BUD AMPS 208 0.5u. +3 314
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Charliemeow
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So just to clarify... Pmps at +12 last nite: .2u
+6 (amps) 208, .5u
+3: 314
+6: 316
I didn't look at your ss yet. Was the amps given on a rising bg? Those 2 shots, then, were only 6 hours apart? That seems a little risky to me, but like I said I didn't check your SS. Maybe I missed something. Interested to hear what the veterans' opinions are.
+6 (amps) 208, .5u
+3: 314
+6: 316
I didn't look at your ss yet. Was the amps given on a rising bg? Those 2 shots, then, were only 6 hours apart? That seems a little risky to me, but like I said I didn't check your SS. Maybe I missed something. Interested to hear what the veterans' opinions are.
A
Anonymous
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yes..the number must have been on the rise as i think you shot 167 last night, shot .2
this may have been too much insulin....may be time to teach hubby (did he test/shoot) this am? about micro dose, like .2 or .3...could we see more tests today...you much already be at +7 or 8 your time.
this may have been too much insulin....may be time to teach hubby (did he test/shoot) this am? about micro dose, like .2 or .3...could we see more tests today...you much already be at +7 or 8 your time.
Gator & H (GA)
Very Active Member
The important thing/reason about teaching the DH is for CONSISTENCY reasons. So we know it is a REAL .5u and not something that was eyeballed.
I think you/Beth put .05 into your SS and not .5?
Looks like .5 this morning was not too much insulin? Looks now like not enough. To me. Are you thinking rebound Lori? I'm thinking the extra .2u wearing off and this cat is a zooooomer.
We'll see where the day ends up. It won't look normal.
I think you/Beth put .05 into your SS and not .5?
Looks like .5 this morning was not too much insulin? Looks now like not enough. To me. Are you thinking rebound Lori? I'm thinking the extra .2u wearing off and this cat is a zooooomer.
We'll see where the day ends up. It won't look normal.
Gator & H (GA)
Very Active Member
dear husband
I might have tried the .6u thing. But we well see where she goes. I would like to avoid the rubber-banding that's been happening with shoot no shoot etc. One way to avoid that is to being them back down slowly. There are some increments between .5 and .75 that need to be tried. But if you do not wish to try to keep a somewhat normal 12/12 [PZI does not require a strict 12/12] then shooting as needed you probably should have shot when she went up over 200 or 250. So if you choose to go more the 12/12 route then we need to try to settle down this rubber-banding.
I might have tried the .6u thing. But we well see where she goes. I would like to avoid the rubber-banding that's been happening with shoot no shoot etc. One way to avoid that is to being them back down slowly. There are some increments between .5 and .75 that need to be tried. But if you do not wish to try to keep a somewhat normal 12/12 [PZI does not require a strict 12/12] then shooting as needed you probably should have shot when she went up over 200 or 250. So if you choose to go more the 12/12 route then we need to try to settle down this rubber-banding.
eeraby
Active Member
I'd really like to try to keep on the 12/12 schedule. UNLESS it is harming her. This seems to be working will for DH's and my schedules. Although I'll be home for January, I will be gone for 10 days at a time throughout the year. He is always here at 5am and 5pm.
K... I'm all for trying lesser doses. We do have the 100u syringes with the 1/2 unit markings (did get them at Walmart but NOT ReliOn Brand).
The main goal here is to keep her under 250, correct? The AMPS 208 with 0.5u was too much insulin and that is what cause the 300s at +3 +6? Too much insulin causes low AND/OR high numbers?
I'm very confused about what happened with the 0.2u last night and why it was higher +6 later for her AMPS and then kept rising.
Thanks
K... I'm all for trying lesser doses. We do have the 100u syringes with the 1/2 unit markings (did get them at Walmart but NOT ReliOn Brand).
The main goal here is to keep her under 250, correct? The AMPS 208 with 0.5u was too much insulin and that is what cause the 300s at +3 +6? Too much insulin causes low AND/OR high numbers?
I'm very confused about what happened with the 0.2u last night and why it was higher +6 later for her AMPS and then kept rising.
Thanks
Joanna & Bix (GA)
Very Active Member
The 0.2 was likely too little insulin. Now and then we see a kitty who drops dramatically on a dose like that, and those are usually kitties who are very close to OTJ. Most cats I've seen don't get much action at all off of a 0.2. No problem shooting that for safety reasons, but if I were in your shoes, I would probably stick with doses of 0.4 - 0.6. If you start getting nadirs below 60, then I would reduce to lower doses.
The dilemma as I see it is that if you go for a nice 12/12 plan you will almost have to undershoot to ensure a shootable PS in 12 hours, and that keeps her riding in higher #s than she could be in otherwise (not harming her, just might not be ideal). If you want to go for the good #s, then you get off schedule, and risk getting into those high reds if you can't catch her at a lower # to shoot. So there's kind of a trade-off that you are picking - better #s and better chance for pancreas healing, vs. schedule sanity and "ok" #s. One option is to shoot for sanity when your schedule requires it, and then go for ideal #s when you can - maybe on a long weekend or whatnot. Until it's clear if she is headed OTJ or not, if it were me I would go for ideal #s if my schedule permitted, and save sanity for later. If you know you have a cat who is not likely headed OTJ, at least not in a quick & easy kind of way, then sanity is what is needed IMO.
I'm not sure if that makes sense, but I wanted to chime in to be sure you have a sense of what the trade-offs are. Some cats will go OTJ very quickly if they can sustain some green and low blue #s for a stretch of a few days. If you do have a window for something like that to happen, IMO you want to take advantage of that if you can stomach it. I'm not sure if *I* could stomach doing it myself :mrgreen: ... just sayin' ....
I got a little lost on the timing of the shots - you shot 6 hours after the last shot? Probably no biggie in this case as the previous shot was 0.2u if I understood, but generally that is a somewhat risky thing to do. With PZI you want to be sure they are past their nadir before shooting, that is what others have mentioned as shooting on a rising #. To test for that (we usually skip it at +12 on the assumption that they are usually rising by then), you need two tests around 15 min apart. If you have a mid-cycle test before your PS, that counts too. But when you don't have that and want to shoot early, you should get two tests to be sure they are on the rise when you shoot. I have shot at +6 before and got shocking results, so I shy away from advising shooting before +8 - +10 except in some really extreme cases (ketones for instance). Generally you should never shoot before +6, just fyi.
The dilemma as I see it is that if you go for a nice 12/12 plan you will almost have to undershoot to ensure a shootable PS in 12 hours, and that keeps her riding in higher #s than she could be in otherwise (not harming her, just might not be ideal). If you want to go for the good #s, then you get off schedule, and risk getting into those high reds if you can't catch her at a lower # to shoot. So there's kind of a trade-off that you are picking - better #s and better chance for pancreas healing, vs. schedule sanity and "ok" #s. One option is to shoot for sanity when your schedule requires it, and then go for ideal #s when you can - maybe on a long weekend or whatnot. Until it's clear if she is headed OTJ or not, if it were me I would go for ideal #s if my schedule permitted, and save sanity for later. If you know you have a cat who is not likely headed OTJ, at least not in a quick & easy kind of way, then sanity is what is needed IMO.
I'm not sure if that makes sense, but I wanted to chime in to be sure you have a sense of what the trade-offs are. Some cats will go OTJ very quickly if they can sustain some green and low blue #s for a stretch of a few days. If you do have a window for something like that to happen, IMO you want to take advantage of that if you can stomach it. I'm not sure if *I* could stomach doing it myself :mrgreen: ... just sayin' ....
I got a little lost on the timing of the shots - you shot 6 hours after the last shot? Probably no biggie in this case as the previous shot was 0.2u if I understood, but generally that is a somewhat risky thing to do. With PZI you want to be sure they are past their nadir before shooting, that is what others have mentioned as shooting on a rising #. To test for that (we usually skip it at +12 on the assumption that they are usually rising by then), you need two tests around 15 min apart. If you have a mid-cycle test before your PS, that counts too. But when you don't have that and want to shoot early, you should get two tests to be sure they are on the rise when you shoot. I have shot at +6 before and got shocking results, so I shy away from advising shooting before +8 - +10 except in some really extreme cases (ketones for instance). Generally you should never shoot before +6, just fyi.
judy and squamee(GA)
Very Active Member
Just to let you know, I was perpetually in a state of confusion when giving insulin. Which is why I think I will never be able to give dosing advice! THere are SO many variables--how much and when they ate, what they ate, if they are ill or have dental problems, etc. etc. etc. And yes, high BG numbers can be because they had too much insulin or because they had too little insulin. Too little insulin doesn't take enough sugar out of the blood stream, and too much insulin scares the body into thinking it has too protect itself so it dumps sugar into the blood (I think I have that straight---not even sure of that). So if you are confused, welcome to the club! Thing is, you have to just keep trying (and listen to more experienced advice) and generally remind yourself that any one dose is not the end of the world and you keep getting more data and trying to learn from it. And also remind yourself that you probably will never have as much control of things as you would like.
Gator & H (GA)
Very Active Member
Depends. If you chose to do an as needed program then my opinion would be likely yes to start with [or even lower]. But if you are trying to do a 12/12 or approximate then the first goal would be to *try* to keep her under 300. Then 250 then 200 and maybe even lower if you were really adventurous.eeraby said:
No, IMHO it did not cause rebound via too much insulin.eeraby said:
Too much insulin can casue low numbers. The idea of Rebound http://petdiabetes.wikia.com/wiki/Rebound is not universally accepted. I'm in a perpetual state of skepticism about it but I have seen cats in situations that sure looked exact like "rebound." So personally I'm a rebound agnostic. :mrgreen: But it is thought that if a cat goes too low or low too fast then they might have a rebound type reaction that would show up later and might cause some high-er numbers.eeraby said:
IMHO this cat is a zoomer when there is no insulin going in her system. And she had gone high too - sometimes it takes a couple cycles just to bring them gently out of high numbers.eeraby said:
I agree with everything Joanna said. And I agree with the idea of potentially taking advantage of any window. It is also possible for a cat to see greens if their numbers are pushed slowly down and into healing ranges slowly. This however might take a little longer for you to master and theoretically might close that window. But, my thought is that potentially the window is not there because this cat has had a few opportunities now to take advantage of those brief healing numbers [a pessimistic view]. I could easily be wrong too.
So some of the same ideas and some ideas that are a little different. You are getting some really good input and ultimately it is your job to match the ideas to your goals for you and your kitty. You are the one holding the syringe. :smile:
One idea for you is to look at the spreadsheets of the cats that have gone into remission [the remissions sticky] and see what that process can look like. You will likely see what Joanna and Lori are talking about and maybe even a little of what I'm talking about.
And ultimately these ideas are not mutually exclusive. Technically you can try a little of both.
A
Anonymous
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beth you are not too stupid!
you just need to trust yourself. we all feel insecure at first...and you are no different. but please just realize you are in the learning phase, and you will get over the hump in time, less time than you think.
now.....if you are willing to change you schedule to like 9/9 than you can have gator and i and joanna too i think help you with dosing. the 5/5 schedule leaves you on your own in the morning. once you get the confidence you can go back to 5/5 if you want...just a thought.
lori
you just need to trust yourself. we all feel insecure at first...and you are no different. but please just realize you are in the learning phase, and you will get over the hump in time, less time than you think.
now.....if you are willing to change you schedule to like 9/9 than you can have gator and i and joanna too i think help you with dosing. the 5/5 schedule leaves you on your own in the morning. once you get the confidence you can go back to 5/5 if you want...just a thought.
lori
Rob & Harley (GA)
Very Active Member
I know I'm late to the party and am not up to date with everything that you have been through, but reading the last few comments I'll agree with Lori.
If you can change your shoot time so they will be online at tha time you can post a new thread every morning stating AMPS ### and they can guide you through the decision making process for the dose. That way you have experienced eyes watching your numbers and patterns and they can explain why they think what they think so you will learn along the way until you are comfortable doing it yourself.
Hang in there, it does get easier, it just takes time.
If you can change your shoot time so they will be online at tha time you can post a new thread every morning stating AMPS ### and they can guide you through the decision making process for the dose. That way you have experienced eyes watching your numbers and patterns and they can explain why they think what they think so you will learn along the way until you are comfortable doing it yourself.
Hang in there, it does get easier, it just takes time.
Joanna & Bix (GA)
Very Active Member
No worries, you are doing great!
Cats are pretty forgiving too, so don't stress yourself too much about trying to get the absolutely perfect dose. I wouldn't shoot more than what you are giving, and I wouldn't shoot less than 0.2 - 0.4 on a shootable PS. If you stay in those ranges, I think things will go just fine.
If the PS is on the lower side you pick a dose that's less than 0.75, if the PS in on the higher side, you want a dose closer to 0.75. And then whatever you shoot, you get what data you are able to so you can evaluate it.
When you see those cycles where the #s just go steadily up to a higher +12 (next PS), then you know the dose was too low. If you see a drop that's bigger than around 70% from PS to nadir, like a 400 down to an 80, then you can figure the dose was a bit too high.
What you want is a drop somewhere in the 60% zone, give or take, and PSs and nadirs that are the #s you are going for. If you want tight regulation (TR) you want PSs around 150 and nadirs around 50 - 80. If you are going for more maintenance #s, you want PSs under whatever your goal is (200? 250? 300? probably depends on personal preference), and nadirs that are in the blue #s.
I wouldn't really worry about trying to figure out how rebound works, that'll make your head spin, and for me it usually led to bad dosing decisions. I agree you have a zoomer - once the PZI has pooped out, you get high #s fairly fast. That may settle down with more time spent in the blues & greens, or it may just be her thing to zoom. The trick is to catch them in the early stages of zoom and get the next shot in their system. Then you can head off the highest of the #s and avoid a steep drop back to good #s. Easier said than done though ohmygod_smile especially if you aren't seeing the zoom at the same # of hours after the shot each cycle. Bix often seems to start climbing more around +16 - you may find there is a pattern with Bud and you get a feel for when to test her, if things aren't staying on a 12/12 schedule. A lot of it is just trial & error.
Cats are pretty forgiving too, so don't stress yourself too much about trying to get the absolutely perfect dose. I wouldn't shoot more than what you are giving, and I wouldn't shoot less than 0.2 - 0.4 on a shootable PS. If you stay in those ranges, I think things will go just fine.
If the PS is on the lower side you pick a dose that's less than 0.75, if the PS in on the higher side, you want a dose closer to 0.75. And then whatever you shoot, you get what data you are able to so you can evaluate it.
When you see those cycles where the #s just go steadily up to a higher +12 (next PS), then you know the dose was too low. If you see a drop that's bigger than around 70% from PS to nadir, like a 400 down to an 80, then you can figure the dose was a bit too high.
What you want is a drop somewhere in the 60% zone, give or take, and PSs and nadirs that are the #s you are going for. If you want tight regulation (TR) you want PSs around 150 and nadirs around 50 - 80. If you are going for more maintenance #s, you want PSs under whatever your goal is (200? 250? 300? probably depends on personal preference), and nadirs that are in the blue #s.
I wouldn't really worry about trying to figure out how rebound works, that'll make your head spin, and for me it usually led to bad dosing decisions. I agree you have a zoomer - once the PZI has pooped out, you get high #s fairly fast. That may settle down with more time spent in the blues & greens, or it may just be her thing to zoom. The trick is to catch them in the early stages of zoom and get the next shot in their system. Then you can head off the highest of the #s and avoid a steep drop back to good #s. Easier said than done though ohmygod_smile especially if you aren't seeing the zoom at the same # of hours after the shot each cycle. Bix often seems to start climbing more around +16 - you may find there is a pattern with Bud and you get a feel for when to test her, if things aren't staying on a 12/12 schedule. A lot of it is just trial & error.
Joanna & Bix (GA)
Very Active Member
Just peeking at your SS, I'd lower your high end dose a little, the 0.75 I agree looks a bit steep. If you have the 1/2 marking syringes, I'd probably try 0.6 as your highest dose and see how things go. You may end up needing a fat 0.6 or even a 0.7, but I'd probably try 0.6 as a starting point. Here's what I'd consider as a starting point (and then refine it as you get more data):
150-200 PS: try 0.4u
200-250 PS: try 0.5u
250+ PS: try 0.6u
We'll see what others think.
150-200 PS: try 0.4u
200-250 PS: try 0.5u
250+ PS: try 0.6u
We'll see what others think.
A
Anonymous
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aside from the one day a day or 2 ago where he did zoom...and for what reason we do not know...let's consider sometimes this kitty has gone 24 hours without insulin because he is NOT a zoomer and (sorry folks) i think he is possibly a fast rebounder. in other words does not even go low before the body knows there is too much insulin on board and start the liver process. make sure when you look at the ss you take note of the many time's she has skipped a shot becuase the kitty was holding out far after the insulin should have worn off. also, she is quite likely a rebounder due to the fact that for over a week whe was (unbeknownst to beth who was following vets orders) being overdosed.
just to consider these ideas when looking at ss.
just to consider these ideas when looking at ss.
Joanna & Bix (GA)
Very Active Member
Hmmm, I hadn't thought about it that way. Now Iz all confuzd! :dizcat 
So you are thinking more the nudge down approach and see what Mr. P can do? Maybe 0.5 on higher PSs, and 0.25 on lower ones, and see what happens?
I think as long as the dose stays lower than 0.75, and she doesn't ride in higher #s for 2 or 3 cycles back to back, it's all good... lots of room to experiment and see what works.
So you are thinking more the nudge down approach and see what Mr. P can do? Maybe 0.5 on higher PSs, and 0.25 on lower ones, and see what happens?
I think as long as the dose stays lower than 0.75, and she doesn't ride in higher #s for 2 or 3 cycles back to back, it's all good... lots of room to experiment and see what works.
A
Anonymous
Guest
no i'm not commenting on the stratagies you guys are proposing. just wanted to know if you saw the ss the way i saw it.
also i am in favor of shooting as needed and not 12/12, but i'm willing to go with the flow here. i do think bud's body was a bit traumatized in the beginning and that his true response is only just beginning to be seen. i like the idea of not shooting below 140 and testing until you have a trend upwards and it's ok to shoot token doses above 170, unless it's totally bed time and you have a trend up then a token .2 at 150 is ok. why let him climb for the next 7 or 8 hours?
he does ride out the insulin and then some on most occasions. if there is an unusual high a few hours or even at nadar i would suspect the liver only becuase of the trauma of the first week.
i still would only pump a token dose at the high only to 'help' him settle down. i think he has seen too much insulin.
also i am in favor of shooting as needed and not 12/12, but i'm willing to go with the flow here. i do think bud's body was a bit traumatized in the beginning and that his true response is only just beginning to be seen. i like the idea of not shooting below 140 and testing until you have a trend upwards and it's ok to shoot token doses above 170, unless it's totally bed time and you have a trend up then a token .2 at 150 is ok. why let him climb for the next 7 or 8 hours?
he does ride out the insulin and then some on most occasions. if there is an unusual high a few hours or even at nadar i would suspect the liver only becuase of the trauma of the first week.
i still would only pump a token dose at the high only to 'help' him settle down. i think he has seen too much insulin.
Joanna & Bix (GA)
Very Active Member
Makes sense to me, thanks for bringing that perspective. It will be interesting to follow along and see how things go. I think Bud is doing great, it is nice when they see some good #s and there is room to finesse the dose like this.
If we are stressing you out Beth, know that we are debating some finer points here, nothing to worry about, and nothing to tear your hair out over trying to figure it all out. Stick with safe doses - whatever makes the most sense to you, and gather data and then keep reevaluting, and you will do just fine.
If we are stressing you out Beth, know that we are debating some finer points here, nothing to worry about, and nothing to tear your hair out over trying to figure it all out. Stick with safe doses - whatever makes the most sense to you, and gather data and then keep reevaluting, and you will do just fine.
A
Anonymous
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:lol: yes beth please don't stress out....overall bud is doing really great actually. and i think you likely do understand most of this. it's nice to have a couple of eyes reviewing and thinking over your chart, does'nt mean anything is wrong...like joanna said, just fine tuning.
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