7/18 Harley AMPS 251

[Rob & Harley (GA)]

Good Morning,

Yesterday was certainly stressfull. The storms continued throughout the night but we were spared the really bad stuff right here.

Joanna, my DBF Steve (human diabetic) said he would have held the 1.2u too so when you agreed I panicked a little bit all day long. But given his numbers yesterday it was ok after all.

So I held the new dose again today since I'll be able to test. Can anyone tell me what to expect? What low PS # should I be looking for to decrease? Work day mornings are a little rushed and I don't want to make a mistake or miss something that could harm him.

If someone has a little spare time to give me a crash course in spreadsheet reading I would really appreciate it. I keep re-reading the Fac's and stickies and answers to previous questions. But for some reason it just doesn't sink in or make sense in any meaningful way to me.

I'll keep reading.

Robin

Yesterdays News
viewtopic.php?f=24&t=19994

 

[Joanna & Bix (GA)]

You want to decrease the dose if you get unshootable PSs (below 150), or nadirs that are too low (below 50). Or say you got a 55 nadir and the PSs are coming down and you aren't home to monitor, I would reduce a hair in a situation like that, just to allow some margin for error. Or if you got a lower # early in the cycle, like a 70 at +3 or something, I would reduce.

You can see today you got the improved effect on cycle 3 of this dose. Awesome #s!!! I would probably pull back to 1.3 or 1.2 personally. The 56 is on the early side of the cycle and it's a bit of a drop. Nothing to worry about, but I like a drop more in the 60% range, so this looks to me like a hair too much insulin. If you tried a slightly lower dose and the #s get higher again, then I'd go right back to this dose.

What questions do you have on spreadsheet reading?

Two things that I would read are Start Low Go Slow (link is in the PZI sticky), and over on Lantus the Tilly Protocol. Neither is exactly what is generally recommended for PZI, but they outline the approach, and what to look for in terms of when to raise or lower the dose.

SLGS is too conservative though IMO (it was written a long time ago and has not been updated to more recent thinking). Step 3 is the part with info on when to change the dose. With PZI I would only change in 0.1 or 0.2 increments if the #s is fairly close to what you want, saving 0.5u changes if the BG#s are way out of line. The nadir of 90 is also old-school, or for if you are using a cat meter. With human meters, on the whole they seem to do well with #s in the 50 - 70 range. If you have a civie cat, I would recommend testing them with your meter, so you can get an idea of what a normal # is for your meter. My civie was 56 I think on my human meter, and I saw someone once who tested a civie at 42! So that can give you an idea of what # is a good one on your meter, vs. a hypo # to treat.

Tilly is for other insulins and is a little more aggressive. One key difference with PZI is the 150 no-shoot - generally with PZI you never shoot below that level, vs L & L where you routinely shoot lower than that. There may be other things that are different too, like PZI you can raise the dose faster and can be more variable with timing & such.

The general principles though I think can be applied, and I found reading those kinds of things really helped me feel like I had some sense of what I was doing. Here is a summary of what they are doing on Lantus viewtopic.php?f=9&t=1581, I can't find what I read before for Tilly that was really succinct - the link I see now is pretty involved. If it's too confusing, I'd just skip reading it, since it's really for another insulin anyhow...

 

[Rob & Harley (GA)]

Thanks Joanna,

I feel that this dose 1.4 is too much, especially since I work during the week and can't always test mid cycle. Do you think that 1.2 is safe or should I go to 1 since it looked like 1.2 was starting to settle in, but I jumped the gun. The start low go slow says to reduce by .5u.

I fed the 56 with MC Gravy & creamer because it was so early in the cycle. I hope that was right because now he is going up pretty fast.

What does the ss look like when you start decreasing. I see some lower ps#'s that they shoot a lower dose but doesn't that start the roller coaster ride? What # do you shoot what lower dose?

I've printed out so much that I'm drowning in paper and can't find what I'm looking for. I need to reorganize.

 

[Kelly & Oscar]

I agree, the 56 is a little too low for my comfort level if you are going to be away during the day. I would pull back just a hair - to 1.2 or 1.3 like others suggested.

 

[Rob & Harley (GA)]

Thank you guys, I'm going to drop it to 1.2 for tomorrow and make sure I get home at lunch time.

Harley (headbutts) thanks you too.

Robin

 

[Joanna & Bix (GA)]

Yeah, the reduce by 0.5 I would only do if you saw a really really low #. This dose looks just a teeny bit high to me - I'd probably go with 1.2, and try to get a bedtime check in to see how that is doing. Don't worry about trying to get everything perfect - it's all a learning experience, and at each step you gather data and see what works and what doesn't. With Bix if I want to slow a drop I've found that just 2 or 3 bites of HC will do it, or a bigger amount of regular food. If you ever saw something like a 20 I would give HC first and ask questions later. When it's somewhat higher than that though, so not super-scary, but still lower than you want, you can give a few bites of something and then test in 1/2 hour and see where you are, and then adjust from there.

I don't know that it will help you, especially since the SS format is different, but if you look at Bix's SS around 7/20 last year you can see what his looked like when I finally got a breakthrough and then dose reductions. There's no magic to it - if you are getting #s that are lower than you want you lower the dose, vs. higher than you want you raise the dose. Every cat gives you variations on the theme, so it's hard to tell you what it will look like.

With Harley I would probably just stick with one dose for now. Yes, you can vary the dose by PS, but his patterns to me look like he is doing fine on a steady dose, and keeping to one dose makes your life a whole lot easier in trying to interpret the data. So if you shoot say 1.2u tonight you are still coming off of a 1.4 so you will probably see slightly better #s tonight than you will tomorrow, as the extra oomph from the 1.4 wears off. Tomorrow night's shot may give you a clearer picture of how he'll do on the 1.2u.

And keep in mind too that often the picture is changing as you go, especially with cats who have a sputtering pancreas, which seems to be the case for many cats. You just have to stay on your toes and adjust the dose as you need to.

I would keep a no-shoot of at least 150, and make it whatever # you feel comfortable with. If you don't want to shoot under 200, then you shouldn't! Don't feel pressured to do something that doesn't feel safe to you. If you shoot on a 200 and can see that the nadir isn't too low, that will give you confidence to shoot on say 180 next time.

 

[Rob & Harley (GA)]

Thanks, I shot the 1.2 and will check at bedtime.

Your ss is much different but I will keep looking at it to see the trends.

I'm not sure about the no shoot #, 150 sounds low to me, maybe when I get more experience.

Thanks for all your help, I guess this is a moving target after all.

Robin

 

[Joanna & Bix (GA)]

What I've typically seen recommended is to start with 200. Once you get some data and a comfort level then you drop it to 180, and then with more data to 150. I like to mention 150 so people know that's really the hard #. Sometimes I have seen newbies shoot on #s below that not understanding that it's a risk. Or alternately, I've seen people not shoot on a 195 because they thought that was too risky, not realizing 195 is fairly safe. So it's really just so you have that as a reference, not saying at all that you *should* shoot on something as low as 150 if you aren't comfortable with that.