? Responding too much to the higher dose and not enough to the lower

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Likameow

Likameow

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I swear Ben is trying to drive me crazy. When his preshoot number is in the pinks, he seems to have a reasonable response but goes back up to pink. When it's in the reds, he has a dramatic response to the slightly higher dose of insulin. And when he's in the blues, he seems to just surf on that. I'm thinking he needs some sort of adjustment but I can't for the life of me figure out what. Ideas?
 
What's his feeding routine? How many meals per day?

This is theoretical, but maybe last night, he dropped low even on that lower dose. And AMPS was a bounce? And today's cycle looks like the bounce may have cleared quickly.
I sort of see a pattern. When I look at the first week in November, I see lower PMPS numbers and smaller doses. And then a lot of Red AMPS numbers afterwards.
The night of the 6th, you got really low numbers. What if the same thing was happening on the 4th and 5th as well? That would explain the reds the next mornings. Perhaps his PM doses, while lower, are still a bit too much? Some cycles, if he's bouncing, the bounces clear quickly. Like in one cycle. Other times, when he stays flat, they seem to hang around longer.

Just random observations.
 
It looks to me that the 2.4 may have been too much for the amps, as the 2.2 on the 430 May have been too much on 11/12. Maybe the next time, lower the dose for that range. Your cycle yesterday was very nice.

Did we ask Cindi @Merlin to work on the sliding scale for you? I'm thinking you need to trim the dose for the higher ranges.
 
I'm thinking you need to trim the dose on the lower ranges. I think he's going lower than you think during the PM cycles.
 
And if that is the case, then you shouldn't see red bounces in the morning, and might not have to worry about what to shoot at a red number.
If a red number is a "true" number, i.e. wasn't a bounce induced red number, then shooting a bigger dose would make sense. But if it is a bounce, and his bounces clear fast, then the dose ends up being too high. Does that make sense?
 
Carl & Polly & Bob (GA) said:
And if that is the case, then you shouldn't see red bounces in the morning, and might not have to worry about what to shoot at a red number.
If a red number is a "true" number, i.e. wasn't a bounce induced red number, then shooting a bigger dose would make sense. But if it is a bounce, and his bounces clear fast, then the dose ends up being too high. Does that make sense?
Click to expand...

It makes sense, Carl. I just wish it was easier to tell when it's a true number and when it is a bounce. As far as his feeding schedule, he eats 1 can of FF with each shot and free feeds Young again dry. I know it isn't ideal but with my work and the multi-cat household, it's all I can do.

The morning number will be a true high number since he didnt get insulin tonight. I'll try a lower amount.
 
Hey Lisa. Overall, looks like you are seeing more blues and a couple of greens here since the sliding scale was increased on 11/9. With the sliding scale, it is all about continuous adjustment especially since this is a new sliding scale. Once the sliding scale becomes more established, there will be minimal tweaking required.

When you get such a response as you did today, you have two options. One, you can continue to shoot the same number with the same dose and see if you get a similar nadir OR you can change 2.4u on your sliding scale to a 2.2u for that particular number. If you decide to try that dose again and you get the same results (too low a nadir), then you change your sliding scale. If you decide to change immediately, you change your sliding scale. Your current sliding scale looks like this: 181-226=1.4U 227-280=1.6U 281-341=1.8U 342-394=2U 395-432=2.2U 433-457=2.4U. You would change your sliding scale to look like this: 181-226=1.4U 227-280=1.6U 281-341=1.8U 342-394=2U 395-460=2.2U 461plus=2.4u. I highlighted the change in "bold" letters and I also added a few points to the number on the high end of 2.2u. You will need to remember that you made that change so you can monitor that dose. If your new change gives you the desired nadir, then no additional change is needed (or until Ben decides to throw you another result).

If you want to lower the dose on the low end, then you adjust the same way.

If you change your sliding scale, you are going to want to update your ss to indicate some sort of change so we can readily see that change and make it easy for you to monitor.

Does this make sense?
 
Thanks, Cindi. I was looking forward to your reply. I'll make those changes and see what happens.
 
Hey Lisa. I thought we could review the last five cycles since the last update to the sliding scale. On 11/15 we reduced the dose on the high end of the scale. So if you don't mind, I am going to review what we have done so far. I partly need this for me so I can see it on paper.

11/9 Sliding Scale
181 - 226 1.4
227 - 280 1.6
281 - 341 1.8
342 - 394 2.0
395 - 432 2.2
433 plus 2.4

11/15 Sliding Scale (All the same except the numbers in bold)
181 - 226 1.4
227 - 280 1.6
281 - 341 1.8
342 - 394 2.0
395 - 460 2.2
461 plus 2.4
* Reason why decrease dose on higher numbers is due to 11/14 low numbers)

Review of last five cycles including "Notes"
Date / # / Dose / Nadir or close to it
11/15 (AM) 436 2.2 229 (increase dose 2.4u?)
Note: Next time you get this number I would suggest to increase dose to 2.4u
11/15 (PM) 270 1.2 ? (s/b 1.6u but felt number was lowering)
Note: Probably a good call but maybe only decrease by .2u if you felt it was lowering
11/16 (AM) 450 2.00 214 (dose lower due to possible bounce; increase dose 2.2u or back to 2.4u?)
Note: This probably wasn't a bounce but rather high due to previous cycle not getting enough of insulin. Next time, I would go ahead and shoot normal dose.
11/16 (PM) 354 2.00 129 (good dose)
Note: This looks like a good dose for this number...at least for now. Eventually, we may want to get the nadir a little lower but 129 is good.
11/17 (AM) 236 1.60 354 (can not explain)
Note: Not sure why nadir is high. Sometimes it is due to too much insulin. Will need to monitor this number.

So what do you think Lisa regarding the last five cycles?
 
I think you are amazing, Cindi. I'm in awe of your ability to interpret the numbers on a diabetic cat's spreadsheet. I'm thinking that there were times where I was trying too hard to "see" the bounce or the falling number that I failed to see the big picture. I think that these recent cycles seem to show that the sliding scale from 11/9 works pretty good. I'm off for a little while now so I'll work on getting some good nadir tests.

In my defense for some of my less intelligent decisions, I just found out that one of my civies has cancer. So for a couple of days, I was distracted and focused on other things when I should have been focused on the task at hand.

Thanks again for all your help.
 
Oh gosh Lisa, I am so sorry about your other kitty. That is such tough news. You are doing great so no need to say that you were distracted, etc. We all have distractions and your decisions have been great. So hopefully, we can get Ben into some better numbers so you can focus more on your other little kitty. I am guessing in the next couple of cycles, we may be increasing a few numbers. I would like to see some low blues and maybe even some greens here soon. Not sure what happen today as you should have gotten a blue nadir and it doesn't even look like it dipped into the yellow. Well let wait for a few cycles to see what Ben decides to do. Take care to you and your other kitty.
 
Good morning Lisa. I saw that Ben got a nice AMPS. It will be interesting to see what he tests at or near nadir. This is a similar number that you got on 11/11 and 11/13. Is there any chance you can get a mid-cycle test like around +5 or +6? Since it is at the lower end of the range (180-226), you may want to get a +3 just to make sure that he is not going too low. Those tests would be most helpful with the scale since there has not been a test for that time (+5 or +6) in previous like number/doses. Have a great day.
 
I didn't see your post until now. But I did get a few test throughout the cycle. Slept in this morning so my first test wasn't until +5. He did good right up till the end and then bounced up a little bit for the PM shoot. Too bad his pancreas wasn't as good at reacting as his liver. :-)
 
What a great cycle you had. I guess that locks this dose in for this number. Awesome job Lisa for getting some good data today. I sure wish Ben would settle down just a little for his pre-shot numbers. It could be also that he just ran out of insulin as you did have a pretty nice, low AMPS. We will see how the 2.0 will do compared to last night's 2.2 dose and see what he throw you in the AM. It is all good data!
 
All good data! Tonight his PMPS was 84. Silly cat. So no insulin for him. Funny that he was 207 @ +6. Too bad I wasn't home this afternoon to catch the drop. I'm going out this evening but should be able to grab a +4 number tonight.
 
Hey Lisa. Looks like Ben went flat last night. It may have gone flat due to the nice previous cycle, but who knows. I am perplexed on the 84 you got tonight. Because it was a pretty low PMPS number, it probably would have been useless to stall. Not sure if you have stalled before but when we get low numbers, we will with hold food and test in about 20-30 minutes to see if the number rises. Sometimes the number will rise enough to a shootable number. One reason why you may have received a low number tonight is because the dose this morning was too much. So the next time you get a similar number (393), you can choose to shoot the same dose (2u), monitor and see if you get the same result. If you do, then the dose needs to be reduced and tested again. The goal is to shoot every 12 cycles. We do not want Ben to get only 1 shot every 24 hours. He will probably very high tomorrow.
 
So two days ago he got a similar dose (two units) for a number close to the same as today's. And that day he stayed flat all day and hardly dropped at all. So I'm writing off today's cycle as a fluke (unless it had something to do with the new bottle of insulin). Guess I'll see in the morning with his morning shot.
 
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