How to move on with Gandalf?

Hi again!
Once again it has been a while since I was active here, been reading a lot of threads on here though. You learn so much from it, it´s amazing!

Gandalf has had a good week with a lot of blues and some greens. We are currently giving him 2.2 u as a standard. After todays number I assume he is gonna be quite low for the PM shot, like on 5/5 and 8/5. Earlier we have then been lowering his dose by 25 %, should we go even lower in dose or even try to skip the dose if he is around 10-11 mmol/l at PM?

I have been trying to read up on bouncing. When I look at his SS I would say that he is definitely bouncing, quite high when he hits green but also a bit when he hits blue. He also seems to clear his bounces very fast. Do any of you with experience have some better interpretation of his cycles and bouncing?

Also I read in some thread the other day that the kitty can have a late drop in their cycle if the dose is too high. We have seen these late-drop cylces a few times, do you think we should decrease the dose?
Else I think we will just keep going and hopefully he will eventually stop bouncing when he hits blue, and we can start decreasing the dose.

We have been able to test alot lately due to good scheduling at university, but next week is lab-week and we are not gonna be able to get midcycle test during the day every day.
From his SS, is there a dose you think is a safe dose to give when we are not home, but which will also not set back the progress we have made the last week?

Someone in my last thread predicted that a good dose for Gandalf would be 2.2 or 2.0 U, that is exaclty where we´re at. All you who share your knowledge and experiences with others on here are so amazing! Thank you!

 

You are getting quite a bit of difference between the AM and PM cycles. How much variation has there been in shot times? Is there any difference in feeding? During lab week, will you be gone during the day, but able to monitor the evening?

 

We have always been consistent with his meal and shot time. 7.00 and 19.00 every day and no differnece in feeding. Yes, we will be able to monitor during the evening!

 

Your AM dose of 2.2 looks quite safe, even without monitoring, and on any pre-shot above 200, so you should be fine just holding that during the day while you're gone.
Your PM cycle is variable in pre-shot as well as dose reaction. I usually hate sliding scale dosing on prozinc, but it looks like adjusting the dose for that PM cycle like you've been doing, is the right decision at this point since you're given reduced doses and still had strong responses in the evening.

Right now, I would say to keep doing what you're doing until lab week is over, and then post again. Some thoughts for possible strategies:

-moving to an 11.5/12.5 or even 11/13 schedule to give him a little more time to rise before the PM dose

OR

-increasing the AM dose to try to bring those numbers down a bit more, and then keep adjusting the PM dose as needed (this may make bounces, but honestly, I don't think bounces are that bad, I just think they're part of the process)

OR

-lower the PM dose to something that is consistently safe to see if the stability stops the bouncing (this might leave him too high though)

OR

-something else? I'm sure others will chime in with some ideas on all of this in a bit.

Because his cycle is so different during AM/PM, with 2.2u being not quite enough during the day, but 1.6u was almost too much at night (that's a pretty big difference in dosing), it may take some careful experimentation to figure out what's going to work for Gandalf. I'm curious what everyone else will think about this. I might be making it too complicated.

 

Could you explain the 11/13 schedule briefly? I have read a bit about it but has not quite grasped the concept.

 

Instead of giving insulin doses 12 hours apart, you would give the AM dose and wait 13 hours to give the PM dose. That makes the PM dose an hour late, giving the BG an extra hour to rise (hopefully) higher. The AM dose that follows at the set dose time is then 11 hours after that PM dose. In effect it's now an hour early and the BG is "caught" before it can rise higher. The goal is to even out the AM and PMPSs.

 

Thanks! This morning he was very high after an assumed bounce. His nadir is usually around +6 so he was probably a little bit lower than 7,7 mmol/l and then rose fast. I gave him 2,2 u. Maybe we should consider trying the 11/13 schedule?

How do you best treat a bounce? Is it just to keep the regular dose or should the dose be adjusted until the bounce clears?

 

Generally you keep the same dose for a bounce. Doing an increase dose on a "fake" increased number isn't recommended since the number should come back down when the bounce clears.

 

I have made the mistake of dosing on a bounce, throws a little curve ball but you can get back on track. Better to hold steady . I have to stop myself if I get a higher number and look at previous readings to make sure it is a bounce or an actual higher number. Brain is not always fully awake in the mornings

 

Haha, I also noticed that when I am tired or not fully awake I tend to make some bad decisions.
Now we always have a gameplan ready on how to handle various low values if one needs to get up at 2.00 in the morning. Oh what we do for our beloved kitties.

The spreadsheet has really helped us to see some patterns and make (at least sometimes ) better decisions for dosing, but I must say I find all this really hard! Now he has had two quite low PS values in a row so we lowered his dose by 0.2 U. He bounced this cycle so then we keep the 2.0 U to see if it clears. Really wish he would stop bouncing, but am just really happy that he, at least part of the time, is in blue!

 

Remember that those blues are nice healing numbers!

 

We survived lab-week! We actually managed to overlap our schedules so we could get some mid-cycle tests every day.
Gandalf has had two cycles with nice number the past few days, they seem to usually be followed by a flatter and higher cycle.

We have planned to really stick with the 2.2 U dose for longer period of time to see if he can stop bouncing. We hope to be able to get his PS values down since he seem to do pretty well on this dose. We will try and not reduce his dose for PS numbers over 10 mmol/l (if someone can monitor). And also try and stall and retest if under 10 mmol/l.

The huge drop from 16.3 to 5.8 in 4 hours yesterday seemed a bit steep, and he also still seem to bounce when he hits lower blues and greens. But at least he spends some time in blues and greens!

How do you know when it is time to reduce the dose?

 

I would reduce the dose if you get a lime green near mid cycle. Otherwise, keep the dose if it gives you blue and dark green.

 

Thank you! Then we will do that!

 

It does seem like the PM cycles might be a bit less reactionary now than they were before, so holding the dose consistently in the evening might be okay now. If you're going to be around to monitor, you might actually try a bit of an increase since the mid-cycles are still a little high. Most of the greens you've seen are still high greens, so there is room to bring those down a fair amount and still be safe. If you do decide to increase a smidge, it might set off some more bouncing, but once that settles, it may leave you with some better numbers. And please only try that if you're able to monitor and feel comfortable managing it if he does get too close to those lime greens!

 

Yay healing numbers
From what I see, it's not a terrible bounce so hopefully his body is getting used to the better numbers

 

Jeez, he really is testing us right away. I have no idea what happened this morning. 5.1 preshot, stalled for 20 min without feeding, 5.8. Decided to give a very reduced dose, 0.2 U. Probably should have stalled another 20 min, but a half-awake brain does not make good decisions and we had certainly not planned for this scenario. An hour later 14.7. Hard to know how much of this is the foodspike, but very curious to see his numbers today and tonight. Just as you set up a plan to follow...

He have had these very late drop cycles before, but never this low. I am not sure what to do about this. It seems like he has these every six cycles or so.
Do you think we should try 11/13 or should we just keep going and tackle these cycles as they appear? I thought his AM and PMPS were starting to get much more even than before.

I like the idea of upping the dose a tiny bit to push his values down a bit more, since he seem to be bouncing a bit less now than before I start to get hopeful that he might actually settle.

This is so typical catbehaviour, it is kind of hilarious!

 

That really is a low number to start your day! Many of your low pre-shots have resulted in low nadirs as well, so reducing was the right decision. Even if he ends up high this cycle, better safe than sorry.

And you're so right about this being typical cat behavior! How do they know?!?! As soon as we think we figure something out...

I don't think I'd recommend going to an 11/13 right now if your schedule doesn't require it. His recent AM and PM cycles aren't all that different. I think you're probably managing it about as well as could be with lowering the dose on the wonky numbers and holding it steady on everything else. Since this does seem to just be something he does from time to time, I would still go with a slight increase once he's back to normal - and a cycle you can monitor.

 

Helena, I don't know if we ever told you, but many of us suspect our cats have their own message board. I'm fairly sure that Gandalf is on there and had a recent thread that said "Mom has a plan now for what to do for me! What should I do?" And got responses like "Dude, change it up! Throw her a really low number at preshot and then shoot up later! It'll be fun!".

Seriously though that is SO typical for these kitties! I agree with Djamila, I think you're doing the best that can be done for now.

 

Sorry, one time butt in. @Djamila she's back, the all in bold. I just don't know what...

 

Lol...I saw it. I'll try to respond later

 

Thanks! It is nice to get some reassurance and to feel I did the right thing, for once.
He has been in very high numbers today, as expected. Hope we can get back on track quickly!
Then we will keep the schedule, it defenitely works best for us!

 

That is so hilarious!
Gandalf might be cute but he is the most grumpy and stubborn cat I have ever met, when he's in that mood. I love him even more for it but that makes me absolutely convinced he did this to me on purpose!

 

Sooo... These past days have been a bit crazy. Since that 5.1 AMPS a week ago, which clearly was'nt a one time event, he has been all over the place and I could really use some advice.
My gut is telling me that the 2.2U dose might be too much for him now. I mean, he went from 22mmol/l PMPS to 14.4 +6 (nice I thought, a good nights sleep) but the AMPS this morning, 5.9, what the heck??? He was given 2 U this morning since he was coming back up fast. Should I stick with the 2 U now instead, or go lower? 1.5U was not enough yesterday, we have a cycle of similar pattern going on today so I really hope for a lower PS value tonight.

So, as you may read in my notes we tried to be a bit creative with his low pre-shots since someone is home every day now. We tried doing the mini-meal method on may 23, with really good results! The following attempt was not as successful, and it will probably not be successful today either, but this might be something to stick to if we can get some consistent PS going.

At least he seem to be spending quite some time in the blues and greens now. Silver linings!

 

Looks like you tried 2u this morning? I think that was a good choice. It does look like you're getting some longer cycles,which are followed by these higher preshots...which probably doesn't feel great and certainly isn't as balanced as we want!

I like the reduction. Let's see if that helps the PMPS tonight!

 

There's some bouncing going on but you have some great numbers on Gandalf's SS. Bouncing always makes it harder to judge a dose and decide on a dose change. Let's see what 2 u can do today.

 

The mini decrease to 2.0U from 2.2U was a good idea . Nice greens

 

We have our hypo kit out atm. He is dropping way too early so I gave honey as well, lately his nadir seems to have shifted to +7 instead of +5-6. Have no idea what happened tonight since he had a similar PS as this morning and then he only stayed in blues. He is an outdoor cat so there is a possibility that he threw up his dinner outside, but we will never know... Do you think a dose reduction to 1.6 is in order?

 

Yes, you could reduce to 1.6 u after this lime green. It's possible that this was a one time low and he'll need to go back to 1.8 u but you'll need to experiment. Nadirs can shift around for any number of reasons that we'll never understand because they're cats.

 

I don't understand what is happening know. Got a red PS tonight. We had a nice mid blue at +7 and I thought that he would start to creep up (slowly!) again from there since I thought his nadir had shifted to arond +7. But looking now at his SS I guess his nadir could be even later. Was this red a bounce from him dropping further after the blue +7? I had gotten the impression that he had stopped bouncing so high hitting the blues and high greens so I am so confused. I ended up reducing the dose to 1.6U. I had planned to do it before but my partner had not heard the news and gave him 1.8u so we just kept going. I thought the AM cycle yesterday was gonna be a flat bounce-cycle from the hyponumbers but he hit blues. So maybe 1.8u was too much, I don't now but we will see now how he does on 1.6u. He has been so happy lately and his symptoms are gone, I would hate if we got off-track now!

I am also so emotionally drained from yesterday. We had to go to the vet with Gandalfs brother Frodo because he had been gagging like he wanted to throw up all morning, but nothing came out. He had a grassstraw in the corner of his mouth when he came home, so we suspected he had grass stuck in his throat. They checked him and said that they needed to sedate him to try and remove whatever was in there, and that there was a 50/50 chance they would find it. Else we would have to travel over 300 miles to Stockholm to the nearest vet with a rhinoscope to get it out. Well, thankfully they found it, it was a straw of grass!
And now, of course, since Frodo turned out okay, Gandalf seem to do worse. I swear it is always something up with these two! Being a kittymom is though, I can't even imagine what it's like having kids... Sorry for rambling but it is nice to get it off my chest!

 

Thought I should leave a picture of my beautiful boys together!

 

What a beautiful pair of kitties you have!

 

Ranting is allowed here, Helena. As hard as it is, try to look past individual numbers/ colours on your SS. I find it very helpful to squint and scroll down the SS because the trends really stand out that way. When I do that with yours, I see a lovely proliferation of blues and now dark greens. THAT'S progress!

 

Thank you! That makes me feel a lot better. Some days really are tougher than others! Gandalf is happy, in the end that is all that matters!

 

We've all done the ranting before...this is the place for it! I totally get the thought about having kids. I can't even imagine doing that with how much I stress out over my cats!

 

I was reading the advanced sticky-note and the micro dosing caught my attention. Is there someone here who has used this? We do not get consistently low PS and are not stalling alot but I just wonder if that could be something to try if we get days like the AM cycle on 5/23 and the PM cycle on 5/24 again. Try and catch him when he is on his way up again to try and keep him in those nice greens?

The 1.6u seemed to be too low so we went back to 1.8u and imidiately got a lower PS, so we have been trying 1.7u for two cycles now. He just tested 13.4 at PMPS. Yay! We will keep the 1.7u and hopefully it is a bit more stable than the 1.8u and give better mid-cycle values than the 1.6u!

 

Are you using U100 syringes to dose the ProZinc? That's the way to go if you need those tiny in between fractions.

 

Yes I am!

 

I don´t know what to make of the 1.7u dose. He bounced right up to pink after some nice greens, but he dropped there from yellow in 3 hours. He also usually don't have such a late onset. I think we will lower to 1.6u again the next time he has a lower PS.
I think I overreacted when I gave him the wetfood, should have just fed him his rawfood since I tested 1/2 hour later anyway. It metabolizes much slower than wetfood so I did not want to risk him going even lower but I think he was already on the way up. Sleepy brain makes bad desicions...

Just to clarify that I have understood the micro dosing method correctly:
We pick a number, say 8.5 mmol/l, and when he rise above that number we shoot a small dose. And this can be anytime, like 3:30 AM? The normal shottimes are skipped and we give a dose every time he rises above the set BG number?
If we get one of those carazy low flat days again I think we will try this out!

 

I missed seeing this post yesterday. As for microdosing like this, it's very tricky. I know that @StephG did it a version of with her guy but he's an extreme case. There's another protocol based on Dr Hodg(k?)ins TR that calls for dosing in a way similar to this but it's not promoted on FDMB.

Gandalf's numbers are improving so I'd stick with conventional dosing using the U100s to allow tiny fractional changes.

 

I totally had a response here for you yesterday but didn't click "post reply" . In essence, micro dosing is tricky and even though it is very tempting when they are still at higher / flat numbers, I personally, do not see a need for you to try it with Gandalf. It looks like you are getting around to his ideal dose, for now because it can change too . So I have to agree with Kris in sticking with current dosing twice a day.
*This is just my thought, you are still free to ignore it*

 

I kind of went rogue and did something similar. Usually on days where he was really high, blacks, and wasn't moving. I tried to keep the normal shooting schedule because I wasn't chasing the numbers every day. Chuck was on a high dose so he could burn through half a unit in an hour. Most of the time anything under half a unit wouldn't even move his numbers. Chuck's prozinc journey was a hot mess but we made it work, kinda.

Quick glance at his SS and I agree that maybe sticking with the conventional dosing for a bit longer might be easiest and you might see more lower ps as he gets use to the greens.

I feel for ya! Having a tricky kitty is stressful and I was constantly trying to figure out a way to get ahead of the game.

 

Hi all! Thanks for your input!
I have been away for a couple of days so my partner have been dealing with Gandalf alone. He has had a rough, eventful couple of cycles. We both agreed that micro dosing wasn't an option unless we were both home, so missed the window there, but I agree with you all that it probably wont be successful and it is better to just keep the regular schedule. I looked at his spreadsheet and we have given him 1.4u (or in the region of) several times when he is rising past 8.0 mmol/l and he goes flat and a little high. So I can't see how giving him 0.25u when he rises would have any impact at all.

I think we will lower the dose again try 1.6 u again after the huge drop last night. This morning he had jumped right up to red again. He sure is tricky, but at least he is hitting a lot of blues and greens lately. Just wish he could get used to the greens and stop bouncing!

 

Bouncy cats are very frustrating and make it difficult to judge a dose. Gandalf is getting a lot of good blues and greens though. Is he feeling well? We have to keep reminding ourselves that the way they feel/act is important too.

 

Thanks! I believe he is, I have not noticed any symptoms in quite a while, and he is his happy cuddly self!


I woke up to see that he just had another huge- drop cycle with another bounce, this time on 1.6u. I am not sure how to handle this, how do you know when it is time to lower the dose for a bouncy kitty? Does lower when lime green apply to them as well? I think we stick with the 1.6u a little bit longer to see how it goes, but another one of these cycles and I think we will lower to 1.5u.

 

If the low isn't lime green and you can monitor it's worth keeping that dose. He's giving you some nice numbers on a lower dose and that's a good sign. It's stressful for you though.

 

With the exception of AMPS 9 June, I think you are pretty near his ideal dose (given that could still change later ) because it doesn't seem he is bouncing as often I guess is the best word . I would try to hold the 1.6U longer, like you suggested. If he nadirs closer to the 2.7, then try the 1.5U. Will be good also, as he is on a bounce cycle right now and it might last a few more . Let's see what the others say too.

 

I agree. I think you're very close to the ideal dose...so I wouldn't want to lower now.

 

Oh that is exciting, I really hope we get there! Fingers crossed he will have more predictable cycles when/if we hit the sweet spot! Expecting to see some action this cycle or (most likely) tonights cycle based on his recent pattern, it would be soooo nice with some consistency.
Recently he only seem to bounce when he hits the lower greens, I must say that feels like progress!

 

Two cycles later we got some action... So much for predictability and consitency!

Pretty sure he would have gone lime-green yesterday if we had not steered with som LC wetfood at PM +6. I gave 1.6u this morning, what do you think, should we stick to 1.6 u or try lowering it to 1.5u?

 

Heyyyy look at that! Gandalf felt the need to remind you that consistency is no fun.

I think the 1.6 you gave is fine. The way Gandalf usually reacts is that you lower, he stays high for a bit. Maybe sticking with that same dose will help? Just be sure to monitor (though I know you will, so it isn't even necessary to say it...but I still have to!).

 

He usually have some higher and a bit flatter cycles after a bounce like that, but today he seem to be dropping quite low again right away. I don't know how to interpret this!

 

Was anything different last night, Helena? I'm with Rachel in holding the dose since you monitor well and if nothing was different last night, if he gives a PS <13.8 only do a teeny tiny reduction so the 1.5U instead of 1.6U

 

He's being a cat! They won't even try to make it a bit easier on us. I agree with staying at 1.6 u a bit longer.

 

Then we will probably do the 1.5u in a few minutes. He just gave us 11.8 mmol/l for PMPS, stalling right now to see what is going on.

He just had three back-to-back cycles where he hit mid-low blues!

Edit: 13.8 mmol/l +30min, gave the 1.6u anyway!