9/29 Minnie PMPS 213

tiffmaxee said:
I would not have increased. I think she was bouncing from the 39 and the yellow signaled the end of the bounce. This might be a bounce clearing cycle. You might be very busy or I could be wrong and a non event. You test enough though.
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Thanks for the insight :) I wasn't focusing on this yellow specifically, more that we've been on 4.25u for >20 cycles. It isn't clear from the TR guidelines what to do in our situation. This is the best I could find
- [increase instructions] <100 - hold for at least 10 cycles, Increase by (unspecified amount)
- [decrease insturctions] decrease after 1wk: regularly has nadir 50-80 & stays<100

So...I stayed with 4.25u for a long time! How long could/should I stay at that dose assuming her numbers continued as they were - mostly blues/green nadir with occasional lime?
 
She dropped under 40 on 4.25 but you didn’t take the reduction. Instead you raised the dose or was that a typo? Her dose should have been reduced to 4.0. I’m confused.
 
Hm that's a really tough call. I think given the IAA, I probably would have done the same just to see what happens. With Mr Kitty, I went with 2 under 40 because reductions didn't seem to hold and the antibodies would take over again (or at least that was my plan, he had other ideas). Then the acro Dx changed things a bit.

I think no harm no foul as long as you're around to test.
 
FrostD said:
Hm that's a really tough call. I think given the IAA, I probably would have done the same just to see what happens. With Mr Kitty, I went with 2 under 40 because reductions didn't seem to hold and the antibodies would take over again (or at least that was my plan, he had other ideas). Then the acro Dx changed things a bit.

I think no harm no foul as long as you're around to test.
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I defer to you as I didn’t have IAA with Max.
 
tiffmaxee said:
Interesting. Did you ever increase after a 39?
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I did a few early MC interventions in the 50s/60s (between baby and cat I needed sleep lol) that I'm sure would have been 30s/40s had I waited or missed the early test. I held for a few cycles and yes did end up needing to increase in a few instances. One was at 6.5U, I did not reduce, and I ended up running all the way to 13.5U to chase the greens again.

With IAA, anecdotally it seems that keeping green as much as possible keeps antibodies at bay. Those blues and higher can really take hold and you chase them.

Acro is different because tumor pulses, so want them to run a little higher, hence most of us using 70 as reduction threshold...if tumor decides to stop pulsing then BG drops.
 
tiffmaxee said:
I defer to you as I didn’t have IAA with Max.
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It's sometimes a little more of an art/gut feeling than a science and makes decisions a little more difficult. Like you said, she tests enough and can handle those lows so I'm not really worried. I think you're right about the bounce so we'll see! I also tended to "ignore"/give less weight to the bounce breaking cycles because he would go much lower.
 
IAA is different from steroid induced numbers like Ruby but I've held her dose for a good while now. When I increased I really regretted it. As long as she gets a green number every 3-4 days I've been happy to stay with this because I am working and DBF tests her when he is at home but can't give her 100% of his attention.

Minnie hasn't bounced to a pink in more than a month. I would say you're doing great with her! Is your goal to get her tightly regulated and maybe OTJ?
 
:D sometimes it's better to log out a few hours and have all this interesting and educational conversation to come back to!!!
tiffmaxee said:
She dropped under 40 on 4.25 but you didn’t take the reduction. Instead you raised the dose or was that a typo? Her dose should have been reduced to 4.0. I’m confused.
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You and me both! It's a while ago now so I'm not sure what I was thinking, though I know I was beginning to have doubts on accuracy of the 4.25u - every shot I check where the zero line is relative to the plunger and eyeball the dose based on that. I think the couple I marked "4.5*" were where I tried using the callipers because 4.5 on the callipers was the same as my eyeballed 4.25. That plus I was beginning to have doubts about the meter accuracy too. Not very helpful, I know.

Overall I've generally been a bit unsure of what to do next. She'll have a run of blues/greens and then a sudden lime. I haven't been able to identify exactly what might trigger the limes, though I have realized she doesn't always eat if I go out even though I leave the auto-feeder. Now I'll check in on them with the camera and if I see her sleeping, call her name and quite often she'll wake up and eat.:p and so I guess I've hesitated about reducing because I didn't think it would stick based on the rest of her numbers - @FrostD has it exactly right, definitely feels like art/gut feeling rather than science!
PerfumedCatMom said:
Minnie hasn't bounced to a pink in more than a month. I would say you're doing great with her! Is your goal to get her tightly regulated and maybe OTJ?
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Thank you! It bizarrely seems that she decided to get with the program once we got the IAA diagnosis. To be honest, I really didn't believe she'd ever go OTJ (and oof, I can't imagine having to deal with <0.5u dosing!) but once we got the IAA diagnosis, it seemed like perhaps it's a possibility once the antibodies are out of the picture. I have to say, I do feel a lot better now that she's pretty stable with her numbers even if they're a little high still - I think the biggest stress to me is the uncertainty. I was out most of Sunday and was a bit anxious, so I mixed in a bit of HC FF gravy with her breakfast and in the autofeeder though she did just hit 49 (or 170 if I believed the other meter!).

Thanks for the input! :)

ETA - and while I wrote that, she quietly crept up to the lemon tree while snoozing!!
AMPS 120 +2.5 114 +6 89 +11 90
 
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FrostD said:
With IAA, anecdotally it seems that keeping green as much as possible keeps antibodies at bay. Those blues and higher can really take hold and you chase them.

Acro is different because tumor pulses, so want them to run a little higher, hence most of us using 70 as reduction threshold...if tumor decides to stop pulsing then BG drops.
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I have a different take on things. My Neko had IAA and acromegaly, and I've seen one or two (hundred?) cats with one or the other here. With acro, if you are following TR, reductions are at 50. Unless your cat is a long term diabetic and doesn't hold reductions well. Neko always held reductions so I stuck to a reduction point of 50, except after SRT. The only caveat and reason you might increase the reduction point is if you know things are changing because of treatment (cabergoline, SRT, etc.) or have a couple quick reductions in a row showing you that the tumour is ramping down. Or if your kitty also has IAA and the IAA is breaking. So you change the reduction point for safety if things are changing quickly. Normal ebbing and flowing of the tumour that isn't necessary.

With IAA, you want to keep as much green as safely possible. And regardless, you always reduce if you see the 30's or lower. There was no reduction after a 31 on 9/13 or the 20's :eek::eek: on 9/19, or again 39 on the 26th. Possibly even lower on the 26th because there no tests for 4 hours after the 49. If you were treating Minnie as a cat that does not hold reductions well - a possibility with IAA in the picture, then the reduction strategy is three times between 40 and 49 on separate days, or once under 40. On 4.25 units I see 5 days with times in the 40's, three days with the 30's and once with the 20's. Give that girl a reduction, not an increase! This if for Minnie's safety. Better to be high for a day than too low for a minute.

ETA: We had once member who thought she knew her cat well, kept him in lower numbers and didn't take reductions per the protocol but left out higher carb food. Came home one time to him seizing, after years of being a diabetic. Don't get complacent. Hypos kill, it did in that case.
 
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