1/20 Cobb PMPS 203 +2 166 +5 166

Yesterday

Cobb is well this morning. Not begging for food, so my times feedings must be working! He did figure out how to turn on the radio on my husband's end table this morning. Thank goodness it was on NPR and not some incredibly loud rock or rap station!!

Question...could the loss of those blue and green numbers be directly related to the missed shot? Meaning the 10unite was good until he went without insulin for 24 hours, thereby giving the resistance time to get in there and now I'm having to increase to get ahead of that? (Does that question make sense?)

Edited to add: since last night it looks like Cobb stayed in the pinks the whole time I went ahead and bumped it up to 11units this morning.

Re: 1/20 Cobb AMPS 293 +3.5 310

Hi guys .. no dosing advice from me but glad to hear the timed feedings are working .. sounds like it's time to move the radio to higher grounds :lol: have a great day guys!

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292

Looks like it's going to be a flat cycle for Cobb today, although he typically drops after +6 so we'll see where the rest of today goes.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292

could be related - but some cats can also get accustomed to a dose and then need more insulin to bring them back to the same numbers. it doesn't really matter though, the important thing is to only stay long enough at a dose to give it a chance to do what it will do, and increase if you're not seeing nadirs that you want.

Good job on the increase this morning. Keep in mind the option of a larger dose increase. at 10u, a 0.5u increase is more like fattening a dose. take a careful look at his spreadsheet and see if you're getting the action you want from a 0.5u increase. if not, try a 0.75 or 1.0u increase and see what that does. cats are different on this and how they respond to increases and the way to decide on Cobb at this level of dose is just to try each and see.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292

Thanks Julie! I went up by .5 so I would get to a whole number in case a 1 unit increase is recommended next. Purely selfish, but those lines are easier to see!!

What do you think will be "easier" at this point? Going up by 1unit and then backing down if earned?

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292

i hate to say it, but it depends on the numbers! don't you hate that answer?! ;-) i know i did - but it really is the kind of thing that you can only decide as you go along.

give this dose 6 cycles to settle and then we can look at it. so if THIS dose takes him to 100 nadirs, then maybe the next dose increase would be 0.5u also.

but if THIS dose takes him only to 250 nadirs, then maybe give a 1.0u dose increase a try.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292

Yes, I do hate that answer! ECID...I'm hearing the C stands for both cat and child, so I'm getting it from both sides right now!! I'll be a patient bean though! :lol:

Julie, Thank you for also helping to clear things up last night. Some of the condos got confusing and out of hand and I know almost pushed me into taking a break like Rebekah. But I know that has been addressed elsewhere as well. It can be frustrating getting advice that comes when you least expect it and it contradicts those who have been helping us on a daily basis. Thank you for being a voice of reason. I appreciate it.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292

Poor Suzanne...I really do feel for you with both a new baby and a big gulping kitty!

You have been doing great though, and although I'm sure you've been ready to run away from home a few (dozen) times, you've stayed strong and are doing the best you can.

:YMHUG: :YMHUG: Big hugs for you

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271

Suzanne --

Please give a cyber-yell if you're feeling overwhelmed or there's too much information coming at you. Julie or one of us can try to step back and summarize. It's so much easier when it's not your cat. The other thing to be aware of is that if you find a post is offensive, if it offers you dangerous advice, if someone is sending you PM messages that you want to avoid dealing with, etc., you can report it. One of the moderators will take a look and potentially intervene.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271

Sienne and Gabby said:

Suzanne --

Please give a cyber-yell if you're feeling overwhelmed or there's too much information coming at you. Julie or one of us can try to step back and summarize. It's so much easier when it's not your cat. The other thing to be aware of is that if you find a post is offensive, if it offers you dangerous advice, if someone is sending you PM messages that you want to avoid dealing with, etc., you can report it. One of the moderators will take a look and potentially intervene.

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Thank you! I'll remember that.

Depending on how Cobb responds to this dose, and if everyone thinks it would be helpful, I might be ready to try some R later this week or next. But talk amongst yourselves first! If I do it, I'd like those of you who have been helping us to be on board. If you don't think it will help, I won't waste the money buying it!

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

Well, that's an unexpected drop Mr. Cobb! Are we going to have an active night since I put the threat of R back on the table? That threat is always there, my furry friend so don't get complacent!

I'll grab a +2 before I go to sleep bit could be a long night. Matty has cut 5 teeth since Thanksgiving!!! And putting him in his crib only leads to him waking up and crying. Anyone have any good tips for alleviating that for a baby bean?

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

I can't help with the baby bean, but I can say that I love this PMPS for Cobb. :mrgreen: Let's see what he can do with it.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

They used to have a gel teething ring ... squishy , soft and cold helped.
I don't know if they still do that. But many babies like popsicles... something to push an opposing pressure on the budding teeth.
And baby appropriate pain relievers.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

I'll copy Libby, no help with the baby but I can cheer on Cobb tonight too.

On increase amounts, you'll find that keeping track of nadirs for a dose and what the resulting increase does will help in the future. Maybe that's a long winded way of saying ECID. :lol: We didn't quite get to 10 units, but Jill suggested a rule of thumb that worked for me, which was .25U increases under 150 nadirs and .5 above that. You might have to tweak either the cutoff level or the increase amounts (.5 vs. 1U) but that's the idea. I've seen Nancy/Pepper get good results sometimes with .25 increases with higher doses than you are on now. And sometimes not. :roll:

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

Jazzy's highest dose was 14.5u. I did 1 unit increases once or twice, but most of the time I stuck with 0.5u. She did well with that. I didn't sit on a dose for long if it wasn't working, though. Jazzy's pattern was that if she was going to respond to a dose, she did it on the 5th cycle. Once I figured that out, if she didn't move on the 5th cycle I increased on cycle 6.

I had heard the same advice to increase in higher increments after 10u, but my health at the time did not allow me to test enough to be comfortable with 1u increases. I was more comfortable with 0.5u. I figured 5 cycles was only 2.5 days, and taking an extra 2.5 days to move up to the next unit was unlikely to cause great harm. It worked for Jazzy, though I'm sure it wouldn't work for everyone.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

Libby and Lucy said:

Once I figured that out, if she didn't move on the 5th cycle I increased on cycle 6.

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Question...as you get closer to the ideal dose, is that when you can see a pattern in when you need to increase? For example, we saw blues by the 3rd cycle at 10units so I held the dose longer than the 4 cycles I had been holding, and two cycles longer than the typical 6. Cobb saw green on the 8th cycle of 10units. He bounced, cleared; and then saw green on the 10th cycle at that dose. On 10.5units, we didn't see anything by the 3rd cycle, so I moved on this morning. Should I have held it a few more cycles? If he is going to do something with his current dose, will (in your opinion) I see it by the 3rd cycle, 8th cycle, or somewhere in between? (Does that make sense?)

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

you're very welcome, suzanne. i've been in your shoes through the chaos, although i think Rebekah had it worse than i did. One of my friends with an acro diagnosis left the board when it happened to her. you're at a vulnerable time when you don't know what's going on with your cat, and even though i knew punkin had acromegaly, i didn't know what was ahead for us. it felt scary to me.

just know that we're here for you.

i will add about the dose increases - i felt some pressure to go to 1u increases when punkin passed 10 units. they unnerved me for whatever reason. i thought i had done a 1u increase on one or two occasions, but i've just gone through his ss and i'm not seeing it. must've been that i considered it, but ultimately didn't. I mostly gave 0.5u increases and if i felt like i was just tweaking, sometimes i did 0.25u increases. It was pointed out to me that the goal was to move punkin's blood sugar and if i was seeing it move with a smaller increase, then there was nothing wrong with the smaller increase! there really are no rules on this and there isn't a protocol to follow.

a cat with iaa often seems to have the effect that Wendy calls "the dose going stale." you increase a dose and get better numbers initially, and then the good numbers sorta disappear and the BG range seems to rise.

punkin only had the acro, not iaa. Beginning in May of 2011, his dose was 7.0u and his blood sugar went up in the 200's and 300's and i'd increase the dose and nothing would change, then i'd increase again and nothing would change. i felt like i was chasing him and he was too far out in front of me. i think i could've increased with a larger dose at that point and perhaps been able to get "on top" of his numbers. This was no doubt a time when the acro tumor (benign) was very active.

We were using a Freestyle Lite at that point and it has since become known as the meter that shows all blues and yellows. Wendy/Neko had one too. it's a very pretty spreadsheet! and it was easier to not see the highs, but of course, they were there even if i didn't see them.

Punkin didn't see a green from June 1 to July 31st. by August 2011 he was at 14u. we had the SRT done in September when he was at 15.5u.

We'll talk about the R. Mostly, I think it's up to you. Cobb is mostly flat, which i think is mostly manageable with the Lantus. Do you like all those "mostly's?" :lol:

Re Matty - wish i were there to give you a break! do you have any luck with orajel or numz-it? can't remember how that's spelled. those cold pack things they can chew on are awesome. none of my kids had too much trouble with teething - either that or time has made those memories fade! that could be - my youngest is 21! besides, you're so tired then who remembers anything afterwards?!

eta - just saw yours and libby's posts. i think it's smart to hold a dose when you're seeing nadirs you like. if it repeats, you keep holding. you give it a "reasonable" number of cycles to see if Cobb's going to stay there, ie, if he bounces from it you wait to see if the bounce is going to clear and he'll return to greens.

if the bounce clears and you don't see greens again, that's when i'd increase.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

I think you'll be able to see patterns better as you go along. Not every cat is as predictable as Jazzy was. :smile:

What I see for Cobb so far:

7u - he moved after 4 cycles, which is also when you increased to 7.5. Was this movement caused by the 7u dose (after the depot filled), or because of the 7.5u? Probably it was more from the 7u than 7.5, since the depot usually does not fill up instantly upon a dose increase.

7.5u - movement was at the end of cycle 3

8u - movement was in cycle 3

8.5u - movement was in cycle 4, but less movement

9 u - no movement to speak of in 4 cycles

9.5 - moved in 1st cycle into 2nd cycle. This may have had depot influence from the 9 unit dose.

10u - moved in cycle 3, stayed pretty good and got even better in cycle 6 and 8. Got a little bouncy after hitting green, but that is understandable. Bounces clearing after 1 cycle, which is great.

10u - possible fur shot on 1/13, recovered in just one cycle but has not quite gotten back to green.

Right now, I would say you would probably get a hint after 3 cycles and would know for sure after 5 cycles (I say 5 because of the movement we saw on the first shot of 7.5u and 9.5u). I think if you see hints of movement in cycle 3 or 4, I would hold on for another cycle or two to see what happens. The red numbers on 1/18 are out of character and might mean something. It's hard to say what, but if it becomes a pattern we can look harder at it.

What do you think? You know Cobb much better than I do, do you have any other observations?

Re: 1/20 Cobb PMPS 203 +2 166

We've got a dropper! :lol:

Libby, I want to give you good response to your post. Can I do that tomorrow when I'm not as tired?

Julie, I understand the "mostlys." Do I like them? No. But I'll accept them. If R is not indicated for Cobb, I'd rather not use it. I guess we'll have that discussion when it is needed.

As for the teething, no on the Orajel. "They" say not to use it on infants under 2 any more. We have done teething tablets and do baby Advil. He won't take a teether. We've done a cold washcloth that he'll use during the day, but not at night. I guess it's just going to be something we have to wait out.

Re: 1/20 Cobb PMPS 203 +2 166

Keep offering the teether. If he figures out it feels good, he may change his mind about using it.

My granddaughter loved popsicles but her mom didn't like the sugar, so she made her own out of various juices. Most WalMarts have molds that let you make your own.

Might be worth trying!

Re: 1/20 Cobb PMPS 203 +2 166

cobbsmom said:

We've got a dropper!

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eta -with BK not every increase provided improved action. Now that I think about it most increases didn't.. . . . :roll:

From where I'm standing, the progress Cobb is seeing looks quite respectable indeed!

Re: 1/20 Cobb PMPS 203 +2 166

Just jumping in to cheer you on! Suzanne, you are doing a great job.
Get some good sleep tonight, if that's possible!!

Ella & Rusty

Re: 1/20 Cobb PMPS 203 +2 166

I just wanted to pop in and offer support. I think you handled yesterday's condo with graciousness. You've worked hard to stay informed and keep a cool head. I think that will go a long way in helping Cobb.

Re: 1/20 Cobb AMPS 293 +3.5 310 +7 292 +9.5 271 PMPS 203

Libby and Lucy said:

I think you'll be able to see patterns better as you go along. Not every cat is as predictable as Jazzy was. :smile:

What I see for Cobb so far:

7u - he moved after 4 cycles, which is also when you increased to 7.5. Was this movement caused by the 7u dose (after the depot filled), or because of the 7.5u? Probably it was more from the 7u than 7.5, since the depot usually does not fill up instantly upon a dose increase.

7.5u - movement was at the end of cycle 3

8u - movement was in cycle 3

8.5u - movement was in cycle 4, but less movement

9 u - no movement to speak of in 4 cycles

9.5 - moved in 1st cycle into 2nd cycle. This may have had depot influence from the 9 unit dose.

10u - moved in cycle 3, stayed pretty good and got even better in cycle 6 and 8. Got a little bouncy after hitting green, but that is understandable. Bounces clearing after 1 cycle, which is great.

10u - possible fur shot on 1/13, recovered in just one cycle but has not quite gotten back to green.

Right now, I would say you would probably get a hint after 3 cycles and would know for sure after 5 cycles (I say 5 because of the movement we saw on the first shot of 7.5u and 9.5u). I think if you see hints of movement in cycle 3 or 4, I would hold on for another cycle or two to see what happens. The red numbers on 1/18 are out of character and might mean something. It's hard to say what, but if it becomes a pattern we can look harder at it.

What do you think? You know Cobb much better than I do, do you have any other observations?

Click to expand...

I wonder if the red on 1/18 was stress induced. My parents, sister, and her two kids were staying with us for the night. That meant double the crying and a loud, hyper 3yo. I did find Cobb had pooped outside of his box, which hasn't happened since, and we found him hiding in the pantry that morning. We think pooped because he felt cornered downstairs.

One of my burning questions is: why good movement in lower doses and then not higher ones? At 10u, we saw a good response until that missed shot. 10.5u...nothing. But now at 11, in the second cycle we're seeing some blue. Is that the resistance we're all assuming Cobb has? Dose going stale at 10u? Logically (I know, the L-word and FD don't go together), it seems you should see some response on a higher dose if you've seen one on a lower dose... even the same response, not even necessarily better! Just curious on your opinion. I know test results might answer that question quickly.

It sounds like, for now, hold the dose at least 3-4 cycles and, if no movement, increase. If past 3 cycles, given the response at 10u, hold through 8, and then reevaluate since the missed shot skews the data from there.