8/7 Pumbaa - AMPS/66 - I shot the full dose.

[Pumbaa]

I understand that the shot I would give this morning won't affect this morning's cycle, supposedly, (due to the shed, etc.)

Yesterday, Pumbaa had a huge bounce morning.

Yesterday PM:
PMPS =361
+3 = 258
+7 = 185
+8 = 196

This morning:
AMPS = 66, fed sardines, didn't shoot
+12.25 = 59, I fed his regular food
+12.5 = 63
+12.75 = 69

I haven't given the injection yet. Just looking for some guidance that shooting him his full SK 2.50U would be the right thing to do. I should be home most of today to watch and test him.

Suze

@ +13 = 65. I gave him the full Skinny 2.50U, 45 minutes later than normal. He ate some more.
@ +.5 = 89, but I'll be watching him closely due to the food spike.

 

[Dale 'n' Chip]

Re: 8/7 Pumbaa question - AMPS/66 to shoot or not to shoot

You need him to be heading up before you feed to really be sure.

This is likely just a case of the nadir out of place.

If you have your HC food ready and can watch him perhaps it would be better to shoot, and then watch closely for the reduction?

 

[Pumbaa]

Re: 8/7 Pumbaa question - AMPS/66 to shoot or not to shoot

Chippendale's:

No kidding about whacked out nadir. :roll: When I finally went to be last night at +8, he was on the rise, and I didn't think he would drop like this overnight.

I didn't want the shed to deplete in a few cycles since he's getting such good results (other than the bounces) these days, so I did go ahead and shoot the full SK2.50U 45 minutes late.

I've got HC food handy, and honey, and plenty of lancets and test strips, so we are good there.

I just wish that his numbers would even out, and he had regular nadirs that I didn't have to hunt for daily.

Haven't even had time to check Chip's SS this morning...how's he doing?

 

[Dale 'n' Chip]

Re: 8/7 Pumbaa question - AMPS/66 to shoot or not to shoot

That is a big drop from the bounce to a new low for this era. Maybe with close monitoring he can *earn* the reduction.

Chip is up the the usual. At least still getting some yellow everyday.

I'm guessing Chip will need to go up to 2.5U as soon as possible per the protocol.

 

[Pumbaa]

Re: 8/7 Pumbaa question - AMPS/66 to shoot or not to shoot

I'm so glad that my test strips are now only $0.18 each! *LOL*

It would be great if the SK 2.50U turns out to be Pumbaa's breakthrough dose.

I was sooooooo hoping that new Levemir pen was going to provide you with spectacular results for Chip. *sigh* Hopefully you won't have to take him up to 2.50U. And hopefully, once he starts dropping in numbers, he's going to stay more even and not start bouncing again. Is he still acting better than he was on the Lantus?

 

[Dale 'n' Chip]

Re: 8/7 Pumbaa question - AMPS/66 to shoot or not to shoot

He's acting great. At least I know this pen is good, so it's just a matter of hitting a better dose. It may be higher than 2.5 but at least he isn't bouncing.

I guess I keep forgetting to mention, with these terumo syringes, I can shoot 1.5U Levemir and he hardly knows it happened. Testing and shooting are practically non-events. And he's eating well these days. So it's just a matter of getting better numbers. And it's a great relief to not be running out of insulin anytime soon.

These syringes are 6/16 instead of 5/16 and I like this length. An easy shoot and no fur shots.

 

[Pumbaa]

Re: 8/7 Pumbaa question - AMPS/66 to shoot or not to shoot

Glad that Chip is still acting great, and that Terumo syringes are working out for you two!

I still have a bunch of the monojects left, then the 60 UltiCare Vet syringes I ordered last time, so it will be a while before I order the Terumo and try those out.

 

[max&emmasmommie]

Remember what I said about seeing Green at shot-time? I haven't had a chance to post that on the board for everyone to check out, but it's an interesting theory. Maybe you just found his dose!

 

[Pumbaa]

Remember what I said about seeing Green at shot-time? I haven't had a chance to post that on the board for everyone to check out, but it's an interesting theory. Maybe you just found his dose!

Dale: From your keyboard to God's ear!!!!!!

 

[Pumbaa]

He dived down to 95 at PM +3, from a PMPS of 243.

No sleep for me tonight, to make sure Pumbaa doesn't keep diving.

Will the bounces and dives ever end? I don't know that I will live long enough to keep only napping instead of really sleeping, so that I can keep testing the little guy and make sure he isn't diving to too low numbers.

What can I do to even this little guy out????

 

[max&emmasmommie]

I really think you are getting there.

Did you see the answer I got to my bouncing/how to dose question in TR? The answer was that you should look at 3-4 cycles, not just any one, and take the lowest number of those cycles to make your decisions. That makes a lot of sense, and yet that's not what I did with Max, is it?

When I was giving Max 2.5u the last time, and I got a Green pmps on 7/27/12. I wasn't even considering raising the dose after seeing that. However, when I raised the dose to 2.75 after about another week, on 8/5/12, I got another Green amps on 7/7, and then three more Green shot times after I went back to 2.5u. Maybe I topped off the shed?

I was VERY afraid to raise the dose after I got that 92 in the midcycle on 7/12. In retrospect, his pancreas was healing, but I didn't know that at the time. Then, he started having blacks and reds again. I raised the dose, and "here we are."

Of course, this isn't "advice." I wish I had some for you, but it would be great if, somehow, the data you have gathered plus some advice from people who know what they are doing in addition to this data Max gave me would help you. I just have a gut feeling that Max's experience is relevant to other cats who bounce on Lantus as he did. The hard part is that your cat dives much lower than Max did, huh?

EDITED: Well, no, lately he hasn't been that low.

 

[Pumbaa]

Dale, I think we're getting there, too.

Haven't seen your question...will have to check TR. That's good news, though, since I have been looking at overall cycles during a dose instead of just one cycle. I don't understand how vets dose based on one curve done in their office every week or two. Yikes!

I look at your Max's SS (and other SS's too) all the time, trying to have an epiphany and figure Pumbaa out. And I'm trying to not jinx myself by typing when I see a new trend, 'cause Pumbaa then just does the opposite of what I've typed. *LOL*

While Pumbaa hasn't been diving into dangerously low numbers lately, I still worry about that happening and that is why I test him so often. I just don't know when he's going to dive, and how low he's going to go. I'll bet I've missed some <50 numbers, though.

 

[knolet]

I'm trying to not jinx myself by typing when I see a new trend, 'cause Pumbaa then just does the opposite of what I've typed. *LOL* quote]

Maybe you should purposely type the opposite of what you're seeing as a trend, then when Pumbaa reads over your shoulder to do the opposite, he'll be right where you want him. :razz:

 

[Pumbaa]

Maybe you should purposely type the opposite of what you're seeing as a trend, then when Pumbaa reads over your shoulder to do the opposite, he'll be right where you want him. :razz:

Believe me, I've thought about that!!!! (I'm not kidding!) *LOL*

 

[Dale 'n' Chip]

But you'd also need to *think* opposite thoughts (and believe them) since he's also psychic. :twisted:

BTW aren't you glad you shot the full dose!

 

[Pumbaa]

Chippendale's:

Yes, I am glad that I shot the full dose. It was so damn instinctive to immediately think that, since he was at 66, I should skip a shot. Until sanity returned and I remembered that, no matter what I did, it would not affect this cycle.

At the same time, I am very confused due to conflicting information. I've been meaning to pose this question, but haven't had the time/energy.

So, the fact is that we shoot L or L insulins and they have a shed that needs to fill or unfill, depending on whether we are increasing or decreasing the dose, and the shed can take up to 6 cycles to do it's thing.

Due to this shed, the injection I gave Pumbaa tonight will not have an immediate impact on his numbers tonight. Correct?

So why the below conflicting information?

1) if this shed is built up in the cat's body, why are there still 12 hour cycles? I would think there would be a 24-hour supply of insulin available and working if the current injection did not affect anything but the shed. Is this why Pumbaa's nadirs are all over the place?

2) I was told that, if I really need to get a good night's sleep, it's okay to skip a shot. But, wouldn't that just mean that I wouldn't be able to get that good nights sleep for a couple of days, when the skipped shot rears its ugly head?

3) Why do we delay injections when the numbers are still dropping at the PS if the current injection won't have anything to do with the current cycle?

Things that make you go "hmmmmm...".

PS: Whoohooooo! Chip had two blues in a row! And he had an all-time low of 147 on Levemir! Way to go!!!!!!

 

[Dale 'n' Chip]

Those are great questions. None of the those guidelines are absolute, but I suspect most of the Lantus oomph in felines is usually available the following cycle, after the next shot. So it peaks in about 6 hours and fades out. But because of the precipitation variability factor, almost anything may happen. You usually get *something* from the current shot, any Lantus that doesn't precipitate correctly is available immediately. That may be a significant portion of any given shot, or almost none.

In addition to that, you can also start chain reactions, in the delicate equilibrium of regulation and counterregulation. So holding or skipping may cause an unexpected swing in either direction, something to the effect of "dumping the shed" so that's why it's usually best to do everything orderly. On time and correct amounts. To reduce the surprises as much as we can. Which sometimes is still not much.

Levemir is a different ballgame. It may be the lack of pulsing and swinging that doesn't start those chain reactions for Chip, and allows him to stay *more* ahead of the dose than some cats. And holding him so perfectly flat pink likely increases his resistance. But the good side of that is he may bounce somewhat less as long as it eventually gets some traction.

 

[Pumbaa]

Those are great questions.

Thank you.

I'm a very logical, detailed person, and some of this information just does not compute!

You usually get *something* from the current shot, any Lantus that doesn't precipitate correctly is available immediately. That may be a significant portion of any given shot, or almost none.

Now that is an interesting observation. So why are we led to believe that the current injection won't affect the current cycle, in some Lantus caveats?

In addition to that, you can also start chain reactions, in the delicate equilibrium of regulation and counterregulation. So holding or skipping may cause an unexpected swing in either direction, something to the effect of "dumping the shed" so that's why it's usually best to do everything orderly. On time and correct amounts. To reduce the surprises as much as we can. Which sometimes is still not much.

This I understand, but I never want to start a chain reaction that is going to put Pumbaa in danger.

Levemir is a different ballgame. It may be the lack of pulsing and swinging that doesn't start those chain reactions for Chip, and allows him to stay *more* ahead of the dose than some cats. And holding him so perfectly flat pink likely increases his resistance. But the good side of that is he may bounce somewhat less as long as it eventually gets some traction.

Is this Levemir, overall, or just what you have seen in Chip? Because the lack of bouncing and diving on Levimir is not true for all cats, from what I have read. I know you've done a lot of research on Levemir, and I'm interested in your findings. I'm still pondering switching Pumbaa to Levemir when his Lantus is running out.

Suze

 

[Dale 'n' Chip]

Is this Levemir, overall, or just what you have seen in Chip? Because the lack of bouncing and diving on Levimir is not true for all cats, from what I have read. I know you've done a lot of research on Levemir, and I'm interested in your findings. I'm still pondering switching Pumbaa to Levemir when his Lantus is running out.

Suze

I'm trying to figure out what is going on with Levemir and Chip.

But for everyone Levemir should be potentially smoother and gentler, and have the later onset and nadir since it must go through two stages before it becomes available for use.

Lantus goes through only one stage. Or none. Any Lantus that doesn't precipitate is directly available for action, like shooting a short acting insulin. While apparently something like 99% of Levemir is bound to albumin when it hits the bloodstream so it's unavailable. That won't directly affect bouncing, but it allows an opportunity to ease down instead of crashing down abruptly for potentially less bouncing.

I think most go on the assumption (for Lantus) that you get *something* that cycle from every shot.

 

[Pumbaa]

I think most go on the assumption (for Lantus) that you get *something* that cycle from every shot.

That isn't what I have assumed, at all. Which is why I was questioning the conflicting information.

But for everyone Levemir should be potentially smoother and gentler, and have the later onset and nadir since it must go through two stages before it becomes available for use.

The differences between the two L insulins has really been confusing, but I like your input, and that leads me to wanting to switch Pumbaa from Lantus to Levemir much more strongly.

Thank you for your input, Dale!

 

[Dale 'n' Chip]

I think most go on the assumption (for Lantus) that you get *something* that cycle from every shot.

That isn't what I have assumed, at all. Which is why I was questioning the conflicting information.

I would use the assumption you *may* get something (perhaps significant) now from any given shot with Lantus. With Levemir "not so much" now.

 

[max&emmasmommie]

Hey, Suze,

Ugh, I wrote a long answer to you, and I lost it when I realized that I had forgotten to test and shoot Max tonight. Here's a much more brief version:

1) if this shed is built up in the cat's body, why are there still 12 hour cycles? I would think there would be a 24-hour supply of insulin available and working if the current injection did not affect anything but the shed. Is this why Pumbaa's nadirs are all over the place?

Lantus is designed to work with the circadian rhythm. Our bodies allow us to sleep for 8-10 or more hours without eating. The liver takes care of us while we are fasting through the night. There is a hormone that we produce from the adrenal glands when our blood sugar is low, and it stimulates the liver to provide a little extra sugar here and there to help us stay alive and capable of waking up for emergencies in the night until we get a chance to eat again. There is something called the "Dawn Phenomenon:" blood sugar rises in the morning hours. So, our blood sugar is not only dependent on what we eat and when, but on what time of day it is, too. In cats, there must be a similar mechanism. Consider how much more they sleep. I realize they sleep less soundly, but think about how infrequently they eat in the wild. For some reason, Lantus works for cats. Therefore, there must be a similar interaction with the circadian rhythm in cats.

2) I was told that, if I really need to get a good night's sleep, it's okay to skip a shot. But, wouldn't that just mean that I wouldn't be able to get that good nights sleep for a couple of days, when the skipped shot rears its ugly head?

I think I would wait until 8 hours after any skipped shot to be completely comfortable that Max will not hypo. If the skipped shot was in the morning, getting sleep at night isn't a problem, but I think that what I consider a good night's sleep -- 8 to 10 hours with only groggy trips to the bathroom and for water -- isn't possible if the shot is skipped in the evening.

I think that "the current shot will not affect the next cycle" means you DO have to worry about a hypo if he's low, and you don't need to worry that any high reading is because of the skip; either of those possibilities are going to happen whether or not you skip the shot. It's the next cycle that will be much changed if the cat is getting less than what he needs. If his shed is overflowing when you skip the shot, you will still see a low number. The dawn phenomenon will, theoretically, help with the BG when the Lantus is starting to "wear off" in the last part of the 12 hour cycle.

3) Why do we delay injections when the numbers are still dropping at the PS if the current injection won't have anything to do with the current cycle?

I would say it's because you don't know "for sure" what's going to happen. Look at Max's spreadsheet on the days that his +1 and +2 were lower than the pre-shot. What if he just kept going down? When the next cycle starts the effect of the current shot will be compounded by the shed that was there when you gave the shot on time. What if something other than the way that Lantus is working is the problem? It's scary using TR, and it's not without risk. Suppose the adrenal glands did not kick out that hormone for dawn phenomenon (whenever that happens in cats). What if his liver did not respond to the hormone? What if the liver had no way to provide sugar because it wasn't available? What if; what if ; what if. You want to know, as best you can, that everything is "normal" for the cat when you give another dose.

You are doing great. Pumbaa will be fine. Don't forget to check out my thread: Discussion: How to Dose/Stop Bounce in TR and Levemir if you are interested. (I kinda put it up for you in particular. :smile: The answers I'm getting are sooo interesting, I think.)

 

[Pumbaa]

Mammadale:

Yes, I've been reading the posts with the questions on bouncing and diving and dosing. Thank you for posing those questions. The responses have been interesting.

Our bodies allow us to sleep for 8-10 or more hours without eating.

Hahahahahahahahaha!!!! You typed that with a straight face, considering all of the testing you (and I) have been doing at all hours?

I've heard of the "Dawn Phenomenon", but always thought of it more so in the terms of how our blood pressure starts to rise, not about the liver functioning.

Still trying to absorb the rest of your information, but my brain is sluggish from lack of sleep, and I am currently obsessing over Pumbaa's late night drops in BG numbers/his erratic PM nadirs. The circadian rhythms and Dawn Phenomenon aren't computing because of what Pumbaa did last night (and also probabaly a couple of nights ago before he had that AMPS of 66). I'm afraid to sleep at night now, because I just can't predict what he is going to do and when he's going to drop. I'm pleased that he's been staying in healthy green numbers, not dangerous ones, but I just don't know when he's going to drop too low. So I test, test, test. Just like you do. I hope Max is still doing splendidly! I want to go check out his SS before I try and get another hour or two of sleep. (I just looked at Max's SS...look at those beautiful greens, even when you skip shots! And he hasn't been dropping into dangerous green numbers, either. Absolutely beautiful numbers!!!!!!)

Suze