7/27 Hershey PMPS(236) +4(368) +5(381) REDUCIE

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Re: 7/27 Hershey AMPS(72) +4.75(30) +6.25(40) +7.75(79)

Great day, and great job, Libby!

Carl
 
Re: 7/27 Hershey AMPS(72) +4.75(30) +6.25(40) +7.75(79)

Sorry I missed you, Jane. Hope you have a peaceful night!

Hey, Carl - Thanks for the encouragement. It's really exciting to see Hershey playing in the greens! I was so worried with him being 10 years old and not knowing how long he's had diabetes...


+9.5 (127)
 
Re: 7/27 Hershey AMPS(72) +4.75(30) +7.75(79) +9.5(127)

Well, Hershey definitely made you work today. With perfect 20/20 hindsight, I think you probably should have taken the reduction the last time Hershey dropped into the 30s. My guess is that the reason you were told to not reduce is that you had taken a reduction the day before. Often, if you take back-to-back reductions, the last one fails. I think if this happens again, we need to consider either taking a full 0.25u reduction or if you skinny the dose, then you takes more skinniness off if the reductions are close together and the last one is in the 30s.

I would suggest taking a full 0.25u reduction. You were having to work way too hard to get Hershey's numbers up.
 
Re: 7/27 Hershey AMPS(72) +4.75(30) +7.75(79) +9.5(127)

Libby

What a day you and Hershey had!

In looking at his SS, I agree with Sienne that you should take a .25u reduction this time because he got low and did not want to come up. Shaving was ok the other day because we didn't know if it was shed or not and remember I told you he'd tell us soon enough by going low again. And so he did.

I was shaving Gracie's below 40s and did it one time too many and let her depot get ahead of me. The result was being up all night trying to keep her out of the 20s/30s. We'd get her up into the 50s and she'd drop back down into the 20s. So now, with 30s, I take a bigger reduction (unless she's clearing a bounce like today.....I'll probably just shave because she gets all drama queen on bounce clearing cycles).

Good shooting this morning!
 
Re: 7/27 Hershey AMPS(72) +4.75(30) +7.75(79) +9.5(127)

Wow! What a day!

Good job Libby!

Hershey Is having some exciting days!
 
Re: 7/27 Hershey PMPS(236) REDUCIE

Hey, Sienne and Marje - Man! You just caught us before injecting! We had shut down the computer because we're having a terrific storm...I don't think Hershey is afraid, so it has nothing to do with his #. He just seems interested.

Anyhoo - Started the computer to post as Doug was about to shoot and saw your notes. I was thinking a .25u reduction from a f1u would be a f.75u or roughly .8u. After discussing the math for :30 and not being to come to an agreement, we went with .75u and can work it out later. So, now shot time is 8pm, a whole hour off. But, we'll work back to it.

Sienne and Gabby said:
or if you skinny the dose, then you takes more skinniness off if the reductions are close together and the last one is in the 30s.

I would suggest taking a full 0.25u reduction. You were having to work way too hard to get Hershey's numbers up.
paha on the more skinniness. Guess we should start that math discussion now! :lol: :lol: You're right it was difficult to get Hershey's numbers up today. He's not usually that difficult. Not sure what that means...

You're right, Marje - It didn't take him long to tell us what we should have done. I wish he'd be more forthcoming BEFORE the fact! ;-)

Thanks, y'all!!

@Kim - Hey, good to see you. Yes, ma'am lots of excitement with Hershey!! I hope you and your fur-kids are well :-D
 
Re: 7/27 Hershey PMPS(236) REDUCIE

HOLY CARP IS RIGHT!!! WHAT A DAY YOU HAD!!!!! And I thought Moonie gave me a pretty low one :o
You got your BOS and did a fantastic job!! It is definitely scary to see 30's though--In my experience the 30's number calls for the full 0.25U reduction, and Boy does Hershey deserve it!!
I am so Happy for you :mrgreen: :mrgreen: :mrgreen: Great Job Libby,Doug, and Hershey!
Congrats on your well earned reducie--Hugs & love from us!! :mrgreen: :mrgreen: :mrgreen:
 
Re: 7/27 Hershey PMPS(236) +4(368) REDUCIE

Wow Hershey....
Libby, he's been holding this bounce in for 3 cycles, so he must have decided to give them all to you at the same time! That's okay, they go away, and at least you can sleep well tonight.
Lots and lots of green in TR today,
Carl
 
Re: 7/27 Hershey PMPS(236) +4(368) REDUCIE

Hi guys,

This is Jill.

My little girl (Charlie) has only been going through this for the past month so we're still figuring this all out. Not sure I'll ever have it all figured out, but I'm trying and working hard at it.

We just read about all the drama. I'm completely green here so forgive my potentially stupid questions. I realize now that when I posted my thread, you were already getting advice from a lot of experts telling you to go for it.

Still. I'm not sure why. Maybe someone can help me out so I can understand better for the future? Or maybe it's because you're using levemir and it's different than lantus?

If I understand correctly, you gave insulin after your little guy came out at 72 at AMPS. That's 4 in Euro numbers.
We live in Amsterdam (so all our BG metrics are in "world" version figures).
Isn't 4 really too low to shoot? And wasn't that proven since it took you to 30 at +4.75?

Hindsight is 20-20... so I'm not trying to lecture here (I just really don't understand it so I want to learn). Is there some reason why it's worth taking the risk? For example, is there a logic that says it's good to shoot low to keep the kitty's numbers as close to between 3-5 as possible? Or was your assumption that the 72 would rise higher due to food and thus, shooting the full shot would enable you guys to hang in "the zone"?

I just read your entire thread and it was a real nail-biter. Aren't numbers in the 30's seriously HIGH HIGH risk zone for hypo's/seizures/etc? I guess so (since you gave carb food and karo, etc) but you seemed so calm throughout it all, so I wonder. Would you ever do that again?

Why did you make this call?

Very very brave and very happy it all turned out well in the end. Just wanting to understand. What risks are worth taking? And what's the rationale for it?

Congratulations on reducing the dosage! Really good to hear that. Hearing good news about other kitties makes me hopeful that the awful month we have had is going to turn around, and things are going to get better for us.

Good teamwork, Doug, Libby and family, and thanks for posting all this so the rest of us can learn from it. ;-)
 
Re: 7/27 Hershey PMPS(236) +4(368) REDUCIE

Hi Jill,
I will try to explain from the point of view of an "outsider". I've never used Lantus or Levemir, and I didn't really understand it or how they worked a few months back. I used to think like you are thinking right now.... "why would you shoot numbers that low?" "Aren't you running the risk of making your cat go hypo?" "why would anybody ever shoot insulin into a number that was within the range of normal BGs?" It was because I really didn't understand how the insulin itself works. I used PZI on Bob, and it was a "if you shoot this, then that will happen in the next 6 hours" type of insulin. We think of PZI or Prozinc much the same way that a person would think about a prescription drug like a pain killer in human terms. If you take one pill, X will happen. If you take two pills, then 2X or more will happen. It will last a certain amount of time, then it will taper off, and then you have to take another pill. That's "easy" to understand, right?

Well, Lantus and Lev don't work the same way. They have a more constant effect. The depot pretty much guarantees that some insulin is in the cat's system all the time. You keep adding more, because some days the cat needs more (or less) than on other days. It's still hard for me to explain exactly how that all works, but I have come to think of it as the same concept as a water tower. Don't know if you have those in Amsterdam, but I'm assuming you must?

The way a water tower works, and what they are for, is to maintain a certain amount of water pressure in the supply lines. You have this big pipe that carries water to a community, pumped from some reservoir someplace. But all day long, people are using more or less water than at other times of the day, so the water pressure changes every time somebody turns on a faucet, or flushes a toilet, or washes a load of clothes. In the summertime, lots of people use a lot of water to wash their cars or to water their lawns. So, the more people are using water, the lower the pressure in the supply line goes, and the pumps can't keep up with the demand. So they put these huge tanks of water on top of a tower. When the water demand is the highest, and the pressure starts to drop in the supply line, water flows out of the towers to take up the slack, and the pressure in the whole line stays more or less constant. When the demand goes down, then the water coming from the reservoir and the pumps goes back into the tower tanks and refills them. It sits there until the next time it is needed. If nobody is using water for any length of time, then the pressure builds up, and the pumps shut off. OK, now to translate that to "Lantus/Lev"....

You have this depot of insulin (water tank) sitting in kitty's system ready to be used when needed. And you add more to the total every time you give a shot. As the BG goes up during the day, the insulin is "used up" as much as required. If the total insulin in the body ends up being insufficient, the BG goes up, and you end up needing to increase the dose to compensate. When the supply of insulin exceeds what is required, the BG goes down to low numbers (like Hershey today), and you end up dropping the dose for a few cycles to get things back in balance. You never know exactly when something like this will happen, so you have to be ready to test and when you see the 30's or 40's, you add carbs on purpose to bring the numbers back up quickly, then you cut back on the insulin. In a perfect world, this would happen every few days, and you'd keep reducing the dose, and eventually kitty will go off the juice in a logical and gradual progression.

Unfortunately, there is nothing "perfect" about the world of feline diabetes. There are too many other things that influence the BG numbers that have little to do with the insulin you are shooting every day. There's food, there's things like infections and dental issues and stress, there's how well the pancreas is healing and how much of its own insulin it is producing each day. So, sometimes you see a reaction like this today, and you drop the dose, and a few days later, it looks like the new dose isn't working well enough, so you have to increase a bit.

But the thing you hope to see is that the cat becomes better regulated, and the BG level stays pretty flat over the course of 12 hours (especially when you are seeing nice blue and green numbers most of the time). A "perfect curve" would be the curve of a diet controlled diabetic cat. All the numbers all day long would be in the normal range, with little fluctuation. So, with Lantus, because the dose is dependent upon the nadir numbers and not the preshot numbers, you routinely see people who have been doing this for a decent amount of time giving "regular" doses on preshot numbers that would be considered "normal" BG numbers. Because they have collected enough data to know that even though they are shooting 1u into a 90, the nadir is still going to be in the safe and normal range. A cat like Hershey might get to a point soon where he is in the "good numbers" all day long on .5u twice a day. When that happens, Libby might be able to reduce to .25u twice a day, and after a few days, she would see Hershey still in good numbers all day long, and she might reduce a little more. That continues long enough, and at some point, she'll be able to try "no insulin" and see if he stays in normal numbers. Along the way, she might have to tweak the dose by tiny amounts up or down, and she'll probably see more days like today.

Libby, and anyone else who deals with lows like today does appear to be "calm", but I'll bet when she saw a 30 something on the meter, her heart beat a little fast for a time. :smile: And the people who are here walking people through these episodes might also appear to be calm. It's easy for me to be calm when I'm following the condo or dropping a line in it once in a while. That's because I'm not the one seeing the 30 on the meter. I'm hundreds of miles away, and although I've never used this insulin, I have watched "this" many times, and I've stayed up a few nights "hand holding" and reminding people when the next test time is, and to feed another spoonful of gravy.

I know that Sienne and many others have pointed out this many times - there's a big difference between low numbers like 30 and 40, and "clinical hypoglycemia" where symptoms like seizures take place. I have read along in threads where someone has actually had to deal with seizures and rushing kitty to the ER. But I have not seen one time where something like Libby went through with Hershey today ended up with a trip to the ER. The emergency situations have usually come about due to "mistakes". Like maybe shooting too much by mistake, or not testing regularly at preshots. Very few and very far in between has that happened. Managing low numbers happens all the time, and there are standard procedures to follow that keep kitty safe. Like testing early on in the cycle so that you'll expect the low numbers later on and be ready to deal with them. Like posting a 911 or adding the low numbers to your subject line so that people see them and jump in to help. Like always making sure you have plenty of test strips and high carb and gravy food on hand.
I'm completely green here so forgive my potentially stupid questions.
None of your questions are stupid. You should always ask, and if you don't understand the answers, say that. Maybe one person can't make you understand the way they said it, and another person will say it differently and it will click for you.

so I wonder. Would you ever do that again?
Why did you make this call?
What risks are worth taking? And what's the rationale for it?
Since you asked Libby those questions directly, I don't want to speak for her, but I'm thinking the answer to the first question is "yes" and that she can help you out by answering the rest of them too.

Sorry, I tend to be very "wordy", but that's what happens at 4am.... I ramble!

Carl
 
What a great explanation, Carl. Thank you.

Libby, glad to see Hershey getting a well earned reduction! Hope today is going well for you guys!

~Deborah
 
@Carl - Let's hope he decided to give them all at one time and soon it'll clear! Thanks for the explanation, too. Thought the water tower analogy was a good one. BTW - my daddy was a water plant operator! :-D
*********************************

@Jill - Hey, thanks for stopping by. I appreciate your support. I don't think any of us will ever have this dance figured out. Lots of trial and error and so many things we have no control over! We've been on insulin about 6-1/2 months, 5 of those on ProZinc. We still have a LOT to learn about Levemir, that's why I ask LOTS of questions! :-D

As Carl already said, there are no stupid questions. Carl has given a great explanation, as usual. So, I'll speak to the calm part - If you check Hershey's SS, you'll see he has had low numbers on a few occasions. The first time was pretty scary, not gonna lie, and I was so thankful to have my ProZinc family holding my hand. We couldn't seem to get his numbers up. I had dressed, packed a bag and was getting together whatever I thought we'd need a the ER! Thankfully, one more test showed a slight rise. :-D Getting more tests and going through similar situations, I learned more about Hershey and how he behaves in the low numbers...just like he does in all of the other numbers! ;-) I even shared a picture once of him lounging during one of his low episodes.

Switching to Levemir was a whole new ballgame. When he saw low numbers for the first time, it was brand new and I was thankful to have my LL family holding my hand! I take my commitment to Hershey very seriously and would never intentionally do anything to endanger him. Honestly, I had a moment of second-thought before shooting that number. Then, I reminded myself that we changed insulins and went with the TR protocol because I truly believe it is his best chance to regulation and hopefully, remission. Even if remission never happens, I believe every period of time he enjoys more normal numbers is a break his pancreas welcomes.

I knew I was going to be home the whole cycle, had a fresh supply of test strips, LC, MC, HC food and Karo syrup (which we've only had to use once or twice since starting insulin). When we started ProZinc, we read a lot of condos, visited a lot and quickly became friends with people we knew had the knowledge to help us help Hershey. Upon joining the TR forum, we read a lot of condos, visited a lot and quickly became friends with people who had the LL knowledge to help us help Hershey. (And, thankfully, Carl is part of my ProZinc family that still keeps up with us in LL! :-D ) This place is a gold mine! Even though it's a much larger group, there has never been a time I REALLY needed something that someone didn't come to help. I have read so many success stories of remission and see all the great numbers and I want that for Hershey.

So, yes, I'd make the same call, again. And, YES! things will get better!!
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@Deborah - Thanks for visiting and the congrats on the reducie. Just hope he settles in quickly. :-D And, yes, Carl is great at explanations :smile: :smile:
 
Thanks for the explanations, guys. Not sure I fully get it but I get the general idea. Trust that you'll tell me when it's time for me to get the BOS with Charlie. For now, I have lots of anxiety due to the month we've had so I'm trying to learn whatever I can, implement what seems reasonable, and observe Charlie to see if she's going in the right direction. So far this board has helped us tremendously. Hope Hershey continues to progress like he has been. Best of luck to you guys too. :smile:
 
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