5/14 Merlin AMPS 501,+5/60,+6/50,+8/190, PMPS 394,+4/356
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Sue and Oliver (GA)
Very Active Member
Re: 5/14 Merlin AMPS 501
Hoping today is a great day, Cindi.
Hoping today is a great day, Cindi.
Merlin
Very Active Member
Re: 5/14 Merlin AMPS 501
Well - isn't this the biggest bounce you have ever seen? Anyway, I had to run errands all day today and I thought this would be a good time for my husband to test on his own. Since we got such a high number this am (501), all I could hope for was probably a 200 nadir today???? Wrong, wrong, wrong. I asked him to test at +5 and when he called me and said that Merlin was at 60...I couldn't believe it. So asked him to feed Merlin a little LC food and test him in 30 minutes. He tested in about 30 minutes and it was 50. So asked him again to feed him a little more LC food with a little freeze dried chicken and test again in 30 minutes. So after 30 minutes, he tried to get enough blood and after four tries, he and Merlin was done. I figured since it was at 6-6 1/2 hours by that time, that we were probably in the clear. Once I got home, I took and it and he had already jumped to 190. I sure hope he slows down. You would think that 1.4u would be good for 501 which I guess it was. Nice to get down that low for a change. Anyway, that was a good test for my hubby today. Tomorrow I leave for the airport around 4am so hopefully he can get a shot in before I board the plane.
My questions are;
1) Did he bounce because he didn't get any insulin last night (due to a fur shot) and this was a shock to his system getting the 1.4u?
2) Or did he have some insulin still in him and 1.4u just added to it?
3) Do you think 1.4u was a correct dose or should it have been different?
Well - isn't this the biggest bounce you have ever seen? Anyway, I had to run errands all day today and I thought this would be a good time for my husband to test on his own. Since we got such a high number this am (501), all I could hope for was probably a 200 nadir today???? Wrong, wrong, wrong. I asked him to test at +5 and when he called me and said that Merlin was at 60...I couldn't believe it. So asked him to feed Merlin a little LC food and test him in 30 minutes. He tested in about 30 minutes and it was 50. So asked him again to feed him a little more LC food with a little freeze dried chicken and test again in 30 minutes. So after 30 minutes, he tried to get enough blood and after four tries, he and Merlin was done. I figured since it was at 6-6 1/2 hours by that time, that we were probably in the clear. Once I got home, I took and it and he had already jumped to 190. I sure hope he slows down. You would think that 1.4u would be good for 501 which I guess it was. Nice to get down that low for a change. Anyway, that was a good test for my hubby today. Tomorrow I leave for the airport around 4am so hopefully he can get a shot in before I board the plane.
My questions are;
1) Did he bounce because he didn't get any insulin last night (due to a fur shot) and this was a shock to his system getting the 1.4u?
2) Or did he have some insulin still in him and 1.4u just added to it?
3) Do you think 1.4u was a correct dose or should it have been different?
Jen&Eddie
Very Active Member
Re: 5/14 Merlin AMPS 501,+5/60,+6/50,+8/190
Wow that's a heck of a drop. Merlin's interesting in that the insulin drops him right off those high pre-shot numbers.
Here's what I ultimately concluded with Eddie and after studying everything about how insulin works that I could get my hands on (take this with a grain of salt as I'm certainly not a vet, a scientist or a medical expert). If you take a look at his SS, you see a lot of flat cycles. He's pretty much the poster child for what a flat bounce cycle looks like. He did it ALL.THE.TIME on ProZinc, and he still does it on Lantus.
Basically, there's two kinds of bouncing. There's the release of glucose from the liver, and that's the big spikes you see at the end of a cycle and high pre-shot numbers. These high spikes don't stick around for long and the insulin brings the kitty down from those huge spikes. Merlin is a pro at those huge glucose spikes. For whatever reason, this type of bounce seems to be the more common type in ProZinc kitties - at least the ones that are actively posting.
Then, there's also bounces that are due to the counter-regulatory hormones. Basically, rather than the release of glucose, the body releases other hormones that make the cat temporary insulin resistant. This can last for a few hours where the insulin doesn't seem to be onsetting, or there's a late onset, or it can last a full cycle, which is a flat cycle that doesn't really budge. Those hormones can stick around for up to 72 hours. Take a look at Eddie's SS starting on the PM cycle of 3/30. You can see he had a crazy low cycle that night and I fought for hours to keep him up in safe numbers. The next three cycles, he was flat yellow and the insulin didn't budge him. That's those hormones at work, and that's what a flat bounce cycle looks like. Then, on the 4/1 PM cycle, the counter-regulatory hormones finally started to clear out, and he had a good cycle that night with a late onset and late nadir. There were likely still some of those hormones hanging around early in the PM cycle, so that's why you see a late onet, and a late nadir. After that, Eddie proceeded to bounce in mostly flat yellow for a full six cycles after that. If there's insulin the in the cat's system that is active, but counter-regulatory hormones are preventing it from being absorbed by the glucose receptor cells, that active insulin can all of a sudden kick in when those counter-regulator hormones all of a sudden clear out and you can end up with an unexpectedly active cycle or an unexpectedly large drop.
If I had to guess, that's what I'd say happened. Merlin was clearing a bounce and the insulin hit fast and hard.
I think that Merlin is doing both kinds of bouncing. He's getting the wild glucose spikes, which don't persist for long (thankfully), and he also has some cycles that it looks like the insulin doesn't do anything. In my humble opinion, over time, it seems like a sliding scale may not be necessary with Merlin. No matter the dose, those spiky pre-shot numbers are usually coming down. I guess, I might continue doing what you're doing with a consistent dose - maybe the 1.2u. The tough part is that the huge drops when he's coming down from a big pre-shot number just set him up for the next bounce - be it the release of glucose, causing another high pre-shot number, or be it the release of the counter-regulatory hormones, which result in a flat cycle. Since Merlin really isn't stuck in those high numbers, I wonder if the gentler, longer-duration L's might help with his swinging up and down. ProZinc is great at beating down those high numbers, but part of the reason I switched Eddie is because I decided it was just a little too harsh, and we got into a pattern of scary drops and fighting to keep Eddie in safe numbers followed by several yucky bounce cycles. With ProZinc, just to toss the idea out there, I'm thinking it's possible that he may do better backing off the dose to try to slow his bouncing down. If he's not blasting up before the end of the cycle, you may see a flatter pattern and better duration overall.
I hope others will chime in. :smile: Merlin's SS reminds me a lot of Eddie's. I hope we can help you figure something out.
Wow that's a heck of a drop. Merlin's interesting in that the insulin drops him right off those high pre-shot numbers.
Here's what I ultimately concluded with Eddie and after studying everything about how insulin works that I could get my hands on (take this with a grain of salt as I'm certainly not a vet, a scientist or a medical expert). If you take a look at his SS, you see a lot of flat cycles. He's pretty much the poster child for what a flat bounce cycle looks like. He did it ALL.THE.TIME on ProZinc, and he still does it on Lantus.
Basically, there's two kinds of bouncing. There's the release of glucose from the liver, and that's the big spikes you see at the end of a cycle and high pre-shot numbers. These high spikes don't stick around for long and the insulin brings the kitty down from those huge spikes. Merlin is a pro at those huge glucose spikes. For whatever reason, this type of bounce seems to be the more common type in ProZinc kitties - at least the ones that are actively posting.
Then, there's also bounces that are due to the counter-regulatory hormones. Basically, rather than the release of glucose, the body releases other hormones that make the cat temporary insulin resistant. This can last for a few hours where the insulin doesn't seem to be onsetting, or there's a late onset, or it can last a full cycle, which is a flat cycle that doesn't really budge. Those hormones can stick around for up to 72 hours. Take a look at Eddie's SS starting on the PM cycle of 3/30. You can see he had a crazy low cycle that night and I fought for hours to keep him up in safe numbers. The next three cycles, he was flat yellow and the insulin didn't budge him. That's those hormones at work, and that's what a flat bounce cycle looks like. Then, on the 4/1 PM cycle, the counter-regulatory hormones finally started to clear out, and he had a good cycle that night with a late onset and late nadir. There were likely still some of those hormones hanging around early in the PM cycle, so that's why you see a late onet, and a late nadir. After that, Eddie proceeded to bounce in mostly flat yellow for a full six cycles after that. If there's insulin the in the cat's system that is active, but counter-regulatory hormones are preventing it from being absorbed by the glucose receptor cells, that active insulin can all of a sudden kick in when those counter-regulator hormones all of a sudden clear out and you can end up with an unexpectedly active cycle or an unexpectedly large drop.
If I had to guess, that's what I'd say happened. Merlin was clearing a bounce and the insulin hit fast and hard.
I think that Merlin is doing both kinds of bouncing. He's getting the wild glucose spikes, which don't persist for long (thankfully), and he also has some cycles that it looks like the insulin doesn't do anything. In my humble opinion, over time, it seems like a sliding scale may not be necessary with Merlin. No matter the dose, those spiky pre-shot numbers are usually coming down. I guess, I might continue doing what you're doing with a consistent dose - maybe the 1.2u. The tough part is that the huge drops when he's coming down from a big pre-shot number just set him up for the next bounce - be it the release of glucose, causing another high pre-shot number, or be it the release of the counter-regulatory hormones, which result in a flat cycle. Since Merlin really isn't stuck in those high numbers, I wonder if the gentler, longer-duration L's might help with his swinging up and down. ProZinc is great at beating down those high numbers, but part of the reason I switched Eddie is because I decided it was just a little too harsh, and we got into a pattern of scary drops and fighting to keep Eddie in safe numbers followed by several yucky bounce cycles. With ProZinc, just to toss the idea out there, I'm thinking it's possible that he may do better backing off the dose to try to slow his bouncing down. If he's not blasting up before the end of the cycle, you may see a flatter pattern and better duration overall.
I hope others will chime in. :smile: Merlin's SS reminds me a lot of Eddie's. I hope we can help you figure something out.
Merlin
Very Active Member
Re: 5/14 Merlin AMPS 501,+5/60,+6/50,+8/190
Thanks Jen for that great explanation. I think I finally got it! His week that we went 1u (4/28-5/5) he was really consistent with 300's. Even though that is bad, it appears that it was more flatter with that consistent 1u dose at least at AM & PM pre-shot time. I am wondering what a 1.2u will do. I just need to get the pre-shot numbers lower. I wish I would have taken mid-cycle tests. I shoot myself for following the vet's instructions of not testing. Why, why, why? Oh well, under the bridge...never again.
So another question. You mentioned: With ProZinc, just to toss the idea out there, I'm thinking it's possible that he may do better backing off the dose to try to slow his bouncing down. If he's not blasting up before the end of the cycle, you may see a flatter pattern and better duration overall.
So based on the above, it sounds like I should try 1.2u but do you have another dose in mind?
Thanks Jen for that great explanation. I think I finally got it! His week that we went 1u (4/28-5/5) he was really consistent with 300's. Even though that is bad, it appears that it was more flatter with that consistent 1u dose at least at AM & PM pre-shot time. I am wondering what a 1.2u will do. I just need to get the pre-shot numbers lower. I wish I would have taken mid-cycle tests. I shoot myself for following the vet's instructions of not testing. Why, why, why? Oh well, under the bridge...never again.
So another question. You mentioned: With ProZinc, just to toss the idea out there, I'm thinking it's possible that he may do better backing off the dose to try to slow his bouncing down. If he's not blasting up before the end of the cycle, you may see a flatter pattern and better duration overall.
So based on the above, it sounds like I should try 1.2u but do you have another dose in mind?
Jen&Eddie
Very Active Member
Re: 5/14 Merlin AMPS 501,+5/60,+6/50,+8/190
An option might be to try the 1.2 for maybe 6 or so cycles to see what it's doing. That should give time to see what the dose does absent the effect of the counter-regulatory hormones. One other thing that you might think about doing is occasionally grabbing a test a little later in the cycle to see if he's having a later nadir on occasion. For example, if you catch something in the 100's at +6, maybe grab a +8 to see if he had a later nadir. If you catch a lower nadir earlier in the cycle, and see that he's on his way up, a later test to see if his nadir is late isn't probably necessary. That's probably about as clear as mud...
To give an example, during the AM cycles of 5/6 and 5/8, I wonder if Merlin had a later lower nadir after +8. It's not necessary all the time, but some of those cycles that sort of look like he's getting an OK, but not a great nadir at +6, once in a while, you might see if he's gone lower by +8. Just a thought. :smile:
If you're seeing decent nadirs, even if it's not every cycle (to account for bouncing) on the 1.2 you might try holding for a few more cycles, and then trying to go down to 1u for the next 6 cycles. If you see the same patterns, it will tell you that the lower dose is doing the same thing as the higher dose. If his numbers are worse, you can go right back up. If they are the same, or better, hold for several cycles, then maybe try lowering a bit again, and so on...This is fairly counter-intuitive, and is really specific to Merlin. The reason I toss this idea out there is looking back, at the beginning of April, when you first starting spotting some of those nadirs that were too low, a lot of the cycles look similar to what Merlin's doing now, even when you were shooting 3u or 2u. It's possible that the fast drops early in the cycle are causing Merlin to start to bounce before he even hits what would be a good nadir at a lower dose. By way of example, Merlin had a great green nadir on 0.8 units during the AM cycle of 4/27. He even had a decent cycle with a dose of 0.6u that night before the vetty appointment. 1.4 is close to double the amount of insulin, so about two weeks ago, he had a great nadir on roughly half the dose.
I do want to qualify everything I'm staying here by saying that the decision is yours as to whether to lower, increase, or hold the dose, and you're really doing a great job gathering data, so eventually, one way or another, you'll narrow down what is working and what isn't. It's possible (likey?
) that others may suggest the exact opposite of what I'm suggesting. I wish I had something more definitive to tell you.
Edited to add because I forgot this part: if you are able to hone in a dose that gets nice nadirs and hopefully less pre-shot bouncing, but it still isn't getting long enough duration, you might consider either TID or shooting as needed. Deb basically shoots as needed with Lucian and it varies for her between 8 hours and 12 hours. I did this with Eddie to an extent too...I had to stall with numbers that were too low to shoot pretty frequently, so we shot (as much as we could with our schedules,) once he was over 200 or close to it anywhere from 9 hours to 14 or more hours after his shot. I personally would be reluctant to suggest TID or shooting as needed just yet, to rule out a need for less insulin for Merlin first. But that's just my two cents on that topic.
An option might be to try the 1.2 for maybe 6 or so cycles to see what it's doing. That should give time to see what the dose does absent the effect of the counter-regulatory hormones. One other thing that you might think about doing is occasionally grabbing a test a little later in the cycle to see if he's having a later nadir on occasion. For example, if you catch something in the 100's at +6, maybe grab a +8 to see if he had a later nadir. If you catch a lower nadir earlier in the cycle, and see that he's on his way up, a later test to see if his nadir is late isn't probably necessary. That's probably about as clear as mud...
To give an example, during the AM cycles of 5/6 and 5/8, I wonder if Merlin had a later lower nadir after +8. It's not necessary all the time, but some of those cycles that sort of look like he's getting an OK, but not a great nadir at +6, once in a while, you might see if he's gone lower by +8. Just a thought. :smile:
If you're seeing decent nadirs, even if it's not every cycle (to account for bouncing) on the 1.2 you might try holding for a few more cycles, and then trying to go down to 1u for the next 6 cycles. If you see the same patterns, it will tell you that the lower dose is doing the same thing as the higher dose. If his numbers are worse, you can go right back up. If they are the same, or better, hold for several cycles, then maybe try lowering a bit again, and so on...This is fairly counter-intuitive, and is really specific to Merlin. The reason I toss this idea out there is looking back, at the beginning of April, when you first starting spotting some of those nadirs that were too low, a lot of the cycles look similar to what Merlin's doing now, even when you were shooting 3u or 2u. It's possible that the fast drops early in the cycle are causing Merlin to start to bounce before he even hits what would be a good nadir at a lower dose. By way of example, Merlin had a great green nadir on 0.8 units during the AM cycle of 4/27. He even had a decent cycle with a dose of 0.6u that night before the vetty appointment. 1.4 is close to double the amount of insulin, so about two weeks ago, he had a great nadir on roughly half the dose.
I do want to qualify everything I'm staying here by saying that the decision is yours as to whether to lower, increase, or hold the dose, and you're really doing a great job gathering data, so eventually, one way or another, you'll narrow down what is working and what isn't. It's possible (likey?
) that others may suggest the exact opposite of what I'm suggesting. I wish I had something more definitive to tell you.Edited to add because I forgot this part: if you are able to hone in a dose that gets nice nadirs and hopefully less pre-shot bouncing, but it still isn't getting long enough duration, you might consider either TID or shooting as needed. Deb basically shoots as needed with Lucian and it varies for her between 8 hours and 12 hours. I did this with Eddie to an extent too...I had to stall with numbers that were too low to shoot pretty frequently, so we shot (as much as we could with our schedules,) once he was over 200 or close to it anywhere from 9 hours to 14 or more hours after his shot. I personally would be reluctant to suggest TID or shooting as needed just yet, to rule out a need for less insulin for Merlin first. But that's just my two cents on that topic.
Sue and Oliver (GA)
Very Active Member
Re: 5/14 Merlin AMPS 501,+5/60,+6/50,+8/190
I agree with Jen. (And I greatly admire the way she thinks about this whole sugar dance and explains it so well.) I think their cycles do look very similar, alternating between crash type bounces and flat cycle bounces. And yes, I like lowering the dose and seeing if that smooths things out a little. Since the vet agrees with 1.2, that would be a good place to start.
Good job on the low number today. Sounds like DH got a trial under fire!
I agree with Jen. (And I greatly admire the way she thinks about this whole sugar dance and explains it so well.) I think their cycles do look very similar, alternating between crash type bounces and flat cycle bounces. And yes, I like lowering the dose and seeing if that smooths things out a little. Since the vet agrees with 1.2, that would be a good place to start.
Good job on the low number today. Sounds like DH got a trial under fire!
Merlin
Very Active Member
Re: 5/14 Merlin AMPS 501,+5/60,+6/50,+8/190, PMPS 394
5/14
AMPS 501; 1.4u
+5 - 60
+6 - 50
+6.5 - Jon couldn't get any blood to test
+8 - 190
PMPS - 394; 1.2u
Thank you so much for the great insight and education. Like I said, I think I got it and I am so excited now to recognize possibly what he is trying to do. I can see both examples all over Merlin's spreadsheet. He has provided great examples of both liver glucose release and counter regulatory hormone release. It is so true that no matter what dose I give him, he will give me about the same results. I like having plans and I really like the plan of 1.2u for at least six cycles (see how it goes); then possibly lowering it 1u (see how it goes), etc. I also like the idea that we can up it just a smidge or continue to lower the dose even though we get the same release. I will be gone for eight cycles but hopefully I will be able to recognize the need to change the dose without being at home.
I also like the idea of paying attention to the nadir. If it is early, then probably no need to test further that day but if it looks like it looking good at +6, then test again around +8 or even +7 to see if it is continuing.
Thanks again for taking time in sharing all your knowledge with me. I really, really appreciate it.
After thought: I wish there was a way to bookmark some of these posts (for me) especially when I have important information such as this because I like to go back and reread it. I have a bunch of other posts that I go back and reread.
5/14
AMPS 501; 1.4u
+5 - 60
+6 - 50
+6.5 - Jon couldn't get any blood to test
+8 - 190
PMPS - 394; 1.2u
Thank you so much for the great insight and education. Like I said, I think I got it and I am so excited now to recognize possibly what he is trying to do. I can see both examples all over Merlin's spreadsheet. He has provided great examples of both liver glucose release and counter regulatory hormone release. It is so true that no matter what dose I give him, he will give me about the same results. I like having plans and I really like the plan of 1.2u for at least six cycles (see how it goes); then possibly lowering it 1u (see how it goes), etc. I also like the idea that we can up it just a smidge or continue to lower the dose even though we get the same release. I will be gone for eight cycles but hopefully I will be able to recognize the need to change the dose without being at home.
I also like the idea of paying attention to the nadir. If it is early, then probably no need to test further that day but if it looks like it looking good at +6, then test again around +8 or even +7 to see if it is continuing.
Thanks again for taking time in sharing all your knowledge with me. I really, really appreciate it.
After thought: I wish there was a way to bookmark some of these posts (for me) especially when I have important information such as this because I like to go back and reread it. I have a bunch of other posts that I go back and reread.
Jen&Eddie
Very Active Member
Re: 5/14 Merlin AMPS 501,+5/60,+6/50,+8/190, PMPS 394
You're so welcome Cindi!
If you decide to try this experiment, I really hope you see some improvement with Merlin's bounciness. The upside is that he is capable of reaching healthy numbers - he's not stuck in high flat numbers all the time, so the challenge is figuring out the best way to get him to spend more time in those numbers. I've got my fingers and toes crossed for you two. You've worked so hard for him and you're doing such a good job with him! DH also did a great job with him today, too! :mrgreen: Good luck with your trip!
You're so welcome Cindi!
If you decide to try this experiment, I really hope you see some improvement with Merlin's bounciness. The upside is that he is capable of reaching healthy numbers - he's not stuck in high flat numbers all the time, so the challenge is figuring out the best way to get him to spend more time in those numbers. I've got my fingers and toes crossed for you two. You've worked so hard for him and you're doing such a good job with him! DH also did a great job with him today, too! :mrgreen: Good luck with your trip!
Merlin
Very Active Member
Re: 5/14 Merlin AMPS 501,+5/60,+6/50,+8/190, PMPS 394
5/14
AMPS 501; 1.4u
+5 - 60
+6 - 50
+6.5 - Jon couldn't get any blood to test
+8 - 190
PMPS - 394; 1.2u
+4 - 356
Lets see if I am learning my new info correctly...looks like his last +4 number, he may be temporary insulin resistant i.e. counter regulatory hormones being released) because it appears that he is going to be fairly flat tonight. This mostly so typical of Merlin to be higher than the day and flatter than the day. We are pretty confident that the shot was a good one and not a fur shot.
Have a good day.
5/14
AMPS 501; 1.4u
+5 - 60
+6 - 50
+6.5 - Jon couldn't get any blood to test
+8 - 190
PMPS - 394; 1.2u
+4 - 356
Lets see if I am learning my new info correctly...looks like his last +4 number, he may be temporary insulin resistant i.e. counter regulatory hormones being released) because it appears that he is going to be fairly flat tonight. This mostly so typical of Merlin to be higher than the day and flatter than the day. We are pretty confident that the shot was a good one and not a fur shot.
Have a good day.
Sue and Oliver (GA)
Very Active Member
Yes, I think a flat cycle is definitely likely to follow the low nadir one. So maybe he is a little bit predictable?
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