction experiment. With my guy Eddie, I generally followed the "liver training" approach, but experimented a couple times with trying to back off the dose a bit with varying degrees of success. Merlin is getting nice nadirs with the current scale you're shooting, but if he continues to bounce and bounce and bounce, you might want to consider backing off a bit. What are you thinking?
 
Thanks for such a great explanation. What I think at this point is to continue to shoot for the nadirs. His numbers for AMPS from 3/31 to 4/3 was nicely coming down (since we reset). Even his PMPS was improving during that time. I am hoping that if I keep on the course of shooting towards the nadirs that we will see the pre-shot numbers decrease. Even from yesterday to today there was some increase. It seems that Merlin isn't one to do anything too quickly, unfortunately. As along as I see improvements, I think I'm going to stay the course of "liver training." If there is not improvement, then I will make a change.

Any suggestion, for awhile, at what intervals I should test? I always like to test at least once either at +5, +6 or +7. I still really don't know when he bottoms out. I think it is at +5. But in the meantime, any suggestions until we see better numbers?
 
In terms of testing, often times a test at +2 or +3 will give you an idea whether Merlin is going to have a fast drop, anywhere between +4 and +7 will usually be around the nadir (this can vary quite a bit, even from one cycle to the next). Sometimes, even grabbing a test a little later in the cycle, around +10 or so, can give you an idea as to how fast he's going up towards the end of the cycle. I personally don't think there's any such thing as too much testing, since the more data, the better, right? :lol: That said, varying the times you test from cycle to cycle will also help fill in some of those puzzle pieces. Generally speaking, the tests between roughly +3 to +7 or so will probably give you the most info. What I have done with Eddie at times to try to see when his nadir is happening since he was all over the place, was to start testing hourly at +4 until he started to rise again so I could nail down pretty closely when his nadir occurred.

You can also let the numbers sort of be your guide as to how frequently you test. As you start to get a feel for Merlin's patterns, if you spot a lower number than normal earlier in the cycle, you'll probably want to test more often. If it looks like he's sitting fairly high and flat, you can perhaps poke a little less frequently. If it looks like the cycle is going "fast," i.e., big downward jumps from test to test, you may want to test more frequently, or if it's slower, just small movement from one test to the next, you may want to space those tests out a bit. Does that make sense?

This also of course depends on your schedule. :-D A test or two mid-cycle for each cycle usually will give you enough data to get a feel for what is happening during a cycle.
 
Gracie seems to nadir at +5.5, almost exactly; you might try checking +5, +5.5, and +6 to see if that might be true of Merlin.

Also, it is possible to freeze the heading rows of your spreadsheet, if you want. That'll make them visible even as you scroll down the page. Log in to drive. highlight the top rows you want to freeze, then click on View, Freeze Rows, and select the number of rows you want to freeze.
 
4/5
AlphaTrak2
AMPS - 505; .8
+3 - 443

I will try to get a test almost every hour today up to +7 or more - depends.
 
Looks like he's coming down a little more slowly - could be those "bouncy" hormones that are slowing him down a bit. With Eddie, what I noticed, is that when the "onset" of the insulin seemed to be a little slow, he tended to have a longer, more stretched out cycle. It will be interesting to see if Merlin's cycle is a bit longer and smoother today.
 
Looks like he is still headed down, so maybe he's going to stretch this cycle out for you a bit.
 
4/5
AlphaTrak2
AMPS - 505; .8
+3 - 443
+4 - 397
+5 - 331
+6 - 276
+7 - 303

I guess I don't have to poke him anymore until PMPS. I am wondering if I shouldn't give him 1U? Not sure if he has allergies or a cold coming on. He has a runny nose and is sneezing. He had a really bad cold about 3 months ago and doxycycline cleared it up. I wonder if this cold or allergies has anything to do with his higher numbers?
 
4/5
AlphaTrak2
AMPS - 505; .8
+3 - 443
+4 - 397
+5 - 331
+6 - 276
+7 - 303
PMPS - 343

Well that number really threw me. It was like you guessed that he may have a long, drawn out cycle. I am so confused but even though the numbers are bad, I expected them to be worse. So I guess a .6 would be in order for tonight.
 
That looks like a clearing bounce to me...more or less straight down from AM to PM. If he were mine I'd lean towards a smaller dose, like the 0.6. If he's cleared, it may be an active cycle, so you might want to get a before-bed test at +2 or +3 just to ensure that he's not dropping too fast.
 
4/5
AlphaTrak2
AMPS - 505; .8
+3 - 443
+4 - 397
+5 - 331
+6 - 276
+7 - 303
PMPS - 343
+3 - 179
 
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