7/25 Pearl PMPS 98 increase dose

Happy Sunday!

Pearl is holding steady on the drop dose. In general, at previous doses she hovers in the high greens. This is maintained when I reduce her after 14 cycles in the greens.

On the drop dose, she has crossed the border into the low blues (literally about 5 points difference on average than previous doses), which confuses me b/c with Green color I know I reduce after 14 cycles. The color blue is throwing me off (even though we are essentially flat to what we were with the Green at higher doses, she is not trending upwards). As usual, please ignore the Pred cycles if looking at her ss.

At the drop dose, we are at Cycle 11. I will continue to hold this dose for the time being (beyond cycle 14), see if she wants some more greens before making a decision on whether to go back up a teeeeeensy bit or bump her down to OTJ trial. Does this sound like correct thinking?

I know Pearl is in the minority with how she earns her reductions usually. If I am confusing you , you can read this sticky about earning a reduction by spending 14 consecutive cycles always in normal number range (this is what Pearl does, she does not choose to drop below 50).

I am also not convinced we don't have some inverted cycles starting to form on this dose , which would lead me to believe we need to try OTJ (since I find it so odd she would be ok on 0.25U but literally 1/8 unit lower start inverting cycles due to need of more insulin).

Surf safely kitties!
7/23 post: https://felinediabetes.com/FDMB/threads/7-23-pearl-pmps-104-pred-day.250272/#post-2823087

 

After 14 cycles you could try an unofficial otj. You would not give insulin but test for a few days to see if she’s ready to make it official. Let me discuss this with a few others and get back to you.

 

Thank you, Elise, I would really appreciate the consensus on this decision. I know Pearl is right on the border, I think that's where I am getting confused about whether to try or not. She is on a par as she has been at higher doses, but leave it to Pearl to be squirrely and different from others.

Thank you so much for your input and for helping figure this out!

 

Those low blues are just barely blue. I like the idea of an unofficial OTJ trial.

 

I didn’t see what you were seeing as I said I believe yesterday but asked others who feel you should take her back up to .25 so far. Still waiting for a few more opinions but no to the OTJ trial, official or otherwise.

 

I’m waiting for a few more to weigh in. Hold tight.

 

Just my own reference point for agreeing with what Elise is saying -- look at Tina's SS and how ready she was to go OTJ in November 2019.
In the past, I have read that numbers in the 50s through 80 (human meter) would create the strongest OTJ trial. Of course, all kitties are not pushed to go that low.

 

Sorry6, but I don't see it. I think Pearl looked better at then 0.25u dose. I'm also not seeing inverted curves.

 

I hope this helps. It looks like an increase is the decision. Good luck with whatever you decide to do.

 

Thank you all so much. I appreciate your input, so I will move her to 0.25U tonight!

 

Hi Margaret and sweet Pearlie!!!

I’ve missed you both and I’m glad to see Pearl doing so well. I will throw my hand up in the air as the bad guy being the first, in those Elise asked, to say she isn’t having inverted curves and she needs more insulin. But I thought I owed you more of an explanation.

When we start an OTJ trial, “low blues” that are barely blue are not where we want to be when they are the majority of the tests at a dose. We want almost all below 100 BGs. That gives a stronger remission. Any time you see a kitty, like Pearl who goes from more greens than blues on a dose to more blues than green on a reduced dose, it’s time to increase the dose. Upward trends in BG generally need more insulin. Maybe, she’ll only need it a few cycles but she does need to get back to more blues.

Regarding the inverted curves, I’m pretty sure I discussed those with you (or maybe Lyla) long ago. About the only time I pay alot of attention to meter variance is determining if a cat is flat or not. And Pearl is very flat even though she has a few cycles where she starts in green, goes up to blue, and then comes back down. But.....her BGs are pretty much within 20% of each other except, for example, 7/23 where she popped up to 130 after pred. We just throw that one out.

What we are looking for in inverted curves is a BG that is over the 20% variance and usually, by a good amount. The occasional inverted curve might happen and I wouldn’t give it a second thought. But if she truly had inverted curves and it was happening every day, then we want to think about whether she’s got too much or not enough insulin on board as inverted curves can be caused by both.

Rest assured that those of us with alot of experience would definitely point out to you if we saw inverted curves.

Good luck with the dose increase and please give your sweet, beautiful girl a hug from her Auntie!

 

Hi Marje! Thank you so much for stopping by! I've missed you so, and it's wonderful to see you here! I appreciate your responses very much.

Pearl usually gets her reductions by being in Green, as you know. I've upped her back to 0.25U tonight, and appreciate the inputs from everyone - I knew something was wrong, but couldn't figure out what (since Pearl is usually so Green and I was so worried about those darned inverted curves). But in general, I always wonder at the time she earns her reduction after 14 green cycles - since her Greens aren't low green, they are medium to high, does it "count"? Or is it a sign she is not ready to reduce (like if she is in the 90s)? In general, when you look at her ss, did she look good on the 0.25U before, or was she still too high and in retrospect I should have not reduced her?

Thank you so much. Yes, I think once Pearl threw an inverted curve long ago so that idea has stuck in my brain. I will banish the idea of inverted curves from my brain and stop worrying about if that is happening or not (you know me, overthinking). That will make things so much easier, in fact.

I also can get mixed up about the meter variance, I pay such laser-focused attention to the exact numbers - I will need to be concentrating more on the 20% rule of variance.

Thank you we love and appreciate you so!

 

You’re welcome! I always keep you and Pearl in my thoughts.

A cat in the 90s for seven days should have the dose reduced. Remember a cat’s body can’t tell the difference between 60s and 90s. But you want to be sure within that week that most of the BGs are below 100. There might be a few BGs a little over 100 but it should be few.

I would have tried the reduction but after the first cycle at the new dose, I’d have gone back up because the BG clearly trended up quickly.

Deal!

In most cases, we take the meter reading at face value but when we are looking to see if the BG is flat or not, we should keep meter variance in mind. Even if I wasn’t thinking about meter variance, Pearl still looks pretty flat to my eye except her pred days.

You are always welcome