Eddie PMPS = 302, +3 = 161, +5 = 91 and AM recap

[Jen&Eddie]

Yesterday: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=112232
Our PM cycle ended up being pretty good! Blues for the first time in days! Clearly my insulin is still effective. Nadir was over 50% of a drop from PMPS and I last measured at +8 which was 100. Assuming he didn't go lower after that, nadir was a little late. The dose also appears to have been still working at +12 (unless the reading was inaccurate), after which there was a BIG bounce up to our shoot number of 395 at +12.5.

AMPS: 395 (delayed +12.5) (1.4u)
+5 = 252 (decrease consistent with last night so far)
+6 = 317 (? - food influenced?)
+7 = 306 (cycle long bounce? putting on patience pants)
+8 = 300 (patience pants in place) - will see what the PM brings!
PMPS = 302 (1.4u)
+3 = 161 (erm slow down a bit probably?!)
+4 = 138 (nice and easy please -- fed 1 Tbsp. FF)
+5 = 91 (Fed usual 1/2 can FF)
+6 = 107
+7 = 141

So, since 1.4u was clearly effective last night, and it does appear that Eddie takes at least a cycle (if not a few), to settle into a dose, my question is whether to proceed with a set unit of 1.4u, or whether to continue with the sliding scale as planned (1u for 200/1.2u for 250/1.4u for 300+).

My next question is how to shoot the bounce. Assuming I should continue with the sliding scale, do I shoot the bounce number or if it's like this morning, where he has a lower +12 number, and then bounces to a higher 300+ number a little later, should I shoot based on the later "bounce" number?

I have yet another questions: the ProZinc protocol suggests that where there is bouncing, and the nadir is a greater decrease than 50%, that the dose may be too high, and a reduction may be considered. I know some of the L protocols indicate to shoot "through" the bounce. Since ProZinc is non-depot, but Eddie seems to take a couple days to "settle in" does it make more sense to shoot "through" the bounce, at least in this instance?

Finally, the 1.25u seemed pretty clearly to be not enough to get a good nadir, even after several cycles. Is it odd that such a tiny increase to 1.4u should result in such dramatically different results? I've been trying to think of various reasons why the 1.25 cycles may not have been effective, and I imagine there's a lot of potential reasons. I'm wondering if there are some possible variables that we could control for, for future reference.

Poor sick DH is home again today with the flu. I'm going to have him check +6 and probably every couple hours after that to see how low nadir is and what time it happens.

Thank you for your patience with my questions and for helping me and Eddie figure out the "right" dose!

 

[Sue and Oliver (GA)]

Re: Eddie AMPS 395 BLUES in last PM cycle!

Yesterday: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=112232
So, since 1.4u was clearly effective last night, and it does appear that Eddie takes at least a cycle (if not a few), to settle into a dose, my question is whether to proceed with a set unit of 1.4u, or whether to continue with the sliding scale as planned (1u for 200/1.2u for 250/1.4u for 300+).

I'm not sure. I do like the flexibility of the sliding scale.....but he does seem to need to settle into a dose. Maybe use both (see my thoughts below)

My next question is how to shoot the bounce. Assuming I should continue with the sliding scale, do I shoot the bounce number or if it's like this morning, where he has a lower +12 number, and then bounces to a higher 300+ number a little later, should I shoot based on the later "bounce" number?

Again, it is that ECID thing. Some cats don't seem to mind your shooting the bounce. Some don't react well. The times you have shot a little higher for the higher number, he seems to have done okay.

I have yet another questions: the ProZinc protocol suggests that where there is bouncing, and the nadir is a greater decrease than 50%, that the dose may be too high, and a reduction may be considered. I know some of the L protocols indicate to shoot "through" the bounce. Since ProZinc is non-depot, but Eddie seems to take a couple days to "settle in" does it make more sense to shoot "through" the bounce, at least in this instance?

The protocol was written conservatively as we figured people would print off the protocol and not post and use it as a guide, not getting any advice on line. (we have a lot of lurkers). As long as you are testing and examining his data and using it as your guide, the best thing is to try an approach, see how it worked and proceed accordingly. Some people want to proceed very cautiously (you can see this with posters on PZI) and some want to push faster. Either approach is okay, as long as the bean tests and monitors.

If Eddie were mine, I would be more daring (shooting the bounce) and going with the higher possiblity rather than the lower on days I could monitor - like today. And be more cautious when he was going to be alone. This is one of the benefits of ProZinc. You don't have to pick a dose and hold it for three days.


Finally, the 1.25u seemed pretty clearly to be not enough to get a good nadir, even after several cycles. Is it odd that such a tiny increase to 1.4u should result in such dramatically different results? I've been trying to think of various reasons why the 1.25 cycles may not have been effective, and I imagine there's a lot of potential reasons. I'm wondering if there are some possible variables that we could control for, for future reference.

There is a post floating around from Dr. Lisa where she lists all the variables that affect a given number. It's enlightening but discouraging because it gives you an idea of how powerless you are holding that syringe. :mrgreen: He may pick a fight that day with his brother and his levels may rise and it has nothing to do with the dose he was given. Or he might vomit under the couch where you don't see it for three days and he is higher and you are wondering what happened with the dose....

The other thing is that some cats react to a tiny difference in dose and some don't. There are people on the forum who think tiny increases and decreases are worthless. And technically they probably should be right. But I have seen too many cases where a .1 increase makes a difference.

Thank you for your patience with my questions and for helping me and Eddie figure out the "right" dose!

I like your questions and imagine you would be surprised how many lurkers read them and gain from them. Some day when you are feeling brave, go over to the Think Tank forum. People argue about these kinds of questions all the time. It is an interesting forum but a little intimidating. And remember that everything there does not apply to Your insulin. :mrgreen:

 

[Jen&Eddie]

Re: Eddie AMPS 395 BLUES in last PM cycle!

Wow Sue! Thank you so much for your thoughtful response!!

Yesterday: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=112232
So, since 1.4u was clearly effective last night, and it does appear that Eddie takes at least a cycle (if not a few), to settle into a dose, my question is whether to proceed with a set unit of 1.4u, or whether to continue with the sliding scale as planned (1u for 200/1.2u for 250/1.4u for 300+).

I'm not sure. I do like the flexibility of the sliding scale.....but he does seem to need to settle into a dose. Maybe use both (see my thoughts below)

I think I'm going to try a hybrid approach. Basically use the same scale and hold for a minimum of a few cycles to see how it works, and adjust the scale as needed. Kind of ends up being three times the analysis to determine the effectiveness of the different amounts on the scale, but I think it gives us flexibility to deal with some occasional lower pre-shots. I should perhaps put in my signature that Eddie's on a custom dose.

My next question is how to shoot the bounce. Assuming I should continue with the sliding scale, do I shoot the bounce number or if it's like this morning, where he has a lower +12 number, and then bounces to a higher 300+ number a little later, should I shoot based on the later "bounce" number?

Again, it is that ECID thing. Some cats don't seem to mind your shooting the bounce. Some don't react well. The times you have shot a little higher for the higher number, he seems to have done okay.

I think you're correct. Eddie does seem to do OK shooting based on the bounce number. He tends to come off the higher number relatively quickly, and settles into the same range as when his PS's are a little lower. It doesn't seem to really make much of a difference if he's in the low 300's or into the 400's on a bouncy pre-shot.

I have yet another questions: the ProZinc protocol suggests that where there is bouncing, and the nadir is a greater decrease than 50%, that the dose may be too high, and a reduction may be considered. I know some of the L protocols indicate to shoot "through" the bounce. Since ProZinc is non-depot, but Eddie seems to take a couple days to "settle in" does it make more sense to shoot "through" the bounce, at least in this instance?

The protocol was written conservatively as we figured people would print off the protocol and not post and use it as a guide, not getting any advice on line. (we have a lot of lurkers). As long as you are testing and examining his data and using it as your guide, the best thing is to try an approach, see how it worked and proceed accordingly. Some people want to proceed very cautiously (you can see this with posters on PZI) and some want to push faster. Either approach is okay, as long as the bean tests and monitors.

If Eddie were mine, I would be more daring (shooting the bounce) and going with the higher possiblity rather than the lower on days I could monitor - like today. And be more cautious when he was going to be alone. This is one of the benefits of ProZinc. You don't have to pick a dose and hold it for three days.

I'm not the most patient person in the world, as you have probably picked up on :lol: , so a more aggressive approach makes sense to me, since I usually monitor religiously to get more data on what a dose is doing. If there are times I can't monitor as closely, like if I can't make it home over lunch, I'm more inclined to take a more conservative approach, and I think this totally makes sense.

Finally, the 1.25u seemed pretty clearly to be not enough to get a good nadir, even after several cycles. Is it odd that such a tiny increase to 1.4u should result in such dramatically different results? I've been trying to think of various reasons why the 1.25 cycles may not have been effective, and I imagine there's a lot of potential reasons. I'm wondering if there are some possible variables that we could control for, for future reference.

There is a post floating around from Dr. Lisa where she lists all the variables that affect a given number. It's enlightening but discouraging because it gives you an idea of how powerless you are holding that syringe. :mrgreen: He may pick a fight that day with his brother and his levels may rise and it has nothing to do with the dose he was given. Or he might vomit under the couch where you don't see it for three days and he is higher and you are wondering what happened with the dose....

I will have to search for that post. It can be a little discouraging thinking about all the variables that are out of our control, but if there are ones we can control for great! One less thing to take into account when analyzing the numbers. I'm actually a tiny bit suspicious that our u40 needles were somehow not getting the insulin where it needed to go for best absorption? I've run across a couple posts taking about that. DH checks for fur shots, and we've only had one (when I shot, rather than hubby). We shoot in the area of the scruff. DH considers his primary job to be administering insulin, as instructed by me , and he's not comfortable shooting in the alternative areas, so I'm not going to push him on that (for now). The u100 needles have a shorter needle, and clearly, based on last night at least, the insulin got where it needed to go! I'll be very curious to see what today brings.

The other thing is that some cats react to a tiny difference in dose and some don't. There are people on the forum who think tiny increases and decreases are worthless. And technically they probably should be right. But I have seen too many cases where a .1 increase makes a difference.

Thank you for your patience with my questions and for helping me and Eddie figure out the "right" dose!

I like your questions and imagine you would be surprised how many lurkers read them and gain from them. Some day when you are feeling brave, go over to the Think Tank forum. People argue about these kinds of questions all the time. It is an interesting forum but a little intimidating. And remember that everything there does not apply to Your insulin. :mrgreen:

I have read through some of the posts in the Think Tank and I do find it very, very interesting from an intellectual perspective. I think it will be a while before I'm brave enough to post there. :smile: But, I'm hopeful, as I learn more, that I can pop in and try to help with dosing advice with other ProZinc users. I'm not quite there yet, I don't think, but getting there!

I thought of one more question: :mrgreen: I'm assuming ECID, but do some cats settle into a dose and stop bouncing eventually, even without reducing the dose, or does a bouncy cycle generally continue indefinitely until the dose is changed? We haven't been at this very long, but initially, I was approaching things in terms of trying to get a flatter cycle to avoid continuous bounces. Now I'm wondering if Eddie will eventually just get used to the more normal numbers at nadir, and will stop bouncing on his own.

Thank you SO VERY MUCH Sue!

 

[Sue and Oliver (GA)]

Re: Eddie AMPS 395 BLUES in last PM cycle!

I have read through some of the posts in the Think Tank and I do find it very, very interesting from an intellectual perspective. I think it will be a while before I'm brave enough to post there. But, I'm hopeful, as I learn more, that I can pop in and try to help with dosing advice with other ProZinc users. I'm not quite there yet, I don't think, but getting there!

I have read some of your posts to newbies on Health. They are excellent. It is very powerful for a new person to read a post from someone who has been doing this just a month but has seen the benefits of diet change and testing and who is experiencing success. Paying it forward with your experiences is the only way this forum survives. I have no doubt you will be a valuable voice.


I thought of one more question: I'm assuming ECID, but do some cats settle into a dose and stop bouncing eventually, even without reducing the dose, or does a bouncy cycle generally continue indefinitely until the dose is changed? We haven't been at this very long, but initially, I was approaching things in terms of trying to get a flatter cycle to avoid continuous bounces. Now I'm wondering if Eddie will eventually just get used to the more normal numbers at nadir, and will stop bouncing on his own.

Yep, there is no generalization. For example, Cassie (bookworm) bounces after two years on basically the same small dose. At first, he bounced for several cycles. Now he usually only bounces once and settles in. Some people call bouncing liver training. Once the liver figures out the lower number isn't dangerous, it quits releasing extra glucose. But the training varies with each cat...One approach is to lower the dose a smidge and try to flatten the curve. I think that works better with the L insulins as they already have a flatter cycle, or with a cat who is really experiencing drastic drops and highs .

 

[Jen&Eddie]

Re: Eddie AMPS = 395, PMPS = 302 and AM recap

After an interesting night last night on our new 1.4u dose, with a nadir at +8 down to 100 (or maybe even later and lower) and a sightly longer duration this AM, after not seeing blues for several days, I was curious to see what today would bring. I'm looking forward to experimenting with a new custom protocol!

So AM went as follows:

AMPS: 395 (delayed +12.5) (+12 reading was 182, so he went up almost 200 points in half an hour prior to shot) (1.4u)
+5 = 252 (decrease consistent with last night so far) Fed normal lunch of 1/2 can LC FF.
+6 = 317
+7 = 306
+8 = 300
PMPS = 302 (1.4u)

I have pulled my patience pants on, and I'm going to go with the theory that this AM cycle is a rebound cycle in response to our nice blue numbers yesterday, unless of course I'm totally wrong. ;-)

I have a pretty good idea that we've fairly frequently seen pre-shot numbers that are bounces. I'm basing this on a really fast rise that we see pretty frequently between +10 and +12, and even between +12 like today, and a retest 30 mins. later. Then, today's cycle appears to have decreased about 150 points or so, then he stopped, and put it in reverse, and held pretty steady around 300. Panicking liver? I don't think this is like Somogyi which seems to look like a much, much more drastic upwards spike mid-cycle after a low dip. That being said, I think I've read in a couple spots on this forum that an entire cycle can be a rebound, but I don't know if I've seen an example of this on a spreadsheet to know what it looks like. Given the results we had last night, I seriously doubt that the AM cycle reflects that the dose is inadequate.

Am I correct in my understanding that cats can have a high flat cycle that is a rebound?

Looking back over Eddie's spreadsheet, I think may actually see this pattern before. For example, on the AM cycle on 1/3 it was pink and flat the whole time, following some greens in the PM cycle that was our last dose at 3u. At the time, I assumed that I had a fur shot and that he was high and steady as a result.

As Sue and I discussed at length above (thanks Sue!), I'm going to hold the dose through the rebound for at least a few (4-5?) cycles to see what happens and give Eddie a chance to settle in (liver training?), unless we get a really low number (probably <50), then I'll adjust that particular dose on the sliding scale a smidge. I read somewhere else, and of course now I can't find the post, that referred to "warranted" liver panic if numbers were in the danger zone below 40 or so, and "unwarranted" liver panic where the liver just panics when it sees levels it's not used to, and this concept makes sense to me. That's my reasoning behind some "liver tough love" and not reducing due to a rebound or bounce when the nadir numbers haven't gone that low. At least that's the plan for now! :smile:

I like to think of this approach as carefully beating down FD with a stick, rather than trying to outmaneuver it (and drive myself crazy in the process). I welcome any thoughts or suggestions!

 

[Jen&Eddie]

Re: Eddie AMPS = 395, PMPS = 302, +3 = 161 and AM recap

Looks like PM cycle is going to confirm that 1.4u is effective...Maybe a little too effective? Will closely monitor.
At PM +3 down to 161.
---
PM +4 = 138 (fed 1 Tbsp. FF)
---
PM +5 = 91 (fed usual 1/2 Can FF)
---
PM +6 = 107
---
PM + 7 = 141 good cycle! :mrgreen: Will see what AMPS brings.

 

[Sue and Oliver (GA)]

Re: Eddie AMPS = 395, PMPS = 302, +3 = 161 and AM recap

So he really does have a flat cycle at first after a dose change, then he reacts. Good info to have. Hope he doesn't drop down too far tonight and that you get some sleep.

 

[Jen&Eddie]

Re: Eddie AMPS = 395, PMPS = 302, +3 = 161 and AM recap

So he really does have a flat cycle at first after a dose change, then he reacts. Good info to have. Hope he doesn't drop down too far tonight and that you get some sleep.

Thanks Sue! Finally, a pattern that actually played out like I thought it might! :smile: I wasn't going to test tonight till +4 or +5, but I'm glad I did. Will probably start feeding small amounts of LC FF at +4 to keep things under control. A good night's sleep would be nice!