07/05 Abbott PMPS 432, 3rd bounce --TR

AbbottTheCat

AbbottTheCat

Member Since 2022
https://www.felinediabetes.com/FDMB/threads/07-04-abbott-pmps-361-2-209-4-90-5-84.265402/

PMPS 432, this is his 3rd bounce this week. I am feeding the PM lows into the greens to keep him surfing but he always bounces back up. I'm not sure what else I could be doing but open to suggestions.

I had a question about TR and bounces. The method states that you hold the dose for 10 cycles when you see nadirs under 100, I am doing that, tonight will be the 8th cycle.

Let's say I hold the dose for 10, a reduction or increase has not been earned. Still bouncing into let's say after 15 cycles. Still no reduction or increase earned. What's to say that this can't go on forever. At some point would you step outside of the guidelines and increase the dose? Or would you try something else? What would this look like?
 
With TR you can increase on a bounce. It’s just not best to increase on a bounce clearing cycle because you can get extra momentum and have to keep chasing the bg to prevent a drop. If you don’t see blue or green tonight you can increase tomorrow morning.
 
Ok, let's say I don't see blues or greens tonight and I increase tomorrow AM, then I get a bounce clearing PMPS let's say under 200. Would I shoot that increased dose?
Since this is not discussed in the TR dosing sticky, could you provide some more info? Maybe an example, or a link to a thread you know of?
 
You would not be increasing on a bounce clearing cycle at that point as it would be the second cycle on the new dose. If tomorrow morning the amps is low yellow or blue then don’t increase as that might be a bounce clearing cycle. The Ted tonight could be the high before the bounce starts to clear so if the amps is lower hold the dose again tomorrow.
 
AbbottTheCat said:
Let's say I hold the dose for 10, a reduction or increase has not been earned. Still bouncing into let's say after 15 cycles. Still no reduction or increase earned. What's to say that this can't go on forever. At some point would you step outside of the guidelines and increase the dose? Or would you try something else? What would this look like?
Click to expand...
Not sure what you mean about increase not earned? You would not hold the dose for longer than 10 cycles if the nadirs are not in the range you want them to be in. If, after he clears a bounce, you see nadirs in the 50s or low 60s, you would hold the dose. If not, you have room for an increase. Like Elise said, tonight's red might be the high before the bounce breaks and you could very well have a yellow AMPS. If that is the case, hold the dose and see what he does in the AM cycle. That nadir will determine whether you continue to hold or increase (or reduce if he earns a reduction).
 
Ok so I know a bounce has cleared when I get a drop from red to yellow? Pink to yellow? What exactly is the metric for a bounce clearing?

And regarding increase let’s see if I’m understanding you:
During a bounce I do not increase because don’t want to add momentum to bounce clearing?

When bounce clears I look at the very NEXT cycle’s nadir and THAT determines if I increase or hold?

“”If, after he clears a bounce, you see nadirs in the 50s or low 60s, you would hold the dose.Ifnot, you have room for an increase””

…so increase even if I see nadir under 100? Let’s say 90.

I apologize if this isn’t crystal clear, the dosing sticky leaves room for interpretation:

“”when your cat starts to see nadirs under 100””
does not make mention of wether this would be a sampling of cycles or the CURRENT cycle.
Reading between the lines but could I translate this to mean: hold the dose for 10 days UNLESS you see a SINGLE cycle nadir over 200 that IS NOT a bounce?

I can’t be the first one to point out this grey area :)
 
You can increase during a bounce. The only time not to is the bounce clearing cycle. There are lots of gray areas with fd. That’s why you will see people say know your cat. They don’t all react the same way. Your data will guide you. The goal with TR is fir your cat to be in mostly normal numbers 50-120.
 
Well at any rate I will continue to ask for help when I need it. Sometimes it’s hard to gauge if I’m making progress or spinning my wheels but I will keep chipping away until we get there.
 
AbbottTheCat said:
Ok so I know a bounce has cleared when I get a drop from red to yellow? Pink to yellow? What exactly is the metric for a bounce clearing?
Click to expand...
That depends on where your kitty is on the road to regulation. When a cat is in much higher numbers and bounces from yellows, going back to yellows would indicate bounce clearing. Abbot was seeing blue nadirs at 1U so going back into blues or lower would signal bounces clearing. Abbot seems to be a cat that nadirs at the end of the cycle when clearing a bounce and then gives you an active cycle in the next one. For example 6/24, 6/30, 7/1, 7/3, 7/4. So the bounce clearing is spread over 2 cycles. Since there are always exceptions to everything (especially in FD which is non-linear and often inexplicable), there are times when he has cleared the bounce in one cycle - like 6/25. Tonight's cycle looks like the former. He might nadir at AMPS and give you an active cycle tomorrow. Or he may not - just to prove me wrong - they like to do that.


AbbottTheCat said:
When bounce clears I look at the very NEXT cycle’s nadir and THAT determines if I increase or hold?
Click to expand...
This would depend on whether the bounce clearing is spilling on to the next cycle - like I explained above. If his PS is the nadir of the previous cycle, it's possible he will give you an active cycle in the next one.


AbbottTheCat said:
…so increase even if I see nadir under 100? Let’s say 90.
Click to expand...
Yes. The aim of the TR protocol is that the cat be "Tightly regulated" which is defined as "generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin". In practice, you want the cat to spend as much time in normal numbers as possible, with nadirs in the 50-80 range. You are looking for a combination of nadirs and duration. Some cats run lower than others while others will hang out in the higher end of the normal range.

Abbot has seen a nadir of 66 on 1.25U. If his nadirs start trending higher you want to increase the dose.


AbbottTheCat said:
I apologize if this isn’t crystal clear, the dosing sticky leaves room for interpretation:

“”when your cat starts to see nadirs under 100””
does not make mention of wether this would be a sampling of cycles or the CURRENT cycle.
Reading between the lines but could I translate this to mean: hold the dose for 10 days UNLESS you see a SINGLE cycle nadir over 200 that IS NOT a bounce?

I can’t be the first one to point out this grey area :)
Click to expand...
The logic behind linking nadirs to increases is that you can be more aggressive in dosing at higher numbers. With nadirs over 300 increase by 0.5U and increase every 6 cycles. Nadirs over 200, increase every 6 cycles but increase only by 0.25U. Nadirs below 200 and 100, increase every 10 cycles. When we speak of nadirs, we speak of them in the context of the current dose.

AbbottTheCat said:
Well at any rate I will continue to ask for help when I need it. Sometimes it’s hard to gauge if I’m making progress or spinning my wheels but I will keep chipping away until we get there.
Click to expand...
Please do. :) Of course you are making progress. He is seeing stretches of green more frequently, clearing bounces faster, no longer bouncing to blacks and reds (as much).
 
Thank you! That was all a real eye opener for me, especially about his bounce clearing tendencies, I think you hit the nail on the head with that. I learned a lot from your reply and still learning from everyone here. It's a steep learning curve but I think we are up for it. good night!
 
You must log in or register to reply here.
Back
Top