Martini 11/10 Any experienced eyes would be much appreciated :(

[SMM]

I have been trying to regulate Martini for many months. Just when I think I have it figured out, she throws another curve ball at me. I am testing all I can - been working evenings lately also.
Today I am totally lost - 14 (256)AMPS then +4- (287)16, and +7 later still (287) 16. She is always high in the morning AMPS which I don't understand either. I know it was not a Fur Shot this morning, can anyone please point me to some direction to follow? I am just so frustrated that I cannot help her more. Am I shooting too little? too much? Can anyone see any pattern on her spreadsheet? Anything??
Did not include previous condo as it was over a month ago.
Thank you so very much for any input.

 

[Wendy&Neko]

Link to the previous post here - you never know when there might be something worth while reading there. She's only seen green once since your last post here. It could be she's built up a little glucose toxicity since then.

Martini could be bouncing a little from the blues she saw yesterday/last night. She might have gone lower after +2 last night. Many cats go lower at night. She's not used to green or even low blues, so it's not surprising she's bouncing. Or she could be doing a flat yellow cycle before going lower tonight. You'll find out soon enough.

Just wondering, what is the dose "~1.5" mean. Lantus likes consistent dosing and it seems you are changing doses sooner than the 1 week as per SLGS.

Other than the numbers, how is Martini doing? How are the 5 P's? (peeing, pooing, playing, preening, purring).

 

[SMM]

~1.5 is explained in the notes on the side. I am trying with calipers but the stupid BD needles and air bubbles are driving me bananas. I started writing ~1.5 as approx 1.5 but have given up. Yes, I am confusing/confused! at times 1.50/1.5/sk1.5 are the same 'guesses'. I only switched to 1.25 because of the 3.7 as per SLGS, is this not correct? Then panicked and went back to 1.5
Martini pees quite a bit when over 12, poos good, plays - a bit - she is 15, almost 16, preens a LOT, and purrs quite a bit. Thank you for asking that. Is there anything I can do stop the 'bouncing' if that is what is happening? How can I tell if it is bouncing as you said it 'could be'? I would have expected too for her to dip a bit at +7, but no, she stayed the same high as +4.
Could she be bouncing every single morning from lows at nights?
Thank you Wendy.

 

[Wendy&Neko]

~1.5 is explained in the notes on the side. I am trying with calipers but the stupid BD needles and air bubbles are driving me bananas. I started writing ~1.5 as approx 1.5 but have given up

I looked back on the remarks, and couldn't see anything written, other than writing 1.5 is easier than writing ~1.5. I endured the BD syringes for 5 years and used calipers for the last about 4 years. Calipers really did help me get more consistency because the placing of the "zero" line is fairly random. For quite a while, Neko's dose was under the zero line - meaning there was almost 0.5 units under the zero line. But just sometimes. Bubbles are indeed a pain. You do have to push hard on the plunger before you insert it into the cartridge (or vial if using that, I found cartridges easier). I always took out about 1/3 to 1/2 of a unit extra, then drew out the plunger some more to let more air into the syringe. Then start the tapping - air bubbles seem to like to go together. Then when you have the one large bubble, slowly and carefully push the plunger back down again.

Glad to hear Martini is feeling good - cats are more than their numbers. Over 12 she's probably over renal threshold, hence the peeing more.

As for what you can do to slow the bouncing (you may not ever be able to stop it), is to find a dose where she spends more time in green. Have you ever considered trying TR for dosing? With a reduction point of 90, it's hard to dial in a dose that gets some green without them going too low. BTW, Neko bounced all her life on insulin, she just lowered the height of her bounces over time. I learned to accept them, and realize it meant her self defence mechanims were working just fine.

Could she be bouncing every single morning from lows at nights?

Entirely possible. Neko once did a three months stretch of going low at night and bouncing during the day. Day time data made it look like she needed an increase, but she was earning reductions at night. Drove me crazy. If Martini is blue at +2, is it possible for you to get a +4 test? That still means you get a decent amount of sleep. However, from what I do see on the spreadsheet, she could just be bouncing from blues and I think she needs more insulin. The issue is that according to SLGS, you hold the dose cause she showed you a nadir under 150. Your call if you want to tweat how you do SLGS a bit or follow TR or stay with the original SLGS guidelines. What do you think Martini needs?

 

[SMM]

You are indeed correct Wendy, I had written it in (1.50's), but 'overtyped' it with something else. My sincere apologies. The darn needles sometimes show a zero line and it is not, and vice versa. I try to do the best I can even with the calipers. I try the tapping etc, but sometimes it just won't get out. Probably my fault again.
Martini has cleared bounces in the past quickly, today seems to be a very bad day for some reason. Very seldom is she a blue after PMPS, but I'll have to figure out some way to test +4 etc while I am at work. I will hold 1.5 for another few days, then increase and try to figure out TR on my schedule. Looks to me like you believe she could be better on TR, and I appreciate that.
I think Martini needs a better mommy, clearly I have failed her miserably. Thanks again Wendy.

 

[Wendy&Neko]

Sandy - no you have not failed her at all! You are giving her insulin and home testing, two things most people don't do with a FD diagnosis. All I'm saying is that it would be good to find a dose where she sees a little more green, but it's hard to do that with SLGS. She did see one nadir below 150 on this dose, but most nadirs are above 150. With someone who has the data and experience that you do, you could try an increase even on SLGS. I wouldn't suggest that with someone new. You are doing a great job testing more than many people who follow SLGS and lately testing more than enough for TR.

I'm just suggesting the +4 at nights, not during the day while you are at work. Cause it's possible she's going lower at night - it's very common with cats, but not all do that. So we just need to put on our detective hat and do some investigation. And I'm all about gathering data, while still maximizing sleep.

 

[SMM]

Experience me? LOL... I am lost, but appreciate the thought. Right now I'm doing evening 'shifts' most nights so I have to figure out how to do that detective work. I test when I can, I know she needs more green so one more day of 1.5 (10 cycles) and I will raise it. I so appreciate your thoughts.

 

[Photorecon]

The entire objective of the dosing exercise is to reeducate the pancreas in accepting lower numbers.
Green might be completely out of question for Martini right now so keep pushing sugar level down
with 1.5. Only after a few days you will be able to conclude that a dose will never do any better. Once
you've been patient enough and nothing goes well, increase but no more then .25 at the time.

When I pump my insulin I do :

1 : Push hard on the plunger and keep it that way until the needle is in
2: let the plunger go
3 : Suck the insulin on step higher then what I need (if I need 1.25, I'll pump 1.5
4 : point the needle up and hit the barrel so only juice is on top of the plunger
5 : Sloooowly push the plunger with two fingers at the root of the barrel and one (my thumb) until a small bobble goes out

For .5 you set the bottom of the black line (plunger) flush on the line on the barrel
With .25 you set it slightly past the next .5 so a tiny empty space is visible on top.

You'll get used to all this and it will become automatic.

Keep on with the good records on your SS

Sébastien
.

 

[SMM]

Merci aussi Sebastien!
I can see you have also have problems with getting SK regulated.
Yup, I understand about reeducating the pancreas, I'm a big chicken (in case I'm not around) about hypo, and I'm afraid it has hurt Martini for the most part.
Thanks for what you do with the injections, I try also but sometimes it just gets frustrating. The plunger can be flush with the line or above/below the line on those stupid needles. Sounds like you and Wendy got it worked out and I have to keep working on it tho.
I started 1.75 (calipers/best of my ability) this morning, will see how she does whether to stay SLGS or try TR.
Again thank you to both of you.