Shaikha 5/28 t.i.d. day #2 + curves

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wombat88

wombat88

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Yesterday was a pretty good day, so am hoping for a good one again today! I'd love to be able to keep her in blues and greens for a change rather than those nasty blacks and reds she was getting. She started off at a good level this AM, but will curve to see how it goes. I gave what I'm calling 0.7U last night, though it really is tough to measure that accurately even on a U100 syringe so it probably is more honest to call it a "skinny" 0.8U. We'll see how she does today. So far, so good. Great appetite, no evidence of any issues health-wise. And a good stool today, so I was glad too see that too after the diarrhea yesterday. I will continue to feed her RC Intestinal HE, but got a note that the RC Venison has shipped so I'll try to switch her to that after it comes in. Will continue to edit the chart below as I get new numbers today:

5/27 PMPS = 252, gave 0.7U
5/28 numbers:
AMPS = 270, gave 0.7U
+2 = 359
+3 = 300
+4.5 = 285
+6 = 321
MDPS= 447, gave 0.8U cat(2)_steam
+2 = 486
+4 = 234 (finally! hope this isn't too fast a drop though but glad to see a decent yellow)
+5 = 282 (as I suspected, +4 was likely her nadir)
PMPS = 409, gave 0.8U

PS: Thanks for all the GREAT feedback and encouragement yesterday! It was sort of scary to make the change, but your support helped very much. :smile:
 
Looks like you had a food spike and the numbers are now starting to come down. This is probably the body settling in to the new TID dosing and possibly still freaking out a bit from the greens yesterday. I hope you guys get to see blue today!

As for the food question from your other thread - I personally feed my crew about 1.5oz 5-6 times a day with lots of water mixed in. That way there are no large meals to overwhelm the insulin or pancreas at any point. It is just what works for us. You may consider putting your whole crew on the same feeding schedule so you don't have a kitty pawing for food when it isn't their turn :-D
 
I know you want to be conservative but you are actually giving her less insulin during the day at 0.7u than before you started t.i.d. That will mess up the equation ...... I think she is doing great! how does she seem to feel?

Nancy and Payne
 
Nancy and Payne said:
I know you want to be conservative but you are actually giving her less insulin during the day at 0.7u than before you started t.i.d. That will mess up the equation ...... I think she is doing great! how does she seem to feel?

Nancy and Payne
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Well, given her results this morning I think you are definitely right. I was worried about the steep drop yesterday AM but think you may have been correct about why it happened. I do think we need to increase dose since the lowest she's gotten this AM is 285 and she's going up again. It was like she got no insulin at all, actually. Am thinking about going to a full 1U at the 2pm dose. What do you think? She's doing well, other than being hungry all the time. She will be happy to get food in two more hours, I think.
 
Actually your lowest point today was her AMPS, the rest looks a little inverse to me suggesting too much insulin.

Or it could be a bounce from the blues and greens from yesterday.
 
Kelly & Oscar said:
You sure are having high numbers today. I don't know that I'd go with a full 1u - maybe a skinny 1u?
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That might work. 0.8U is at the 2 mark on my syringe, while 1U is at 2.5 (half units are not marked). Trying to split up the already-tiny one unit marks into fourths is is tough but I try. These are such tiny doses it would be easier if the syringe had even more hash marks than it does. I use BD U100 syringes and I think they are good quality. Any way to dose more precisely other than trying to guesstimate?
 
Rob & Harley said:
Actually your lowest point today was her AMPS, the rest looks a little inverse to me suggesting too much insulin. Or it could be a bounce from the blues and greens from yesterday.
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How do you tell?? If I cut her back to say 0.5U three times per day, that is less insulin in total during the day than she was getting in one dose just a week ago. She is really hard to figure out, this one.
 
It is hard to tell. With a bounce from the 81 I would have expected to see it start more yesterday than today but she did go up higher but you were able to control it. Your PMPS and AMPS are very similar so that was good on the .7u.

Think of this as data gathering for tid. There is no shed with Prozinc so instead you are controlling the overlap.

I think you are really close with your dose, maybe some fine tuning along the way, up a little or down a little is all you need. I wouldn't go down to .5u, you would lose too much traction.

The oldtimers used to say not to shoot a bounce, so if the high numbers are from a bounce I would stick with the .7u or .8u and see if it clears.

If it is too much insulin you could go to .6u and see if the numbers improve or not.

With the U100 syringes and no half markings I think I would stick to the .2u increments. They will be easier to measure.
 
Well, she was up to 447 at mid-day and didn't seem to go lower at all during the AM. I shot 0.8U (easy to measure at the 2 mark on my syringe) so we'll see how it goes this afternoon. Will try to hold at 0.8 for a while and see if it improves with the more frequent dosing. Dang! I was hoping after yesterday that we were close. We may still be, but I feel sorry for her poor little ears with all the curves. She's so good about it all though. Another option is I can try a can of lower carb rabbit to see if she'll eat that. It is higher in fat though, so I've held off as her pancreatitis tends to do better with lower fat foods. One concern I've got also is that she feels warmer to me than normal. It is hot though, so it may just be that but given that we just finished antibiotics I wonder. I may take her temp tonight to see if it is elevated at all, because if she's developing a fever that would also explain the higher numbers. She isn't acting like she has a fever though - no appetite loss or lethargy. She's hungry and quite alert.

With the elevation in numbers, should I check for ketones at all? She's never thrown any, but I have a meter now so it is easier to tell. Before I had to take urine samples to the vet or have him test her there. How often should I test for those?
 
It's always a good idea to check for ketones, it's easy and cheap in comparison to letting them get out of control. Don't you use the Ketostix? If you are worried about it you can check every day just to be sure.

I was hoping yesterday was going to be the norm too. Maybe she just needs some time to get used to it. Just like starting the insulin there may be a settling in time to it.
 
This cycle *could* be a bounce from something that happened overnight when there was no testing. You will be able to see if things change this afternoon/evening. You did get some movement today, but it only lasted until +4 before things started going way up. It will be interesting to see what the afternoon and evening cycles give you today.
 
IMHO you are trying to do two things at once .... and I have been hammered by the old timers on that one. ohmygod_smile I thought the point was to see how she responds to t.i.d. and if it brings her numbers down. If you throw in trying to find her sweet spot, then you are doing a disservice to seeing how she responds to the 3x a day.

I would be doing ketone strips just to see how she is doing and if she has any, pull out the meter. Has she had ketones? She sounds as if she's doing well, that is the important thing.
Nancy
 
I don't think you got a bounce off the drop yesterday from the reds to greens - if she bounced, I don't think the 0.4 would have held the #s as well as it did. You got a U-curve off that shot, which is really pretty good. If she were bouncing at that point, I would have expected all reds & blacks in that cycle, or at minimum all pinks if she is a mini-bouncer.

Today it's hard to say for sure - #s are a little disappointing, could be a sign of the dose too high, or could be it's too low and losing momentum.

What confuses me is the great response yesterday - first I was thinking that (AM shot) was your first +8 shot and so you had some nice overlap going and that's why, but then when I looked at the SS again I realized that was a +12 shot, so hmmm, kind of confuses the picture as to where that was a fluke cycle, or her insulin needs have actually gone down. I know you discussed this some already, but sorry I don't recall what the conclusion was

I guess as others said it's some data gathering and it will get clearer. One thought I have is that you got a U-curve off the 0.4 shot, but not as good #s as you want. So looking at that cycle (really the first TID data you have), I would lean towards 0.5 or 0.6 as the dose to try. But then on the other hand knowing how much the vet had to shoot to get good #s, and with all the food/carb considerations in the mix, I'm not sure lowering the dose is the way to go. And as Rob said, you got a pretty even PS from last night to this morning, so that would suggest the dose was reasonable, or slightly low (assuming you are going for lower PSs than that).

I guess there is some trial and error & you will get it figured out!

:dizcat

p.s. love the MDPS term, LOL!
 
For her ears, I don't think you need to test as often as you are. Of course it is great to have the data, but with TID you MUST test a minimum of one spot test per cycle so you are sure you are always shooting on a rising #. You want to be sure her ears are up to that, so I would consider pulling back on some of the extra testing so you don't wear her ears out.

I would go for 1-2 spot tests per cycle, and vary the times. Maybe a +1 or +2 and a +5 one cycle, a +4 and a +7 another cycle, etc. I'd rather see you get in a +1 or +2 after the evening shot (to see if she is already zooming before the next shot kicks in, or holding steady at +8ish), than an hourly check from +2 to +4. It's nice to have something like that now and then so you can see the rate of drop from hour to hour, but I don't think it's needed right now. Right now IMO you want to see how much she is zooming between shots (so +1 and +2 checks), what her nadir is (so checks anywhere from +4 on), and PSs.

Nancy, what you said about trying to do 2 things at once makes a lot of sense, but I wasn't sure what you meant about the sweet spot vs. response to TID dosing. Could you clarify?
 
p.s. you also should do a rising # check if you don't have midcycle data anytime you are shooting earlier than +12 - so for instance if you don't have spot checks overnight, you should get 2 readings maybe 10 minutes apart in the morning to be sure she is rising before shooting

just wanted to be clear on that in case any newbies are following along! :)
 
Joanna & Bix (GA) said:
For her ears, I don't think you need to test as often as you are. Of course it is great to have the data, but with TID you MUST test a minimum of one spot test per cycle so you are sure you are always shooting on a rising #. You want to be sure her ears are up to that, so I would consider pulling back on some of the extra testing so you don't wear her ears out.

I would go for 1-2 spot tests per cycle, and vary the times. Maybe a +1 or +2 and a +5 one cycle, a +4 and a +7 another cycle, etc. I'd rather see you get in a +1 or +2 after the evening shot (to see if she is already zooming before the next shot kicks in, or holding steady at +8ish), than an hourly check from +2 to +4. It's nice to have something like that now and then so you can see the rate of drop from hour to hour, but I don't think it's needed right now. Right now IMO you want to see how much she is zooming between shots (so +1 and +2 checks), what her nadir is (so checks anywhere from +4 on), and PSs.
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She's actually doing great with the testing, but I don't want her to get scared of me. She's started running away a little, which suggests she's tired of the pricks. She still purrs the whole time she's in my lap though, so I think we're still friends. :)

Interesting what you said about the +1 and +2 tests. I didn't think there would be much change just an hour after the shot (other than perhaps a food spike). What is the typical pattern so close to a shot? A slight rise? No change? Just curious. Shaikha seems to be reaching her lowest levels as early at +3 or +4. I always expected to see nadirs later, but that hasn't usually happened with her. When I've tested later at +5 or +6 when I'd expect they would be happening she's already on her way up. I've learned to test earlier or I miss the low point. Not sure if the more frequent dosing will change that or not.

At +2 this time she was only up to 486, so not much of a rise from pre-shot levels despite the food. Hoping she goes down from here. We'll see.
 
Nancy and Payne said:
IMHO you are trying to do two things at once .... and I have been hammered by the old timers on that one. ohmygod_smile I thought the point was to see how she responds to t.i.d. and if it brings her numbers down. If you throw in trying to find her sweet spot, then you are doing a disservice to seeing how she responds to the 3x a day.

I would be doing ketone strips just to see how she is doing and if she has any, pull out the meter. Has she had ketones? She sounds as if she's doing well, that is the important thing.
Nancy
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You lost me, Nancy. Doing a disservice how? By giving too much or too little? My plan at this point is to see if we get some movement with the smaller bump up. It may be that this AM her dose was closer to 0.6U than 0.7 since I don't have hash marks between units on my syringes. This time she definitely got 0.8 since that's not between hash marks on my syringes. If she's still not moving, I will likely give 0.8 at dinner again since I won't be testing overnight. If in the AM tomorrow she's still higher, we'll need to re-evaluate. She's acting fine otherwise. My vet may be getting a phone call this weekend given the way she's going.

I've never had good luck testing her urine for ketones so I've never gotten to use my ketostix. Ketone tests have been done at my vet's when he was able to express her bladder. I've got a smart cat box but she refuses to use it. We went through a bad period where she was peeing on the floor constantly. After months of work, I've finally gotten her to pee in litterboxes lined with puppy pads. I could try to use the ketostix on that if they are soggy enough to dip but she's so private about using the box I never know when she'll go, and if I put her in a room by herself she'll hold it rather than go. She doesn't like change. I've got a ketone meter now so I guess I'll try to use that. She has never thrown ketones though, even when her numbers were off the charts. We've been lucky that way.
 
Joanna & Bix (GA) said:
p.s. you also should do a rising # check if you don't have midcycle data anytime you are shooting earlier than +12 - so for instance if you don't have spot checks overnight, you should get 2 readings maybe 10 minutes apart in the morning to be sure she is rising before shooting. just wanted to be clear on that in case any newbies are following along! :)
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Good to know. I think I'd read that somewhere but have never tried doing one. Will do so next time I'm not able to do a mid-cycle check. Will try to do an additional test tonight at +1 or +2 after her PM shot as you suggest. It comes so late it is hard though. Got to get some sleep sometime. :)
 
wombat88 said:
Interesting what you said about the +1 and +2 tests. I didn't think there would be much change just an hour after the shot (other than perhaps a food spike). What is the typical pattern so close to a shot? A slight rise? No change? Just curious. Shaikha seems to be reaching her lowest levels as early at +3 or +4. I always expected to see nadirs later, but that hasn't usually happened with her. When I've tested later at +5 or +6 when I'd expect they would be happening she's already on her way up. I've learned to test earlier or I miss the low point. Not sure if the more frequent dosing will change that or not.

At +2 this time she was only up to 486, so not much of a rise from pre-shot levels despite the food. Hoping she goes down from here. We'll see.
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It's not super-essential necessarily, so no need to stay up late for that. A +1 doesn't have to do with the shot, it has to do with knowing what is happening before the shot starts working. If for instance you had a 180 PS and then your +1 is 500, that is some mega-zoom, and if your PS is at +8 and the +1 what is normally +9, that would be most likely a bounce (unless the dose was super-low and then it might be early poop-out).

As another example, if you had a 180 PS and then a +1 of 190, you know you are not seeing a lot of zoom. So then if you saw something like a 380 at +6 you would know something went wrong. Either your dose was way too low (unlikely if you held the dose the same as last cycle, and the last cycle looked decent), or the dose was too high, or something like a food spike wonkified things.

If you aren't sure of the dose it can help with the detective work. The time before the shot kicks in (somewhere around +2 give or take maybe 45 minutes, I'm not sure what the verdict is on ProZinc) can help you see if you have a nice overlap between doses, or if you have mega-zoom or possible bounce going on. It's not a critical test though, just something to have a spot test for now & then. Vs. something like a +3 that, barring a big overshoot, is almost always nicely sandwiched between +2 and +4, so doesn't usually tell you a whole lot from a detective-work standpoint (unless you are doing a mini-curve, so getting the +3 rather than the +2 +4, then of course it is very useful!).

Now that I've said all that you'll get some +1 & +2s and they won't tell us a thing :lol:

I think the concensus on +4 nadirs with ProZinc is that they are often a sign the dose is too low? I'm not sure that is the only interpretation though. Sometimes they can be from the dose too high (though I don't think that is the case here), and I'm not sure if that might just be where some cats nadir.
 
Joanna & Bix (GA) said:
I think the concensus on +4 nadirs with ProZinc is that they are often a sign the dose is too low? I'm not sure that is the only interpretation though. Sometimes they can be from the dose too high (though I don't think that is the case here), and I'm not sure if that might just be where some cats nadir.
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She always has seemed to nadir sooner than you'd expect, so it may be the pancreatitis? Then again, she's more unpredictable I think than most. She'll have a good day, then an awful day, etc. even if all conditions are the same. We at least are down to 234 now at +4, so we are headed in the right direction for a change. I don't know if the drop is too fast or not, but having a nadir around now is not atypical for her. I am thinking about testing her again at +5 to see if that's the lowest point or not. It would be helpful to know how low she gets so I can plan what to give at the next dose.

What do you all think of the change this time? Given that she didn't really drop much in the AM and this time went down more on a slight bump up, I'm wondering whether the dose was too low before. ohmygod_smile I sort of wish her pancreas would hang out a sign saying "This much next time please..."
 
What I meant to say was my understanding of t.i.d. and how I practice it and how I was guided by the oldies is to take your last b.i.d. dose and divide it by 3 and that becomes your dose .... unless that dose makes her go too high/low you stay at that dose for 2-3 days. Then you look at all the data you have collected and adjust the dose by that. What you are practicing is a form of TR, where you dose t.i.d. and change the dose each time by the last PS, the only problem with that is, it is real easy to re-bound. Plus there is the whole discussion about what number you are shooting? Some people believe you shoot the # before the shot and adjust your dose by that. (that is a form of TR when done b.i.d.) Some people believe you are shooting your next PS # ..... if you take a set # and test for days on that # then you have some idea how she reacts to that # and if she nadirs early/late. (Payne will change) I'm not trying to be confusing but you get great numbers on 1u and then you go down and get bad #'s. (unless she is getting sick and I would take her temp.) great no ketones, my personal hell .....

It is all very confusing I know, and it is for your sugar baby that you are doing all this ..... I agree to cut back on testing, my only difference would be no +1 .... I know some use as an idea how long the last dose is working but I think you find that out in your PS and +2 or +3, MHO.

Nancy and Payne
(it's starting to rain and she's trying to catch the drops through the window :)
 
I would go ahead and test at +5 or +6, you've already committed so much time to this and now it's getting interesting. I'd like to know where she goes from here.

All day I've been leaning towards the dose is too high, but now I'm starting to think this morning was a bounce, that's why I'd like to see another spot check.

Get some Neosporin + pain releif for her little ears, or rub some vitamin E on them.

If their P's hung out a sign saying give me this much insulin none of us would be here :lol: . I've always wanted their bg # to flash on their forehead when you kiss their noses :-D .
 
Rob & Harley said:
I would go ahead and test at +5 or +6, you've already committed so much time to this and now it's getting interesting. I'd like to know where she goes from here.

All day I've been leaning towards the dose is too high, but now I'm starting to think this morning was a bounce, that's why I'd like to see another spot check.

Get some Neosporin + pain releif for her little ears, or rub some vitamin E on them.

If their P's hung out a sign saying give me this much insulin none of us would be here :lol: . I've always wanted their bg # to flash on their forehead when you kiss their noses :-D .
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You're in luck. I just checked and she was on the way up again, so the reading at +4 was her nadir. That's not atypical for her. She was at 282 at +5. So now what do you think? I got no movement this AM, but with a little more at mid-day she went lower for a change. I was thinking the opposite, that she isn't getting enough, but you have more experience than I do.

How is "too high" different from a bounce? I thought bouncing happened because you gave too much? Or can you bounce because you gave too little and the pancreas doesn't know how to react? :?
 
A bounce can be from her body freaking out by going lower than she is used to (81) and thinking she is going hypo, which she isn't, but since her body thinks so her liver dumps sugar to protect her and you get higher bg's because of it. If that is what happened you should just ride it out and not increase the insulin because of the bounce, the bounce will clear by itself in a cycle or two or three. Which is what it is starting to look like to me. If you increase the insulin because of the higher numbers she will bounce again and you can get into a vicious cycle.
 
Hmmmm I might do 0.8 for this evening's shot and see what happens. What do others think about going back to 1u in the morning? Yesterday might have been a fluke. confused_cat
 
Kelly & Oscar said:
Hmmmm I might do 0.8 for this evening's shot and see what happens. What do others think about going back to 1u in the morning? Yesterday might have been a fluke. confused_cat
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That's exactly what I did. I was so beat last night I went to bed right after I gave her the insulin, so I didn't do any readings after that. This AM she was 290. I do think that yesterday she was having a bounce from the day before. I plan to keep everything the same on dose to see how she reacts on Day 3 unless she drops excessively low to try to get things leveled out.
 
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