9/28 China AMBG 67,PMPS 253,+2 263,+6 216

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Chris & China (GA)

Chris & China (GA)

Member Since 2013
Yesterdays craziness

After yesterday's adventure in the 20's, when I saw how quickly she'd cleared the bounce, (plus the fact that I totally screwed up last night at PMPS) and her BG was still dropping this morning, I figured I would get at least a stress-free day and not shoot this morning. I only hope we don't lose any momentum considering how well she's been doing. I know an early shot acts like an increase, so I'm thrilled she didn't go way low last night too

It's a dark, rainy day and just perfect for snoozles, so that's what we're doing today. Will see where we are at PMPS time and go from there.

At least this time I can't screw up the schedule like I did last night since I didn't shoot this morning :oops:

Hope everyone is having a nice Caturday and that all the kitties are doing well!
 
Re: 9/28 China AMBG 67,+6 90 NO SHOT IN AM

You have to do what you need to do to keep China safe. I hope she'll get back on track quickly.
 
Re: 9/28 China AMBG 67,+6 90 NO SHOT IN AM

Thanks for the visit Carla!

I was pretty freaked yesterday when she'd dropped so low, so when she had dropping numbers this morning, I just didn't want a repeat of yesterday. It'll be interesting to see where she is at PMPS time. I was a little shocked at the 90 at +6 (I figured it'd be higher) but at least it looks like I made the right decision in not shooting this morning. If she was only at 90 at +6 with no insulin, she probably would have gone really low again if I had given it
 
Re: 9/28 China AMBG 67,+6 90 NO SHOT IN AM

Good call today Chris. Sometimes the shed just needs to drain a bit. BTW, your +6 is really a +18. :-D
 
Re: 9/28 China AMBG 67,+18 90 NO SHOT IN AM

Wow, 90 at +18! Wonderful! Looks like you made the right decision. Plus, you guys need a stress free day after the one you had yesterday. Enjoy the rest!
 
Re: 9/28 China AMBG 67,+18 90,PMPS 253..Bounce or no insulin

Well at PMPS China's at 253...I don't know if she could have gone up 163 points in 6 hours since she didn't get any food other than a couple teaspoons at +18, so I have to wonder if this is more of a bounce from the lows she probably hit at +10 through +12 last night.

Any ideas?
 
Re: 9/28 China AMBG 67,+18 90,PMPS 253..Bounce or no insulin

Just as an FYI, I don't think China's numbers were necessarily dropping this morning. Maybe with a third test you could have known with greater certainty. A 72 at +12 followed by a 67 at your next test could easily have been surfing since the two numbers are virtually the same.

As for whether your PMPS is a bounce or the result of a skipped shot, it could be either. It's entirely possible for numbers to jump 163 points in 6 hours. (I've had Gabby jump from the 40s to the 400s in that period of time and J.D. does it with regularity.) What I am curious about is why you didn't reduce the dose this evening. A 22 yesterday does not get a shaved dose. It warrants a 0.25u reduction and your SS indicates you shot 0.75u which is the dose that dropped China into the 20s. Please monitor carefully tonight.
 
Re: 9/28 China AMBG 67,+18 90,PMPS 253..Bounce or no insulin

I didn't reduce it further because we'd just reduced her from 1 unit to .75 at PMPS on 9/26, which is another reason I felt it best to let her shed drain a little this morning. She did the 22 on the 2nd cycle of .75 and I figured that was mostly shed action from the 1 unit dose. By letting it drain some, I hoped I didn't have another day like yesterday.

She has a history of failed reductions, so I didn't think I should reduce her twice in 3 cycles

Edited to add...If this was wrong, please explain. I totally understand the concept of "Under 50 is a reduction", but 2 reductions in 3 cycles?
 
Re: 9/28 China AMBG 67,+18 90,PMPS 253..Bounce or no insulin

I'm not perfectly clear on it, but I think the issue isn't so much "under 50" as much as "22". I understand the logic of she just got a reduction, and she's had failed reductions, and the depot would have emptied a little due to the skip.

But "22" is pretty extremely low?
 
Re: 9/28 China AMBG 67,+18 90,PMPS 253..Bounce or no insulin

Oh I know Carl...scared me to death!! She's gone into the 20's a couple of times, but I know I've been really lucky that I didn't end up with a much worse outcome than just being stressed out for a day
 
Re: 9/28 China AMBG 67,+18 90,PMPS 253..Bounce or no insulin

Carl & Bob said:
I'm not perfectly clear on it, but I think the issue isn't so much "under 50" as much as "22". I understand the logic of she just got a reduction, and she's had failed reductions, and the depot would have emptied a little due to the skip.

But "22" is pretty extremely low?
Click to expand...
exactly. a 22 is screaming for a reduction... no matter what the history. a full 0.25u reduction.
trust me, i understand your reluctance to reduce, but a 22 is pretty darn low... a scary low.

i took a look at china's spreadsheet from top to bottom. i'm not so sure this pattern of skipping shots or skinny-ing up the dose is working for you. it might not be a bad idea to go back to basics since china is responding so very well to lantus! :mrgreen:

fwiw, just my thoughts...
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

i'm not so sure this pattern of skipping shots or skinny-ing up the dose is working for you
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Thanks for looking it over Jill, but I'm not sure what you mean by "pattern of skipping shots or skinny-ing up dose"...I've only skinnied up her dose once (1.25s for 6 cycles on 9/6,7, 8) because she dropped to 49 and hadn't held her reductions...and then when she dropped to 33, I took her down to 1 unit. The only time I've skipped shots were the few times when I was dealing with my mom's hospital visits or doctors appointments and couldn't be home to test when she had a low number at PS time. This morning was the first time I'd skipped a dose when I could be home to test.

Is there something you're seeing that I'm not? I'm still learning this dance, so if you are, I'd appreciate the tips
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

my apologies. i was looking strictly at data. not logical reasons for skipping. :oops:
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

No apologies necessary Jill...as I said, I'm still fairly new to this dance, and just wasn't sure if you were seeing something I wasn't.

We're all good here...and China's doing so great! I can hardly believe the difference in her in just a little over 3 months...she's a totally different cat! If Lantus could take 10 years off my age, I'd be using it too...LOL (just kidding, but it really is crazy how I had thought she was suffering from "old cat", and now that her blood glucose is under better control, she looks like a young adult instead of a senior citizen)
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

That is a great response!

I have a question for Jill if she's still here. How does one stack up all those back to back mandatory reductions (33, shoot through the bounce, 22, etc.) in a case like this when it's still the depot talking?
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

that's so good to hear!
no matter what any kitty's numbers look like it warms my heart to hear about the improvements in their behavior. :mrgreen:
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

Dale 'n' Chip said:
That is a great response!

I have a question for Jill if she's still here. How does one stack up all those back to back mandatory reductions (33, shoot through the bounce, 22, etc.) in a case like this when it's still the depot talking?
Click to expand...

I think the depot is partially muted due to the skipped shot?
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

Dale 'n' Chip said:
I have a question for Jill if she's still here. How does one stack up all those back to back mandatory reductions (33, shoot through the bounce, 22, etc.) in a case like this when it's still the depot talking?
Click to expand...
boy, do i ever wish i could give you a one size fits all answer, but i can't.
in a situation as you've described all you can do is give it your best shot (no pun intended). :-D

20s are scary. when using lantus & given onset is generally around +2... there's not a whole lot of notice given for a drop to the low 20s. at least with lev, you have a little more time to notice and react to an extreme drop... "if" you're testing often.

imho, a drop to 20s warrants a full reduction when using lantus. if you have to work your way back up the dosing scale by adding a drop or two to the dose, so be it. one thing you don't want to do is reproduce the same cycle that drops a kitty into the 20s.

sometimes you have to get creative by feeding before nadir in order to hang onto a dose. i've done that with alex for years because i have to get enough insulin in her to counteract her horrendous food spikes and at the same time prevent her from bottoming out while trying to keep her in green numbers. the drawback to that is i have to make sure she eats even if it means assist feeding if she won't eat.

getting back to your question... when you KNOW there are residual effects left over from the depot... i'd feed to prevent the drop if for no other reason than not having to take another reduction so soon.
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

Thanks. :smile:

I learned how to do that from watching what you do with Alex.

I think Chis is doing a great job! I suspect I would have done it the same way. All but skipping the shot?

But I have to admit the "modified" protocol is still above my pay grade, in a case like this when the cat seems to be on a mission.
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

The reason I skipped this morning, was because of that 22, and the fact that it happened on only the 2nd cycle of the reduction from 1 to .75u I felt that the 22 was more "shed action" than anything.

I'd had to stall twice in 2 cycles before giving any insulin (9/26) and she still dropped to 22 on the AMPS on 9/27 (and on the AMPS stall, she'd gone from 61 to 90 so I was pretty sure she was coming up and it wasn't meter variance talking)

This morning, when she dropped from 72 to 67 she was either clearing a bounce in record time, or her number was still dropping so I felt it best to skip this one and let the depot drain a little so I wouldn't have another 22 (or worse). I think the fact that she only came up to 90 at +18 tells me I was probably right to skip it. Of course there's no way to know what would have happened if I gave her any amount of insulin.

I'd also been up all night the night of the 25th, and then got that 22 the morning of the 27th and was just too tired and stressed out to do it again so soon. China will recover from the skipped shot...if I'd shot, even .5 I can't say that.

Thanks for all the tips everyone! I really do learn so much from situations like this!
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

I've been so tired like that I've done some *crazy* things. Most of which I regretted. :oops:

Not that I'm saying skipping the shot was crazy. ;-)

You should have plenty of time to catch up on sleep when she is OTJ?
 
Re: 9/28 China AMBG 67,PMPS 253,+2 263..Bounce or no insulin

LOL..yeah me too....I never thought it was possible to get up in the middle of the night, find a cat, poke said cat's ear and get a BG reading and have no memory of it the next morning other than an extra reading on the glucometer you can't explain :lol: :lol:
 
Jill...could you explain this?
when you KNOW there are residual effects left over from the depot... i'd feed to prevent the drop if for no other reason than not having to take another reduction so soon.
Click to expand...

How can you "KNOW" (in advance of a big drop) that there are residual effects left over from the depot?

And if I could "know" there was going to be a big drop, would I have wanted to maybe feed her a MC food to try to keep her from dropping so low? (again, if I could know what would happen before it did)

Is the fact she dropped from 90 to 74 at +1 something that I should have noticed and maybe fed her a little MC food? (of course I rarely do a +1, but "something" told me to watch her closer than normal yesterday morning)
 
Chris & China said:
Jill...could you explain this?
when you KNOW there are residual effects left over from the depot... i'd feed to prevent the drop if for no other reason than not having to take another reduction so soon.
Click to expand...
Click to expand...
sure.
a given: lantus is a depot insulin. it takes a good 3 days or more to build up in kitty's system before we can see what a particular dose is capable of. by the same token, when you reduce the dose it takes time for the residual effects of the dose to completely diminish.

it takes alex approximately 5 cycles for the depot to deplete on even tiny doses, but ECID. i've also noticed it takes longer than 5 cycles for the depot to diminish on doses of 2 units or more (with alex).

reductions taken too close together fail more often than not. for that reason, after a reduction i'd feed to prevent alex from earning yet another reduction which is too close together because i "KNOW" those cycles immediately following a reduction have a little extra "oomph" to them because of the insulin depot. i also know that once the depot from the higher dose has diminished is when i'll see the "true" effects of what the reduced dose can do... and not until then. imho, if i can stabilize alex on the reduced dose by using food to prevent her from earning a reduction too close to the last reduction... while the depot remains at play... chances are the reduction will hold.

Chris & China said:
How can you "KNOW" (in advance of a big drop) that there are residual effects left over from the depot?
Click to expand...
you can't always know (for sure) in advance if kitty is headed for a big drop, but what you do know for sure is the depot doesn't immediately go away just because the dose has been reduced. therefore, immediately following a reduction you can count on the next several cycles being influenced by the depot.

as far as knowing if a big drop is coming...
with lantus, those +1s and +2s will often provide a clue. if they're lower than the preshot number it's time to sit up and pay attention because *usually* a drop is coming. i look for the rate/size of the drop when we're talking about drops. although, it's important to realize a drop from let's say a ps number of 75 to a +1 of 50 means a whole lot more than the same 25 point drop from a ps number of 200 to a +1 of 175. in the sticky, along with the +10s and +11s, we call those +1s and +2s "the forgotten spot checks". they can tell you a lot. :-D

Chris & China said:
And if I could "know" there was going to be a big drop, would I have wanted to maybe feed her a MC food to try to keep her from dropping so low? (again, if I could know what would happen before it did)

Is the fact she dropped from 90 to 74 at +1 something that I should have noticed and maybe fed her a little MC food? (of course I rarely do a +1, but "something" told me to watch her closer than normal yesterday morning)
Click to expand...
using your example, you wouldn't "know" a big drop was coming until you saw the 74 at +1. that's when you would want to feed a little to bump the numbers up about 20 - 30 points before onset occurs. whether you would feed LC, MC, or pull out the HC depends on your knowledge of china... what percentage of carbs will it take to bump her up at any given point in the cycle... depending on how carb-sensitive she is.


make sense? it's late... very early in the morning and i'm getting a little cross-eyed. :lol:
i'll be in and out a lot on sunday, but i'll check back with you to see if you have any questions.
 
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