Help - Silverado and wonky numbers again.

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Jane & Boo (GA)

Jane & Boo (GA)

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I don't know whether to stick with the 4Units BID or start lowering the dose now. I'm real confused. After weeks of high numbers, I got this yesterday:

AMPS 135 - No shot, but did feed FF LowCarb
+13 177 No shot
+14 215 No shot
+15 246 Shot 1 unit
PMPS 294 Shot 3 units
+6 296

Now this morning I was expecting to see a 300 +, but I got
251.

Should I shoot the 4 Units?, drop back to 3Units? or less?

It's another work day, so I can't monitor him through the day.

Jane & Silverado
 
Jane...See if you can get some of the Veteran's input, as I am suspecting they are going to tell you to stick with one dose amount for at least three days before upping/downing the dose...My experience is that you need to let the insulin 'settle and adjust' in the system before changing, and to me it appears you are changing too often with each reading...My opinion, but I personally would give each dose a few days to work its magic...slowly....
 
There are more experienced number watchers than me, but I'd say shoot 3 instead of 4. It looks like the 3.6 to 4 built up so you've got overlap. It usually takes 2 cycles for us to see overlap results, but ECID. There's a chance shooting 3 will get you a higher PMPS tonight, but I'm definitely a better safe than sorry shooter.
 
Thanks for the response.

Hope, what is this "overlap" you refer to. Is that a good thing? a bad thing? or just a thing? Should I go back to the 3.6 Units and give it more time to settle? I agree with you about the "better safe than sorry" approach. I only shot 2Units this morning because I couldn't stick around to see what effect the 3 Units might have. It scares me to death to think he might end up in trouble at a time when I'm not there to help him. Keep the info coming... Lord knows I need it.

Many thanks again.
Jane & Silverado
 
Overlap is what you get when one dose of insulin starts to kick in (onset) before the other one has worn off. It is good because it will keep their BG #s steadier but it does have to be taken into account when dosing.
 
Overlap is your friend!!!! :) Too much is bad, that's why you always want to shoot on a rising #, but when you get overlap nicely lined up it helps smooth out the curve. For example, with good overlap you might see PSs in the low 200s and a nadir in the mid 100s. Without the overlap, on a dose that gives you a good drop though, you might see that same nadir, but PSs in the low 400s instead. That means each shot is like starting over from scratch, and then you have big drops & steep climbs. That's why sometimes it makes sense to shoot early, so you can catch the #s before they get high and take advantage of more overlap than you might be seeing 12/12.

I haven't studied his #s at length, but on general principles I would say that if you tried 3.6 for a few days and it didn't seem to be enough, the next step would be to try 3.8. With the 4u, you perhaps saw a dramatic breakthrough - good, but probably a hair too much since you want a shootable # at +12. My experience with Bix was that only small changes were generally needed. I think you need to shoot what you feel safe with though. Personally, I would probably go back to 3.6 to regain my bearings and get some more mid-cycle tests in to be sure it wasn't giving him better results than you realized, and then if not, try 3.8.

For settling in period, ECID. Bix usually was about 3 cycles when I would see much better results, sometimes 4. I think 3 - 5 days is a fairly standard recommendation.

Since you got surprisingly good results these couple cycles on lower doses you could also try those a little longer and see how it goes. I wouldn't stay at lower doses too long though, especially since you have tried all those doses before (sometimes it just seems like he is married to those yellows, doesn't it? weird!) If you don't get improvement (or #s start getting higher) in a couple cycles, then you could jump back up to 3.6 or 3.8.

Personally, I probably would not shoot 4u unless you give 3.8 a chance for a few days and it is not enough. Although he still may end up needing 4u, you know that PS was too low, so that suggests to me that dose is too high for BID.
 
Silverado's PMPS was 286. I gave 3 units and will do another BG test at +4 or +5 if I can get awake for it. Thanks for all of the info and the lesson on "overlap". I will start working the dose back up again. Should I work up slowly again? or do you think I could just go straight to the 3.6 and stay there for 3 or 4 days, then move up to 3.8 if needed. I worry that all of these drastic dose changes will throw his pancreas and/or liver into full blown revolt.

Jane & Silverado
 
I'd say work slowly back up. How'd the 3 units do last night? You might be able to hold there for a bit (as long as you're not getting significantly higher PS readings) and then slowly work back up. Then again, ECID. I tried that with my cat and she went sky high and we had to fight the numbers back down. But some cats work really well that way and I would think it's easier on their system (as long as they aren't hitting sky high numbers.)
 
Jane & Silverado said:
Silverado's PMPS was 286. I gave 3 units and will do another BG test at +4 or +5 if I can get awake for it. Thanks for all of the info and the lesson on "overlap". I will start working the dose back up again. Should I work up slowly again? or do you think I could just go straight to the 3.6 and stay there for 3 or 4 days, then move up to 3.8 if needed. I worry that all of these drastic dose changes will throw his pancreas and/or liver into full blown revolt.

Jane & Silverado
Click to expand...

Yes, Jane, work back up slowly, and yes, 3 days is good for the system to acclimate...It takes alot of patience, join us all with that one! And, by the way, your PMPS of 286 was really not that bad, just some fine-tuning and you will be spot on!
 
Personally I would jump back to at least 3.5 unless you have some reason to suspect that dose is too much (I wouldn't consider a 0.5u jump anything drastic). Again I haven't studied the #s at length, but the first I see a breakthrough is at 4u, so to me it looks like you will probably need to get pretty close to 4 to see action again, and then at that point I would back off just a teeny bit if needed, rather than dropping the dose down a lot.

That is just my 2c though :) you need to do what feels right to you, and I certainly have dropped the dose back plenty of times myself and worked back up slowly (which is part of why I wouldn't recommend that, since I tended to undershoot at times :oops: and left Bixie in higher #s a lot longer than was needed). As long as he doesn't have ketones though and is eating well and acting relatively well, you can take your time with it without being too worried, especially since he seems to keep in moderate #s all the time.
 
Since he didn't do well at 3.0U and 3.2U previously, I decided to go to 3.4 and stay there for a few days and see what happens. I'll report with progress... hopefully there will be progress. Thanks for all of the advise. Now that I know what the overlap is all about, I feel like I'm back on track. You guys are the best.

Jane & Silverado
 
Joanna, your logic makes perfect sense to me and makes me feel better about my decision to go ahead and bump him up to 3.4 and then work up slowly from there. And now that I know about the overlap, I think I'll find that Silverado's dose is going to fall somewhere above the 3.4, but less than 4.0. I test daily for ketones and he has never had even the slightest trace, so moving his dose up slowly and in small increments from this point is something that he and I can both deal with. I'm keeping my fingers crossed that we can hone in on the right number and get him regulated. Thanks for the input.

Jane & Silverado
 
After having said all that about overlap I'm not actually sure how much it applies to him, since he's not much of a zoomer. With a lot of cats you can really see it by testing something like +11 and +12, or +1 or +2 after a shot, and gauge how much the #s are rising, or if they are flattish (yay, overlap!!!). Since he tends to have pretty moderate #s all the time, I don't know how the principles work - does that mean he already has overlap? Or maybe just isn't a zoomer? Bix has been in that camp lately, almost no zoom at all, so then overlap (if it's there) seems perhaps more shed-like, rather than something you can see in the zoom control. Not sure what to make of that, and sorry to probably just be confusing you. :-D
 
Yea, but I'm starting to get used to this constant state of confusion. Since the weekend us coming up, I will do more interim testing and see what we have.

Take care.
Jane & Silverado
 
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