Dosing advice for AM

Jenna Josie

Jenna Josie

Active Member
Prior thread:
http://www.felinediabetes.com/FDMB/threads/new-update-josies-bouncy-return.205218/

So we’ve been bringing her dose back up in tiny increments since 2.2 sent her into all kinds of craziness November 16/17, and it’s been basically doing nothing, including statistically no drop at all last night through +6 (which is weird, even for her!).

Then tonight, her third cycle of 1.6 ... she dropped! I started steering her when her +4 was 80, down from a preshot of 262. I think I’ve got her slowed — fingers crossed! — and am hanging out waiting to get her +6, but — once again :rolleyes: — have no clue what to do for the AM.

My guess is that she’ll be high after this high-and-flat-then-drop ride she’s on, and I assume that in any case, she has earned a reduction (I think she would have gone limes without the steering), but I’m hopeful for suggestions as to how much ... ? (Assuming, of course, she is high enough to shoot.).

I’ll update her SS with at least her +6 and +7 tonight. I’m really just getting this post up now to distract myself while I’m waiting. :)

Edit: Took AMPS at +11.5 = 116, hardly up from her +8 last night of 103. No shot for right now, but I did feed her a little bit.
 
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WOW Josie! Yes she almost surely would have gone limes without steering. You just used LC to steer? Good job!

Since you've already fed, are you thinking of doing the Teasel Reverse today?
 
Are you home today? How confident are you that she'll stay flat this cycle? If you're around and feeling brave, I'd almost say keep the dose through this cycle and see what happens. A normal cat would have earned a reduction, but I'm looking at the 11/17 cycle and thinking you might want to keep it up for this cycle and maybe lower on the next cycle. It's a gamble of course, so it just depends on your day and if you can spend it testing/steering again if it turns out she doesn't want to stay high and flat.
 
Hi Rachel and Djamila.

Yes, Teasel Reverse; yes, home today (though awake? That's another question altogether lol :coffee::coffee::coffee:)

Just took another test, which is actually her +12.5. With food on board, she is at 161 -- so, yay! At least she's on her way back up, finally.

My primary concern about holding the dose is that she is Very Annoyed with all the ear sticking. At one point last night, I accidentally hit the vein :oops::(, and so she's pretty sore, poor thing, and letting me know it. (And she she's never let me test the other ear, so that's out.)

That said, I do think that 161 is enough of a rise to hold the dose. I think I will get one more test and, assuming she's continuing up, stick with the 1.6. If she's not/stuck around 160, maybe 1.4?

What do you think, oh wise women?
 
I think that sounds like a good plan, Jenna. Generally, when you reduce Josie she ends up going higher than we planned, but you just never know what can happen...she likes to throw a wrench in things!
 
I think that sounds good.

There is also a school of thought where you actually do a small increase during the bounce cycle. I haven't seen anyone try it on prozinc in the past couple of years, but found it on some old threads with some long term cats where the owner was pretty sure the cat would stay high and flat after a green. The increase was to counter the high numbers, and then back to the regular dose for the next cycle. Long timers (more than six months or on their second diagnosis) have different rules. BTW I'm not suggesting you do that this morning. Just feeling a little rambly this morning :)
 
Wow. Even you guys still get monkey wrenches. I didn’t realize. Praying for Josie to stay safe today. Can someone tell me what the reverse Teasel is? Lol. I have a feeling I may need that in my bag of tricks one day!!
 
Check out Teasel's SS - monkey wrenches galore! He was diagnosed almost 3 YEARS AGO. o_O I've saved my sanity by accepting that he's unpredictable, staying calm, being patient and - very important - bending the rules as needed.

The Teasel Reverse - tried when a PS is too low (within reason) or lower than usual:
  1. after testing PS (and doing a retest if you doubt the number), feed as normal
  2. wait 30 to 45 minutes for food to get into bloodstream and test BG again
  3. if BG is at a comfortable level give the full dose if high enough or shave off a little if needed.
How much to reduce is guesswork but a SS of data and lots of "experiments" will help hone your judgment.
 
+13 = 224: It looks like she may bounce, but in any case, I went ahead and gave her 1.6. @Djamila That strategy -- a slight increase to counteract a bounce -- is too much for my nerves! At least for now . . .

Kris & Teasel said:
The Teasel Reverse - tried when a PS is too low (within reason) or lower than usual:
  1. after testing PS (and doing a retest if you doubt the number), feed as normal
  2. wait 30 to 45 minutes for food to get into bloodstream and test BG again
  3. if BG is at a comfortable level give the full dose if high enough or shave off a little if needed.
Click to expand...
I love that the Teasel Reverse is now a detailed protocol! :D

I do have a general question about the bolded part, though. I've noticed the 30-45 minute window in other threads about other things, but I also know that SOP for hypo-range is to feed and then test in 20 minutes. Is the difference that 30-45 minutes gives a picture of the true food impact whereas 20 minutes gives an indication, but that since hypo-range is an "under duress" situation, an indication (vs. true impact) is sufficient in the moment? :bookworm:
 
In looking at Teasels Ss I see you are constantly adjusting doses as well. How do you handle the stress? I was hoping that at some point I would acheive a stardust dose and be able to breathe! Also have questions as to the the type of insulin used. Obviously I just went with what the vet said since this was all new to me, but you guys seem to know more than they do. In what instances would it be recommended to try another insulin?
 
Jenna Josie said:
Is the difference that 30-45 minutes gives a picture of the true food impact whereas 20 minutes gives an indication, but that since hypo-range is an "under duress" situation, an indication (vs. true impact) is sufficient in the moment? :bookworm:
Click to expand...

Yup. Exactly. We've also found that 20 minutes often just isn't enough time to be sure it's a rising number and not just meter variation. And most people after waiting 20 minutes, don't want to keep stalling so they'll give up too soon. If you wait 30-45 minutes it takes care of both of those things.
 
Jenna Josie said:
+13 = 224: It looks like she may bounce, but in any case, I went ahead and gave her 1.6. @Djamila That strategy -- a slight increase to counteract a bounce -- is too much for my nerves! At least for now . . .


I love that the Teasel Reverse is now a detailed protocol! :D

I do have a general question about the bolded part, though. I've noticed the 30-45 minute window in other threads about other things, but I also know that SOP for hypo-range is to feed and then test in 20 minutes. Is the difference that 30-45 minutes gives a picture of the true food impact whereas 20 minutes gives an indication, but that since hypo-range is an "under duress" situation, an indication (vs. true impact) is sufficient in the moment? :bookworm:
Click to expand...
The Teasel Reverse is something different from the hypo "protocol". That's done when your kitty is in confirmed low numbers (near 50 on a human meter, 68 on a pet meter) and you're steering away from the brink. You might also do this if there's a precipitous BG drop at +2 and you want to intervene. The Teasel Reverse is something I did when a PS was a little low for comfort but still dosable. I decided on the 30-45 minute window because the full meal would be doing its work by then.
 
Lisa and little said:
I was hoping that at some point I would acheive a stardust dose
Click to expand...
If only! ;) This is something you don't realize at the start and vets don't talk about it because some of them don't realize it either, hence the approach of getting kitty into the clinic for a day or longer "to get him/her regulated". Ummm ... no. Not going to happen. o_O There's the odd cat that responds really well and in a stable fashion right off the bat but they're in a very small minority.

Re insulin: Teasel has been on Lantus, then ProZinc, then Lantus, then Levemir and finally back to Lantus. He spent many, many months on each so I wasn't switching willy nilly after too short a time. He's extremely bouncy and lived on a trampoline while on ProZinc. He still bounced a fair bit on Levemir which is supposed to be the best for giving long, flat curves. Didn't do that for Teasel. For many complicated reasons he's been back on Lantus now for 5 months or so. I have A LOT of experience finessing his dosing but he still bamboozles me regularly. It is what it is ...:confused:
 
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