Lori,
You do have to consider both the PS numbers and the nadir. I know that with Lantus for instance, the nadir is the key, and many lantus beans follow the strategy of "shoot low to stay low". That is because after some time on that insulin, the curves don't look like "PZI" curves. They are supposed to look flatter through the day. That is the way the insulin is intended to work as well. So for them, how low kitty goes is the more important thing.
With the P insulins, flat isn't the goal, at least until kitty is almost off the juice, where you want to see all the numbers in the "normal" range or as close to it as possible.
Until then, we "live" with the smiley curves. As time goes by, the smile gets less and less pronounced. As the pancreas heals, the PS's go down, then the dose is reduced to keep the nadir safe. So as things get better, there's less of a drop because less of a drop is all that is needed.
Here's how I would approach this, knowing what I know now, if I were to adopt a brand new sugarcat -
I would start low like we tell everyone they should do, like 1u bid.
I would see what kind of drop that got me, trying for 50% or better. If I wasn't getting that much drop, I'd increase the dose in .25 increments until I got the drop I needed on a consistent basis.
I would hope that would not cause drastic or frequent bouncing, but if it did, I'd live with the bounces until kitty stopped bouncing. I would attempt to hold the dose until the bounces stopped.
If they just didn't stop, then after a week or so, I'd increase again. And hold again. I'd live with whatever numbers I got for a week or so. The only thing that would make me reduce is if I saw numbers that were too low, and not just once but three or four times.
By "low", I don't just mean hypo green numbers. I mean numbers that were getting me a 75-85% drop. Those would cause bounces, bounces that can and should be avoided.
My goal would be to see the PS numbers come down and remain that way. Say like always pinks.
At that point, I would look at the dose. If I was getting green nadirs and pink PS's, then I would look at reducing the dose If I have pink PS's, I'd rather have blue nadirs.
I tend to think that a drop of two "colors" is enough at that point. I would hope it would reduce or eliminate bouncing, and allow the pancreas to heal. And bring the PS numbers down to yellows. Then I can live with a green nadir, I'd even take upper greens at that point.
And I'd hold that dose until the PS numbers came down a little more, then hopefully reduce again.
I wish I had all Bob's data, but I never kept a SS. I just wrote it down on notebook paper, tore out the pages one by one and fax'd them to the vet. Since then, they've been boxed, moved, and I have no clue where all of them even are anymore.
But that is how Bob's dance started to wind down. His PS's dropped, so I cut the dose to keep the nadir safe. Unlike just about everyone here, I didn't test enough with Bob. I didn't get anywhere close to enough mid-cycle readings for his data to be really useful to others. But as I reduced, his PS's kept falling. It took about 4 weeks for him to go from 4u bid to nothing. The last week or so, I dose hopped from 1u or more to .25u based solely on what his PS was that cycle. I was "shooting forward", not looking backward. I was trying to shoot at a target PS for the next cycle. If I saw a 200, I shot say 1.5, hoping his next PS would be lower, so I could shoot less next time. If it wasn't lower, I held the dose. If it was lower, I may have shot .5 or .75 depending on what the number was.
I was totally winging it... I was no longer asking the vet for advice because she was against me reducing in the first place. I didn't ask here for dosing advice. I had hardly posted in PZI at that point, and from what I had seen in Health, I didn't think anyone would agree with or support the way I was doing it anyway. All I know is that it worked for Bob, and that was all I cared about. I wasn't following any protocol.
Here is the big difference between me and everybody else who posts in PZI on a daily basis. First, let me say I think it is a beautiful and wonderful difference, and that all of you are "right" in doing this. All of you, you all want to "know" on a day to day, or cycle to cycle basis "why". Why is it working, why isn't it working, what is different today than yesterday??? Me, I didn't care "why". Not then. I sure as hell do now, but then, I just wanted it to work. I didn't care how or why. Looking back, I'm amazed that it worked, that I didn't harm Bob, that he didn't hypo or die.
The only drawback to "y'alls way" is that there isn't always an explanation as to "why". Not on a cycle by cycle basis anyway. That's something I learned from reading Dr. Lisa's posts. When you consider all the other stuff that affects BG or kitty, period, over the course of a day, it is virtually impossible to determine "why" it works today and doesn't work tomorrow on the same exact dose and the same exact diet. Some days I read posts, and see "why?" and I sit here thinking "I have no clue why. I can't see any reason, no logic, no nothing!" But then I think "but it really doesn't matter why. I can't understand it, I can't figure it out, so let's just write it off as "wonky", put it in the rearview mirror, and push forward unless it keeps happening". If it does keep happening, we will collectively figure out the "why" and fix it. If it doesn't keep happening, then who cares "why"? Just because is good enough a reason. It's a cat, it's a hormone, it's not a machine or a precise formula.
There isn't a text book way to deal with this. There aren't road signs or mile markers that indicate "when you get here, then go there". There's no such thing as "if you do this, then this will happen". Not with any degree of certainty anyway.
The best we can do is "if something like this happens, then we should try something like this to see if it works"
Here's what crosses my mind every day I log on to the board:
These cats are getting such loving care from the most wonderful pet owners in the world. Their lives are a million times better than they could be, if they had owners who weren't willing to go this far to help them. Their lives would be so much shorter without these amazing people knocking themselves out every day. Any cat here, no matter how messed up their numbers are, or how many countless things they have wrong with them - ANY cat here is better off than EVERY cat who is NOT here.
There is nothing wrong with having to keep increasing the dose, Lori. I know you hate it. But you know as well as I do that some cats need more, some need less. It doesn't mean one person is "getting it right" and the other isn't. It's not up to US at all. It's up to the kitty, and how much insulin it is going to take to make things better. That doesn't mean just keep going up and up and up. It just means that there is some point where it is the "right dose", and it's a dose that will allow for a decrease when it makes sense to start decreasing. But you are having these reservations for precisely the right reasons. You want to keep Copper safe, because that is the most important thing. So be cautious, of course. And think of, and ask for, ideas about something else that might be causing the high numbers. That's the best resource we have. There probably isn't a illness or condition in the cat universe that somebody on FDMB hasn't had to deal with before. The "community" is our greatest weapon.
I hope tomorrow is a bright sunshiny day for you and for Copper! It's raining here now too, but not cold. But supposed to be nice tomorrow. I hope so, because I get to take out the ATVs tomorrow to get them ready for the beach season! Woooooooot!!!
Carl
(Say it isn't so!!!!!)