Help with Asher

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donnahc

donnahc

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I know, everyone is running in the opposite direction now ;)
I think my dude has everyone stumped but I need to formulate a plan to move ahead. Any insight is much appreciated. I am about at wits end.

He seems normal but I did see him drink water today. It has been very hot and humid here and both cats are lying around not moving much. But no extra pee in litter box and everyone is eating, just slower and a bit less. I have the fans on and it is a little cooler today. Dunno if heat plays a part in bg.

Today we woke to amps 309 and I backed off and shot 2.7, since I have no idea what’s going on with him and I had to try something.
So here is today so far:

amps 309, shot 2.7
+ 2 294
+5.5 243
+8 248

Meh.

Will fill in numbers as day goes on.

Spreadsheet is current and I have stared at it for hours and don’t get what’s going on :(
 
WIll send positive vibes your way! Could you just chalk it up to he's a cat? Maisey had 3-4 days of mostly blues then threw a red. Then did more blues and yellows and just before she went OTJ she threw a 411. My thought would be to stick with the lower shoots, because there are the most low numbers, but I have had very little experience.
 
after looking over ss...i'm wondering if starting back at 1.6 might be wise...if you look at the whole picture...carefully
 
I appreciate you looking over the chart Lori. Hope I answered all your Q’s.
Let me know what you think once you have a chance to finish perusing.
Thanks tons!
:mrgreen:
 
Ha, we answered at the same time :) Wow, 1.6. Well, what I am doing now doesn’t seem to be working...
 
it's a bold move i know...but i do think you've done bolder :lol:
seriously, asher is as likely overdosing as anything else.
 
Yeah I guess we have on occasion :oops:
So if we would reduce, how long do you think you stay there at that dose before you make a move? A few cycles or a few days?
 
no need to be embarrassed. I like BOS!
let's take it one day at a time ok?
let's not make decisions on what if just yet.
let's let the numbers do the talking.
I know you are east coast and I am west coast so I will not be around when amps are being shot. err on the side of shooting low and I will check on you and always be availabe for your pmps. errr. what time Pacific do you pmps?????
 
Right now we are on a schedule that our pmps would be 3:30pm your time. This is why I always get ahead of myself and ask in diff scenarios what to do, just in case :mrgreen:
 
Hmmmm... in looking at your spreadsheet it looks like most of the raises to the mid 2 units for dosing was done when you weren't doing many spot checks. Your pre shot values look about the same as before, so I wonder if the raises were actually warranted, or if you missed the occasional green blip like you used to get in the mid 1u doses. Like Lori said, the only thing you can do to rule out needing a lower dose is to try it. I would definitely give it more than 2 days to settle down though. A big drop like that - the body won't know what to do with it for the first few cycles. Tentatively, I would advocate 4 to 5 days at that dose, but that is all dependent on what Asher throws at you. If you all of a sudden get lots of 300s +, then you must take up the dose.

On another note - sometimes kitty's insulin needs change for no reason. I have seen spreadsheets of many kitties here look like they are going OTJ only, to have numbers rise back up to an even higher dose than was previously needed. Sometimes there is just no rhyme or reason, but it is good to rule out mitigating factors :-D
 
Just did pmps so here is where we are for the day on 2.7 units shot this morning:

amps 309
+ 2 294
+5.5 243
+8 248
pmps 266

So kind of flat all day.

My partner Tom and I talked about it and we are going to try the reduction, but 1.6 scares me a bit. Should we do a more gradual reduction or would that not tell us as much?

What do you guys think?
 
Ok Tom and I discussed this one more time and we feel comfortable backing off to 2 units.
Hopefully that is good.
So...we’ll keep you posted.
Any other opinions along the way, please tell us :)
Thanks guys!
 
Donna, as the mommy/daddy team you do know your kitty better than anyone. And you may have a very strong instinct saying 'no, 1.6 is too big a drop' listen to that. Most people find it hard to reduce (with high numbers)...harder to reduce than to increase dosage. The idea that less insulin is better is very hard to swallow. Trust me....I know!
So I'm totally in your corner with your decision and will be watching along with you for any new trends and hopefully lower numbers.
Lori
 
Thanks guys. I so appreciate everyone’s input.
I hope we’ll see something good with a lower dose. I don’t know what else to do if we don’t.
 
I can tell you what I did when I was stumped. I went back to the lowest dose that I felt 100% sure was not too high a dose. Then I increased very systematically in 0.2 increments every 3rd day until we got a breakthrough. I only decreased the dose if 1) the nadir was below 50 on any cycle, 2) the PS was below 150 on any cycle, or 3) I knew Bix tended to build momentum by shot 3 on a dose, so if I saw the results were good enough on shot 1 or 2, I pulled back a teensy bit for the next shot. Now, Bix's patterns were different than Ashers, but that is what worked for us.

Here's what I see when I look at the recent data: on 4/21 and 4/22 you got a nice U-curve on 2.5 suggesting that dose was too low. On 4/23 you got some WOW factor on 2.8, and then it's been all blah since then, which could be b/c the dose is too high, or too low and he has already overcome it. I'm not sure how much value the earlier data is, b/c his insulin needs may have changed, and also often it seems like they overcome the doses and there's no going back.

The benefit I think of reducing the dose is that if you need to raise it, that will give you the confidence to do so. It is scary to raise the dose where you are now, b/c you don't feel sure that the dose is too low. So that leaves you waffling in holding doses, or moving in tiny increments, etc. (or at least that is what I did when I was in a similar place).

If it were me, I think I would keep increasing the dose, and get something like a +2 or +4 spot check in every cycle, hypo kit in hand just in case. It's hard to recommend that to anyone, and I certainly wouldn't recommend it if you were a newbie, that's just what I think I would be doing. What I DID was lower the dose and then end up raising back up, but having learned from that :-D I would skip the lowering, in the absense of anything that clearly looks to me like the dose is too high.

The other thing I did was set a timeframe of 1 month from the point where I got systematic with it, and decided if I didn't have him regulated by then I would switch insulins. The benefit of the Ls I think is that they have the protocol to follow. What I have seen at times is people who got blah or poor results on PZI do well on one of the Ls in large part (IMO! & btw not speaking of anyone who is currently posting in this forum) b/c it gave them the confidence to raise the dose, which they didn't have on PZI.

If you do reduce, I would NOT stay there for long if the #s don't improve. When they are overdosed and a reduction works, we usually see improvement almost immediately - blues showing up in 1 or 2 cycles. One of the biggest mistakes I made was a rebound check reduction that I held for several days when it was clear to everyone but me that his dose was too low at that point. So don't do that. :mrgreen:
 
oh no joanna....we dissagree! confused_cat
i am one person who dramatically lowered my dose on my move to Lev.

if you really look at this SS it looks like the more she pumps the higher the numbers get. and when she does get a green...it's followed by more high and higher numbers.

and we have seen more folks gain from lowering dose than not. no?
 
Mmm, I can only think of a couple who gained from lowering, not counting those with clear-cut signs the dose is too high. Seems like most just keep riding in mixed numbers and not making progress, and one just yesterday who shot to horrifying reds and blacks (though could be from other reasons). I think it's ok if she tries it though, as long as she tests for ketones, and raises back up quickly if the numbers don't improve.
 
ok i forget...is this a ketone prone kitty?
and i hate to say it...but i've about had it with this particular insulin...the new pro zinc.
it's just been tooooooo hard.
i don't remember struggeling this much with the old pzi...do you?
 
I test for ketones maybe a little more than once a week right now. Like every 5 days or so. Think that’s ok?
Touch wood, anti jinx, he hasn’t had any show up yet.
 
I have to say, I am more scared doing this than raising a dose. nailbite_smile
So scared that with not enuf insulin he could get DKA or something horrible.
If I wasn’t so tired I’d prob be crying.

But I feel like we have to know if he’s overdosed for sure to move forward. So we’ll press on.
 
Sorry I keep posting things but my head is racing...but only in spurts.

So if numbers are bad and we have to raise him, I know Joanna said you did it by .2 at a time and every 3rd day. Depending on how bad the numbers are, would we have to do it faster? Or is that the safest way to do it to know you don’t wiz past his best dose?
 
I would test for ketones every day while dropping your dose just to calm your fears. That way you will stay on top of it and can react quickly.

If his bg's zoom really high right away you will know that he is not getting enough insulin and can raise him back up right away.
 
oh dear....we have really gone badly tonight.
all the mommies are worried sick.
i don't know how to reassure everyone that you are all doing ok. that it's not the end of the world and that your cats are good.
you can lower the dose, you can try that. if it works you'll know soon enuf. if it doesn't you up it again and we talk about another insulin.
but donna...it's ok i promise...it's not as bad as you think.
 
You are doing this to be sure you did not accidentally skip over a dose that worked, so if possible, it's better to do It as Joanna suggested. If you get horribly high numbers you can re-evaluate--- unlikely to be any kind of emergency, so there will be time to study and discuss data.
 
I just started a new thread for all the mommies...maybe you want to read it?
 
Oh no Lori, Lev has taken over your mind! :mrgreen: Maybe you are right, I have only used PZI and Vetsulin so I can't say, and thankfully Bix did well on PZI. I think it has always been this much struggle, hasn't it? I don't recall any time where more than a few kitties have gone OTJ really quickly & easily. I think we suffer from the lack of a protocol, and the lack of any uber-expertise (no offense to anyone).

Donna, I wouldn't lower the dose to anything less that what feels right to you. If your gut is against it, trust that. If you are going to do it though, I'd take the pull off the bandaid approach. Take a couple days, stick with the plan, and see what happens. If the #s go higher and his symptoms are worse, then you are clear and can raise back up immediately. If you don't want to try lowering at all, I think that's ok too.

For raises back up, you can do 0.5 increments if the numbers are bad. 0.2 is if the #s aren't horrible, or if you are seeing progress and don't want to overdo it. So if you are in say yellow PSs I would say go in 0.2 increments. If the PSs are red and the nadirs aren't good, I would move in 0.5s. Also I don't think you need to spend time in doses you already know don't work, I would breeze right past those pretty fast.
 
joanna i just don't remember the fears of DKA and Hypo's being so dire. They were the rare rare exception and no one really worried that much...unless they had good reason. and no one here has good reason. no DKA...no Hypo's ...nothing is on the horizon or even close. well except for samwise and I know she never worries bout it :lol:
 
After reading through this, I'm really starting to think it might be time to switch Sam to a different insulin. Oy, the thought of learning a new insulin and its protocol does not appeal to me, but there's got to be a better way to deal with these wonky numbers.
 
Kristen I don't think it's a terrible idea. I took a peek at Sam's SS and it looks to me like he is a drama dropper, which can make it hard to get them regulated on PZI. You've tried doses high enough to get a nadir below 50 :shock: and for the most part it looks like he hasn't gotten great duration on PZI. You could try something like TID, but that's so stressful I can't really recommend it to anyone who isn't gung ho. If you are really thinking about switching, I'd consider posting on the different forums and asking for a look at the SS and suggestions. You might find that someone has some ideas on how to get him there on PZI, or you may get good suggestions about switching. When I look at today's #s on his SS I just want to cry! :-|

p.s. sorry for the hijack!
 
Thanks, Joanna. I'm giving the 1 u one more cycle today to see how it goes then I'll reassess. I just read that with Lev you can't really preload syringes, which sucks because that's exactly what I do for my husband when I travel.

I should start a thread of my own. Sorry for the second hijack!
 
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