8/4 Pumbaa - Way to clear that bounce & Dose question

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Pumbaa

Pumbaa

Member Since 2012
Pumbaa had an absolutely BEAUTIFUL day of blues and greens yesterday. His AM nadir (74) was at +5, but his PM nadir (70) was at +7. Activity-wise, he was a wildman! He got into things and did things he hasn't done in years! It was great to see him feeling this wonderful!

So, he bounced this morning, and started that day with an AMPS of 323. Fine. It could have been worse...it could have been a dreaded black or red number, right? He spent the first part of the morning hiding under my bed. That's what happens when he bounces like that. :(

But, bless his little pancreas, he cleared the bounce quickly, in one cycle, and dropped in numbers all day today for a low of 143 at AM +9 (as far as I know from the tests I did).

We're starting the night at 168, and he could either go up like he did on 8/2 when he was clearing a similar bounce and had very similar daytime numbers, or he could drop down into the greens again, only time will tell!

Dose Question:

Pumbaa is now on his 10th cycle at 2.25U.

None of the protocols (TRP, SL/GS, Roomp/Rand) really state how you count a bounce for the high number.

Those bounce numbers aren't truly indicative of how his body is reacting to the insulin, it's an indication of his liver dumping sugars into his system in response to the low numbers he got from utilizing the insulin.

TRP only addresses the nadir for dose increases.
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
Click to expand...

SL/GS assumes only a weekly or bi-weekly curve is being done, so the confusion would be what day I picked for this "curve". If I picked yesterday, Pumbaa would get a dose reduction. If I picked today, I would keep the dose the same.
• If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
• If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.
Click to expand...

Roomp/Rand is similar to TRP, but they also address the peak numbers and not just the nadirs.
If nadir blood glucose concentration < 200mg/dL but peak is > 200mg/dL, increase every 5-7 days by 0.25-0.5 IU depending on
if cat on low or high dose of insulin
Click to expand...

Two out of three of the above would tell me to increase the dose, and SL/GS would tell me to either increase or decrease depending on which day of data I used.

Talk about confusing! So, based on Pumbaa's recent numbers, what do I do with him next?

Just for smiles!

1) I have a Border Collie, Beck. And much to the chagrin of my two cats, Border Collies herd, instinctively. Last night, at around 3 am, Pumbaa was doing his "catch me if you can" routine at testing time, and I thought I had him cornered in my office (with doors to other rooms already closed so he couldn't access them). He hid behind the kitty condo, and then tried to sneak around the corner and out the door. My shadow, Beck, was right there, and I said, "Beck, get Pumbaa!" And Beck put her paw down on Pumbaa's back and nailed him to the floor so I could grab him. Good doggie!!!! *LOL* (Don't worry, Beck raised Pumbba from the time Pumbaa was about 8 weeks old, and they go through this routine all the time.)

2) Catching Pumbaa for testing has been a nightmare the better he feels. He races in between furniture in the living room, making me chase him. If I haven't closed doors to other rooms in the house, he might go hide under my bed, or in the litter box, or under the guest room futon, whatever. But he always starts by making me chase him around the living/dining room, since he has many places to hide behind there. My sofa and love seat are next to each other in an "L" shape. The over-plump arms touch, but the bottoms don't, leaving Pumbaa room to run in between and get away from me, while I have to circumvent this 7" wide sofa. So, today, once again trying to prove that I AM smarter than my cat (I'm not if I have to constantly have to figure out how to stay a step ahead of him! *LOL*), I moved the sofa away from the loveseat, so that I, too, can get between the two pieces of furniture! Take that, Pumbaa! ;)

3) It was almost a pleasure today to go to Walmart and purchase 100 test strips for the Relion Prime for $18. I love the greatly reduced (half) price of the test strips compared to the Relion Confirm/Micro. I love that I no longer have to order these online for $28/100 and try to not have to pay shipping on top of that. I love that I don't have to worry in advance about placing an online order in time and can just go to Walmart and get these test strips, for $9.00 a week, if the budget is tight.
 
Pumbaa said:
So, based on Pumbaa's recent numbers, what do I do with him next?
Click to expand...
That one is easy. Pumbaa didn't earn the reduction. He didn't even earn a hold the dose.

But you can always increase to a fat 2.25 for 5 days since that increment worked well last time.

Pumbaa is doing great! :mrgreen:
 
Yeah, I was hoping that I wouldn't have to increase his dose, even just to a fat 2.25U which = a skinny 2.50U.

I guess I just prayed that he would level out, and no longer bounce at this dose. I want those bounces to go away, and I want to no longer have to worry about dives. Those are my short term goals.

Maybe going up to a skinny 2.50 U is going to be his "magic" dose?

Tonight's numbers will determine my dose in the morning. But I do know that I am no longer increasing/decreasing by .25U, as that seems too traumatic to Pumbaa. Fats and skinnies are the way to go.

I'm still doing major praying for Chip. I hope he drops and keeps you on your toes tonight! :)

Suze
 
Chip sure isn't bouncing. More like in a big flat pink coma.

He hasn't hit black since starting Levemir.

I think that is a sure clue his dose needs to be significantly higher.

Sneakers is dancing in blue at 22U. @-)
 
Dale 'n' Chip said:
Chip sure isn't bouncing. More like in a big flat pink coma.
Click to expand...
I hope and pray that Chip was in this "coma" just because his insulin was compromised some how!
 
Actually I'm glad it wasn't compromised. Because it means I didn't waste all that time on the first pen. It just means he needs a bigger dose to get started.

If I sound like the borg enforcer here, it's only so Pumbaa and Chip don't have to get soiled in the collective. ;-)
 
The new shed hasn't filled yet, so how do you know that the old pen wasn't compromised?

Chip has only been on the new pen for the start of his 3rd cycle, and it could take 6 cycles for the shed to fill.

Be patient! Relax. Pray. :)
 
Okay. We'll fill the shed before we go crazy.

But I think I'll still be as aggressive as the protocol allows. @-)
 
Great to hear Pumbba's blue & green! What an improvement!
Rosy's with wonky black & red this week. Kinda scary without knowing where did all those come from. :?
 
Helen,

Wow...Rosy really did go wonky this week with those AMPS numbers, but all of her PMPS numbers are great. That is so strange! Has anyone given you any ideas why this might be happening? It doesn't appear to be the new pen because this didn't start for 10 days after you started using the new pen. It doesn't look like BIPO (Big Insulin Poop Out) because the PMPS would be high as well.

I'm going to have to go and read your condo's to see what people have to say about this trend of Rosy's. Hope someone figures it out!

Suze
 
Well Suze, I noticed this strange trend of Rosy after I brought forward her shooting time by 3 hrs. Since then I started to take more test on her in the PMcycle. When you look at the previous SS, because I did not have as much figure to compare, the trend was there. Rosy did not have these red at the AM PS that's why I did not notice it.
The only cause anyone can think of is an infection, but if infection her bg will not come down from black to the blue at PMPS? Rosy acted too normal to have an infection. Finishing her food, no symptom of UTI, perfect bowel movement, no dental issue. Her last blood test was in Feb which was normal.
So far, no clue on what caused a single nadir at PMPS! This is frustrating.
 
Helen,

What is your shooting time now?

Can you do a full curve in the daytime tomorrow? And can you get a +2, +4 and +6 tomorrow night?

I didn't see the same trend on Rosy's old SS, but you're a lot more familiar with her numbers and so it probably jumps out at you now.

You said that the AC goes off at midnight, and questioned whether the heat could be affecting Rosy's numbers. It would be interesting to know when midnight occurs on your SS, and then compare her numbers to the AC running or not.

Also, can you insert a comment on the SS cells when Rosy gets fed, and what she is being fed at those times. That might help people figure out her mystery numbers as well.

Hang in there! There's got to be a logical explanation for these numbers! (Here I go again, trying to use logic to figure out our cats. Will I never learn that there is no logic to the things they do? *LOL*)

Suze
 
My shooting time is now 6/6. How do you mean by daytime full curve? Hourly testing during the AM cycle?
The aircon goes off at PM+4 but 2 fan are always on, window opened. It is really not that hot! The aircon is on at around AM+6 after I finished the house cleaning & vacumm.
Rosy's fed at
AMPS canned food
AM+2 canned food
AM+8 canned food
PMPS canned food
PM+3 steamed chicken
Canned food is Wiskas chicken loaf mixed with either Wellness Core or Ziwipeak

If there is no red or black readings, I wont go into detail finding, you know me Suze ;-) Thanks!
 
Helen,

Thank you, it made it easier looking at Rosy's SS knowing your shooting & feeding schedule and your AC schedule, and how it's "not that hot" with the fans on and the windows open. :)

I didn't think the AC had anything to do with the numbers, and especially not now, since, if it did, Rosy would stay high until AM +6 and she doesn't.

By a curve I mean testing every 2 hours during a cycle, which makes it easier to spot trends. I just learned a couple of days ago about Lantus users sometimes having another dip in their numbers around +10 or +11. And, is it possible that she's getting some fleeting greens in there that would cause her to start bouncing now, every night around the same time, and then clearing the bounce the next morning?

The steamed chicken at PM +3 is just pure protein, so that wouldn't cause the rise in numbers. But could Rosy still be hungry after that, and be getting into some higher carbed food somewhere after PM +3?

I'm just throwing some ideas out there. Maybe they'll help you figure Rosy out, maybe they won't. But I sure hope you figure her out and this weird trend stops. Good luck! (((HUGS)))

Suze
 
Way to go Pumbaa! He's doing great!

I wish I could give you dose advice, but it's a mystery to me, too, in all but the simplest of circumstances. I will say that I don't think the protocols are meant to be followed based on the numbers a cat has when he's bouncing. That would not make any sense.

The liver, apparently, isn't dumping glucose into the system in any controlled manner that is calibrated to counteract the insulin/carb intake exactly (or even close to exactly). That's what my experience tells me. The liver is overcompensating. This is probably because 1) it's not designed to operate except as an emergency safety net to get the creature through a short period of starvation long enough for the creature to find some food; 2) maybe it has no way of knowing how long it will take for the creature to find that food; 3) maybe in a non-diabetic who ate a natural diet his whole life it does a much better job 4) who knows what else! 5) who knows what else, else, else, else! (I was an English lit major with a History minor, and I have a law degree. What do I know?!)

It's easy for me to say, now that my cat has stopped bouncing, that you just have to wait it out, and be sure he's not bouncing before you use "nadir." At least you are testing him over and over, and will catch his below 50 BG. It seems to me that the cat has to stop bouncing for at least a 1 hour period day here or there before you can think about using the the numbers to make decisions. I could be wrong, but that is my gut feeling. Then, you have to figure out which numbers to use, as you said, raise the dose because Day X had a nadir of 301 or do I drop the dose down because Day Y had a nadir of 109?

Look at Max's spreadsheet. I had him on 2.75 for 32 days from April 27 forward, and he started having pre-shot BGs that were too low to shoot (below 200). He had about 6 of them before I lowered the dose in preparation for the pet sitter. He had his teeth cleaned, and was on AB for a couple of weeks after the cleaning. Then, after I got home, I had him on 2.75 for about 8 days when I finally caught him with a BG below 50. He had had his teeth cleaned about 38 days before that first below 50. Granted, I wasn't good about getting him his shot on time, I didn't shoot below 200, and I didn't test often enough before I lowered the dose for the pet sitter. However, someone on TR said that she thought 2.75 was going to be his breakthrough dose.

I'm sure the teeth cleaning helped. Nonetheless, between the evidence that he had below 200 pre-shot readings when he was on 2.75u and not on 2.5u and that he started getting reductions after only 8 days back at 2.75, it's clear that was the dose he needed to make progress.

Maybe that's how you tell if he's stopped bouncing? -- he has below 200 pre-shot tests every so often AND he's getting below 50 readings? If you disregard the days he was high, and just look at the days/nights his pre-shot was below 200 and he had an even lower reading later on that day/night, could it be that those are the "curves" that are relevant? I'll post this question in TR and we will see what we get. I don't think most people like to answer hypotheticals, but it wouldn't hurt to start a discussion.
 
Dale,

I like hypotheticals, and I don't even have a law degree. :) (I'm impressed, btw. You are quite accomplished!) I think you can learn a lot, in advance, from hypothetical questions.

Yeah, sure...it's easy for everyone whose cat has stopped bouncing to say, "they bounce until they don't." Hahahahaha! Well, I'm at least very thankful that Pumbaa's bounces have been clearing much quicker. And some day, hopefully, I, too, can be the proud owner of a non-bouncy FD kitty!

And thank you, Pumbaa is doing much better. But Max is doing absolutely fanstastic!!!!

Suze
 
Ugh, having a law degree these days is like taking out a mortgage, getting fire insurance and then having your house washed away by a flood. You have to pay the mortgage, but you can't rent the land out for much as pasture land, and you have to pay rent somewhere, too! Not recommended.
 
*LOL* Great analogy. But the words don't paint a very pretty picture. Sorry to hear that! :(

Too bad you live on the opposite side of the country. Eric Holder & Company are keeping plenty of attorney's busy suing Arizona and other states for wanting to enforce immigration laws. :roll:
 
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