Hermione's Dosing Rollercoaster pt4

The other thread was getting long so I figured it's time for a new one.

I've been fighting a cold so I didn't get as many tests in as I would have liked. I didn't even turn on my computer since I'm feeling awful and Nutter is feeling good enough to totter around the house and get stuck in strange places because he can't turn around or back up without falling over. Fortunately he doesn't panic or get upset, he just makes these really sad quiet meows until I find him and get him unstuck. I let him out of the room I was keeping him in because being isolated WAS making him upset and even if I let his best buddy in with him he just yowled. Poor old dude!

Here are Hermione's recent numbers, which are as disappointing as Nutter's recovery is encouraging

10/20
520 AMPS, 1u given
591 PMPS, skinny 1.25u given, just below the 1.25 mark

10/21
608 AMPS, 1.25u given - negative for ketones.

 

Poor Nutter! Your description of him getting stuck was heart-wrenching. I'm glad he's feeling better though.

I see what you mean about Hermione's numbers - very puzzling. You have lots of data which is great . If I look at your SS for a very general "overview", it seems that the more recent blues and yellows are associated with doses in the 1 - 2 u range. Your recent lower doses have left you in black/red/pink territory for many cycles which makes me think they're too low. I see that you've often responded to an AM/PMPS with a dose tweak. Hermione is a very volatile girl, much like my guy. My approach is to try to keep dosing as stable as possible and any changes are miniscule - and Teasel still overreacts. I wonder whether selecting some "OK" dose and keeping it for several days might break you out of the blacks. Of course you'd have to respond if she dropped too low. Just a thought based on my experience with a jumpy kitty.

 

Yeah, it's pretty sad when he gets stuck. But he really doesn't get upset about it, more like he's puzzled. And he's never actually wedged in anywhere, it's things like walking behind the toilet and not being able to make the turn at the tub. He's doing much better today though, he can make slow turns without falling. It was really terrifying when he first came down with this - I was sure he'd had a stroke.

Thanks for the encouragement & suggestions! I'm trying not to be frustrated right now, but it's hard when we were doing so well

505 @ +4
480 for PMPS, 1.25u given. Hopefully we're getting closer & that's not just strip variance!

 

259 @ +9!

Kris, looks like your eye for data is right! I was watching a hockey game with Hermione on my lap so I didn't get a nadir test. Nutter has been doing really well, and I'm less congested so hopefully things will keep trending in a positive direction.

 

279 for AMPS!

I gave her a little reduction to 1u. I'll get a test before I go to bed and have extra alarm clocks set so I don't sleep through nadir!

 

I'm thrilled for you and Hermione, Kimi! If she's like Teasel, she can get "stuck" in high numbers and loses responsiveness to a dose that might have worked previously. A dose increase can give her the nudge she needs. I always have to be aware of this with Teasel. !

 

I am with Kris. She needs small increases. It'all be interesting to see if one unit is enough today - good data to have.

Are you considering U100s? It looks like she will need tiny increases/decreases like Teasel. U100s and the conversion chart would make that easier.

 

I'm with Sue on the U100s, Kimi. You'd have a ton more fractional doses to work with along with "fats" and "skinnies".

 

Looks like Teasel and Hermione may be sugar siblings

The 1u wasn't quite enough, or possibly she's bouncing. I'll do a curve today. I'll be ordering u100s on Monday since it's pretty obvious she's going to be a tiny changes only girl. There is a limit with what I can do even with caliper measurements on the u40s.

417 @ +3
381 @ +7 (Hermione was asleep on my legs! I know she's feeling great when she snuggles with me)
551 for PMPS, 1.25u given

 

A 0.1 u increase in dose brought Teasel from AMPS of 479 to a +5 of 157. How's that for a reaction?! And a 0.1 u change would be impossible with a U40 syringe.

 

Yes, I definitely think that's the kind of tiny change Hermione needs right now. And she didn't want me to do a curve today, she spent the day cuddled up with me except when she let me cook & eat dinner. I hate to disrupt our snuggle time, especially since it means she's feeling good. I know I shouldn't let her keep me from testing her appropriately, but I've been so stressed with Nutter and me being sick I just wanted to let her sleep on me while I watched tv

475 @ +5 (when I made dinner)
513 for AMPS, 1.25u given

Nutter is almost back to normal! He still has a head tilt, which my vet warned me might be permanent, and if he shakes his head or tries to move too fast he's still wobbly. But it's an amazing improvement from just a few days ago when I thought he had a stroke.

 

You'll get there with Hermione, Kimi. Some of us have kitties who want to teach us as much as possible while they're at it. I'm glad that Nutter is so much better. I could just picture the old boy stuck behind the toilet calling for you to come and rescue him.

 

Hermione is doing better today!

485 @ +5
385 for PMPS. I gave 1.25u since she wasn't liking the bigger reduction.

Oh, and here's Nutter today on his favorite dog bed. The rolled up towel is so he has something to lean on until he gets his balance all the way back. He'll go lay next to it all by himself.

 

What a sweet boy! Glad Hermione is doing better.

 

The downward trend is good. Glad Nutter is improving, Kimi. He is so lucky to have you to take such good care of him.

 

Thanks, gang! I'm fortunate to have an equine medicine background as well as being very comfortable with needles, blood, etc, so once I understand what to do I'm diligent about doing it. I'm also very lucky that my cats are generally good patients

AMPS was 501, I gave her 1.25u then fell asleep without setting my alarm so no mid-cycle numbers
PMPS was 441, 1.5u given.

I'm still on vacation from work, so I decided to be a little adventurous and give her a slight increase.

 

The increase worked, although a bit too well. I'm looking forward to my u100 syringes now, since it looks like her ideal dose right now falls between 1.25 & 1.5u.

373 @ +4
232 @ +8
187 for AMPS!
198 after 20 min stall, AT strip instead of FS
209 after 40 min total stall on AT strip

I gave 1u based on the % of dose instead of just looking at the dose number. She seems to react poorly to large dose changes, and even though the last time she was given 1u on a yellow she had a big bounce mid-cycle it also set up the run of beautiful blues. I just didn't feel brave enough to give more than 1u. Fingers crossed it works out!

 

244 @ +4

So far so good. Keeping my fingers crossed!

 

Welcome to the world of nanodosing, Kimi! You'll like the options you have with the U100s. I see you use those $$$ AT strips for critical times like I do. I'm more comfortable with the FS strips in my AT meter now, given that I know they always read higher and I've worked out an approximate % higher when I open a new vial of AT strips and do a few same drop comparisons. I'd break the bank if I used only AT strips!

 

Yes, what they charge for AT strips is criminal. I work out the best code for each new bottle of FS strips compared to an AT strip on the same blood drop - fortunately Hermione is very patient! But I still don't trust them in the blue range.

541 for PMPS 1.5u given.

I swear I did a nadir test this morning but there's nothing in my paper log. I'm testing my cat in my dreams!

 

Expected bounce but the yellows and blues were nice.

 

I also expected the bounce. What I didn't expect is this +8 number!

99 @ +8! I double checked it with an AT strip.

She was cuddling with me for +6 again, but I didn't expect her to be in the greens! She didn't act like she was low, just snuggly and full of purrs. My u100 syringes can't get here soon enough. She sure seems to want to be somewhere between 1.25u & 1.5u right now.

 

86 for AMPS on AT strip!!

Hermione really does like messing with us, doesn't she?!

Going by what was suggested last time she held nice low numbers (and because she's pestering me for food) I'm going to give her a partial meal & test again in a few hours.

 

183 @ +3 with no shot and half a can of FF given at AMPS!

If I had u100 syringes I could give her a tiny dose. But since I don't have them yet I'm skipping. It's well past my bedtime, and I don't want to be asleep if she gets really low

 

My goodness, you're having an exciting time with Miss Hermione! You'll be glad to have those U100s.

 

So she needs insulin but would like somewhere in the 1-1.25 unit range. Looks like the 1.5 was a little too much, even for a black.

I like your idea of giving a dose a tiny dose in the 180s, but the U100s would be nice, and you do need to sleep At least she is giving you some good numbers!

 

It's crazy how reactive she is now! I would have loved to give her a microdose this morning but I knew I'd fall asleep and didn't want to be snoozing if she had a crisis.

497 for PMPS, I let one drop out from 1.5u so hopefully she won't be too low to shoot in the morning. My u100s should be here tomorrow!

 

331 @ +6

 

She's an awful lot like Teasel in her responses. I wear patience pants all day every day.

 

109 for AMPS, checked on AT strip. Repeating yesterday's protocol and giving her a little food. I'll check her before I go to sleep again.

I'm really looking forward to the u100 syringes. This is driving me batty!
ALL the patience pants, ALL the time. ALL OF THE TIME!

 

194 @ +3

Again too late for me to give her insulin with a u40 syringe. Although letting out a drop seemed to help a little with the extra long duration.

 

She is back into that pattern of a low amps. Did we try an 11/13 schedule to help with this, with a lower dose than "normal" for pmps?

 

Yes, that's what we did last time, Sue. I meant to give her PM shot early today but had to clean poop out of her tail. Long haired kitties can be so much fun! I also didn't get my u100 syringes in today's mail, so I reduced her dose to 1.25u.

501 @ PMPS, 1.25 given.

 

440 @ +10

Clearly 1.25u isn't enough, and 1.5u is too much. My u100 syringes arrived today - after I'd given her PM shot of course! - so I'll give 1.4u a try.

 

456 for AMPS, 1.4u given

Fingers crossed!

 

179 @ +6

So far so good....

 

And you always have the "between the lines" doses like 0.1, 0.3, 0.5, 0.7, etc.

 

Yup! Although they're very close on my syringes. I got the smallest u100 dose I found at ADW with 1/2 unit marks (3/10cc) but maybe I overlooked a smaller one.

 

Nice nadir!

 

No, what you got were the ones I use, Kimi. The half unit marks allow 0.2, 0.4, etc. dosing. I eyeball halfway between those half unit unit marks when I want to try 0.1, 0.3, etc. dosing. And to split it even finer, I nudge the plunger just up to or just beyond a mark to get the "fats" and "skinnies" that I call the 0.05, 0.15, 0.25 etc. doses. Some people do this by letting out a drop or two. I can manage it with my reading glasses (!) and holding the syringe up to a bright desk lamp. Where there's a will, there's a way.

 

I already need my reading glasses to draw insulin anyway - my arms aren't long enough I'm glad I didn't overlook a better size syringe too. This dose seems to be working well, although she seems a bit high for PS numbers. Hopefully she'll smooth out a bit once she's used to the dose.

450 @ PMPS, 1.4u given.

 

445 @ +9

Bouncy bouncy bouncy

 

494 for AMPS, 1.4u again.

 

I feel your pain.

 

Like those blues, don't like those blacks and reds...

Wonder if a curve would help us see when she starts up and if there are lower numbers in the cycle somewhere?

 

I need to do a curve, but this weekend has been really crazy for me. It so confusing that .1u change can make her swing so wildly.

414 @ PMPS .4u again.

 

She and Teasel are related.

 

They most definitely are!

558 @+8

 

Darn. Back to bouncing. Do you want trying to skinny up the dose just a little to try to smooth things out?

 

Yes, I was thinking I'll let out a smidge. Crazy cat!

 

525 for AMPS

I gave just hair under 1.4u.

 

464 @ +6
492 @ PMPS

I went ahead & bumped back up to 1.5. I'll be around to monitor & will get a curve.

 

422 @ +4

 

300 @ +6

At least it's going down for a change!

 

Good to see apink.

 

It sure was nice to see pink, but we're back into black again

595 @ +11

I got distracted by the Indians game and missed a +8/9 test - Hermione was watching it with me. Well, she was sleeping on the sofa next to me

 

560 @ AMPS 1.5u given

 

All we can do is persist ...

 

Yup. Hike up our patience pants and keep on keeping on!

347 @ PMPS, fat 1.4u given - just over the line.

Here's hoping she likes this dose now that we got her moving again.

 

351 @ +6

Hmmm. Not sure what to think of that.

 

Better to surf in the pinks than in reds and blacks?

 

Surfing in pinks is WAY better than reds & blacks, for sure!

But we're back to black for AMPS I bumped back up to 1.5, which is barely half a drop more than she got 12 hours ago. My cat is trying to drive me crazy lol

Although I did see just the thread about the possible change in the formula for Fancy Feast classics. I DID just open a new case of FF classics Turkey & Giblets a few days before her numbers went all crazy. The GA on the cans looks ok to me, but she's been picky about eating this new batch. I chalked it up to cat rules - the more your person buys of something, the less you like it no matter how much you loved it before But just in case it is the FF, I bought a few cans of Nature's Variety Instinct Ultimate Protein. I'm trying that today, she wolfed it down like she hasn't seen food in a week!

525 AMPS, 1.5u given - Nature's Variety Instinct Ultimate Protein instead of FF this AM

 

Kimi, your sense of humour will save you!

 

Maybe time to up the dose?

 

Some days it's either laugh or cry, so I choose to laugh

Yes, I think we might need a little bump, but since I just gave her a different food I'd like to give it a whole cycle. Although her numbers haven't improved on it...

536 @ +6
462 @ PMPS, 1.5u given

 

Well, whether its coincidence or the change in food, her numbers are better (for now)

339 @ +6
254 for AMPS. I gave 1.4u so we'll see how she likes it.

 

Bouncy bouncy goes Hermione

425 @ +5

642 @ PMPS. I'm really hoping that's strip variance. I gave her a little bump to 1.6u. I love the u100 syringes!

 

Well, I guess I can say it's not the food.

514 @ +6

Sigh. On the bright side that means I don't have to feed her that expensive food.

 

Darn. I don't know what is going on with her. Hope the 1.6 gives you some better numbers after she settles in.

 

Me too, Sue. I'm worried about her being so high so long again. I'm trying to get a ketone test but I haven't been able to catch her in the litterbox today. She's still happy and snuggly so I guess I just need to hike up my patience pants

520 @ AMPS, 1.6u given

 

Like Teasel, she had some better numbers occasionally when she was on a substantially higher dose, around 3 units. You might well be heading back there. I always look back at where Teasel was in August when I came here - getting 3.6 u (blindly!) and throwing some good numbers. I suspect he was near hypo overnight during that time but can't be absolutely sure. I've since been up and down the dose scale because I'm doing things the FDMB way but I keep going back to that early data as a sort of benchmark. We're slowly edging back up again so I'll see where we end up. I know now, though, that dosing is a moving target for many kitties and Teasel is one of them for sure!

 

Hermione and Teasel are definitely extra-bouncy sugar siblings! As unfortunate as it is that there are other cats who are just as difficult to regulate, it sure makes it emotionally easier on me to know I'm not alone

571 for PMPS, 1.6u given. And I caught her in the litter box, negative for ketones!

 

489 @ +8

 

571 for AMPS 1.6u given

 

You must have a very large wardrobe of patience pants, Kimi! I know how you feel and all we can do is persevere.

 

I don't know, Kimi. I am thinking she needs to get increases every six cycles and maybe by 0.4, not 0.2. I know she bounces but she has been sitting in high numbers so long. Maybe get a curve when you can and then increase. I am wondering about insulin resistance - when they sit in high numbers and become used to them, and then make increases regularly until you break through.

 

Good advice from Sue. Teasel gets stuck this way. He needs dose increases as well right now.

 

466 for PMPS, 1.6u given.

I'm home from work tonight so I'll get a curve. I agree on bumping the increase a bit, she's not really responding to the tiny increases. Nutter is also having a bit of a setback - not a serious thing but he's not as energetic as he has been. I think he may be getting a herpes flare from the stress of his IVD - being a former barn cat he has chronic FHV-1 too. All my other cats are vaccinated against it, so I'm pretty sure that's not affecting Hermione's blood sugar. She's also not showing any signs she's feeling punky.

I won't do a big increase for AM, just because I've got a bad track record of sleeping through nadir tests But I can do it tomorrow for PM if her curve tonight is high and flat.

My little girl can't do anything the easy way lol

 

391 @ +5 Pink is better than red!

Nutter is feeling a bit better. He's not running a fever and still eating, drinking, peeing & pooping so my vet said to keep an eye on him rather than bring him in today.

 

399 @ +7

 

370 @ +9

 

374 for AMPS 1.6u given

My cat never ceases to confuse me

 

361 @ +4

 

At least she's surfing in pink! Looks like this is her version of coming down in numbers with this dose. I suspect you'll have to go up some more to get a lower nadir number. She really does give you a run for your money, Kimi.

 

Yes, she's slowly coming down! New thread time too