Pumbaa dose question...

[Pumbaa]

Okay, he's been green for over 17 hours now. His lowest reading was 55 last night, but he had been grazing all night due to all of the calories he was also burning zooming around the house and acting like a total nut.

He had been at 2.50U for four cycles, up from a skinny 2.50U.

This morning, I gave him a BCS of 1.50U.

Tonight, do I go back to the full 2.50U, or give him a decrease to a skinny 2.50U? He didn't technically earn the dose decrease by dropping below 50, but I think that was because of how much he was eating last night.

He's been grazing all day today, as well, and I've had to put extra food out because he's been way more active today as well.

I keep thinking, you can't take insulin out once you put it in. But I also don't want to jump the gun and do a decrease too soon, especially not after my BCS this morning.

SuZzzzzzzzzze

 

[Dale 'n' Chip]

I suspect the skinny 2.50U should be fine if he's still green but rising (before food) at shot time.

It's just hard to shoot the full dose that low for the first time. No ill effects so far from the chicken shot, but that may start to show up tonight?

The caveat is you will need to test and monitor tonight unless he launches into a bounce or something. Hey what a great dilemma to have!

 

[Marje and Gracie]

Suze

WOW!!! How great are these two cycles for Pumbaa!!!

There are two answers depending on the two protocols. I know you have been working with what seems best for Pumbaa and so you may decide the best course of action is somewhere in between.

The SLGS protocol has you evaluate nadirs after 1-2 weeks and if they are below 90, reduce by .25u.

The TR protocol would have you hold the dose because he didn't go below 50 and he is a newly diagnosed diabetic. From your comments, it seems you fed him the TJs Tuna at the 55 and he was up at the next test. For me, that is not indicative of a need to reduce because he came right up. When I'm more likely to recommend a caregiver (CG) might reduce even if they didn't earn it is if they feed and feed and feed HC and the number just will not budge away from 50.

I think his numbers today are due to the depot and you won't see the effects of the BCS until tonight or tomorrow. Today's AMPS would have been a lovely number to shoot the full dose and you have shot lower with a full dose but I note your comments that you got no sleep and you had a deadline today. I'm glad you considered all of that in your decision because the CG is important here, too. IMHO, you might not have seen much difference in his a.m. cycle due to the depot but numbers "might" have been a little lower requiring you to test a little more.

The depot from lantus/levemir "can" affect up to six subsequent cycles. Does it in every cat? No and most typically, it probably affects 3-4 subsequent cycles. But with a BCS, you are draining the depot a tad. It will be interesting to see if that draining will kick in before PMPS tonight or whether he will still be working off his 2.5u depot and just keep chugging away.

Whether you should hold the dose tonight or reduce is up to you. If you have all the supplies you need and you are up for it, and he gives you a BG above 50 (see below for caveat), I would continue to shoot the 2.5u and not give the reduction until he actually goes below 50. I think that is your best scenario for keeping his momentum going and you've come a long way with him...and done a great job.

As an aside....I think he was dropping yesterday because he was clearing a bounce and you did a great job shooting. While I suspect you will see him come up tonight, if he comes back down, it's probably a second dip and I wouldn't expect him to go below 70 or so at PMPS. But he's a cat and he might. I think you have enough data and you know him and how to bring him up.....you could shoot any number above 50 with a full dose (whether you decide to leave it at 2.5u or reduce to sk2.5u) as long as you then feed and get a +1 and a +2. But for someone like you with all this great data, I'm an advocate for "shoot low to stay low" as long as you take into consideration your own physical state and needs.

I hope that helps. What time is your +11....I'd be happy to check back in and "discuss" it more with you then.

 

[Pumbaa]

He's now up to 156 at +10.

Either the BCS from this morning is rearing its ugly head, or Pumbaa is going to bounce. After that huge string of greens, I'm glad I have a spare BG monitor because I he could blow the current one up if he bounces as high as normal. *LOL*

But I'm hoping not. I'm hoping his bouncing days are over! I would be very happy if he would stay in the blues tonight, or low yellows.

 

[Pumbaa]

Marje, quick one...I didn't give Pumbaa any HC last night. The TJ's Tuna for cats is pretty much animal grade tuna fish, and almost pure protein.

 

[Pumbaa]

Marje...just finished reading. Thank you!

I just did a +10 for Pumbaa 'cause I won't be home for a +11, and I did want to see what direction he was going in. But thank you for the +11 offer!

I think, with the 156 he just got, I will go ahead and shoot the full 2.50U tonight. I'm kinda relieved that he did go up.

Like you said, I don't want to lose momentum. And the BCS I gave him this morning was so that, if I crash hard tonight due to lack of sleep last night and today, I won't have to test him every hour like last night. (Maybe. Hopefully. But he is unpredictable.) I'm just always scared that, when I'm overtired like this, once I fall asleep for a "little nap", I might not wake up even with alarms going off in my ears.

I need to have some late-night friends call me at designated time to make sure I wake up at testing time!

SuZzzzzzzze (it makes me yawn every time I type that. *LOL*)

 

[Marje and Gracie]

Marje, quick one...I didn't give Pumbaa any HC last night. The TJ's Tuna for cats is pretty much animal grade tuna fish, and almost pure protein.

Suze...exactly!! Because you didn't give HC and he came right up by the next test, it indicates to me that he isn't quite ready for that reduction. If you had given HC repeatedly and he didn't want to come up, then it's time to think that he might need a reduction.

I'll give another example. With Gracie, she'll cruise along in 70s to 90s and then throw me a 45; I'll give her LC, she'll come up, I continue with the dose. But a few cycles later, it will be two or three hours of nothing but 40s and I feed her 10 or 11% (I don't feed HC either), and she won't budge. That's a clue to me that she's ready for a reduction because I know her. If I hold that dose another cycle, I'll probably get a number in the 30s or it might even happen later that same cycle.

An example on her SS is 7/24. She is not a newly diagnosed diabetic so she either needs to go under 40 once, under 50 three times, or stay in normal numbers a week for a reduction....if I was strictly following protocol. But that was her first time below 50 and I fed and fed and she just hung out in the 40s so I reduced her. And she held it and then earned another reduction in a few cycles by going into the 30s.

 

[Marje and Gracie]

Sounds great!!! I also hope he'll just cruise in a nice blue number and give you both a break tonight.

No bouncing, Pumbaa!!!!

 

[Dale 'n' Chip]

...And the BCS I gave him this morning was so that, if I crash hard tonight due to lack of sleep last night and today, I won't have to test him every hour like last night. (Maybe. Hopefully. But he is unpredictable.) I'm just always scared that, when I'm overtired like this, once I fall asleep for a "little nap", I might not wake up even with alarms going off in my ears.

I need to have some late-night friends call me at designated time to make sure I wake up at testing time!

SuZzzzzzzze (it makes me yawn every time I type that. *LOL*)

It makes me yawn for you everytime I read it.

And yawn for me too, but I slept soundly through the whole thing last night because I knew on some level Chip's red bounce was good for 12 hours. And it was. ;-)

After watching Pumbaa's patterns as much as I have, I doubt you can crash super hard before he makes it to pink? It's a no brainier what to shoot with that mid blue, but you do want him to revisit green right away and he still might in spite of the earlier chicken shot? In the past when he went green-blue-green, the second green wasn't a dangerous dive. And he's such a world class bouncer he's probably never at great risk ordinarily. But I can still see you "crashing hard" tonight with one eye open unless/until you see pink/yellow and rising. And I don't mean the Hello Kitty PINK eyeshadow on the pillow. ;-)

 

[Pumbaa]

Suze...exactly!! Because you didn't give HC and he came right up by the next test, it indicates to me that he isn't quite ready for that reduction. If you had given HC repeatedly and he didn't want to come up, then it's time to think that he might need a reduction.

I gotcha now! Brain not processing very well lately (as in since Pumbaa was diagnosed! *LOL*) Since he kept grazing on LC food, and that kept him above the 50 mark, he didn't earn a reduction. I have to say that I'm proud of my little guy for instinctively knowing when he needs to keep eating.

I'll give another example. With Gracie, she'll cruise along in 70s to 90s and then throw me a 45; I'll give her LC, she'll come up, I continue with the dose. But a few cycles later, it will be two or three hours of nothing but 40s and I feed her 10 or 11% (I don't feed HC either), and she won't budge. That's a clue to me that she's ready for a reduction because I know her. If I hold that dose another cycle, I'll probably get a number in the 30s or it might even happen later that same cycle.

An example on her SS is 7/24. She is not a newly diagnosed diabetic so she either needs to go under 40 once, under 50 three times, or stay in normal numbers a week for a reduction....if I was strictly following protocol. But that was her first time below 50 and I fed and fed and she just hung out in the 40s so I reduced her. And she held it and then earned another reduction in a few cycles by going into the 30s.

Just when I was figuring out Pumbaa and his dose increases and how to best manage them, now I have so much to learn about dose decreases! But I thank you...this is really helpful.

And, so, now we know that the little ungrateful wretch kept me up all night last night, making me chase him around the house to catch him and test him countless times and he couldn't even be courteous enough to drop 5 more stinking points and earn a reduction???? Bah! We'll see if I clean HIS litter box tonight! :twisted:

SuZzzzzzzzze

ps: His PMPS was 341, so I did shoot the full 2.50U.

 

[Dale 'n' Chip]

...And I don't mean the Hello Kitty PINK eyeshadow on the pillow. ;-)

You know I should have used the spoiler alert on that one since I was afraid Pumbaa would read it.

I suppose I should have stopped myself from even having the thought since he can read minds.

Maybe we can get from SuZzzzzzzze back to Suze? ;-)

 

[Pumbaa]

It makes me yawn for you everytime I read it.
And yawn for me too, but I slept soundly through the whole thing last night because I knew on some level Chip's red bounce was good for 12 hours. And it was. ;-)

I can't read the word "yawn" normally, without starting to yawn. It's so damn contagious! Why is that? *LOL* And your day is coming, my friend! Enjoy your sleep while you can get it!

After watching Pumbaa's patterns as much as I have, I doubt you can crash super hard before he makes it to pink? It's a no brainier what to shoot with that mid blue, but you do want him to revisit green right away and he still might in spite of the earlier chicken shot? In the past when he went green-blue-green, the second green wasn't a dangerous dive. And he's such a world class bouncer he's probably never at great risk ordinarily. But I can still see you "crashing hard" tonight with one eye open unless/until you see pink/yellow and rising. And I don't mean the Hello Kitty PINK eyeshadow on the pillow. ;-)

Unfortunately, the very macho little Pumbaa donned his pink tutu for the PMPS. Or maybe fortunately, because when I crash I am afraid that it will take an atom bomb falling on my house to wake me up to test him. I use two alarm clocks now in the morning to get me up for the AM testing/feeding/shooting time. I can crash super hard in about 15 minutes these days. The problem for me is getting up again in 45 minutes to test.

I'll still test Pumbaa tonight at +3 and +6, to see where he is heading. Hopefully he's going to clear this bounce quickly, and one day soon become one of those cats who just stopped bouncing!

SuZzzzzzzze

 

[Pumbaa]

...And I don't mean the Hello Kitty PINK eyeshadow on the pillow. ;-)

You know I should have used the spoiler alert on that one since I was afraid Pumbaa would read it.

I suppose I should have stopped myself from even having the thought since he can read minds.

Maybe we can get from SuZzzzzzzze back to Suze? ;-)

*LMAOPMP*
I thank you immensely, tonight, for putting that pink suggestion out to Pumbaa!

Is it you who has been telling him, telepathically, that I need more cardiovascular exercise and how healthy it is for mom to chase him around the house for 15 minutes ten times a day to catch him for testing? I don't know whether to thank you for this or make a voodoo doll in your honor and torture it daily for this. Hahahaha!

I need to go make a graphic of Pumbaa wearing a pink tutu! Once I take the time to do this, maybe Pumbaa will be too embarrassed to ever go pink again.

SuZzzzzze