ele i posted for you on micheles slidescale thread

[Anonymous]

sorry did'nt want to continue that discussion on her thread but look at it and see what you think.

 

[Ele & Blackie (GA)]

Thanks, Lori, for starting a new thread. I was trying to figure out how liver training plays into (or doesn't) using a sliding scale.

To answer your question, Lori, on the 14th, that 2.4 units on the 111 was at +15. I waited for a rising number and then lowered the dose .2 (it was 2.6 in the am). It had been my experience that when I shot a lower dose on a low number, Blackie would still go up. I agree that night was rebound, but I've also seen Blackie rebound no matter what the dose. His body seemed to just get scared of the low number. For example, on 12/27, pmps I shot 2 units on a +13 125 bg. The amps had been 3 units, so I dropped the dose 1 unit. And Blackie shot up into the 300's that night. Again on 1/10 I shot 2.8 on a 123 and got a good nadir that night. So this is why I try to shoot through the low numbers. I have to admit, I've never not shot, so maybe I'm missing something there.

I am very willing to listen to advice and hear about other dosing methods. I just want Blackie to be in good numbers - I know he'll never go OTJ.

 

[Susie and Moochie]

Re: ele i posted for you on micheles slidescale thread(ETA)

Ele, I have been lucky with Moochie since the first few months after her Dx when she was so high. She was difficult at the beginning but she got a lot more stable, went OTJ, went back on insulin, and remains pretty stable - lucky for me. Blackie doesn't seem to be quite that simple to dose.

Like I said in Michele's thread, I don't normally do dosing advice because Moochie is a special case in her own little dry foodie way. What I will suggest is that you not try a sliding scale just yet. As I recall (and please correct me if I am wrong) Blackie had some infections going on toward the end of last year which were probably contributing to the crazy numbers back then. How has he been lately, other than crazy BGs?



ETA - I should add that a reduced dose on a low but rising number is not what I mean by not using a scale ;-)

 

[Anonymous]

yes, agree with susie, reduce dose on low #. i think that's what she said there. but i don't understand, is'nt that in some way using a scale. lower # lower dose?
ele one thing about rebound and why you get stuck in it is this.
when a cat rebounds the next day he is generally very sensitive to insulin. many a cat does not get a shot the next dose time if he rebounds. the body needs to adjust itself.
hey i just realized what retraining his liver might mean!
but i'm thinking that would only be done if you can see a rebound looking situation which i see more of on you SS than anyone commenting seems to.
IMHO. i just see a cat in continual rebound.
i humbly refrain from thinking i'm giving advice and just food for thought.

 

[Ele & Blackie (GA)]

This is liver training:

As I understand it, liver training is this: when the body gets used to high BG#s, the liver panics when it sees a lower number. The definition of "lower" depends on what kind of numbers you have been getting. For Buzz recently, her liver was freaked out by yellows because she has spent 2 weeks in pinks and reds.

When the liver panics, it sends out attack troops to fight the low numbers. These troops take the form of glucagon, which is the hormone (?) that creates glucose. The liver thinks the body is experiencing hypo, so it freaks out.

The liver has to (and will) get used to the lower numbers; hence the rationale of shooting through rather than reducing the dose. Reducing the dose is like giving a tantruming 2 year old what they want: it will produce the same undesirable result (panicking) every time, and it will allow the liver to think it is in charge.

This was from Sarah's expanation here: viewtopic.php?f=24&t=4691

So if you use a sliding scale, does the liver get trained in a different way? This is where I'm confused.

 

[Susie and Moochie]

Okay, I think I understand what you mean by liver training I just never thought of it that way nor did I dose based on that. I dosed in a "see a number, shoot a number" manner so to speak. Moochie never rebounded so I don't think that "liver training" was necessary for her since her liver never over-reacted to lower numbers.

I believe it's a matter of not only ECID, Ele, but how you view treatment/dose increases and decreases. I'm sorry, that still doesn't clearly answer your question does it?

Lori, that is what I was saying about the reduced dose. It's not what I consider a sliding scale rather it is a way to keep insulin in the system while staying safer at a lower preshot number than I feel safe shooting a full dose of PZI on.


BTW, the reason I am not suggesting lowering the dose is that I don't see a pattern of rebound. What I see is a possible under-dosing situation at this point since the reduction from the 2.2U to the 1U. I think it's possible that the correct dose is somewhere between where you are right now and the 2.2U

 

[Anonymous]

well tomtom had his hypo rebound 2+ years ago, that night he got low as 40 i think at +3. well, next morning he was in the high 300's. did'nt shoot it...watched it gradually come on down and by that evening when he was on his way back up i shot .5
back in those days he was not so insulin sensitive as he is now so that was token dose for him. it was from that day forward that he marched proudly to the falls and remission. took a few weeks of very iffy shooting and lots of testing.
we had 2 1/2 years of remission bliss.
ele, it's really how you want to play it.
when rebounding goes on for awhile it probably takes more thought to get out of the cycle but i would just study the ss and think.
i do that all the time with tom
i did it the first time around too.
and don't be so sure he'll never go otj.
don't give up on that. it happens every day.

 

[Gator & H (GA)]

So if you use a sliding scale, does the liver get trained in a different way? This is where I'm confused.

Different how? IMHO with SS the [ideal] objective is to:

1) find a dose that the cat is sensitive to
2) get the cat throwing some regular [AMPS≈PMPS, w/a nadir around +5-+7] looking curves [this happens with #1 generally]. I would call this the "stabilize" step.
3) slowly march down the PSs [ideally] in your chosen range

I don't think liver training for SS is any different. The thing with SS that's often forgotten is that it should be custom for each cat. I think "liver training" might kind of be a moot point if a non-custom scale were applied.

 

[Susie and Moochie]

Exactly the strategy of a sliding scale IMHO. Back when Moochie went on one we didn't keep spreadsheets so I have copies of these really, really long word docs of the "old way" that we kept our charts. Much too long to post here.

What happened with the Mooch was that she came down from the 400s and 500s at preshot with nice curves (nice, considering the ugly numbers) to the point where she was consistently below 200-250 at preshot while dropping down around 100 at peak. At that time the scale did indeed become a moot point because she had broken through the high numbers to the point where the lower end of the scale became a fixed dose.

If anyone wants to call that "liver training" it's okay. I just never thought of it in those terms. She just needed some time at adjustable doses on the high end to work her way down.

Bear in mind that Moochie is a CP kitty and it's pretty clear that the CP caused the diabetes - at least as clear as it can be as to a "cause" - so take it fwiw.

 

[Anonymous]

is this IMHO a new thing? i've never seen so many HUMBLE opinions! is this becuase of the debate over dosing advisor? i think we're all being extraordinarily polite with our conversations this time around.
:mrgreen:

 

[Anonymous]

susie did you check out blackie's jan. 14th day. i think there were other days like that but it stands out as just one starting point for a series of rebound days. IMHO

 

[Susie and Moochie]

I did actually but I was looking at the days after it through the end of the month while Ele was holding the dose of 2.2U. They looked pretty good. I see what you mean about that day and I can't explain it except to say that sometimes it's just one number. Sometimes it is indicative of more but I don't think this one was.

 

[Joanna & Bix (GA)]

is this IMHO a new thing? i've never seen so many HUMBLE opinions! is this becuase of the debate over dosing advisor? i think we're all being extraordinarily polite with our conversations this time around.
:mrgreen:

LOL Lori!!! I've seen so many blow-ups, between TT & newbie threads, I for one try to tread lightly. Right after the TT thread I was even adding a little disclaimer in some posts, but I've slacked off on that front. It's tough I think to strike the right balance, and so easy for the typed word to be taken the wrong way.

IMHO :lol: here's what I see.

I think there is massive confusion on the board (in general - I've seen it for the most part on Health) because the term "rebound" is used for different kinds of rebound. It didn't click for me until I actually got Bix regulated and could then look back and make sense of it. He seemed to be reboundy, but other than a couple spots here & there I could never find evidence of Somogyi rebound, and reducing the dose for him (which is what you are supposed to do for Somogyi, and if it is that, it's supposed to lead to lower #s) was never successful. So ultimately I concluded that his rebound was liver-training, and as far as I understand everything, I continue to see evidence of that when I look back at his numbers.

I find it helpful to differentiate between the different things, and I can think back to several Health threads where I think people debating "rebound or not?" may have been talking at cross-purposes. The distinction to make IMHO is effect (rebound #s) vs. cause (Somogyi rebound, or something else). One can rightly see rebound in the #s, but that doesn't mean it's Somogyi necessarily. Here are the categories off the top of my head. I don't recall seeing this documented anywhere, but it's what makes sense to me. I'm open to being corrected.

* Liver-training rebound = zoominess after they get good #s they aren't used to

* Somogyi rebound = zoominess after either a steep drop or hypo #s

* Other zoominess = zoominess from other causes, such as infection, high carb food, or other factors

A lot of times I see what looks like rebound (better #s follow by high #s), and the key factor to me is IDing the cause. If I see evidence (or strong suspicion) of hypo #s or really steep drops, then I think Somogyi. Without seeing that, I tend to think it's something else. I usually won't argue with someone wanting to try a reduced dose even if I don't see evidence of Somogyi, because heck, you never know.

Looking at Blackie's #s on the 14th, that was the shot at +15 right, I don't see anything that might trigger Somogyi rebound. With Bix at a +15 shot I would have to raise the dose to get similar results to a +12. And I think Ele has found Blackie reacts similarly to late shots. So (darn it, I never remember to open the SS first!!! will go double check after I post) unless there is a steep drop or low #, I don't know how Somogyi could be triggered in that case. I see it as probably not enough insulin at the +15 shot, so that led to things being out of control for a bit.

As far as a sliding scale, the difference I would see if you are trying to tackle liver training vs. Somogyi rebound would be that with Somogyi you want to lower the dose and try to avoid sharp drops & low #s. So in that case, I would think a higher dose on higher PSs could amplify the effect, rather than helping.

With liver training, you want to keep the #s in the greens & blues for as long as you can, so in that case shooting higher doses at higher PSs might make sense. The risk there is that from the higher #s you may get a really steep drop, and then that could trigger Somogyi rebound. For Bix when he was in higher #s I did find I needed to raise the dose, but I tried to ease things down as gently as could (while still getting action) so I didn't accidentally create more problems. Except whenever I got impatient and overshot.

My general opinion about sliding scales is that if you find that works for your cat, great!!! With Bix, I found once he was regulated, a steady dose kept him in good #s and there was no need to create a scale, I really never got oddball high PSs with him like some cats may throw. And before he was regulated, I needed the steady dose to get him there. Whenever I tried to adjust for the PS, I usually overdid it and we got off track. But I am all for it when that is what works well for the cat & the bean.

With Blackie, he was regulated quite nicely on a steady dose a few months ago. That's why I am a believer that he has a chance to get back to that, if whatever is going on with him lately settles down.

Just my 2c... & a whole lot more loose change. :lol:

[ETA: Another difference I see too is the pattern of the rebound - Somogyi is a sharp or deep drop, followed by sudden and dramatic highs that may then come down at the end of the cycle (pattern may be different for longer acting insulins like Lantus, I don't know much about that). Liver training looks to me more like a nice stretch of good #s, and then sharp highs and the end of the cycle, or on the following cycle. So going back to Blackie on the 14th if those #s in the 50s had been followed by immediate highs I might think Somogyi. What I see instead is a nice long ride on the 2.6, followed by highs once the overlap had worn off. With Bix sometimes I charted the #s, and that really helped me to see when he was getting sharp ups & downs & possible Somogyi, vs. dramatic highs only once the insulin was starting to wear off.]

 

[Susie and Moochie]

My general opinion about sliding scales is that if you find that works for your cat, great!!! With Bix, I found once he was regulated, a steady dose kept him in good #s and there was no need to create a scale, I really never got oddball high PSs with him like some cats may throw. And before he was regulated, I needed the steady dose to get him there. Whenever I tried to adjust for the PS, I usually overdid it and we got off track. But I am all for it when that is what works well for the cat & the bean.

This is my general opinion as well. That's why I don't suggest it but do tell Moochie's story when the subject comes up. She did have crazy high numbers and those were the numbers that the sliding scale brought down because a fixed dose didn't cut it. She needed to get to the point where, like Bix, her numbers were low enough (regulated, if you will) that a fixed dose worked. After that there was, indeed, no need for a sliding scale.

As far as the "IMHO" it is actually what we should all be saying in some way when we give advice - dosing or otherwise - whether we use that acronym or just say "in my opinion" or "in my experience with my cat" since we can only give our own opinions be they ever so humble or not so much :lol: