7/18 BRUNO PSAM: 382, PMPS: 380 +2=365, +4=326

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Hi Ana

I read back through your condos to 7/16 and saw this in yesterday's condo:
As per some other member suggestion, we reduce to 0.5u
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When you reduce the dose without him earning an actual reduction (and that would include working extremely hard to keep him above 40 by feeding a lot of HC and syrup) so you can see if he will flatten out, then we call it a "rebound check". Generally speaking, unless the dose has gone up in larger increments than we normally do under the TR protocol, it isn't necessary to do a rebound check. What happens is they end up spending a lot of unnecessary time in high numbers. Sometimes we have kitties come here where the vet started them way too high and then increased in 1u increments. If the kitty is diving really low and bouncing really high, it generally makes sense to do a rebound check.

But I wouldn't have decreased Bruno's dose unless you were going to be gone for an extended period of time and were just not going to be able to test him. For example, when members travel and have a petsitter, they usually reduce the dose or if they have a family event that will take them away an entire day, they will temporarily reduce it. I think Bruno was just starting to settle in at the 0.75u dose and starting to look good. If he were my cat, I'd increase back to 0.75u and let him get back into those lovely greens.
 
Marje, I read the protocol over and over again, but still need guidance and Bruno keeps bouncing and bouncing, I thought that according to Protocol if his numbers were still high it was right to increase the dose in .25 He is in so little insulin since he was diagnosed, but I also think that the "curve" at the vet that took him 10 days, was a super roller coaster for him. They started with 2u same day reduce to 0.8 next dose increased to 1u, then gave nothing for couple of shots, gave him pills for glucose, etc etc.
Now, I realize that this was terrible for him. When he was first diagnosed and with out insulin his highest was 420. since then he has been in the 500's more than one time.
So far, it's been 2 months and cannot make him stable, so on the facebook group I had the following comments from different people:

" when you do your reduction, your goal is to back down to a dose that gives you level numbers, quite even and no bounce.
let's say you drop to a 0.5u dose, and let him sit there for a few shots.... just to let the bouncing stop.
Once he's in whatever zone and flat numbers with little movement, you will then be able to make an increase if needed"

"sure you can make the reduction on the next shot.
Now keep in mind that you may still see lowish numbers because you will drop from 0.75 to 0.5u and the shed will dump the extra 0.25u... so the reduction is often not seen in the numbers until the the next shot after the reduction.
If you are around to test a couple times tonite after the reduction, I'd say reduce tonite."

"ok look how his numbers dropped from the 0.5u shot... he dropped from 373 to 293 in 2hrs then down to 250, so let's see if he stays in the 200s.
You will know better in the morning at AMPS. I hope he will be high 200s/low 300s, then go with 0.5u again and let's see if he can drop into the 200s again..
You want to stop the bouncing, then go up slowly"

"the reason he would be high, then go low, then go high again would be from too much insulin. Try another shot of the same dose.... you gave 0.5u?
If you see him going low, then high again, maybe try 0.25u on the next shot.
Or if you don't want to go with 0.25u, draw up 0.5u and then twist out 1 drop. then your dose will be 0.375u!"

"Sometimes more isnt better. If its to much, it will drop him to far and cause a bounce. Which is when you see that roller coaster on numbers. This is why we take it slow on going up or down on dosage. Like mine right now is teetering between 2u-2.25u."
 
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