Pig 1/18 amps: 386 +2 408 (Regretting the R skip last night)

01/17/2018 thread

Regretting the R skip last night. Seeing much higher numbers today. I plan on doing R tonight unless Pig decides to surprise me, which he is good at doing.

I also plan on running R with every shot over the next couple days until Sunday morning. He will be due for an L increase soon, so no R then.

Should I remain with the .5uR or raise by .25u? or by .5u? Trying to understand it and need suggestions. I want to do what is best for Pig.

 

I want to start giving R at every shot. His numbers are taking their toll. He is so tired all the time. When is it safe to start doing this???

 

I'm not an R expert. When Leo was in the throes of Acro, I just kept cranking up the Levemir.

You are correct that the numbers are probably taking their toll. Increases are warranted. Pig has not been in the (100-200) range in forever. I would increase his primary insulin (Lantus) at least.
.

 

He is due a raise. It never seems to help with the L... But, it will. Soon. So, do we raise on the fifth or sixth cycle? I can't keep it straight.

 

Those yellows were nice. It's interesting they are in the cycle following the PM R cycle.
The gurus say that can be the pattern---low numbers in the next cycle.
I haven't seen it for Yum yet.

The rule for Lantus increases is after 6 cycles, so increase on the 7th cycle. Sometimes I cheat but those with experience say it is a big risky mistake..
Good luck.

 

You can increase the Lantus tomorrow, after six cycles at this dose. Especially now that you are seeing yellows again. "Cheating" has the potential to be dangerous for your cat.

As for R, if Pig is very low 400's or less, I would stick with 0.5 units. That is taking his numbers down about 100 points, or a bit less, and that is what you want. If you see a high 400's you could experiment with a 0.75 unit dose of R.

There are a couple of recommendations on when to NOT use R: if you cannot monitor that cycle, if he is breaking a bounce, or you are increasing the Lantus. At this point, I don't think you have enough data to shoot R in the morning and walk out the door.

I don't think today's higher numbers are due to not using R, but rather he is bouncing in response to yesterday's yellow. He probably got lower than 283 as that was still relatively early in the cycle. He was no where near dangerous numbers, but lower than he is used to, so bouncing. Typically if you see the mid cycle numbers higher, like today, it's good to look back and see if one of the previous cycle or two might have had a lower number. That's your clue for a bounce happening.

So the plan for now.
- shoot R tonight. Go with 0.5 units unless you see high 400's and can monitor tonight, in which case you would try 0.75 units.
- increase the Lantus tomorrow to 17 units.
- shoot R tomorrow night as per the scale or 0.5 with low 400's or less, 0.75 above.
- make sense?

You are starting to get good data on 0.5 units of R. If you want, you could skip the +1 test if you go with 0.5 units tonight, as it seems action doesn't start with Pig until +2.

 

Thank you @Wendy&Neko!! Yes... That makes perfect sense and now I have a clear plan. No, you are entirely right. I want this as safe as possible. I do get a little anxious to see his numbers drop, but I also do not want to shock his system at all. I certainly trust your judgement more than mine. I never even thought to look at the last few cycles. See, I'm horrible with numbers and patterns. I am also far to close, emotionally, to the situation to make calculated decisions. Its good to have an outsider, expert opinion.

 

I had thought the same about the lower numbers following the R cycle. However, I do not think I have near enough data to call it a pattern. My thoughts were this, I dose .5uR tonight as Wendy suggested and watch as the R and L hold his numbers down and flat until his unit raise of L. The unit raise of L, hopefully, will hold his numbers (at the very least) in a relatively flat curve... I could be entirely wrong though... I know nothing... Lol

 

Well, then... I am excited! Only 2 more hours then its off to the races! I can't wait to see Pigs progress over this long weekend!! I am praying for yellows!

 

Looking at just one cycle will seldom give you answers to what is happening. Unfortunately, it means more work, but you have to look at patterns over several cycles. And that's just the Lantus action. Then you can see how R changes those patterns.

Eventually, when you have enough data to get an idea of what will be happening in a cycle, you will be able to shoot R with less monitoring. But if ever in doubt,the best course of action is always to skip R.

 

Okay... I honestly do not mind the extra work at all. I will do whatever it takes to have him feeling better...

Its the dosing that worries me. I never know what or how much to give. Maybe I am over complicating it and not trusting myself.

 

I totally get what your saying "lantus doesn't do it" my girl got to 24 units before her cycles broke. Fortunately we had started R, but she only needed a couple of doses. not sure if we just got the "right dose" or a mixture of both. Now she is down to 16 units. It works if you work it. Have faith. It's a tough dance. But so worth it. head bumps to Pig

 

Okay... We are having a much better night. Numbers are a bit higher, but Pig seems to be feeling better.

pmps @ 394
+1 @ 435

 

I honestly cannot wait for that point. I know it is going to take time and you are right, it is hard. However, I would never give up on this guy. I also know that many know better than me. Pig is in great hands here! I am hoping for wonderful results!!
Faith I have!!

 

Soooo... Here comes the Pig with his bag full of surprises. Now he has me wondering if I made a mistake, but I triple checked the R dosage, just as I did the L. I leave nothing to chance...

+2 @ 332 !!

That is a 100pnt drop from +1! Trying not to freak out....

 

Whoa! Bit of a big drop there. Hope it doesn't cause a bounce. Slow down a little Pig!

 

Oh.. He is going to make for an interesting night for sure...

+2.5 @ 311

 

I am a bit worried! Should I be worried? I know I triple checked that dose and it was bang on .5u.... I have gone back to the syringe over and over making sure...

 

Don't worry, at least not yet. Even if a bit of a drop, he has a long way to go to be in any danger. At this point, the worst that can happen is a bounce. He'll be due another meal soon which will also slow him down.

I'm not sure what type of syringes you are using, but the lines on some are worse than others. I used BD's and the amount of space under the zero line could vary from syringe to syringe, easily making a difference of 0.25 units.

 

I am forcing myself to take a breath and focus on school... I know my stress effects him and this is not about me, its about him...

Shew... He slowed down a bit..
+3 @ 336

Speaking of meals... is there a specific feeding regime you recommend? Still trying to find that balance.
I use UtiCare VetRx from ADW diabetes... How do you bypass the line discrepancy? I set up two separate syringes as guides. One for the .25u and .5u. I keep them in his medicine box in the fridge. I used that to compare the dose tonight... it looked the same, but with such small amounts...

 

In general for meals, you want to feed most if not all of the carbs in the first half of the cycle. If you feed carbs after the peak of the insulin, you can slow down that insulin action and cause a sharp rise at the end of the cycle. Several small meals are easier on the pancreas than one big meal. How you spread that out depends a bit on the cat. Some people have cats that like to dive at the beginning of the cycle, so for them, they feed more food at the beginning of the cycle to balance when the insulin onsets. Also you might feed differently for a hoover vs. a grazer. Neko had her main meal, plus a couple others, and a small snack at +9, zero or low carb. Her nadir on Lev was also later than on Lantus.

Sample syringes is one method for getting consistent dosing, which is more important than being exactly accurate. Some people use calipers for dosing. Here is a post on that.

 

Sorry.. Had a bit of computer trouble. Okay. See I like that idea. My only issue is this. I have not been able to find a no carb wet food other than Tiki Cat and I am not entirely sure that I can afford to give that to him as a meal 2x a day. Also, the more towards whole meats I get, the harder it is for him to have a good BM. The lack of fiber seems to back him up. However, I will admit that many of the problems I am seeing could be contributed to his higher BGs. I feed Sheba Pate which is supposed to only be 3% carbs overall. I do not know if that is acceptable or if I should continue to shop around. I completely agree with the smaller meals, it has always seemed to work better for Pig. They both (Pig and Tail) get 2.6oz BID with 1oz nibbles at around +3.5, +7.5 Pig's time and Pig I give about .5oz at +9.5. He eats a LOT and is always hungry. When I cut him down to twice a day I thought he was going to hurt himself trying to get to food.

I saw an article on caliper dosing. Perhaps this is the one. I do like that idea a lot. There has got to be more accuracy with that.

+3.5 @ 278 (Meal after +3.5 test)
+4 @ 330

 

Seems to be holding steady for now...

+5 @ 336

 

Running a nice flat curve and I am off to bed....

+6 @ 337

 

It might be good to reflect the yellow on the SS.
When you get a number at an in between time you can stack the numbers on top of each other
For example today in the pmps cell at +3 you would put your +3 result, 336, and underneath you would write 278@+3.5.
You would then colour the cell manually, I would colour it yellow (or whatever colour the lowest number represents) so that at a glance that he did drop into yellow, as it's the lows we are looking for. Plus it will do your heart good to see a little sunshine on Pigs SS.
You will also need to select text wrapping (ask if you are not sure how to do that), so that you can see what you have written easily without hovering over each individual cell.

If you look back at Georges ss you'll see examples of where I stacked numbers.

Making sure he is well hydrated by adding water to his food can help with that. And some people add a teaspoon of pumpkin to the food for extra fibre if constipation is an issue. You can used canned pumpkin, just make sure it's the plain stuff, nothing added, or you can use fresh steamed pumpkin (folk freeze it into portions to use when the need it.

Night Night

 

Oh my gosh THANK YOU!! I have been fighting with that sheet all night trying to do just that, but have it retain the same color! I'm a dunce!

I do add a lot of water and have heard that pumpkin is good... Only my vet said there was no science behind it, so I assumed it was not worth a try. However, I am totally on board with it! I will give it a go. That will not disrupt his BG?

 

I believe not.
As with all changes, start off slow with the pumpkin.

I can imagine that no one has done a scientific study with pumpkin, but some folk that use it here on the site have had success with it.

 

Don't worry about getting zero carb fAnd that was when she was fairly well regulated, so I could see any changes. oods. Instead, get something that is under 10% carbs and his GI system can handle. Low phosphorus is always a bonus. Zero carb is not necessarily better than low carb. I could feed Neko up to 8% carb without noticing much of a difference in her numbers. Here's an post on Low Carb vs. Lower Carb from the old board.

I also added pumpkin to her diet. Some people use babyfood squash (plain, no additives).