6/9 Pumpaa Help...he's all over the place!

[Pumbaa]

I've been really busy this last week with rush client stuff, and while I've been testing Pumbaa regularly and frequently, and updating his SS when I could, I haven't had time for daily condos.

I need some help, interpreting his numbers, and figuring out a course of action.

When I upped his dose to 2.25U (BID), his number were wonderful! Finally we were seeing regular blues and greens! On the 11th cycle, he even dropped down to a 48! I asked at that time if I should decrease his dose by .25U, as that seemed to be the rule of thumb for tight regulation, reduce the dose after any reading under 50, but was advised to keep him at 2.25U until he stabilized more.

Well, he hasn't stabilized at 2.25U.

Initially, it appeared that his bounces were lower, and he was clearing them quicker. But then, at the 16th cycle (taking into account clearing bounces) he started having numbers back up in the 400s. *sigh*

Since the rule of thumb is that it can take up to 72 hours to clear a bounce like that, I was patient. This morning was the end of the 72 hours, and Pumbaa started the morning at 145. Beautiful!

But I don't understand why he went up at +3, +6 and +9, but then dropped for his PMPS. That just doesn't compute. So, for tonight's dose, I dropped him from 2.25U to 2.0U, so we can get a grip on this. I think I should have dropped him to 2.0U when he hit that 48 BG reading, even though he had barfed after eating that morning. He made up for the barfing and had eaten well about an hour later.

Pumbaa does not act like his normal self when his numbers fluctuate this greatly. He was doing great when he was in the blues and greens, with bounces only going up to yellow.

I did not want to increase his dose because, per the relaxed protocol, if the lowest nadir numbers for the week to two weeks were below 100, you decrease. So decrease I did tonight, but only by .25U.

If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.

Input is very welcome! Why did Pumbaa drop for his PMPS tonight? (I know, some people will say that this is within the +/- 20% accuracy of the meters, but I've tested my meter on the same bead of blood and haven't ever seen a 20% difference.)

Suze

PS: Having a magnetic dry erase board on my fridge has been a life saver. I can still record all of the test readings, and then carry the board into my office to easily update Pumbaa's SS when I have time! Plus, I have a 2 day history right in front of me when I go to the fridge to get the insulin out! I highly recommend getting one of these!

 

[Sienne and Gabby (GA)]

Hi, Suze.

I usually don't post here but I agree with you. I'd have reduced Pumpaa's dose with that 48 regardless of whether you're using the TR or SLGS protocol. (FWIW, with SLGS, you reduce by 0.25u. There's a statement that's buried in there that with some insulins, such as Lantus, you decrease by a smaller amount than the 0.5u that's noted.)

I wouldn't get too hung up on when the lowest point in the cycle is. Nadirs can shift around. If you look at Gabby's SS, her nadir is typically early but she can surprise me!

 

[Pumbaa]

Sienne, that was my judgment as well, but I was advised against the decrease. I think people just scan your input and then offer their input, even though I had noted that Pumbaa had eaten voraciously after the barf session.

I know that nadirs can shift, but that was very strange behavior for Pumbaa today, to have his lowest number of the cycle at the end, when he had been rising all day.

To make this more confusing today, Pumbaa just had a 93 at +3.5 PM. I'm very glad that I decreased his dose! I am so tempted to give him carbs, instead of just having put out more lo-carb high-protein food, so that I can get some sleep tonight, but I can't do that to my little guy. *sigh* I'll test him at +4 to see if he's still dropping and then deal with the numbers then. I tried giving him ground chicken just now, but he turned it down in favor of more canned FF Classics.

Suze

Update: Down to 80 at +4.5. He ate more of the canned food, but I put down more pure protein chicken and sprinkled it with parmesan to get him to eat it. If the insulin needs to work on something, I say let it work on protein and not on carbs that are going to spike his BG levels quickly but shortly.

No sleep for me tonight.

 

[Libby and Lucy]

((((Suze)))) I can tell you're frustrated, so I thought I would try to point out how well Pumbaa is doing. :smile: Scroll back up your spreadsheet just a couple of weeks - it was mostly pink, with a little bit of blue here and there. Now scroll back down to this week - it is mostly yellow and blue with a little bit of pink (and some red, but only a little). The high numbers are going away much more quickly than they used to, and he is spending the majority of his time in yellow/blue and some green. That's good!

Usually what happens is that the bounces gradually get lower and clear out more quickly, and it looks like Pumbaa is on that path now (and I do think that 340 yesterday was probably a tiny little bounce from the blues the night before, and the teeny bounce was clearing already at PMPS time which is why the PMPS was lower than the mid-cycle number and he kept going down). It looks like a late nadir, but probably it is just because that is when the bounce decided to clear.

You can look at my Lucy's spreadsheet and see that she stubbornly held on to her pink PS numbers for a long time, even when she was in green for most of the rest of the day every day. I chose to look at it as being in healing numbers for 18-20 hours a day, not as being in high numbers 4-6 hours a day. Her pancreas must have looked at it that way too, because apparently it really was healing during those hours, and one day all of a sudden the bounces were gone. We see it happen that way all the time. Sure, there are a few kitties who are very stubborn bouncers, but the majority will stop bouncing on their own as long as they continue getting enough insulin.

 

[Pumbaa]

Libby, that was amazing how, in January of '09, Lucy's bounces just stopped.

I am frustrated, because I know Pumbaa doesn't feel his best when his numbers are spiking and diving like this. I'm also frustrated because he doesn't understand that, late at night, when I'm chasing him all over the house to test him because he's diving, that I'm doing this to save his life/trying to prevent him from going hypo.

And thank you for pointing out how well Pumbaa is doing. On the one hand I know that, but simply wish that he would even out a little more. For both of our sakes!

Suze

 

[Libby and Lucy]

Libby, that was amazing how, in January of '09, Lucy's bounces just stopped.

It was great, but not really that amazing. ;-) The bounces diminish as the pancreas heals. Just focus on getting Pumbaa into healing numbers as much as possible, and it is likely that his pancreas will get with the program.

In Lucy's case, I believe that her journey took longer than it might have if I had not wasted the first 6 months before getting serious. The sooner you can get the numbers under control, the better the chances at regulation and remission. Of course there are no guarantees, but IMHO you are doing well to stay on top of the numbers.