8/31- Lucky - Been awhile, need help

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all4mymarine

all4mymarine

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It's been awhile since I've updated here. I've been doing trial and error with dosage and I'm just so confused where to go at this point. I raised the dosage slowly, holding it for 3 days each time and checking him carefully and trying to get an idea of where to go with things. I decided to do this because his numbers just weren't good enough on 1u. I finally got to a point where I felt like I needed to decrease to see if maybe the dose was too high. It was just a feeling I had. PS's a bit better but his nadirs are terrible and the numbers are just so level or flat. There is hardly any fall and rise. I thought it might be because the dose was too high, that's why I dropped it. Like I said, trial and error. And maybe I raised dosage too fast but I read it's okay to hold for 3-5 days and re-evaluate, so I went for 3.

Today I was wanting to see how he would do on .9u and his +6 was almost 300 :( So obviously .9 is not enough?

I'm just a loss right now. I'm not looking for criticism for how I chose to do things, just some ideas about where to go from here. I thought the dental would make things better but they are pretty much the same as before. Now I'm wondering if I do need a new vial like I was thinking before?

I'm starting to feel discouraged. I just want Lucky to be healthy.
 
ok...well I definately understand why you dropped back down to 1 unit
He was doing very well on the one....
but I see that you have had him on the 1 unit for 5 days now....
so here is what I do...
I find that for Shakes, the best thing for me to do is hold the dose for at least 5 days,
if after at least 5 days the numbrs dont change at all I would upp a little and hold that for at least 5 days
Shakes always responded better when I held for a long time so his body could adjust..
I am thinking since you held the 1 unit again for 5 days...maybe up to 1.1 and stay there at least a week
before upping again.
that is what worked best for Shakes and ECID, but it might be worth a try

hang in there, I had Shakes on prozinc (yes up and down) for 2 1/2 months before he started showing
anything good on the numbers area.
unfortunately these things take time...keep in touch and dont worry .no critisism here,
and I am sorry if you ever felt that..

Denise and Shakes
 
Thanks :) I'll try holding a bit longer. It's just hard to hold it when you feel like that dose isn't going to work out.

For some reason I just get the feeling that he needs to be on a higher dose. I know he started off responding really well to 1u. And to be honest, looking at your kitty's SS, the numbers look the same as Lucky's when you were giving a lower dosage.

I've done the start at the bottom, hold dose, and work my way up about 2-3 times now and I always drop back down and start back over with no better results.

I'm just wondering if he does need a higher dose than I've given him so far? I don't have the expert eyes that some might have here so I may not see the clues that someone else might, that's why I came here. But if the consensus is to stay low, then I will at least give him 1.1u tonight.

And no, I haven't really gotten criticism, I just know that some people might do things differently and might have different opinions. Opinions are definitely okay by me, I'm just doing the best I can and following my gut. I just don't want to be going in the wrong direction.
 
ALWAYS TRUST YOUR GUT!!
I cant stress that enough..
just another thought...and its because I just shot up shakes, and had to decide where to shoot
If you are shooting in the scruff, the insulin does not get absorbed as well
as if you shoot in the side..
in the beginning I always shot inthe scuff cause that is what the vet told me
but after all the reading I did, I decided to change and start shooting on his side
I saw an immediate difference in his numbers....and when his numbers start to get stale again
I switch sides and his numbers get better again
I think it is the build up in insulin and it works better is you switch where you inject

just be careful cause if you do you will see an immediate change in numbers so do it on
a lower dose....
just another thought
 
I agree with Denise--follow your own instincts. We all come here and get excellent advice, but ultimately, it's your decision.
You're doing a great job with Lucky!
 
Hi, and welcome back!
It would be nice to see you back with great news like "Hey, guess who'd going OTJ?!!", but I am glad that you came back for help too. That's what everyone who comes here every day comes for - not only for their kitty, but to help someone out when they need it.
You won't get criticism from me, that's for sure. I sort of "winged it" with Bob and did all sorts of things on my own, mostly because I didn't join here soon enough and by the time I did, it wasn't to ask "dose" advice, but other stuff. Bob started low, went as high a 4u BID, and then back down pretty quick. I also did some dose adjustments, didn't shoot the same day and night, all kinds of stuff "outside the box". Bob survived in spite of me!

Anyway, let me tell you how I approach spreadsheets and doses, so you'll understand how I think. When I look at SSs, I don't really pay attention to colors, or "numbers" per se, but rather to percentages. If Lucky is at 425 AMPS, and 200 nadir, I'm not thinking he dropped 225 points, but what percentage he dropped. That's better than a 50% drop, which is really good IMO. Likewise, if he started at 180 and dropped to 120, not so good, because that's only a 33% drop.

Take 8/25 for instance. AMPS of 469, went down to 240 at +4. Almost 50%, and he probably did drop a little more by +6. Next day, AMPS 425, +4 at 225, again, maybe a 50% drop by +6. That was on 1.8u.
But maybe the reds scared you?
So you dropped his dose to 1.0 that night, and again 1.0 the next morning. His +4s after both of those 1u doses were about 25% and 33%. You had pinks and yellows, but the insulin didn't do as much for him. Does any of that make sense?
I think your hunch is right, that he needs an increase. But think of the increase in terms of percentages too. Dropping from 1.8 to 1.0 reduced Lucky's daily intake by almost half. If you are going to increase (or decrease), maybe do so 10% or 15% at a time. so 1.1 or 1.2 might be a logical next step.
I agreee with Denise - adjust, and hold for 4 or 5 days. Give Lucky plenty of time to adjust to the new dose, and convince his liver that it is okay.
And don't be a stranger.
Carl in SC
 
I have some stuff to ask and replies to make but I have dinner to make...I'll be back!

But one quick question....did the 1.8 look like it was too much insulin or at that point did it look like it wasn't enough?
 
Well, I thought it looked like "enough", but it was only for 3 cycles. The only "odd" number was the 407 at +8 which I took for liver panic. What was weird is that the PMPS 4 hours later was down off that 407 to 357.
However, I am not sure about the next AM cycle.... whether those numbers were due to the dose reduction, or whether it was a "bounce" from the 3 cycles at 1.8.
If you are thinking of going back up to that dose, I'd do so in baby steps of .2 until you get there.
I don't remember who said it or which forum I read it in, but the gist was "keep on a dose until you see a definite pattern, and then adjust as needed". It probably takes at least 4 or 5 days for a pattern to be obvious.
Carl
 
I can see why you dropped back down - you had some really nice numbers on 1u a while back, but then not lately.

It's hard to say on the 1.8. It does look like a possible rebound pattern that one cycle, but the numbers aren't low and the drop might have been steep, but not so steep I'd really be worried about it. So I wouldn't stress yourself out over being scared of that dose if you end up there again. If you start to see a pattern of steep drops and rebound, then you have a problem to deal with, but one cycle and no where near low numbers I wouldn't stress over.

Often it seems like the more they ride in higher numbers the more insulin they need, and as they get better numbers their insulin needs go down. So it can vary quite a bit, and a dose that looked like it was working might not be enough to counter the effect of trending higher. I know it is really frustrating though.

What I did when I was in your shoes was start at the lowest dose that I was confident was not too high, and then I moved up in 0.2 increments every 3rd day (getting in a nadir test at minimum on the 4th cycle of each dose before deciding whether or not to move up), until we got a breakthrough (and then had to back off the dose very quickly in small increments to keep the numbers in my target range of 150 to 50. I resolved that if I didn't have Bix regulated in a month from when I started that process, then I would try another insulin. That approach really helped me stop waffling and bouncing around with higher and lower doses, and it got Bix regulated. Might not work for everyone, just sharing what worked for us!
 
Quick question.....

****So if a dose is too high, will I know by #'s that are too low, rebound or both?*** The only thing I'm afraid of is him being in #'s too high for too long and having too much insulin and hypo. Right now the concern is DKA but he's eating well and I still can't catch him going to the litter box to check for ketones. Even if I did, he'd jump out as soon as I came in through the door.

See, the problem is, I'm not sure what dose would be too high at this point, and I'm second guessing the drop and maybe should have kept pushing on with the 1.8. I haven't really gotten a good nadir in quite awhile. Yeah, I've gotten a blue here or there but it seems like a fluke (of course, when I think a certain dose is looking good and hold it, I never see that good # again).

So, as far as a game plan.... I feel comfortable increasing .2u every 4 days or so. I'll post here before I increase a dose. My goal is to see greens again, at least blues, and to have nice yellow PS's. We were there and then things just went crazy! If a dose is not enough, I don't want to stick with it for too long because I want him in good healthy #'s as much as possible. But at the same time, I will commit to keeping it steady long enough to try to get a clear pattern.

I feel at this point, looking back at the greens I got at 1u and thinking if I stick with 1u, it'll happen again is just not going to happen. I do feel his needs have changed. I know to back off a dose when it goes too low but I'm not sure about when a dose is too high. I've been looking for inverse curves and I thought we might have had a few, that's why I dropped back down. Lucky doesn't like this new lower dose, he's been hiding out all day today :(

And yes, I'll pay attention to percentages but at the same time, I can't help but feel that #'s matter!! There's no way we can be on the road to being OTJ if his nadirs continue in the high 200's :(

Thanks everyone for your input, it makes me think!
 
And yes, I'll pay attention to percentages but at the same time, I can't help but feel that #'s matter!! There's no way we can be on the road to being OTJ if his nadirs continue in the high 200's :(
Click to expand...

Well, maybe I didn't say it right or say enough on numbers and %s. Totally with you on not wanting nadirs in the 200's.
Let's say you have a drop that's 50% or better, but instead of 450/225 you're getting 210/90. That's what your looking for. You want a 50% drop. But you also want low numbers.
I'm thinking that once you find a dose that "works", that's what you'll end up with. Eventually, when his pancreas and liver heal and are "trained" respectively, there'll be a dose that gives you yellow PSs and green nadirs. I think it's a matter of patience and timing. Patience on your part, and timing on his. He's got to cooperate, or it can be a dance marathon.
If a dose is so high that it pushes his nadir "too low", his liver will keep kicking in to push his next PS up, and you'll end up with a really deep smiley faced curve. A day or two later, you might see a bounce that flattens the curve, or inverts that smile into a "frown" and end up lowering the dose. That placates his liver, but then your drop isn't as good, like you've observed.

I guess my "theory" is that you have to find a dose that gives you the curve "shape" that you want, let his body get comfortable with it, then increase slightly. The hope with that is that the curve will maintain that nice shape, but lower both the PSs and the nadir gradually together. Ideally, that's when his pancreas will start taking over the job of producing insulin so that you can cut back slowly.

Does that make sense?

Carl
 
Okay, so his PMPS was lower than the +8....not by much but I'm really scratching my head. I've got lower PS's on a lower dose but the numbers are really flat and evened out.

I just don't know what to make of all this anymore! I'll get a +4 tonight and see what happens.

And Carl, I get what you are saying! We actually had those nice percentages AND numbers at one point. It's frustrating knowing we had it and lost it :( I'm on the seemingly never ending quest to get it back! LOL

Oh, and we do inject in the shoulder area. I alternate sides each night, unless I forget which side I did last!
 
all4mymarine said:
Quick question.....

****So if a dose is too high, will I know by #'s that are too low, rebound or both?*** The only thing I'm afraid of is him being in #'s too high for too long and having too much insulin and hypo.
Click to expand...

Yes by #s that are too low, and yes by rebound, but often when we talk of a dose being too high and rebound, it's not so much hypo concern, more "ideal dose" concern. The important point I think is that you manage the risk. If you are getting spot tests in the early half of the cycle, if the drop is too steep or you get an unexpected low, you feed to counteract it. If you aren't home to monitor, then you don't shoot as aggressively.

If you are worried about something like a pattern of chronic rebound where they are in high numbers for an extended time and then all of a sudden crash, I wouldn't worry about that. Chronic rebound like that (from what I have read) only comes from an extended period of repeated acute rebounds, and you just aren't seeing that. Some bouncy numbers here and there are something of course to keep an eye on, but not something to worry about to the point that you are afraid to shoot for green numbers.
 
At this point, I'm not even sure what dose would be considered "too high" because even with 1.8, I didn't get low numbers that would scare me, not at all. They were all still high, even the nadirs.

I think what confuses me the most is his great response in the beginning to 1u and now I get high flat numbers throughout the cycle no matter what dose I give him from 1u all the way to 1.8u. Yeah, there were some break through moments where I saw a blue but it didn't last. Sitting at 1.2u again and slowly working our way back up is really hard with thinking he needs way more than that. I feel like we should have kept going and not dropped back to 1u, but I had to see if maybe the dose was too high and if he would respond better to a lower dose. I guess all I can do is just keep going forward and get back to that higher dose and keep going and see what happens!

If it were your cat and you were looking at his SS, would you feel comfortable going low and slow back up to 1.8 and beyond till you saw better nadirs or just nip this thing in the bud and shoot aggressively at maybe 1.9? This is all taking into consideration that you would be there to monitor the cycle. I'll be home with him all weekend. I know people do things differently and I am completely okay with trying different things to find out what works, as long as it is safe and OK!
 
It's a puzzle when their response changes like that. We've seen it with several cats I think, I don't know what it is. Sometimes their insulin needs change, could be temporary insulin resistance sets in (but why, when they are getting good numbers?). It's a mystery, but I'm sure there are at least a couple peeps around who have had the same experience.

Generally I did not have good results with dose lowering, so I would tend to go with increases rather than lowering unless you have some really clearcut patterns that the dose is too high. Some cats do, but I don't see it here, you have U-curves for the most part.

So that said, it looks like you got a perfect response today, so go figure! I have no idea what to make of it frankly, why the good numbers all of a sudden, but I certainly like today's curve and would keep doing what worked.
 
I'm just not experienced enough to know what to look for :? So when I got up to 1.8u and wasn't getting anywhere, I think I freaked out thinking I might have gone too high. But I'm glad you reassured me that it didn't look too high based on his chart. It's all a learning experience, so if I have to get up that high with dose again, I won't freak out and lower the dose thinking I'm doing something wrong!

But, yeah!!! I came here to update about today and saw your post. I am very pleased with his response today! I'm not sure what's going on, but I hope it continues!!! Something went right today, lol
 
Well actually on 8/26 the 1.8 does look possibly too high b/c of the spike from +6 to +8 and then the drop back down to a lower +12, but I don't know that I would judge by that one cycle. I probably would have lowered some too though after seeing that, it's a classic rebound pattern. But there could be other causes too, like some kind of stress, or a bad reading, or who knows.
 
Yes, that possible rebound is what made me nervous. It was that and the fact that his numbers were just not doing what I was expecting, no matter what dose he was on. I thought that if it was too high of a dose then his number would be going way too low but then I just got the feeling that something wasn't quite right. Oh well, still trying to get data on the 1.2u and so far so good. I think he's in a bit of a liver panic so I'm waiting for that to possibly clear and see another break through :mrgreen:

I'll update with a new thread before I make any changes but for right now we are staying the course with 1.2u.
 
Glad you are gonna stick with the 1.2 for a little while
t o see what happnes
I kno whow frustrating it can be but hang in there...
 
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