8/26 Eddie AMPS 347, PMPS/127, +1/122, +4/66, +6/79, +7/100

[Jen&Eddie]

Yesterday's Condo

Yesterday: AMPS/364, +1/374, +2.5/332, +6/264, +8/183, +9/176, +11/198, PMPS/229, +1/350 +2/374, +4/347, +6/299
Today: AMPS/347, +1/303, +2.5/274, +6.5/189, +7/142, +10.5/122, +11/128, PMPS/127, +1/122, +1.5/98, +2/93, +2.5/89, +3/82, +3.5/64, +4/66, +4.5/66, +5/68, +5.5/79, +6/79, +7/100

Hi LL,

Hi Elise! I was sneaking in reading a few condos while at work today, but didn't have enough time to get up an Eddie condo until now since I'm home - so here it is.

Eddie's bouncing badly right now. I'm pretty sure he no longer likes 2.0u, but I don't know yet whether he wants more insulin or less. He's sort of clearing the bounces, hitting blues, but the drops are setting off the next bounce, so I don't think I can say that his nadirs are really in the 100's warranting an increase quite yet particularly since this PM cycle will be cycle #7 since he hit the 40s early in the cycle despite extra carbing early on. I've been reading old LL posts lately trying to find other bouncy kitties and other strategies to deal with it (and hopefully finding some successes to give me a little hope here!), and I ran across a comment that sometimes early cycle dives can indicate that a kitty will soon be looking for a reduction. I might be able to find the post I was reading, if need be. Any thoughts on that?? I guess I can hope that Eddie's ugly bouncing as of late is his body really protesting about the dose, and that maybe he's getting ready to earn a reduction. Hopefully I'll have a clear picture which way to go soon.

I will refrain from making any predictions about tonight to avoid jinxing things. However, I think I'm going to post what I'm doing food wise in the hopes that I can get some input to see if there's something I can do better or differently to hold up early cycle drops (which I think might result in unwarranted reductions, besides being difficult to manage on a workday morning) - unless of course there's a bounce. Then - nevermind. ohmygod_smile

Long slow slide all day today and Eddie's surfing low blues for the last couple hours. I used to feel confident shooting green pre-shots, but that was before Eddie became a member of the LL dive team. Now, sometimes shooting even mid-blues is terrifying, since Eddie hasn't been following the "flat cycle" theory lately. Maybe it's an issue with too much overlap being responsible for early cycle dives. We did run into that issue constantly with ProZinc, since he had unusually long duration when he was bounce clearing. That's a huge guess, and other than either skipping, shooting late, or doing a one time reduction when I have a hunch that a dive may be coming, I don't think there's an easy answer to how to deal with it, if in fact that's the case.

Eddie felt icky last night I think. He napped with me after work, but didn't get up again after that other than to eat. He slept in the bedroom by himself most of the evening. I brought him out later on, and he pretty much just slept on the cat stand. Tonight, he's blasting around chasing civies, and meowing, so he seems to feel pretty good. Those low blues must feel pretty good compared to that high flat cycle last night.

Vines and hugs to all those in need today. Haven't had a chance to catch up yet, but safe and calm vetty vines for Polly, and vines for JD and Zener as well as anyone else in need.

Edited: Oh derp! I just posted Eddie's condo on Health. ohmygod_smile Deleted and placed it in it's rightful spot.

 

[Jen&Eddie]

Re: 8/26 Eddie AMPS 347, +7/142, PMPS/127, +1/122

Huh. Well, this might be interesting. Down a smidge or surfing at +1 with no food spike after 8% for first supper.
(127) PM = 2 Tbsp. 8%
(122) +1 = 1 T. 18%
(98) +1.5 = 1 T. 18% + 1 drop karo
(93) +2 = 1 T. 18%
(89) +2.5 = 1 T. 18%
(82) +3 = 1 T. 14%
(64) +3.5 = 1 T. 14%
(66) +4 = 1 T. 7%

 

[Deanna & Billie]

Re: 8/26 Eddie AMPS 347, +7/142, PMPS/127, +1/122, +1.5/98

It looks like an awesome night for Eddie and a busy night for you!! I hope he surfs nicely and stays flat. I have noticed that Billie is also more playful when her numbers are lower. I'm glad Eddie had some fun today :smile:

 

[Marilyn and Sheldon]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +1.5/98, +2.5/89

Thanks for the vines for Miss Polly. The LL well wishes worked!

Now, Eddie. How 'bout a nice surf. You know, just cruse along at those comfy numbers. You can do it.

Marilyn and Polly

 

[Marje and Gracie]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +1.5/98, +2/93

Jen

As Julie said on Sunday, some of us have been discussing Eddie and whether it is appropriate to use R.

Before I give you those thoughts, I wonder if it might be worthwhile to try Eddie on levemir? In another week, he will have been on Lantus five months and we usually suggest you try an insulin for about six months before switching but there is no hard and fast rule. And there is also no guarantee he will stop bouncing and diving.

Gracie really did a lot of diving and bouncing on Lantus. She can do it on lev, too, but she has done so, so very much better on levemir. For us, it seems a bit easier to find a good dose and her patterns are a bit more consistent than they ever were on Lantus. And we know if we increase the dose, the bouncing pretty much stops or at least greatly minimizes. Neko has similarly done super on lev as have others.

There isn't any way to know how he would do. Tess is still a big bouncer on lev as is JD. But Eddie seems to respond to a higher dose of insulin in a positive way in terms of the diving and bouncing.

If you don't want to switch, I understand. Lev curves can tend to really vary from cat to cat but most of them will nadir late.....anywhere from +8 to even +14/15. But then they can get great overlap and carryover. My other suggestion is that it seems like you monitor enough to take the dose up. Yes, he got to 48 on this dose but that was once and it's possible his absorption was a little better that cycle or perhaps the dose was just a smidge more (even with calipers, I doubt any of us are right on the money every single time). If you increase, you have to continue to stay on the numbers and manage the curve. It's aggressive but you can look at Gracies 2013 SS....we were pretty aggressive in the spring.

Lastly...R. I'm sure you've read the cautions. R can be very helpful for bouncy cats or, if not used correctly, it can set off worse diving and bouncing. If you look at Eddies 8/23 cycles....it looked like he was headed for the mother of all bounces...and then he came back down in the PM.

Some had concerns for using R on a cat like Eddie. I'm wondering if you just give one single drop as the bounce starts....maybe it will stop him. I used to shoot 0.1u R with Gracie and had good results but then it started dropping her way too fast. Julie had a great idea for me to just try a drop with Gracie and I wonder if that's where you should start with Eddie and see how he does?

When using R, you must understand it's action. For Gracie, I don't see much between the R and R+1 but she usually will kick in and be pretty active from R+2 through R+3 and then slow a bit. But she, Julie's Punkin, and a few others often see a residual effect in 1-2 subsequent cycles. I think the R kicks down that counterregulatory hormone door and then the basal insulin can do it's job. You have to know Eddies onset, nadir, and duration and be able to lay an R curve over that knowing he could drop steadily for four or more hours. The goal is just to stop the numbers from skyrocketing but sometimes (often) the R stops them and then sends the BG down.

You would have to be absolutely certain you give R at a time that it will not overlap Eddies Lantus nadir. And you would have to give it as soon as he heads up. So on 8/23, if you had given just a drop at a.m. +7 at 262, he might not have gotten to red. But if you had waited until he was red, he'd have likely come down on you really, really fast. That's why you cannot give it once he's high because he could decide to break and having R and a bounce break together is no fun.

I would study SSs for Punkin, Gracie(I started using R in Feb, 2013), Alex, Libby's KK and Jazzy, Sandys BK. You will see that they can do well enough that you get to a point where you cannot use it.

I'd also suggest you make sure someone experienced with R is around to help the first time you use it, if you decide to do so. They can help you determine if it's a good time. You will have to test at least every hour for a minimum of four hours but maybe longer. Eventually, you will get a feel for what he will do and you won't have to test every single hour.

Think about the options and let us know if you have questions. Wendy and I can answer questions about lev as can other experienced members like Ella and Ann who use it. And Julie, Sandy, and I can help you with the R. So can Dyana on both accounts but I think she's pretty focused on keeping JD eating now.

 

[tiffmaxee]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +1.5/98, +3/82

Hi Jen. Marje has given you a lot to think about. I've read it twice and my head is spinning.

Looks like Eddie kept coming down all day and is having a nice cycle tonight. I hope he slows down and surfs.

 

[Jen&Eddie]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +1.5/98, +3/82

Wow, Marje - thanks to you and Julie and anyone else who took at look at Eddie and brainstormed ways to help us.

Unless I'm adding wrong I think we're approaching month 5 on Lantus rather than month 6 but nonetheless, we've had time (and data) to see what he does on Lantus.

I'm going to have to think on and chew on these ideas. I do like a lot of things about Lantus, but I've also seen a lot of kitties that seem to flatten out nicely on Lev. I mentioned switching insulin to DH just to discuss, and I got an unconditional "no" (probably due to the small fortune we just spent on pens), but I may broach that topic later....Lev may be a little challenging for us to work around nadir, but maybe we could actually shoot later and get nadir tests after work and early in the morning. I'll have to think about how we could do that with our schedule. I will say that Eddie does seem to go in streaks where he does flatten out at a dose and starts to look really good, but then we end up having to reduce, and the bouncing starts all over again - and you're absolutely correct in that the higher doses do seem to hold down the bouncing better. I don't really think it's necessarily a duration issue - he's just got a powerful bounce response - powerful enough to overcome the insulin particularly towards the end of a cycle.

On raising the dose...I'm so torn on this. In theory, I'm game, since Eddie did pretty well before in gradually increasing his dose even when he had good nadirs. My difficulty at the moment is managing the curve early in the cycle. Tonight for example, Eddie's having some great numbers, but they are propped up every half hour with HC or MC. I doubt he would have made it past +2 tonight without hitting 40s or 30s if I hadn't started feeding 18% and karo starting at +1. I can't do this type of management during the work week though, unless I can figure out a magic formula to feed him enough HC/MC/karo before +2.5 to be able to safely leave him.

I format his numbers in a non-shared SS slightly differently and I can see that he stays flat and in normal numbers for much longer stretches (like at the end of May) and then again in mid-July but those doses get him to the 40's and even 30's (if I'm not paying attention). Is he maybe one of those kitties that does better being allowed to run in the 40's? A dip into the 40's doesn't really bother me when it's at or around nadir but the ones that are at onset are the ones that freak me out a bit. Basically - three dips into the 40's wouldn't necessarily "earn" a reduction. For example even though Eddie went under 50 three times on 2.25u, those dips were at nadir or late in the cycle and required minimal intervention to get him up - except for the last drop, which was similar to what's happening tonight. Rather than waiting for a trend back up, could I simply do a one-time reduced shot, or maybe even skip if the depot is getting too full, and then go right back to the good dose?

I'm going to study some more on R. I've done some degree of studying on it, including on Gracie's, Punkin's and BK's spreadsheets, but I plan on studying more. Given that Eddie's bounce clearing (sometimes) fast and furious, I totally agree that shooting R on a high-preshot could lead to a huge drop and/or disaster. The example you pointed out of shooting maybe just a drop at the AM +7 on on the 23rd, was exactly the type of cycle and timing I was thinking would be when R would be "safest" and/or "most appropriate" for Eddie - trying to put a lid on the bounce before it pushes up so high that the Lantus either can't pull the bounce back down - or he drops like a rock back down from a high preshot, triggering the next bounce. Given my work schedule, it probably would be fairly rare that we could use R to try to stop a bounce, and be home to catch the bounce on the way up, but before it was too close in time to the next shot, and also be home to monitor closely for the next several hours, but it seems to make a huge difference for Eddie if the bounce/dive/bounce cycle can be stopped, even for a handful of cycles.

I do have some extra time off work starting Friday, so perhaps I could increase the dose, as I'd be home for 4 full days to monitor closely, or try R (should a bounce like the AM cycle on the 23rd occur).

Thank you again, so very, very much for your input! It's disheartening to feel like Eddie's not responding like a "normal" kitty, but you've given me some really helpful ideas and options to think about.

 

[Marje and Gracie]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +1.5/98, +4/66, +

You're welcome An, sorry...the six was a typo. I had added it up as five and typed six. I fixed it ;-)

I really don't see that Eddie is not responding as a "normal" kitty. Every kitty dances their own dance and I think the Cairos are more rare than the Eddies

I looked at your feeding and it looks like you are doing things we would suggest (e.g. Front loading the cycle). I might go one more step.....consistently feed the same early schedule every day. I would put as much of his food as I could early in the cycle between PS, +1, and +2 and be consistent. If he's not low and you aren't feeding to keep numbers up, I wouldn't feed a +6. It slows down the effects of the insulin.

I understand the challenge. I've had the same issue of feeding an early drop and then it comes to a screeching halt....some days. Other days, not. I hope it doesn't seem too trite to say it's trial and error and just when you figure it out, it changes.

The thing I like about levemir is it gives you more time between PS and onset. I worked the first year full time and lost so much sleep at night. Even though lev has a later nadir, we generally are testing less at night and sleeping more.

Whichever insulin you decide on, the goal is:

Manage the curve with food -------> flatten the curve----------> adjust the dose.

The other thing about propping him up with food is maybe you should just try (in a day cycle), to stop the drop and then once you have it stopped and he's flat, try to let him surf. It's hard to do and you might find he does drop below 40 if you try. But maybe you think you have to prop him up but maybe you don't. I found us doing that with Gracie. But today, once we got her stopped, we backed off the feeding (other than LC at a normal time she eats every day) and she had a gorgeous surf.

It's hard to day if he likes to surf the 40s. I used to think Gracie I'd but I try not to let her now.

I am not sure if this has helped but it's some things to think about and others might have ideas.

 

[Jen&Eddie]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +1.5/98, +4/66, +

Thank you Marje! I've been experimenting with food, with mixed success, but felt like I was not successfully stopping the early drops.

I looked at your feeding and it looks like you are doing things we would suggest (e.g. Front loading the cycle). I might go one more step.....consistently feed the same early schedule every day. I would put as much of his food as I could early in the cycle between PS, +1, and +2 and be consistent. If he's not low and you aren't feeding to keep numbers up, I wouldn't feed a +6. It slows down the effects of the insulin.

We just started the +1 food. Previously, we fed at PS and +2 (or +2.5 in the AM if I'm racing around trying to get out the door which is the norm lately). With Eddie seeming to nadir really early lately (at least when he's bounce clearing), I totally think it makes sense to withhold the +6 meal, and switch that volume of food to the front end of the cycle.

Would you do the same type of front loading for when he's high at the start of the cycle, where he slides down late and has a late nadir? Or would you feed later in the cycle in that instance?

I understand the challenge. I've had the same issue of feeding an early drop and then it comes to a screeching halt....some days. Other days, not. I hope it doesn't seem too trite to say it's trial and error and just when you figure it out, it changes.

We'll see how long Eddie can actually surf tonight, but I feel like I actually succeeded in managing the drop tonight! No 50+ point drops in half an hour, and no dips into the 40's or 30's early on. This is the first time I've started carbing up as early as +1. Most of the time, I feel like I'm chasing his numbers down, but I think I managed to stay ahead of them tonight. :smile: I do struggle with what to do at +1, because that test sometimes has a food bump, but he comes barreling back down anyway. Tonight he was flat at +1, which was a giant warning sign. I may just have to make an educated guess based on what happened leading up to PS, and if it looks like he's going to have a diving bounce-clearing cycle, just start carbing at +1 and go from there. I suppose since I feel like I nailed it tonight, Eddie will no longer follow that pattern, and we'll have to learn something new. ;-) The +2 test is too late for Eddie lately - a +1, and probably a +1.5 are going to be necessary when he looks like he might be on a mission.

The thing I like about levemir is it gives you more time between PS and onset. I worked the first year full time and lost so much sleep at night. Even though lev has a later nadir, we generally are testing less at night and sleeping more.

With the diving, I like that aspect of Lev, as well. And I can sort of see how one might actually be able to sleep as well. :lol: @-) I might have to actually write down our schedule and figure out if a later "typical" Lev nadir would be workable for us.

The other thing about propping him up with food is maybe you should just try (in a day cycle), to stop the drop and then once you have it stopped and he's flat, try to let him surf. It's hard to do and you might find he does drop below 40 if you try. But maybe you think you have to prop him up but maybe you don't. I found us doing that with Gracie. But today, once we got her stopped, we backed off the feeding (other than LC at a normal time she eats every day) and she had a gorgeous surf.

Yep, this is a challenge, too. Historically, I'd usually switch over to MC or LC too soon after getting Eddie either to stop dropping or up from low numbers, only to have him come back down. When he's diving, it seems like he mostly requires the "big guns" through about +2 or +2.5, then I lower the carb levels down to finally LC. Tonight his last food was low carb at +4, and he stayed surfing since then. (anti-jinx). :mrgreen: Where I'd also screw up previously was to underestimate the speed of the drop, and not feed high enough carbs, and then "chase" the drop with higher carb levels, until I was probably carbing him up after it was not really doing any good to do so. So, he seems to be one that you have to START with the high carbs for big drops, and then lower the carbs as he slows down. If that makes sense...

One other thing I was thinking about....although it makes me nervous to increase with the early cycle diving that Eddie's been doing lately, it occurs to me, that maybe he's diving worse because he's bouncing worse. If the bouncing settles down, maybe he won't have so much momentum when he's bounce-clearing, and the diving will settle down some.

 

[tiffmaxee]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +4/66, +6/79, +7/

Hi Jen. I do feed Max at ps, +1, and then +2.5 lately and it might be helping. I'm also trying to feed lc or mc depending on how fast he is dropping rather than waiting to give it to him when he starts to get low but I think you suggested that I do that come to think of it. I am testing more than ever which I don't think Max is happy about.

Great cycle tonight!

 

[Marje and Gracie]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +4/66, +6/79, +7/

Jen

I have to work tomorrow so need to get to sleep. I'll respond tomorrow night. Sorry...and hope you get to bed soon.

Surf Eddie!

 

[Wendy&Neko]

Re: 8/26 Eddie AMPS 347, PMPS/127, +1/122, +4/66, +6/79, +7/

Nice cycle tonight Eddie - keep on surfing. :mrgreen:

Interesting condo today. At one time I considered trying R, but there was no one around to help me at that time so it didn't happen. But since then I've always watched to see what happens. Suzanne/Cobb is another R user and recent convert to Lev, but he's a high dose kitty. Like Marje, I think I'm testing less and getting more sleep with Neko on Lev, and that's with her having cycles with lower numbers now. Far fewer wake up, test, back to sleep for 50 minutes, get up test, repeat cycles. Less diving, more gradual slides. The sleep breaks are longer now. I still hate that the nadirs can be somewhere around 3:30 to 4:30 in the morning, unless they aren't - she varies her nadir but did on Lantus too.