? 1/8 Silver AMPS 308 - PMPS 320 is this NDW?

http://www.felinediabetes.com/FDMB/threads/1-7-silver-amps-313-8-329-pmps-355.189245/

Doesn't look like the extra 0.25u is doing anything.

 

You don't always see results right away. Give it some time and hopefully you'll see lower numbers.

 

It can take 6-8 cycles for the depot to fill on a new dose (i.e., to see the full benefit of the dose)

Here is some info on the depot. I agree with Carla, give it some time.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

 

Isn’t the depot already full? Surely the new dose is just topping it up?

 

The depot is probably one of the most confusing parts to Lantus/Levemir. Silver's depot (reserve) is curent filled to the 2.0U does and is filling to the 2.25U does as you continue to shoot.

The same is true in reverse - so, let's say there was an earned dose decrease - because the depot had been filled (for example 2.25U) the next couple of cycles (after the reduction) the depot will drain from the 2.25U to the new, reduced dose to 2.0U (again, example) and because of that your kitty can still drop low(er) than would be expected once the depot has stabilized to the new dose (2.0U).

It helped me to think about the depot as a "time-relased" pill (it is not, but it is a concept that we are more familiar with).

I hope that someone can give you a better explanation or explain it better -

 

Thanks. Yes that is helpful. The depot is confusing for sure. Let’s see what the next few days bring then.

 

I hope you see some improvement in Silver's BG in the coming days.

 

Hope his numbers come down a bit for you!

 

I hope this dose works for Silver, paws crossed

 

Pink all day. Not seen a blue since 12/29.

Is this current high NDW?

Could he have had glucose toxicity on the lower dose?

Feel like we are going backwards not forwards.

 

Did you get other tests during the AM cycle? I checked the SS and didn't see any other tests.

Yes it could be NDW and yes it could be a bit of glucose toxicity but regardless hold the dose and follow the protocol. It could also be bounces of lows you are not getting due to missed tests.

 

No. I have a job. Daytime tests not possible. I don’t think he is going low at all. He goes into yellows but that’s not low.

 

I understand! So she could have dipped down-who knows how low. I know it s frustrating not seeing anything but pinks but that doesn't mean there isn't yellows or possibly blues though the day. I am in a similar situation, just grab tests whenever you can and remember this is a marathon, not a sprint.

 

Just keep swimming, Juliet! This sure is the agonizing bit, but you will get to the right dose eventually, and lots of support and encouragement for you until then!

 

Was Silver on Lantus in 2014/15?

 

It's possible. It's also possible he went lower last night and is bouncing. I don't see any tests lasts night, so it's just a guessing game. Can't tell much with just PS data. Since you can get PM data, I encourage you to try to get at least a before bed test each night.

 

Yes he was. I think he went OTJ so fast that time because I took him off dry food.

 

Thanks. I’m feeling soooo discouraged actually. I seem to be getting nowhere and we are three months in now and nowhere close to good numbers anymore.

 

I fell asleep last night hence no tests. It is so hard for me to get midweek testing and I do try to get at least a bedtime test. Sometimes I get a +2 but it’s always so high so am guessing food hike.

 

@Myagi and Heidi I pulled this over from another condo as I didn’t want to hijack it. I understand nadir and I think I understand onset - that’s when the numbers begin to go down right? I think with Silver it’s at +3 as his +2 is always higher due to food hike. But how do you find out the duration? Is that from onset to nadir?

 

Yes. That's pretty much my understanding of duration. When they start to talk about overlap and the depot I get a little lost, but that's why the basics help!
I copied it from this thread and put this thread on my ss for easy reference. Also texted myself that sub quote.
http://www.felinediabetes.com/FDMB/...combining-merging-protocols-good-idea.111088/

 

But one thing I've learned in the last couple of days is onset is often earlier than we think! You said "food hike". Right. Lol. Thanks to @Marje and Gracie and @Gill & George not letting me skate on my "too close to see the forest for the trees" reasons for insisting his onset was +3ish, i started +2 testing and learned his onset is earlier! Because also our kitties change things up - especially as they start to heal.
Hope this helps!

 

Thanks! I have been getting some +2’s after someone said they are a good idea. He does jump quite high tho. His PMPS was 320 and 382 at +2. I’ll be getting a +4 soon.

 

Marje said something really cool about the insight of the +2. Lemme find it and bring it here. Also, lots of seniors have been lovingly asking all along fur +2 testing, I just could only handle what I could at the time and the more I've learned, the more receptive I am to learning. I live in the desert and the ground has to be wet to absorb the rain.... know what I mean?!

 

You are getting somewhere as you are not letting Silver's diabetes to its own devices and you are collecting info about this the very best you can.

That's what I think too . From onset to nadir.
Because everyone talked of a long lasting insulin I took that literally to start with thinking it lasted the 12 hours cycle . Erms. A big fat nopes.

We three are all in the classroom together.

 

Dumb question - if it doesn’t last 12 hrs - and we know it doesn’t - why do we only dose at 12 hr intervals?

 

Keeping an eye out. Hope Silver settles down and begins to work that dose for you.

 

Because of the depot. Early shots act like an increase. Ha! I did learn something!

And there are no dumb questions! (From the girl spending hours trying to figure out of you can average carbs! Lol)

 

Thanks @Tracey&Jones

@Myagi and Heidi yeah I had heard that about early and late shots acting like an increase or decrease. No matter how much I read I don't think I will totally understand the depot tho.

 

Good question as it happens.

I'm still struggling with the depot thought. Nearest me and him have got is a rain water tank on a trickle feed. Top up the tank every 12 hours . Don't let it run totally dry as it will always be trickling away but you want that water to grow healthy plants so try and control the trickle.[

 

Me - I'm still trying to understand why I get good numbers and then lose them again with no rhyme nor reason. We were getting quite a few blues now nothing but pinks and yellows again. I seriously doubt he is currently getting into blues during the day as it was all yellow on the last two curves.

 

Duration isn't onset to nadir, duration isn't a set time at all, it's however long the insulin carries. This can vary by cycle or you might see a pattern that, say, your kitty loses duration at +10 and spikes before preshot or your kitty has a long duration that runs over into the next cycle (that would be overlap, and it's a great thing because as one cycle's insulin wanes, the onset of the next cycle's insulin gets passed the baton and keeps going on that groove).

Sometimes if you feed your cat after nadir, you will see numbers rise and continue to rise (not usually a bounce), sometimes food can put the breaks on a cycle, and that's why in some cases, its best not to feed after nadir...you want the most duration possible. We say the insulin lasts for 12 hours, but it's an approximation, for some it lasts 8 hours, or 10 hours or even 14 hours and beyond. Many factors play in to the duration you get: absorption, food, exercise, where the shot is injected (in a skinny part vs fatty part or accidentally a muscle, etc.) the list goes on.

 

I'll be honest here.

"it's however long the insulin carries" and " your kitty loses duration at +10"

I don't understand.

 

Yes, it is topping it up - with some of the insulin injected. So when increasing .25u, part of that will go to the depot and part into circulation.
It takes several cycles before the depot matches up with the new dose. Giving an increase time to settle in is important. Only then can you make a proper evaluation.

 

Now I’m totally confused. How can duration be that long? Isn’t duration for as long as numbers are decreasing? Once they start increasing without food influence, surely that’s the end of the duration eg using Silver as example. His onset is +3. Nadir +7 and upwards after that. My logic tells me duration is from +3 to +7?

Heading to bed. It’s late here.

 

Yup. Me neither.

 

@Juliet

Just found this on the 'net. It seems to say that the duration clock starts ticking from the time of injection . You look at the blood glucose number at that point.
The numbers go up/down but when they reach about the same point as when the injection was given then that is the end of the duration. Something like that I think.

 

Because most of the time, it does last 12 hours and sometimes longer.

Sometimes it’s shorter because the absorption of that particular shot is less, we overfeed carbs, or we feed too late in the cycle this putting the brakes on duration.

Even if a particular shot has shorter duration, the depot is still at play.

 

No...duration is the entire cycle:

Loss of duration is very difficult for most to pick out.

 

As long as the numbers are decreasing is when it peaks, but it is still working after that. Certainly the depot probably gives a hand in some of this too, but if think of it this way:

Have you ever used an electric toothbrush and forgot to recharge it? They still work, but they slow down and don't work as well as they do on a full charge until finally they just quit until you charge it back up again. The insulin is like that, if it just stopped working shy of the 12 hours, you'd probably have some pretty terrible numbers, similar to what you would see with skipping some shots but it still works, (keep in mind, the depot, makes this tricky to illustrate), but that's the general idea. It works, it just works less well as time goes on, and if you're lucky, you have onset from the next shot before it gets out of hand.

 

Ok girls. This duration thing just went completely over my head! when he's flat Myagi's would be almost 12 hours. But when he's dropping/ improving (which is what's wanted), he doesn't go back as high as that shot number. So what's the duration?

@Juliet @PussCatPrince
So it turns out the +2 pearls of wisdom were spread out over many conversations. The gist was it's our best time/tool for seeing where our kid is likely to go on the cycle. You directly compare +2 to pre shot as an indicator (not a guarantee) of the cycle. These notes were specifically for Myagi so I deleted what wasn't relevant to the generic explanation for us.

"By and large, if his +2 is less than his PS, he’s going to have a pretty active cycle. If you look on 1/5 when you didn’t test until +3, he took a substantial drop. Most likely, he was dropping by +2 but you want to try and catch the drop early enough to just slow it down a bit and flatten him out.

• Controlling the drop with LC food can also allow you to hold the dose longer.....keep the nadir up a bit. Keeping the nadir = holding the dose (if it gets him into green) = healing pancreas
• A very good technique is “getting them on a surfboard”. We want to teach the liver to like green numbers. To do that, at the first green number, be sure and feed him a couple tsp of LC food and see if he will get on that surfboard and stay on it for longer periods of time. You don’t have to overfeed him but the goal is to teach the liver that “green is good” . This goes back to bullet 2 above.
• Like many FD cats, a flat yellow cycle, often is followed by a bounce break."

 

So why is it important for us to understand duration if we can't even figure what it truly is or it's too subtle for us to ascertain?

 

@Marje and Gracie posted while I was writing and I didn't see it. I don't want to have us both responding and confusing you all further, I will defer to her wisdom and experience because she has a good heap more of it than I do.

 

From the New to the Group Sticky Note: Duration - the length of time insulin continues to lower blood glucose. At the peak or nadir, it is the lowest it lowers the blood glucose. Later on, the insulin isn't as strong, so it's not lowering it as much. Ideally you'd get a nice gentle curve where the insulin starts to lower insulin, builds, lowers it some more, peaks, then continues to lower blood sugar from where it would be with no insulin, but it's weaker, so it's not lowering it as much.

Think of a car and momentum. In the first part of the cycle, the foot is on the gas and the car moves faster and faster. Finally it meets the peak, and the foot switches to the brakes. Think of the brakes gently on as the part of the cycle where the insulin is waning. Brakes slow down the car, but it's still moving forward for a while. When the car finally stops moving, that the end of the duration of the forward momentum of the car.

 

It’s important so you can figure out if kitty is bouncing or if he’s lost duration and is going to come right back down after the next shot.

It’s also important if the kitty has extended duration so you can tell if he/she is getting carryover and/or overlap.

Let’s say kitty is 60 at +5 but was fed a lot of HC food and so at +8, is at 285. The BG climbs a little more until the end of the cycle and is at 300 at PMPS. But at +2, kitty onsets from the next shot and drops to 175 and proceeds to have a green cycle. That’s indicative of loss of duration but most members would say it was a bounce that cleared fast.

Why is that important? Because the CG thinks kitty is bouncing and so no test is needed after PMPS until +4 before bed and guess what? Kitty is at 60!!!!

It’s also important because the CG thinks the kitty is bouncing instead of surfing but he can’t surf because of the loss of duration. The CG might think, “well this dose is barely getting him to green for very long” but it could be the HC putting the brakes on the duration.

It’s also important to know if the kitty has a longer duration. Gracie could nadir at +15 from the previous dose on Levemir which would be +3 from the current dose. And then she would onset at +4. I had to be prepared that she was going to likely take a big drop at onset.

While longer or shorter duration might be hard to spot, it can be done with a little practice, learning, asking questions. However, because so many members never learned to spot it, they tell others that it’s a bounce when numbers go up. Sometimes it is a bounce, sometimes it’s just the normal rise at the end of a cycle, sometimes it’s loss of duration.

 

So you would rarely see the car stop (insulin duration end point) unless you over carb because the foot is back on the gas at the next shot?

 

Ok! Copying - thanks! Love it when it makes sense. Still not sure how to figure it out, but at least I get why it's important!

 

I’ll look at Myagi’s SS back a lot further and post to you on his condo so we don’t hijack Silver’s talking about Myagi.

 

Cool. But it's prob not a problem as us 3 chickens (Juliet Heidi & M) were trying to learn together. Lol

 

@PussCatPrince. M it wouldn't let me like your reply. ?

 

Me and him think we almost get this now. If we exchange the word duration for absorption . Our analogy being an alka seltzer . Fizzes slowly , then fast, then slowing down to nothing.

 

Since I couldn’t find anything on Myagi, I copied my post to you on Myagi’s condo below:

I couldn’t find an example on Myagi’s SS but there are several on Gracie’s after her endoscopy when things went crazy.

Click on her SS and scroll to 10/31. Remember she was on Levemir and so she often nadired at +12. She lost duration the a.m. cycle of 10/31, went up, came back down after PMPS. She bounced then and I gave her R so she was back down by p.m. cycle of 11/1. She lost duration that p.m. cycle, was up by AMPS and then came right back down and nipped green. Lost duration again but came back down in the p.m. cycle 11/2.

It was a trying time because she just couldn’t hold onto her duration and it wasn’t the insulin, the shot, etc. we believe something happened during her endoscopy because everything changed after that. You can see how she started getting into pinks and her overall curves were higher.

Let me know if you see what I’m talking about about.

 

'Cept Juliet had to go to bed so will be over our cars and alka seltzer moments.

I was fiddling with my post Heidi . Didn't want to lose my thought .

 

Absorption and duration aren’t the same.

Absorption can affect duration but they are different. Absorption is how much insulin is available to the cat and depot from a shot. Duration is how long that insulin influences the cycle.

 

I realise the difference in the meaning of the words but it is helping get the whole thing to stick for me and him. My brain hurts.

 

Had to run before finished . I forgot to put one of the litter trays into the shower room and so Ty peed all over the floor.
See what happens when paying attention to lessons Juliet. *giggle*

Anyway @Marje and Gracie . I wanted to write thanks so much for taking the time to try & bring more clarity to this class of three. I've copied and printed .

 

Yeah. It this is so impractical. “As soon as he hits green feed him a couple teaspoons low carb”. This presumes you can. This whole thing seems geared to stay at home people who can test often, feed HC LC whatever whenever and doesn’t take into account that people actually have to have jobs.

 

You’re welcome. And I haven’t forgotten about you and Ty.

 

That advice was given to Heidi for Myagi. It wasn’t intended for Silver.

 

Well it’s a bit confusing when it lands up in Silver’s condo.

 

Blame your fellow classmates. We were unruly after you went to bed.

Forgive us.

 

I didn’t post it in Silver’s condo. Heidi was just trying to help you. She also wasn’t indicating it was something you needed to do.

It’s not necessary to take every bit of information given to you so literally. Take the opportunity to learn from it and if it doesn’t work for you and Silver, don’t do it. But please be kind to those trying to share information. Heidi and M have the very best of intentions, as does everyone on the board.

 

Sorry Juliet. I thought I noted it was written fur Myagi and I tried to delete cat specific comments. On a day when you are home doing your curves it would apply. We were all working together yesterday. I did not mean to unduly distress you further. Again, mea culpa.

 

Lol that’s allowed. Wasn’t totally following tho.

 

No worries. I’m reading half asleep. One of those days. My stress levels are waaay too high.

 

I don’t believe I was unkind. Wow. Tone is so misinterpreted in the written word. Bowing out of this condo.