Kitty 8/15 tid

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kse

kse

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Last night I reduced Kitty's insulin to 3 units. It appears the 3.9 was too much and contributing to the rebound/bounce cycle from the 71 we saw on Saturday night's pmps.

So, I shot 3 units into the 314 last night and this morning our amps was 243.

I still am not convinced that 3 units is "her" dose, but I want to stick with it until I see reason to change it.

She is still eating and waking me up to eat...but, she is getting pickier and eating less at her meal times. She acts fine, but she has always been a pig--so, I have my eyes on ketones and a ptitis flare up.

She is due fluids today!

Wishing you all a Good Day!

Kim and Kitty
 
Kim
Awesome and gutsy call! Keep us posted on her mid-day
carl
 
Midday preshot---421...so now the question is...Did she like the 3 units and drop down and bounce again, or was it short? It wasn't short on 314--so, would it be short on a 241?...I don't know!

I stuck with the 3 units for one more cycle. Before deciding to do so, I tested for Ketones---negative! I will be home this cycle--so, I will test and see what is going on with the dose. If it appears to be a short dose tonight, I will quickly move back up.
 
+2 on the midcycle---344...pretty good drop for her...better than on the higher doses! I am getting really confused--so, I think I will go give fluids now, so I can really mix it up!
 
I really hate to ask this, I really do ..... but if you are at the end of your 72 hr. bounce period and you have not been shooting into it ..... then ..... the numbers are exactly what you were looking for? right?

So sometimes if you think of dose on a daily dose, like Payne averages 12u a day when she's feeling good, so that becomes my base dose. Sometimes she needs more because of the CP but the moment she feels better I know I need to go back to her base.

So we could have two things going on with Kitty. Maybe her base # is 9 or 10u and she was getting over 11 at one point. So maybe each dose was working but the daily became too much?? and that caused rebound.

Number 2 is the best ..... something is awakening!! we would love this one!
 
+5 254

Fluids are on board--but, I think it is too early for them to be playing a role in this test...

So, what are you thinking about the 3 Units?
 
I was disappointed in the red today---but, I am thinking that she probably hit blue and bounced a little. That would be a normal pattern for her. I am interested in seeing the duration of the dose.

But, I think it is fair to say it is giving as good of results as the higher doses for now.

I am glad I am able to test the cycle tonight. Hopefully, the fluids won't bottom her out as much on 3 units.

Interesting to say the least!
 
Kim,
What time did you shoot fluids? Wasn't it around 10-12 hours later that you have been noticing the possible benefit? Her numbers look terrific on the 3.0 When I signed off last night, I didn't have an idea you were going that low, I figured 3.5 maybe. Seeing her react to the lower dosage this well has me excited to see what happens from here. I like what Nancy said above. Maybe look at a "daily" intake of 9ish to 10ish for the next few days and she what she gives you back. Things may be beginning to heal and Kitty might be ready for nice improvement overall.

Carl
 
If the fluids follow the same pattern they have been having---the next cycle will get the most benefit. But, I did give the fluids earlier in her cycle than normal, so that might spread the "effects" out more. The last two times I have given fluids, when I went to give the insulin (about 3 hours later) for the next cycle there was still a small pouch. I did shoot away from the pouch--but, I think the pouch and the continued absorption might have played a role in bottoming her out. I am hoping that when I shoot her pm cycle tonight that the pouch will be gone.
 
Hi Kim, nice you got a greenie!!!

I haven't been following along the past few days, but just peeked in, and wanted to mention that if you reduced the dose b/c the drop was too steep and causing rebound that makes sense, but if you reduced the dose b/c she reacted to the greens, then it doesn't make sense to me.

In peeking at the SS, I would have been inclined to keep the dose that looks like it gave her a perfect nadir, only shoot less often (if the trend continued) than +8s (if that is an option for you, I know shooting something like +10s can be unworkable schedule-wise). I don't see anything that looks like the dose is too high from a BID or as-needed perspective, but I haven't studied the SS closely so perhaps I'm missing it.

I think it's expected given her track record that she would be in the reds by +12, so I don't know that I would really call it a bounce other than just her normal higher numbers. There's nothing from the PS to the 71 that makes me think "steep drop", it looks within reason to me, so to me that was the best cycle you've seen lately.

I don't know that 3.9 is the answer, but I'm not getting the pullback to 3u either. If you are lowering the dose to be sure you have shootable TID PSs, I'm not sure that's the compromise I would make personally.

Anyhow, if I'm off base, just ignore me :) I'm only 1/2 tuned it...
 
+6 247

So, it looks like the drop has stopped...just surfing now...I hope she surfs until her next shot...
 
Joanna & Bix (GA) said:
Hi Kim, nice you got a greenie!!!

I haven't been following along the past few days, but just peeked in, and wanted to mention that if you reduced the dose b/c the drop was too steep and causing rebound that makes sense, but if you reduced the dose b/c she reacted to the greens, then it doesn't make sense to me.

In peeking at the SS, I would have been inclined to keep the dose that looks like it gave her a perfect nadir, only shoot less often (if the trend continued) than +8s (if that is an option for you, I know shooting something like +10s can be unworkable schedule-wise). I don't see anything that looks like the dose is too high from a BID or as-needed perspective, but I haven't studied the SS closely so perhaps I'm missing it.

I think it's expected given her track record that she would be in the reds by +12, so I don't know that I would really call it a bounce other than just her normal higher numbers. There's nothing from the PS to the 71 that makes me think "steep drop", it looks within reason to me, so to me that was the best cycle you've seen lately.

I don't know that 3.9 is the answer, but I'm not getting the pullback to 3u either. If you are lowering the dose to be sure you have shootable TID PSs, I'm not sure that's the compromise I would make personally.

Anyhow, if I'm off base, just ignore me :) I'm only 1/2 tuned it...
Click to expand...

Joanna,
If you check out last night's thread, it may make more sense. It made my head hurt last night, but I finally followed. Then I read what you just said, and now my head hurts again. I need some sleep....
viewtopic.php?f=24&t=49934
Carl
 
Thanks Carl. I just took a look, and have posted my comments on that thread. You did a great job with Bob, he is OTJ right? I think you got there b/c you were not overly cautious, and you did what you needed to get good numbers for him, while testing to be sure things were safe. At least that is my impression, hope I got the picture right! If you had better "understood" what was going on, you might well have backed down on the dose and not made the progress that you did. It is tricky to find the right balance - many who do well do so before they know enough to be really scared of hypo. Once that sets in, people chronically underdose from what I have seen. It is very sad to see. I know that is what I did, and thankfully people yelled at me until I got the guts to shoot enough insulin to make progress.

Kim, again I have not studied Kitty's SS in depth and I am decidedly NOT in a good mood, so sorry for the grumpies coming out. I know you are taking care to get Kitty's dosing worked out, and I don't have the TID expertise to feel comfortable really telling you for sure what I would recommend. You have made really good progress of late, and I'm sure you will get things tweaked as you continue, and continue to make more progress.

And most of all, hopefully she is feeling well and acting well, that is what really matters!!!!!!!!!!!!!!!!!!!!!!
 
Sorry you are feeling grumpy, Joanna. This is a rotten time. Can you plan something for yourself that you would enjoy?

Sorry to hijack your thread, Kim. Numbers looking good. Seems you may thwart Kitty in her efforts to keep us all confused!
 
Hi Kim! I just got caught up on your last two threads and studied your spreadsheet from the last few days. I have to completely agree with what Joanna wrote in your thread for yesterday. She is absolutely right from what I have seen on other's spreadsheets that have done similar dances. It would be better to push back the shot time when needed when you get these breakthrough numbers rather than reduce. (This is something that is different for TID vs. BID) IMO with this 3u dose you are already seeing way more red numbers because of it and you might have to push that boulder up the hill again for a little while before you see a good drop again. That 71 was a fluke number IMO. I don't suggest shooting into it, and you haven't seen anything near that prior to then. You have slowly and steadily worked up to that dose, so it isn't a case of just plain shooting too much insulin. It is just Mr. P sputtering and keeping you on your toes.

The next time this happens, I would delay the shot and do a BID schedule as needed until you get TID shootable preshots again. More than likely you won't get a repeat number like that for a while. Also, something to consider - when kitties decide they might like BID again, they don't just all of a sudden switch over. They do this dance between TID and BID off and on again, until they solidly go BID again.
 
Kelly and Joanna,
This is more a question for you (sorry for hijacking, Kim!)

If you switch between BID and TID, or even sort-of switch by going to +10 from +8, do you keep the dose the same? I guess where I'm getting stuck is ...

Say Kitty is getting 3.7 TID (11.1 over the course of 24 hours). When you stretch out the shots, you would be reducing the 24 hour intake a great deal, right. So when you go all the way from TID to BID, if you leave the dose the same, you're effectively reducing the dose by 33% aren't you?
So, when you stretch the shots out, do you increase and try to keep the daily intake constant? Or is what you are really doing dropping the daily dose on purpose?
How long (how many days or cycles) would you take to go from TID to BID?
Is it that you just can't think in terms of "how much insulin do I shoot in 24 hours?" Or "I'm shooting the PS no matter how many hours apart it is?"

I mean, I always shot the PS (mostly because I didn't know better) and didn't do nearly enough mid-cycle tests, and I shot on a roughly 12 hour schedule (give or take a few minutes based on how quickly I could take a break and drop by the house) so I guess I always thought in terms of quantity of insulin in a 24 hour period.

Carl
 
If I moved from a shot at +8 to +10, or +10 to +12, I would raise the dose, and vice versa. With Bix I used to adjust approximately 0.1 or 0.2 for every hour I shifted. If you are coming from BID, a lot of cats don't need a reduction at +11 or even necessarily at +10, but Bix got good duration so I would pull back slightly for him.

I'm not sure those increments would apply for Kitty, who seems to need a lot more insulin than Bix did.

The only way I know to approach it is trial & error. If I got an unshootable PS at +8 and then Kitty went over 150 at say +10, I might stick with the same TID dose for data gathering, rather than increasing to compensate for the delay (given there is little data to go on), but neither decreasing like I might on a 150 PS at +8. Very roughly off the top of my head I would expect if you got a green nadir on a +8 shot off 3.9u, you would probably need something like 4.2 - 4.5 to get a green nadir off a +10 shot. That is VERY rough, and personally I would probably not actually shoot that - I would shoot a lower dose (like 3.9 or 4.0) and gather data, and then ramp up from there if warranted by the data.

I rarely got great results on early shots, which is why I'm hesitant to really give much solid dosing advice on it. I consistently undershot whenever I tried to do it with PZI, but that was before I got Bix regulated and learned to shoot / dose more effectively.
 
This would be a trial and error type of situation IMO. In the beginning I would probably shoot the same TID dose if I had to wait to give a shot since the low preshot could be a one time long duration, or could be a set of say 2 or 3 cycles that give you long duration and then it goes right back to the TID duration. In that switch between TID and BID I would more likely dose as needed with the same TID dose. Once it approached a 12/12 schedule, I'd probably increase a bit to push it toward that kind of duration. Hope this makes sense! :-D
 
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