Cassie 9/1-2 - Now what?

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bookw0rm

bookw0rm

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8/31 AMPS 577, .6 u
PMPS 514, .6 u
+3 472
+6 459
AMPS 377, .6 u

I should have waited and checked again before I gave him his shot this morning. I'm going to go home and check him at +4 (10:30 eastern). Every time it looks like I've figured a pattern out for Cassie, he pulls a weird cycle on me. The vet wants me to move him up to .7; he's been on .6 u for 5 days now. The only thing "different" last night is that he seemed to eat better than he'd been doing for a while. I'm starting to suspect he doesn't eat much during the the day, which is why he has a lower PMPS than an AMPS. That still doesn't help in figuring out what dose to give him.
 
Re: Cassie 9/1 - Now what?

OK Here we go...
she is starting to look so much better
I know when Shakes eats his numbers are so much better
it is because the insulin works better with food....
also, it could be that whatever was happening is clearing now
and lets pray that we start to see better numbers now
I will look at her numbers later after work when I have some more time
nice amps and +4 :mrgreen:

Denise and shakes
 
Re: Cassie 9/1 - Now what?

I was worried because the +12 was lower than the +6 trend. He has exhibited a late nadir before, so I guess I got lucky and he was rising. The question is what will his pmps look like. He's had a few good cycles before but then he always goes haywire again.
 
Re: Cassie 9/1 - Now what?

Pmps 397, .6u; +12.5

Much better. Fingers crossed. Good day, let's hope tomorrow cooperates.
 
Re: Cassie 9/1 - Now what?

I sure don't have any advice...can't figure my own cat out either! At least he wasn't in the 500's today though. Hopefully someone with more experience will be on later.
 
Re: Cassie 9/1 - Now what?

Oh wow, he gets a pretty big response to this dose. I don't typically say this, but if you get another yellow PS I would try lowering the dose to maybe 0.4. Most cycles you are seeing a decent drop from the PS to midcycle, so when you see a higher mid-cycle number that always makes me suspicious.

I don't think I would go to 0.7 personally - back on 8/22 you went from a red PS to a green nadir, which is quite a bit of drop, on 0.75.

Any chance you could do some early shooting, maybe TID (+8s) or something like +10s? If you try that you'd want to reduce your dose some and only shoot on a rising number. I'm thinking it might help you head off those high PSs. I mean, he clearly can get good numbers and responds well to the insulin, it's just hard to figure out how to get to the good numbers and stay there when the PSs are so high.
 
Re: Cassie 9/1 - Now what?

ok...my only advice to you ( and no you definately dont have to listen to me!)
is to please hold this dose for a little while
It may be frustrating, but if you can, give it a try

she is starting to look good at this .6, test as much as you can so you can see where she is going...
 
Re: Cassie 9/1 - Now what?

I forget where you are too on the food question - if you can eliminate the dry I think you may see a big difference. Dry will often cause the red & black numbers, it's just hard to fight it.
 
PMPS 397, .6 u (+12.5)
+6 368
AMPS 445, .6 u (+11.5)

So he seems to be settling into a high flat curve for the pm dose, with some good action on the am. The vet commented that he's a night eater; maybe that's the difference. He is still eating dry food--after the DKA it was more of a concern that he eat at all, and he wouldn't touch the wet. I'm in the process of switching over to Evo dry; he's currently eating a 50/50 mix and I'm going to gradually increase the amount of Evo. He's prone to digestive problems so I'm switching slowly. Once I've gotten him successfully eating Evo, I may experiment with wet food but he currently won't go anywhere near it, even if it's the only thing offered.

I'm planning to try a morning curve one day this weekend. I'm wondering if I need to do any adjusting for how his am/pm curves are so different. Right now I'll settle for figuring out what his dose needs to be to keep the PS numbers down without bouncing in the middle. I hesitate to think we're good--his numbers have been far too erratic at this point, but I can hope that this trend continues. 445 is high, but it's much better than 577, which he pulled on Wed.
 
Lisa,
How convinced are you that his nadir happens around +6? The curve this weekend should help determine that. I'm just thinking out loud, but maybe he could be a candidate for TID? Sometimes he seems to drop a lot by +4 and no results from +6 on the SS. Although the curve you ran a couple weeks ago looks like a mid cycle nadir.... and the night of the 31st seems to show a low at +6.

carl
 
I'm starting to think that the .6u is maybe too much insulin.

Are you doing a curve tomorrow? If you are then we can see what is happening during the day and can adjust from there.
 
If he eats more at night and his numbers are higher at night, that would be consistent with dry food. Do you feed on a schedule? I am a fan of free feeding, however if you are getting a clear food spike, you might find the patterns more consistent and the numbers easier to manage if you feed on a schedule (in relation to shot time, same sched each cycle). Of course if eating is an issue for him that might not work, it's most important that he eat.

Have you tried letting a small amount of canned food dry out, shape it into little pieces like dry food LOL and try to fake him out with that, maybe mixing a couple bits like that with his dry and see if he falls for it? I never tried that, but for some reason it popped in my head.
 
Honestly I don't know where his nadir is. That first wild dose when I first tested seemed to indicate a late nadir-from +6 to +8.5 he sat around 45-50, with liberal application of food. A few times he's dropped hard & fast, and usually ar night he doesn't seem to go anywhere. I think I don't have enough in between numbers to tell.

I plan to try a curve, if not tomorrow then definitely this weekend. I don't reallt understand how you.can diiferentiate between too.much & too little insulin, if both look like high ps with small drops. .6 seems like a really small dose & I still worry about ketones since dka, especially since I'm not having much luck catching him in the box to pee on a stick.

He's definitely a free feeder & I think he eats more a night. I'm trying to at least switch to evo while keeping him eating. I don't think feeding in schedule will work well for us.

We'll see what tomorrow (& later tonight) brings & I'll keep you posted. (plwase forgive typos, typing on phone is annoying.)
 
bookw0rm said:
I don't reallt understand how you.can diiferentiate between too.much & too little insulin, if both look like high ps with small drops.
Click to expand...

Typically flattish or a slight U-curve means too little insulin. Too much insulin is more like an inverse curve, or a flat cycle with a dramatic late drop to a lower by the next +12.

What confuses it is that there seem to be cats who get a flat response and then when you lower the dose a hair they get a better response, even though the pattern wasn't a clearcut one of too much insulin. But then often in those cases they don't hold the improved response, and you might see a good cycle or two, but still not see consistent results.

It's a puzzle really, and you will see that most people (myself included) can't tell 100% unless the pattern is really clearcut. So one of us might suggest trying a dose decrease, and one of us might suggest an increase, and it's exactly that - we can't really tell for sure, and we all have our particular biases of what direction we tend in when it isn't super-clear.

The bottom, and very frustrating line, is that a lot of it is trial and error. I tend to get edgy with decreasing the dose if you have a cat with a ketone history, and especially on dry food, which will drive the numbers up. Every now and then though, we see a cat that does really well on a decrease. I would say if you are going to try it, look for improvement very quickly and if you don't see that, then raise the dose back up. And test vigilantly for ketones.

You could experiment with giving a slightly higher dose at night to counteract more eating, and see if the numbers are better. Especially if you have a night when you can stay up a little late and get in an early cycle spot test or two and a nadir, then you don't need to lie awake worrying you overshot. :)
 
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