10/8 Ozy AMPS-340,+4-278,PMPS-331,+2-371

Yesterday http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=105887

Last night Carl took the time to write a long response with many questions... I appreciate that. I have so many things roiling around in my head about the protocol and bouncing and how to make Ozy better. I will try to respond here. I tried to respond in yesterday's condo and I got into html trouble.

Carl said: I am not seeing what you are seeing, then. In the last seventeen cycles, I see two cycles that I would call "yuck"... Most cycles are either good ones, or the "consequence" of good cycles that we refer to as bounces. That doesn't qualify them as "bad cycles". There are dozens of beans here that would swap spreadsheets with you in a skinny minute.

I say: In the last 14 cycles he has had only two cycles that were healing cycles (enough green). The rest are at best useless and many are high enough to be damaging and leave me desperately try to get a ketone test. Why should "bounce" cycles get a pass? His numbers are high. That ain't good. And, yes, I agree there are cats with higher numbers than Ozy. I find that discouraging, not comforting. For example, I don't know how Lara handles it with River. She says River feels bad when he is high, too.

Carl said: I understand that you feel that on bouncy days, Ozy looks like he feels like crap. There is a possibility that those crappy days have little to do with his BG numbers.

I say: Well there is a correlation between high numbers and when Ozy feels bad. Is that a cause? Maybe not. But I think it is. There are other people who say their cats feel bad when the numbers are high (Lara and Julie, for example). It is possible that he is getting pain from pancreatitis, but he doesn't have the symptoms I associate with pancreatitis. Maybe I should just Bupe him when he is high.

Carl said: I'm not trying to be dense, but I guess I just don't understand what the expectations are....Even though there is a standard protocol to follow, every cat is an experiment.

I say: My number one goal for Ozy is for him to have a high quality of life. That means engaging with the rest of us. Being interested in the world around him. The five P's. I expect him to feel better more of the time than he is. I am ready to experiment to make that happen. I am willing to test like crazy. I am NOT willing to leave him at a dose that keeps him in the 300's most of the time. So, I raised his dose this morning because I would rather test a lot and bring him up if I need to than see him feel bad.

He was at 3 units for 10 cycles. That is the conservative number of cycles to wait. Only twice did he have reasonable numbers. Now you can tell me about "bounces", but to me it just sounds like blah blah blah blah. It just isn't making sense to leave him in high numbers when it gives him a shitty quality of life. I have started calling this whole bouncing thing the Church of the Bounce because it doesn't make sense to me and I am just supposed to "believe". (In Portland, we have a Church Of Elvis.)

I used to feed him when he asked. But then he started gaining weight really fast (from 14.5 in early July to 17.6 in two months. Now I limit his food using the Dr Lisa guide. I also feed him pretty regularly spaced out meals all 24 hours. When his numbers are high, he begs for food all the time. I see that as another sign that he is not well.

So, I hope this helps you see where I am and what confuses me and doesn't work for us (Ozy and me).

Bottom line: I don't "get" bounces. When his numbers are high it is time to change his dose.

Re: 10/8 Ozy AMPS-340,+2-278,+4-278

Interesting discussion yesterday and I have to say Carl knows me pretty well :lol: :lol: :lol: :lol: And, no, I don't feel picked on or singled out and neither does LBG. She has come a long way in the bouncing department; at various times, she could give Ozy a run for his money ;-)

While the actual TR protocol does not specifically address "bouncing", the journal article published by Roomp and Rand makes a reference to what we call "bouncing":

Fluctuations in the first weeks on glargine were common, with low blood glucose concentrations interspersed with high blood glucose concentrations. With time and consistent insulin doses, there was less variation within and between days.

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You have to consider the number of cats they were monitoring and how they might have been conducting the research but, they note it happens. What i see is important is the part I put in bold.

When I was having a bit of an issue with bouncing, Libby gave me some good advice which has also helped me to ignore the bounces and quit being so stressed by them (and yes, I was worried about the high numbers because Gracie was not only quiet but also because I was worried, because she is so young, what long term effects would result from being above renal threshold so much). Here's what Libby said:

isn't it Suze/Pumbaa who is constantly repeating "they bounce until they don't?" It's true, there's no secret, they stop when they're ready to stop. I remember being frustrated that Lucy was pink at AMPS almost every single day, even though she went green at night. Jojo told me not to worry about the pink, she was spending more and more time in green so the little bit of pink didn't matter. She finally got to the point where she was pink for just a few hours every morning. One day she just completely stopped bouncing. I didn't do anything to make that happen, it just happened. Then what you're calling "dives," Jojo would say "look, she is racing as fast as she can to get back to those green numbers that she loves." Perspective. FWIW, I don't really see serious diving going on for Gracie. She's not flat, but it's nothing extreme.

So yes, I would dose to the nadir you want and wait for the numbers to fall into place. If you want nadirs in the 60s (which seems like a good goal), then adjust the dose until the nadirs fall into the 60s. Then STOP. She will eventually start to flatten out. That might take a long time. Once she flattens out, it might be higher than 60s, so you would adjust the dose again to put her back where you want her. If she drops lower than 60s, reduce the dose again to keep her nadirs in that range.

Spend some time studying Mocha's SS. Devon was good at holding doses once they started doing good things. At one point she held the 3u dose for basically a whole month, with numbers that looked a lot like Gracie's do now. Some other doses on the way down the dosing scale were held about that long because the nadirs were good. Also look at Tuffy- she was on 3.5u for almost 3 months. It took 2 months for her to start to flatten out, but then she headed down the dosing scale.

Don't try to minimize them, seriously just ignore them. Another thing the ever-wise Jojo always said is that Lantus (and Lev) are "Zen" insulins. You have to wait for the numbers to come to you. If you are someone who wants to chase numbers, these are not the right insulins for you to use (not "you" individually, but that's what she always said).

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I see you raised the dose this morning and it's what I would have done even though he had a quick trip to 59. If you want the nadirs lower, increase the dose a bit because you test enough to stay on top of the numbers. But also keep in mind what Libby said about chasing numbers. It's hard...and I am the inventor of patience pants that I never wanted to wear. And it might not help because I think it feels different when it is your own cat, but I can give you SCORES of SSs to study of cats that were even bouncier than Ozy, suddenly "snapped" and quit bouncing, and went OTJ.

Think "ommmmmmmmmmm". I do And the other thing I do is when Gracie bounces into yellow....we go out and do something FUN for ourselves.

Re: 10/8 Ozy AMPS-340,+2-278,+4-278

Good luck with the dosecrease. I hope it gives you the numbers you're looking for and helps Ozy feel better.

Re: 10/8 Ozy AMPS-340,+2-278,+4-278

Donaleen, I think you have more than a few things on your side, as you can be around a lot if need be (and I hope this need will decrease, so that you can spread your wings a bit more), you're tireless about finding what's going to help Ozy, and you've got some pretty great advice here.

I learn as much from your condo as I do from my own, as we have very similar issues.

I'm lucky right now as my cat is not currently feeling like s***, but he sure did until I put him back at 3u, which makes me think I'm going to ride out whatever this dose has to show me. I don't know, but maybe there's something in that...when you see your cat isn't feeling terrible while weathering a high.

In any case, I wish you and Ozy some good numbers right around the corner.
And Church of Elvis - wow. Here, Elvis is considered to be Quebecois.

Re: 10/8 Ozy AMPS-340,+2-278,+4-278

Your patience pants fit better and look better on you. Mine are too tight!!!!! I can't sit down.

Re: 10/8 Ozy AMPS-340,+2-278,+4-278

Re: 10/8 Ozy AMPS-340,+2-278,+4-278

Thank you, Marje, for the wisdom. Ohhhhhhmmmmmmmm. I will be contemplating what you said.

Ohhhmmmm....334 I am not paying attention to you.... Ohhhhhmmmmm.

And John is trying the calipers as I write....

Re: 10/8 Ozy AMPS-340,+2-278,+4-278

i'm glad marje took the time today to add all of that post. lots of good info there. i understand completely that the high numbers suck.

for me, this has been a lesson in control as well. i like to be in control of my life! and not being able to control punkin's numbers was so out of my comfort zone. We even drove him to Colorado and went into debt to try to control this disease. we did crazy things like both of us driving home from work in the mornings to take care of him. we failed at controlling it, but we did our very best and it did get us 2.5 years after his diagnosis that we wouldn't otherwise have had. in general, i'd say until the last couple of days he had a good quality of life overall. i have to celebrate that and in hindsight, there's nothing i would've done differently - that i could control at least.

i don't say that to minimize what you're feeling or your goals - i agree with you and for a person like you who is home to monitor and understands how it all works, being more aggressive might be just the thing. it's not something everyone is capable of doing, but i think you are. you'll have to find the balance in the dance. i'm just wanting to offer my own experience with it being a little farther down the journey.

i saw Jaime's thanks to you for helping her with Jupiter today - that was really kind of you. some of the most generous people i've ever met have been through FDMB.

hehe i didn't know there was a Church of Elvis in Portland. Figures! :lol: "Keep Portland Weird" how could it be otherwise!?

Re: 10/8 Ozy AMPS-340,+4-278,PMPS-331

Thanks, Julie. You and Marje are helping me be calm. What Marje said, and Libby said, makes absolute sense to me. And what you said brings it on home.

So here is what I am gonna do, just like Marje/Libby said.

"So yes, I would dose to the nadir you want and wait for the numbers to fall into place. If you want nadirs in the 60s (which seems like a good goal), then adjust the dose until the nadirs fall into the 60s. Then STOP. She will eventually start to flatten out. That might take a long time. Once she flattens out, it might be higher than 60s, so you would adjust the dose again to put her back where you want her. If she drops lower than 60s, reduce the dose again to keep her nadirs in that range."

I am going to hold this dose for three days and see where we are. And I will be hoping for your input.

I don't know what happened to what now seems like (and did at the time) a dream September, with lots of good cycles. But I feel that this is the road back to good numbers for us. I want Ozy to go there again. Ohhhhmmmmm.

And thank you, Carl, for helping me think hard about this. And thank you Lara for cheering me on. And Carla, too.

Kisses and hugs to all
donaleen

Great post, donaleen! :YMHUG: :YMHUG: :YMHUG:

One other thing I will add is that sometimes, out of nowhere, our kitties will lose regulation. It's happened to Gracie, it happened to Trixie, Rusty, and others. Sometimes it might be the insulin, sometimes not. And when it isn't something evident, then the important thing is to not get attached to a dose.

I think you won't have that issue just like I didn't. Yes, at first, it's easy to nailbite_smile nailbite_smile because the dose must go up. But guess what? Sometimes we have to go up to come down (I recently did). If we stay on top of that, the dose increase might only be a small amount for a few cycles just to get things moving.

You're doing great and we are here to support you.

Hi Donaleen :smile:
I'm glad that you got great advice and that you feel a little relaxed about his numbers.
Lucy feels sick whenever she is high too.
In mid-yellow, she would not eat, she would not come hang out, she even sometimes vomits.
I always wonder which comes first - being sick brings her BG high, or high BG makes her sick.

I really hope Ozy's number comes down, and he feels better soon.