Re: Lucky 7/28- can someone look at his SS?

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all4mymarine

all4mymarine

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Edited: Can someone look at Lucky's SS? This is the 4th cycle on 1u and I know that it can be good to stick with a dose, that's why I'm doing this "trial" but I just don't see it working too well at this point. I think he does much better with 1.1u on 300 PS's and 1u on 200 PS's. Does it really look like 1u is going to be worth sticking with any longer? I'm trying to slow down and try to see a pattern maybe but I also don't want to stick with a dose for longer than I need to if it's not working out.


So my morning starts off with a call from the vet saying that she had been thinking a lot about Lucky and how we seemed to have gotten off on the wrong foot and how I'm doing a great job....BUT, I didn't need to test him so much because he's gaining weight and eating well and not drinking as much and I need to do a full curve on him and THEN we'll talk about dose changes and that I don't need to change the dose because cats don't do well with dose changes. I have been keeping the dose the same (except for fats and skinny's maybe) for the past 4 cycles just because I felt I needed to go back to 1u and slowly increase or decrease if needed to find the right dose since things were looking crazy. I didn't tell her that though. I just said, okay, okay, yep, okay, thanks, okay, bye.

After my family leaves on Aug 8th and Lucky has his dental on Aug 12th, I'll be searching for a new vet. Basically I need a vet that I feel is knowledgeable enough to take care of Lucky (the way I would) if I needed them to. I just need his insulin, and that's that. I'm not an idiot, I know how to read #'s and I know what #'s are good and what are bad. I made a commitment to do what it takes after Lucky was dx'ed. I won't lie, for about an hour, I felt that putting him down was the best thing. I cried and cried. I got on the internet and found you guys and saw that it might not be that hard and there was a good chance for remission. How could I possibly lose Lucky knowing I could make him healthy?

SO, with the commitment I made, 200's aren't good enough. That's regulation. I don't want regulation long term, I want remission!

Oh, and they did dentals for Lucky and one of my civvies back in '08 and everything seemed okay then and he needs it sooner than later so I'll let them do it again but I will be shopping for a new vet afterwards...one who shares some of the same ideas. Okay, sorry for the long novel here.

Hope today looks better for Lucky! He started off at 396 :?
 
Re: Lucky 7/28

Good for you for sticking to your guns still. I know the whole "uh huh, yup, ok, got it" routine. lol. Interesting that your conversation sat hard enough on her mind that she felt she needed to call you back though.
 
Re: Lucky 7/28

I also thought her reaction was interesting. Maybe you ought to refer her to this site! She might learn something. LOL.
 
Yeah, I thought it was weird that she called me too. At first I thought she was going to say, yeah, you were right LOL But then I heard the big BUT....
 
There isn't much consistency, that's for sure. You've gotten a better pattern when you've shot 1.1, I think. I'm not sure I'd keep swapping back between 1U and 1.1U though. Pick and dose and stick with it. If Lucky is very low, then lowering makes sense, but even being at 200 isn't "low" in that sense. It may be that you are shooting 1.1U and start to get him headed in the right direction, then cut back and lose momentum. 1U alone doesn't seem to be enough for him, regardless of his pre-shot level.
 
Where you want to stick with a dose for at least 3-4 cycles is on a dose increase, because some cats will build up momentum and get quite a bit better results once they hit their stride on that dose. Dose decreases are different, because you are losing momentum with every shot. So if you reduce a dose and the good numbers are lost, you know you reduced too much and you can raise back up immediately. (I realize I may be the one who recommended the trial, lol, I don't actually remember ...if I did, I'm sure it made sense to me that day! :roll: )

You are getting nice U-curves but with the numbers too high overall, so that points to his need for a higher dose if you want to see more blues and greens. If you get back to a point where the PSs are in the 150 zone or lower, or if mid-cycle numbers are getting below 50 (or too low for where they are in the cycle), then you can play around with reducing just a hair and see if he will stay in good numbers.

The trick that I think takes some time and experience to get comfortable with is that you can really stay on top of the numbers shot by shot if you are monitoring every cycle. When I was at that stage with Bix, I basically tested for a nadir (his was fairly predictable thankfully) every cycle that I could, and adjusted each shot to get the numbers I wanted. If his PS went up above 180 I fattened up the dose, if it got below 150 I skinnied up, etc.

You don't have the data to know what Lucky's nadir might be on those PSs so I'm not saying you should shoot on those right now, I think you need to maybe keep 180-200 as a no-shoot and try to get some data around there before lowering it to 150, but just for the general idea. You can't literally control the numbers, but if you have enough data you can have some confidence in what you are shooting.

I think you have a pretty good sense of things with him, so I think you should shoot what makes sense to you, gather data, and then refine your understanding and strategies as you go. Sometimes there is a compelling reason, but I wouldn't stick with a "trial" if it doesn't make sense to you to be doing it.

There are some exceptions of course, like on dose increases or if you are starting TID or something, I think there are some reasons not to react to every PS and to really stick with a dose for a certain period to give it a chance. But you are not at that stage, you are in a fine-tuning stage, and you can adjust the dose as much as you need to to get the results you want. If you find that a steady dose works well for him (or for your sanity!) that is great and you should respect that, but I think he may do better if you just follow your instincts on what to shoot each shot.
 
You know, it totally makes sense to me to shoot according to PS. I just keep hearing, stick with one dose and he'll start to even out. I think that's where I'm confused because I've done the 3-4 cycles on one dose and yes, he does have nice U curves and I guess you could say he's evened out, but his numbers are still too high. I've tried the sticking with one dose and then he ends up going a bit too low for comfort or he gets a PS that's too low to shoot. So then I decrease and then a couple of cycles later, he's too high again. So my instinct has been, for couple of weeks now, to shoot a dose based on his PS.

I may try 1.1u for a couple of cycles and see how that goes, only backing off a little if I need too. Would you recommend shooting the same 1.1 dose on 300's and low 200's alike or backing off a little on low 200's?

P.S....I'm afraid to admit the Vet may have made me feel a little guilty and scared that his numbers were wacky because I messed with the dosing, even though deep down I know I've done things right for the most part.
 
As a general concept, I am a fan of sticking with the dose unless the PS is under 200. It does get confusing when you have several possible approaches with PZI, but leaving a true sliding scale out of the picture, the reason for the 200 no shoot level is that is where you want to reduce the dose (or delay the shot), i.e. anything under 200. So even a 200 PS you would shoot the dose you normally shoot.

The only reason that I see that you would reduce a dose on a low 200s PS is if you got a perfect nadir on say a 300 PS, then that dose might be too strong for a 200 PS. But if you didn't get a perfect nadir on a higher PS, there is no need to reduce the dose on a lower one. If they are under 200 though, then it's a good idea I think to either monitor closely or reduce the dose a hair (not shooting of course if it is under 150), since there just isn't as much room for a drop from there. But even 200 has a good margin for error - that's why we suggest a 200 no shoot and gradual lowering to 150, to give you some extra room for data collecting rather than just starting out shooting at 150.

You want to look at your data then too and see what it supports - you shot on a 200 the night of 7/26 and the dose was too low - that was a skinny 1u, so you definitely want more than that on a 200. If you will be a nervous wreck shooting 1.1 on a 200, you could try a fat 1, get some data, and then you will know for sure.
 
Nah, don't let the vet get to you. His numbers are really good (promising I mean, with some great spots here & there) actually, not wacky at all. He is doing great, and you have gotten some really nice numbers for him, so more power to you! I think you are doing great. Your vet is probably jealous. :lol:
 
Joanna & Bix (GA) said:
Your vet is probably jealous. :lol:
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LOL!! :lol:

I just need to get a new mindset I think and consider this a new beginning....again lol

I just look back on his SS and see a 292 PS and I shot 1u and he got down to 61 at +4! But then the next cycle with a PS of 291, I shoot 1u and at +4 he's at 149! And even not knowing what a 1u might do one day to the next on the same PS can get nerve wracking. I just need to start afresh and not look back on the SS and go forward and get new data. I know Lucky will be in the 300's tonight for his PMPS (which is right now!) so I'm going to start with 1.1 and go from here! I should look at as the dose amount not being as important as what results I get cycle to cycle. The longer he can be in greens and blues, the better ;-)
 
all4mymarine said:
Joanna & Bix (GA) said:
Your vet is probably jealous. :lol:
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LOL!! :lol:

I just need to get a new mindset I think and consider this a new beginning....again lol

I just look back on his SS and see a 292 PS and I shot 1u and he got down to 61 at +4! But then the next cycle with a PS of 291, I shoot 1u and at +4 he's at 149! And even not knowing what a 1u might do one day to the next on the same PS can get nerve wracking. I just need to start afresh and not look back on the SS and go forward and get new data. I know Lucky will be in the 300's tonight for his PMPS (which is right now!) so I'm going to start with 1.1 and go from here! I should look at as the dose amount not being as important as what results I get cycle to cycle. The longer he can be in greens and blues, the better ;-)
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Did he eat the same exact thing and same amount during both of those cycles? Was his stress level the same? Did one ear prick go easier than the other? There are just so very many variables that might have changed in his moment by moment life during each of those cycles. I realize there's a huge difference between a 61 and a 149. There's also a margin of error in a meter. If you got an equal payoff for an equal dose every time, this dance would be easy, and none of us would ever need dancing lessons :smile:

Don't drive yourself insane. Breath deep. You've had a few stressful days. Lucky knows that.

Carl in SC
 
carlinsc said:
Did he eat the same exact thing and same amount during both of those cycles? Was his stress level the same? Did one ear prick go easier than the other? There are just so very many variables that might have changed in his moment by moment life during each of those cycles. I realize there's a huge difference between a 61 and a 149. There's also a margin of error in a meter. If you got an equal payoff for an equal dose every time, this dance would be easy, and none of us would ever need dancing lessons :smile:

Don't drive yourself insane. Breath deep. You've had a few stressful days. Lucky knows that.

Carl in SC
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You could be right. I'm sure he ate different flavors but I pick foods that are 6% and under. Could be he ate a 3% one cycle and 6% the other. Could have been the meter. I know I shouldn't expect the same cycle every time with the same dose, thanks for reminding me of that! This is exactly why I come here...to get reassurance and to be reminded of things I tend to forget :-D
 
With Bix those random and not consistent drops were only when I had the dose too low. The occasional good numbers really scared me into not increasing his dose. When I finally realized I had no choice if I wanted to get him in good numbers consistently, then I found that with the slightly higher doses, I could get good numbers, and he never had any scary ones really. Once he got to good numbers for most of the day he did go on a quick dose reduction path, but that was only once he saw the good numbers for some long stretches.

ECID though. It is tricky b/c of course you don't want to risk low numbers. I think sometimes they dip into the better numbers because their pancreas pitches in and their body is utilizing the insulin well. We tend to get scared b/c we don't know if they went lower, or were right on the border of going too low or something. When maybe it was just what they wanted, and then their body is going ohmygod_smile when we reduce to be sure it is safe.
 
Joanna, do you agree that on 7/29 we saw a bounce? That seems to be the consensus here: http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=48735

Backing down some on a perceived bounce kind of goes against what we've been discussing as far as shooting a slightly higher dose on a higher PS and shooting a slightly decreased dose on a certain PS # (very low 200's or under).

Joanna & Bix (GA) said:
Ok, so just looked at the SS :-D I wouldn't raise the dose! Looks like you handled it great today!
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Would you have decreased to 1u or stuck with 1.1u on the PMPS for 7/29? I've heard other opinions on this and would love to hear yours! Thanks!!!
 
all4mymarine said:
Joanna, do you agree that on 7/29 we saw a bounce?

Backing down some on a perceived bounce kind of goes against what we've been discussing as far as shooting a slightly higher dose on a higher PS and shooting a slightly decreased dose on a certain PS # (very low 200's or under).

Would you have decreased to 1u or stuck with 1.1u on the PMPS for 7/29? I've heard other opinions on this and would love to hear yours! Thanks!!!
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I don't think anyone can say with 100% certainty what the explanation was on 7/29. You have a possible steep drop, you have some green numbers he doesn't see every cycle, you have high #s by +10, and you have a flat high cycle in the next cycle, so all that looks like a bounce.

But on the other hand, you had a flat high cycle the night before and you've had other highs at +10s, that weren't preceded by a steep drop or by green numbers. And you fed 7%, so that could have led to higher numbers. I never fed carbs around that level for Bix so I don't know, but I know if I gave him a teaspoon of something around 12% he would be in the 300s pretty fast, especially past nadir.

So to me it is all speculation - there's nothing conclusive I see to say they are bouncy pinks, vs. other pinks.

Also, I think it is really important to be clear that there are two kinds of rebound - one is from steep drops or numbers going too low, and the other is liver training, where their liver thinks they are too low when it is in good numbers, and panicks. So in real rebound, you have to lower the dose. In liver training, you should not lower the dose.

All that said, I would have lowered the dose like you did, not because of anything to do with bounce, but b/c I think it's too much drop for one cycle. You want something like 60-65% drop, and you got almost 85%. The kind of cycle you got on 7/26 AM is what is was looking for from shooting 1.1 on the higher PSs - good drop but not extreme, and then a nice +12 where you can see the 1.1 brought him down into lower territory nicely. Yesterday's was a more extreme drop and *possible* bounce, so I would back off a hair and see if you get a gentler curve on the next high PS. But then you may lose any good numbers and have to raise again to get anywhere.

Isn't it fun? ohmygod_smile
 
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