Opie, The Bouncing Ball

@LovingOpie You know he earned a reduction, right? Anything below 40 is an automatic reduction - doesn't matter if you're following MPM, and doesn't matter if he's a long term diabetic, 30's means reduce.

"Any cat, regardless of time since diagnosis should receive a reduction if there is a number below 40."

JanetNJ said:
Wow look at those preshots this week!
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Even more of a reason to reduce, we're starting to see a downward trend.

If it ends up being a failed reduction so be it, this is about keeping Opie safe.
 
Shelley & Jess said:
@LovingOpie You know he earned a reduction, right? Anything below 40 is an automatic reduction - doesn't matter if you're following MPM, and doesn't matter if he's a long term diabetic, 30's means reduce.

"Any cat, regardless of time since diagnosis should receive a reduction if there is a number below 40."


Even more of a reason to reduce, we're starting to see a downward trend.

If it ends up being a failed reduction so be it, this is about keeping Opie safe.
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No, I did not realize he earned a reduction since I had been told not to reduce recently when he went below 50. Thank you for telling me this. I just thought I was to keep going as is since he was doing well despite having difficulty keeping him safe.
 
LovingOpie said:
No, I did not realize he earned a reduction since I had been told not to reduce recently when he went below 50. Thank you for telling me this. I just thought I was to keep going as is since he was doing well despite having difficulty keeping him safe.
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Oh yeah for sure earned a reduction. He was getting very low. Sorry I should have said that and not assumed you knew.
 
When he dropped so steeply this morning, I would have reached for the MC to slow him down - around 15 percent. Then when he went into the 40s again, I would have given food with a little karo. I also would take a other reduction for Opie tonight (even though he will be in a bounce) and even though it is a “back to back” reduction. Opie has been making some serious downward moves lately and we must keep him safe. You can easily go back up if the numbers warrant it.
 
Suzanne & Darcy said:
When he dropped so steeply this morning, I would have reached for the MC to slow him down - around 15 percent. Then when he went into the 40s again, I would have given food with a little karo. I also would take a other reduction for Opie tonight (even though he will be in a bounce) and even though it is a “back to back” reduction. Opie has been making some serious downward moves lately and we must keep him safe. You can easily go back up if the numbers warrant it.
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yes, Opie definitely is making some serious moves and yes, he is in another big bounce. Went down in dose as well so we are now where we started at 1.75u.
 
I would not have increased Opie back up to 2 units so soon. Doses where we see green (and Opie did see green on 1.75 units and then got a bit wonky) are usually held a little longer (even with MPM.) But since you did go back up already just watch him and don’t skip the +2 (even though he started red and may still be high.). Paws crossed for more green (no lime.)
 
Yep, that red this morning could be a high before the break - he was bouncing & due to break. We've seen him do it a couple of times now.

I would've held through this cycle (and maybe the next, depending on the pattern) to be sure.

Here's "another little something" I copied from a Marje & Gracie post.

“High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.

He was bouncing

He was due to clear the bounce

His BG was wobbling a bit like it might be clearing but then the numbers shot way up.

BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle. Still, the above pattern is classic high before the break.

One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.

Not all cats will show a high before the break and even those that do might not do it consistently.
 
Shelley & Jess said:
Yep, that red this morning could be a high before the break - he was bouncing & due to break. We've seen him do it a couple of times now.

I would've held through this cycle (and maybe the next, depending on the pattern) to be sure.

Here's "another little something" I copied from a Marje & Gracie post.

“High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.

He was bouncing

He was due to clear the bounce

His BG was wobbling a bit like it might be clearing but then the numbers shot way up.

BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle. Still, the above pattern is classic high before the break.

One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.

Not all cats will show a high before the break and even those that do might not do it consistently.
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So do you think that I should go back down? I thought that he had been on that dose for 7 cycles and that was more than enough to see a difference. Are you suggesting that I decrease tomorrow AM?
 
Well, he spend quite a bit of time bouncing on the 1.75 dose, but prior to this he had some green numbers - so I would have held a cycle or two longer before deciding. I’m sure that Shelley will chime in this morning, but since you already increased, I would not decrease back down (unless you have a preshot test this morning that gives you pause.) It’s all okay. He may actually need that 2 units.
 
LovingOpie said:
So do you think that I should go back down? I thought that he had been on that dose for 7 cycles and that was more than enough to see a difference. Are you suggesting that I decrease tomorrow AM?
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7 cycles since the reduction, but only 3 cycles since a desired nadir was seen.

07/18 AM cycle green nadir then bounced for 3 cycles
07/20 AM cycle green nadir then 3 cycles of bouncing - I would've waited yesterday because it was the 4th cycle after the last green in case he followed the same pattern as the last break and especially with that unexpected Red showing up - a possible high before the break.

Clearing faster than 3 cycles isn't a consistent pattern with Opie yet.

I would have held for at least one more cycle yesterday and watched the pattern because that was the 4th cycle after the last good nadir.

The pattern I would have watched for - first, compare yesterday to AMPS 07/14 - not necessarily the colours, but the pattern of the cycle and how the numbers flowed, a steady downward cycle. It took Opie two cycles after that high Red AMPS 07/14 to break. You can go back to 07/05 and see that same pattern - the high to start 2 cycles of clearing and finally break.

I wouldn't reduce back down now, but hope I've explained why I would have held - it's still early & hoping to catch you before AMPS today - I hope I gathered my thoughts well enough that it makes some sense!
 
Shelley & Jess said:
Yep, that red this morning could be a high before the break - he was bouncing & due to break. We've seen him do it a couple of times now.

I would've held through this cycle (and maybe the next, depending on the pattern) to be sure.

Here's "another little something" I copied from a Marje & Gracie post.

“High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.

He was bouncing

He was due to clear the bounce

His BG was wobbling a bit like it might be clearing but then the numbers shot way up.

BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle. Still, the above pattern is classic high before the break.

One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.

Not all cats will show a high before the break and even those that do might not do it consistently.
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Suzanne & Darcy said:
I would not have increased Opie back up to 2 units so soon. Doses where we see green (and Opie did see green on 1.75 units and then got a bit wonky) are usually held a little longer (even with MPM.) But since you did go back up already just watch him and don’t skip the +2 (even though he started red and may still be high.). Paws crossed for more green (no lime.)
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Shelley & Jess said:
7 cycles since the reduction, but only 3 cycles since a desired nadir was seen.

07/18 AM cycle green nadir then bounced for 3 cycles
07/20 AM cycle green nadir then 3 cycles of bouncing - I would've waited yesterday because it was the 4th cycle after the last green in case he followed the same pattern as the last break and especially with that unexpected Red showing up - a possible high before the break.

Clearing faster than 3 cycles isn't a consistent pattern with Opie yet.

I would have held for at least one more cycle yesterday and watched the pattern because that was the 4th cycle after the last good nadir.

The pattern I would have watched for - first, compare yesterday to AMPS 07/14 - not necessarily the colours, but the pattern of the cycle and how the numbers flowed, a steady downward cycle. It took Opie two cycles after that high Red AMPS 07/14 to break. You can go back to 07/05 and see that same pattern - the high to start 2 cycles of clearing and finally break.

I wouldn't reduce back down now, but hope I've explained why I would have held - it's still early & hoping to catch you before AMPS today - I hope I gathered my thoughts well enough that it makes some sense!
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Thank you Shelley! It helps a lot when you explain in detail like that and I appreciate it very much. Right now it feels like I will never see the end of bouncing.
 
the duration was good today. His low of 102 was at +8. Of course, he may be quite low at PMPS which will mean an active night.
 
LovingOpie said:
This morning and this evening at the +2 his numbers went higher than the PS. Why is this?
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Do you think he may have bounced on the 2 IU? Either that, or his food intake maybe?

Mine's BG always peaks at food +2, then starts coming down. Although not shared for reasons, my boy's sheet looks scarily similar to Opie's. He'd plummet on the same doses too (2 IU and 1.75 IU) - one day they seem to be perfect for him, the other day he'd crash. I find that food, and how much he eats is a big factor in this. (Which is quite unhelpful, given his dental issues - sometimes he eats, sometimes he doesn't.)

This is my semi-educated guess and own experience, but I'm not overly familiar with ProZinc - so take everything I say with a pinch of salt please.
 
The good news is that he’s coming back down after these bumps and then having some nice stretches in blue.

He has been wonky lately.

Is there anything different about his eating/snacks lately? He seems to be getting a bigger food bump than normal or perhaps his insulin onset time is slipping a little bit later? We also have to take into account meter variance of 20 percent, which can contribute some to the numbers (it’s not the whole explanation, in other words, but can play a part in the numbers we are seeing.)

I would hold on a bit to see if things will smooth out on 2 units. Also, I would still get the +2 test, because if you get complacent that is just the time where Opie would like to show us what he can do/give us a surprise…. Why?…. Because he’s a CAT! And keep the morning meal and small LC snacks going— but I am sure you are already doing this part as it’s become routine.

Has anything else changed with Opie or his siblings or his environment lately?
 
The only thing I can think of is that he is eating a good half a can at a time instead of a quarter. I like that he is eating and hate to stop him but I try to keep it to half only. He eats every 1/2 hour to an hour throughout the morning. It is very low carb food, he has been liking 1% to 3% FF. I didn't think 1% would be that big of a deal but he is sensitive. Knowing this I am pushing the 1% over the 3% but it doesn't always work that way.
 
Back in blue! Odd how it’s the same number as yesterday and at the same point in the cycle - even though Opie started out much higher this morning. I really hope he won’t go up high again later on! Don’t go there, Opie!
 
Suzanne & Darcy said:
Back in blue! Odd how it’s the same number as yesterday and at the same point in the cycle - even though Opie started out much higher this morning. I really hope he won’t go up high again later on! Don’t go there, Opie!
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I noticed that he seems to have the same color at the same time though not always the same number but close. He also seems to be having the nadir at the +8 instead of the +6. I don't understand what he is doing and why he won't settle in. Where are the greens? and I don't mean lettuce and parsley. . .
 
LovingOpie said:
I noticed that he seems to have the same color at the same time though not always the same number but close. He also seems to be having the nadir at the +8 instead of the +6. I don't understand what he is doing and why he won't settle in. Where are the greens? and I don't mean lettuce and parsley. . .
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I think this may be why we are seeing the higher +2 (later onset) and later nadir which would go with a later onset. He has changed his pattern for sure.
 
Suzanne & Darcy said:
I think this may be why we are seeing the higher +2 (later onset) and later nadir which would go with a later onset. He has changed his pattern for sure.
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He did it again. Higher at +2 tonight. Is it a good thing to have changed his pattern? I can't see that it is the food because he is eating like he did all along when he had those good cycles and that didn't bump him. I don't like withholding food because of worrying about the numbers. He is starving all afternoon from nadir to PMPS and then I withhold food on him. . . just doesn't seem right.
 
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Shelley & Jess said:
He's lost momentum. We should've seen green by now.

I'd increase this morning.
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Since his insulin is 2 months old and could be wonky, I decided to try a new bottle and keep the dose for now. I am sorry but I don't get my notification email most of the time and therefore fail to see messages until too late. Yes, I have the correct setting for receiving the emails, I just get them sporadically despite that and knowing this, I do check here often but that doesn't always work either. Anyway, I hope I did right for him but right now he is up again at +2. . . . ugh
 
It doesn't appear to have been the insulin. I hate it when I try and have wasted a good bottle of insulin. It is such a loss financially. . ugh. I am also getting very very frustrated at this point. This is what Opie has done since the very beginning and I had hoped that we would find a way for him to work it out. I will have to increase again tonight.
I have questions. . . what makes it ok to increase back up to a dose where it was too much for him before? and why does he respond differently each time we go back to a dose? If it was too much before, why isn't it too much now? Why does he go up right after we give insulin? Yes, sometimes he drops a real lot, although rarely. What is making him go up like that? Is his body increasing glucose because the insulin was too much and he would drop too low? If he was doing well at 1.75, maybe that is better than going up? All along whenever we went up he did worse in the long run. You can always see it in his eyes when he has more insulin.
Anyway, I am throwing these questions out there and hope some of it will become clearer to me.
 
He's kind of a flat yellow pancake today, isn't he? I'm sorry this is so frustrating. I would try the increase tomorrow morning to 2.25 units -- or tonight since I don't think you've shot yet. More in a minute.
 
So his onset time seems to be delayed a bit. Whether this is due to all the food he's been eating, I have no idea. I don't want you to not feed him enough calories. You should know his ideal weight and if you need him to gain or lose weight and how many calories a day he needs to gain or maintain his weight. This will be a very unsatisfying answer, but cat's insulin requirements can and do change over time. It's frustrating. I'm sorry. @Shelley & Jess you always have some helpful insight. Do you have any for Opie?
 
Look how his nadir has slipped to a later time as well (around +8). At least he seems to be getting better duration sometimes. You've had some not to bad nadirs on this dose the last few days -- just not the greens that we all are hoping for. If you look at the last few days he had some pretty good cycles, just -- again, not what we are hoping for. I'm just trying to point out some positive things.
 
increased dose to 2.25 and so far he is flat pink. . . instead of going higher at +2 he did it at +3. . . all pink.
 
Well we can’t judge things just yet - since you just increased. New dose wonkiness is a real thing. I usually saw more of it on the second cycle or second day after an increase.
 
LovingOpie said:
what makes it ok to increase back up to a dose where it was too much for him before? and why does he respond differently each time we go back to a dose? If it was too much before, why isn't it too much now?
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Remember the Pooped Pancreas story and how sometimes the pancreas works and sometimes it doesn't?

While the pancreas is resting it's not too much insulin, but if the pancreas 'wakes' up and starts producing some insulin and starts helping out then you have too much insulin in the bloodstream and that's when you've got to back off the insulin you give while the pancreas helps out.

Then the pancreas gets tired again and needs to rest again because it's not fully healed yet and why we slowly and steadily increase the insulin again to help that little pancreas while it's resting.

The problem is, we never know when or how long it needs to rest or when it's finally gonna decide to wake up, and even when it is awake it might not be fully up to the task and why our doses go up and down and work and don't work sometimes.

LovingOpie said:
Why does he go up right after we give insulin? Yes, sometimes he drops a real lot, although rarely. What is making him go up like that?
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Do you shoot in the same place all the time? Absorption can vary up to 50% from shot to shot.

With Prozinc, we want to see the +2 about the same as PS (allowing for meter variance). I don't think what you're seeing is anything to worry about. Think of it this way, you test, feed, shoot - the food should give a food bump within the first couple hours. Prozinc expected onset is usually around +2, that's when the insulin should start working and start bringing the BG down, so to see the BG about the same as PS is good and means the insulin is working the way it's supposed to and has started to bring the PS food bump back down at +2.
 
Shelley & Jess said:
the insulin is working the way it's supposed to and has started to bring the PS food bump back down at +2.
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We are assuming this - but since we don’t have a +1 we don’t know if he gets much of a food bump. For the few times recently that we’ve seen a +1 test (recommended by Marje) Opie didn’t get a food bump that I see.
 
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