5/22 Lucky AMPS

[Luckyducky]

Hi everybody. It's been a long time since I posted here on FDMB, and I'm sorry for that. :YMSIGH: First, here's Lucky's spreadsheet and his numbers for today:

AMPS: 338
+9: 54
+10: 99
PMPS: 240
+6: 362

The last few times I visited here on the FDMB I was feeling a bit down, as it seemed the myriad adjustments I was making weren't much improving his strange and unpredictably bouncy numbers. Since I'm not good with keeping up on forums, I decided to try and experiment with all sorts of minor adjustments to Lucky's insulin doses/shot times/shot locations/feeding/daily life schedule/etc., to see what things helped him get better numbers, and what things didn't.

Suffice to say, I'm still not entirely sure what's up with Lucky's bouncing numbers. :YMSIGH: But, there are a couple of things I did seem to learn.

For one, it seems that Lucky's numbers appear to regularly keep dropping past the +12 hour point, on maybe an average of 3 hours after the normal shot time. For some of the times I was experimenting, he seemed to have better overall cycles when I administered his shots in 15 hour intervals instead of 12 (like from 1/24 to 2/8). I'm not sure if it was a fluke, though, as I wasn't able to emulate the same generally good numbers in 15 hour intervals from 2/23 to 3/5.

For two, it seems his numbers can drop really fast (?) within the first couple hours of giving him his shot. I've found on several occasions that his numbers can drop 100 points within 3 hours of giving a shot, which seems like a whole lot to me and gives me the impression that the previous shot's shed might not be draining yet (though I'm not sure if my understanding on sheds is quite right here).

For three, there seems to be a correlation between bounces, higher doses, and lower drops. His numbers seem to generally get better as I approach the 3u mark, but the likelihood for him to drop super-low also increases, and often the low point is at an hour that I only stumble on via random glucose checks, which has been making me paranoid about checking his numbers regularly. @-)

Because Lucky seems to be so prone to bouncing, I've recently decided to switch to the Start Low & Go Slow approach. Waiting for the bounces to clear usually takes several days, which wound up with a situation where his dose was only changing 0.25u every week, and I figured if a week had already passed then I might as well go with the SLGS dosing change approach.

I realize his SS must look a mess, but I've just been trying so hard to figure out what works for him and what doesn't. In a way I'm glad for it, because I think he's been having more greens than before, but again, the SS is kind of messy so it's kind of difficult to tell for certain.

If anyone can glean ANYTHING from his SS and this information that might help me get Lucky on track, I would greatly appreciate it. I'm getting so so tired from trying to figure his dosing out, and any insight would be helpful.

 

[Sienne and Gabby (GA)]

There's no problem with holding a dose that's putting Lucky in a good BG range longer than 3 days. If you look at Gabby's SS, she's been at her current dose since 5/7. The point of getting a cat regulated is that the numbers are in a normal, or close to normal, range. You may need to make small dose adjustments but that's the point of tight regulation. I wouldn't be concerned about holding the dose unless Lucky isn't in the kind of numbers you want.

What is hard for me to sort out with your using a 15-hour cycle is that I think you were losing the overlap between shots. There are cycles where the numbers were clearly on their way up by the time you got to +15 or that the rest of the cycle was going higher. It's hard to know if some of those situations were bounces. I'm definitely not sure why you shot at +17 or +18 or even +20. One thing to keep in mind is that a late shot acts like a dose reduction. I suspect that if you are not shooting at +12, you not only lose overlap, it's having an impact on the depot. Every time you adjust a dose or shoot late, it effects the stability of the depot. The result is typically wonky numbers.

There are so many variables at play it's hard to know what is or isn't working.

BTW, do you know what the carbs were in the dental chews? Most "chewy" stuff has corn syrup in it and is high in carbs.

 

[Luckyducky]

Thanks as always for the fast and thoughtful reply, Sienne. The thing that frustrates me is, Lucky seems to have been getting wonky numbers for a very long time, and I wanted to experiment with the shot times because I was noticing his numbers would frequently be low at the end of a cycle, requiring that I delay the shot. Then in subsequent cycles he would have what looked like a bounce, until the bounce cleared and dropped him low again, forcing me to lower the dosage, and it would go back and forth, making it difficult to follow the Tight Regulation protocol (because all the bounces meant I'd ultimately change the insulin only 0.25u after about a week, which to me seemed like keeping him in the higher numbers longer). Just these past few days I've tried going back to that old approach, and I'm getting the same results --- a high bounce, and a low point at the end of the cycle (or a low point that's at an unpredictable time). I've also noticed recently from testing before the shot time that his number often seems to be dropping before and after the normal shot time (and I recalled reading that it's not a good idea to shoot if the number is still dropping), which gave me the impression that maybe the insulin might be holding it's strength much longer than the 12 hour time frame (which I'm not sure).

Part of my reasoning to try the later shot times was just to see how his numbers would turn out. When it seemed like +15 was working well for him, I figured I should try adjusting the hour interval and see if certain time spans worked better than others. Another part of the reasoning (later on anyways) was that I was seeing his number drop 100 points within a few hours of the shot time, and it made me wonder if I should wait until his numbers had elevated some before shooting.

I'm not sure what the carbs were for the dental chews, but I recall getting the go-ahead to use them here on the forums in a much earlier thread (though I stopped using them back in March altogether, just to see if they might have been adversely affecting his numbers).

I realize that all my tests might seem strange, but I was really prompted to try anything, because his neuropathy seemed to be getting worse, and not better --- and it was just miserable. Not only from seeing Lucky having a hard time walking around, but also because he had to completely sit down while using the bathroom, and he'd get his poop all over the floor and make a terrible mess, every single day. I'd been following the TR protocol and advice on the forums for the better part of a year, and things just didn't seem to be working out. That's why I decided to buckle down and try to figure out what was going on, and start trying out different things. Thankfully, after all this crazy experimenting, I can at least say that his legs are doing much much better than before, and he's been able to jump to high places that he previously wasn't able to reach (part of that might have to do with giving him Zobaline 2x daily instead of only once, which was another experiment I tried out based on some of the posts I read here on the forums. That said, having changed back to a normal TR protocol in recent days, it seems that his legs are getting weak again, and I'm just about at my wit's end trying to figure out what's going on).

Edit: Also, if you look at the past few cycles, it's very reminiscent of the sort of numbers I was dealing with before I decided to make all the micro-adjustments. At the end of this recent cycle he had a high number at 327, I gave the shot, and 3 hours later he's already dropped down to 175. That's almost a drop of 160 points in just a few hours. Why does that happen? I remember reading somewhere that rapidly dropping numbers like that can cause bounces, is that right? Now I figure he's going to have a low point somewhere later in the cycle, if I catch it. But is it really his low number, or maybe his number was still dropping at the time of the previous shot and the new shot is just forcing it down even faster? And if things turn out like yesterday, it's likely he's going to bounce again from the low number again as a result, and it starts all over again. It's frustrating.

 

[rhiannon and shadow (GA)]

Hello. You haven't been around in a while... good to see a post....

After reading what you've tried....
I am wondering ( in my head) if you would be willing to go back to the protocol and give it a try again.
I don't remember all your details but since you have plenty of data, I'm guessing you are able to monitor plenty.

Why not make use of the overlap... and the carryover.. and the depot...?
The dose changing or delays make it so much harder to explain what is going on... and perhaps.... (perhaps) Lucky could be earning decreases
and work his way down...

No pressure from me.... I'm just thinking that he could be making some real progress.
Yes you'll still have bounces, like so many do, but that's where the patience comes and maybe he'd do better this time...

Glad you came back!!

 

[Luckyducky]

Hi Rhiannon, and thanks for the reply. The thing is, I've been trying the protocol again for the last 8 cycles, and encountering the exact same problems I had been facing for the better part of a year before I tried experimenting. Bounces and drops and bounces and drops, with no seeming explanation outside of ECID. How can I effectively follow the protocol when he's bouncing all the time? I can't tell when he's going to clear the bounces, I often can't predict when the low point is going to happen unless I stumble on it, and there's no stability in his readings --- oftentimes in the same cycle he's in the pinks and the greens, which makes it difficult to tell if I should be raising or lowering his dosage. At least when I was experimenting I got to see greens and somewhat more stable numbers than before, and Lucky's hind legs wound up getting better. When I followed the protocol, I saw Lucky go from a cat that climbed up bookcases to a cat that walked around on his hocks and dragged poop all over the floor every day. At least now that doesn't happen anymore, and he can walk on the tips of his toes and jump up on chairs again.

It's just, something about the TR protocol doesn't seem to be working for Lucky, and it's difficult to go back to something that didn't seem to be working (and made both of our lives miserable) when wandering off the beaten path seemed, in some ways, to work out better. I was hoping that if I was told to go back to strictly following the TR protocol, it would be with some new approach or something that would make sense out of going back to it, maybe at least based on some of the successes I had with all the adjustments. I can see how it all looks like a daunting jumble to decrypt, but I was hoping at least some of the things I seemed to learn about Lucky's reaction to the Lantus would be useful in figuring out why he's been so difficult to regulate, and maybe even helpful in formulating an approach that could actually work.

Also, is there a point where someone would just consider switching to another type of insulin? After more than a year of Lantus not working in any predictable sort of fashion, you can imagine I'd start thinking that maybe it isn't right for Lucky.

 

[Sienne and Gabby (GA)]

Any protocol is a guide. Once you've given it a fair trial, you can adapt or change it to meet your cat's needs. What it looks like to me is that you were making frequent changes with shot time. There were too many variables in play to be able to sort out what was or wasn't working. For many kitties, you need to stick with a change for several weeks or longer in order to evaluate whether you get the results you are hoping for. There are other options than a late shot.

Also, FWIW, some kitties do like to bounce. Dyana's J.D. is one of those kitties. Gabby has had cycles where she was in the 400s at AMPS, dropped to the 40s at nadir, and bounced back to the 400s by PMPS. Gabby isn't being quite that dramatic these days but a drop of 150 or so points isn't that extreme. It also sounds like you are anticipating the nadir to be at roughly the same time on a consistent basis. Nadirs change and they can change from cycle to cycle. Cats hate to be predictable!

We do discourage a newbie from shooting a dropping number. Once you're more experienced and feel comfortable steering the cycle with food, this is less of an issue. It also depends on what the pre-shot number is. It's one thing if numbers are dropping and your pre-shot is in the pinks. It's an entirely different issue if the pre-shot is a dropping green number.

What I'd suggest is that you drop a PM to Jill/Alex. She's very good at helping with a customized plan. I also think her analysis of Lucky's SS could be enlightening.

 

[mtncat58]

Hello Lucky,this is going to be confusing,I just thought this was my Lucky's page MOL
Nice to meet you.Purrs =^:^=