7/15 Papaya AMPS=464 +4=376 PMPS=174 +5=155 Decrease ??

Yesterday's extended GREENS!

After an unbelievable three cycles of hitting 40s and staying in blues and greens, we've broken the streak and had a high preshot again. Frankly I'm not complaining because if she was low again she would have had to come with me to work . . . and I don't think either of us would have had fun with that!

Last night she was steady around 110 from an hour before her shot to 3 hours afterwards, so silly me, I thought it was safe to actually do some stuff in the yard and test at +5. Hello 43! I fed her a good portion of 13%. +7 was rising so fed her a bit more to be safe and called it a night. Looking at it now, I wonder if the +7 was still just from the food and if she turned around and went lower again later? Hard to tell, and at that point I really needed to sleep!

My question now is about decreases. I've had three cycles in a row in the 40s, so strictly speaking I should decrease one more time. However, she does not have a history of holding decreases well. Should I just be holding the 2 until I see low numbers again, or do I need to at least shave the 2?

I am thinking ahead to this weekend as well, because Fri/Sat/Sun I am going to be out of the house for probably 11 hours each day with no way to get any daytime midcycle tests. I think it's important to make sure she eats in the beginning hours of the cycle, so I'm going to want to give her shot at least an hour and a half before I leave rather than shoot as I walk out the door. This means the PM shot will likely be a bit late. If she's really low at AMPS I am going to be forced to skip just to keep her safe. So no matter what happens between now and Friday I will NOT be increasing. But should I "NOT be increasing" from the current 2, or from a further reduced dose? I don't want to reduce too much now and be stuck at a too-low dose all week with her feeling miserable, but I don't want any more days hovering at 40 either! Suggestions?

Re: 7/15 Papaya AMPS=464 +4=376 Decrease Question

Amy:

Take a look at the protocol. It's not 3 cycles -- it's 3 drops between 40 - 50 on separate days.

When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately!

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If you think that Papaya actually went lower than 40, you need to reduce.

Re: 7/15 Papaya AMPS=464 +4=376 Decrease Question

Sienne -- OK, that's a valid point about the drops needing to be on separate days, thanks. Mainly I am asking the question because I keep getting told I'm missing decreases, and being too aggressive with dosing. I don't know if I fully agree . . . but I wanted to give those opinions a fair chance in case quicker reductions do stop the bouncing, so I went ahead and decreased by shaving the dose (which I thought according to protocol is the way to go with cats that don't hold reductions) after seeing the first definite 41 on 7/14/13. When I did that, you said:

Sienne and Gabby said:

I think there's a decent chance that Papaya's numbers may have dropped below 40. If you shave a dose when there are low numbers this way, it's a doubly aggressive approach vs. taking a full reduction.

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Perhaps I misunderstood, but this seemed to indicate you felt I was still being too aggressive even though at that point there had not been three days of drops between 40 and 50, just one "maybe" below 40 (and one "maybe" on 7/12).

Looking back, I strongly suspect that she went low on 7/12 in the AM, triggering the bounce to a high PMPS. That would make three days where there is "a decent chance" that she was below 40. So at this point because of drops on 7/13 and 7/14, the 2.0 dose is where I should be. But as to decreases moving forward, I would appreciate a bit more input.

According to what you quoted today, I could literally get 40 six times (twice a day for three days) and am still following protocol if I don't decrease at all - as long as it's a 40 and not a 39. But if it's a 39 once I must decrease a full quarter unit. So I really want to know how to decide, where is the line between thinking "hmm, if I got 40 right now, it is possible that three and a half minutes ago her BG was only 39 and therefore I must reduce" and thinking "well the protocol says I can get between 40 and 50 on three separate days so no need to decrease at all"? It just seems to be such an arbitrary line.

That said, she has been having some less dive-y cycles so I think the move to higher-low-carb has been a good one. (Oh, and Friskies is half the price, which I am loving!!) Thanks for being willing to discuss Papaya and her dosing - I realize she's sort of difficult! Please don't feel I am being argumentative by wanting to dissect the details. I just feel like when there are decisions with some room for interpretation, whichever way I decide it is pretty much guaranteed that the next day someone will look at what I did and tell me that I'm doing it wrong, so I want to understand the whole thought process in hopes that I will be doing the absolute best I can for Papaya.