11/30 Herman amps 115 +5 113 need more juice? +9 92 pmps 92

Yesterday

 

Nice start. I hope you get a blue/green surf today.

 

Definitely would prefer more green! He’s so very flat. He seems happy though so I’ll wait and see. It’s a very very rainy day so my guess is he will stay in bed all day in between the insane number of snacks I’ve trained him to eat from our days of stopping the diving….lucky boy! Need to wean him off all those snacks but boy once it’s a habit it’s hard to break!

 

Wondering if he needs a wee bit more juice. A few factors at play: I started dosing with calipers a few days ago, I think I am getting a *mostly* more accurate dose which I believe to be a hair less than I was giving by eye, and second, I am always left with a significant drop left in the syringe, I did not notice at higher doses but I assume that’s always how it’s been, is this normal? I’ve tried squeezing a bit harder and leaving syringe in longer after pushing plunger but I don’t want to upset Herman, he’s not that easy to give shots to on a good day, it’s a bit of a dance…so I do those things only when I can.
(* I say mostly because I am still struggling with shaking hands and “pushing” past the right dose, squirting out the whole contents by accident at times, refilling, getting bubbles, not being able to get rid of all bubbles, discarding syringe, second guessing…. Bah! ….it’s been a bit messy to be honest, sometimes I stare at the syringe and I swear it looks empty…I’m going through a lot of insulin and syringes, this is certainly not my strong suit! )

But I will get better at it I hope….in the meantime:

Full disclosure…lol I don’t want to increase! Does that make me a bad person? Boy am I enjoying not stressing so much about lows! (My husband went so far as to suggest switching to SLGS for the holiday season so we can get out and do more things, but that really confuses me too, because if a reduction is at 90 where would that leave my current dose? PS I am not thinking of SLGS but I am curious about how one gets to remission on it)…
Anyway again to reiterate about increasing, not my preference..….BUT, if the experts feel I am holding him back by not increasing, I will do it…(or maybe just a mini increase not to a full,0.5?). Otherwise I am happy to carry on and see if he gets better numbers on his own at this dose.

eta, aside from occasional constipation which I am trying to get under control with miralax, Herman is doing great overall! Thought I should add that. His coat looks lovely, good energy, and neuropathy improving greatly!

 

Good morning Amy
How are you finding the calipers? I know it took me a minute to get used to ignoring the lines on the syringes and trusting that the calipers are doing their thing

 

Still a learning curve but I’ll get there! I overthink things

 

I am curious what others think about this When I look at Herman’s SS his numbers look so good I have been wondering if he is ready for a decrease? He does get an occasional blue but these are almost always below 120 which is still considered in the normal range. I think it is difficult for cats to go OTJ using SLGS. I do see some people changing the reduction threshold so they don’t end up stopping insulin too soon. You are doing such a great job with Herman!

 

Thanks! Such a journey - such an investment in time, money, effort and emotions - all worth it! But hard not to wonder, over think and second guess. When I read the protocol sticky I don't think I fully understand it:

• Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.

Is the 50-80 just referring to nadir ("has its lowest BG") or is it ideally that they be mostly within those numbers all day while staying under 100 "overall" (meaning if you average out all the bg's including random blues the number should be under 100)?

 

Lowest BG's are the nadir, so you want nadirs in the 50-80 range, and overall (meaning all) numbers below 100. You could do the odd low blue, but not common. Recently Herman has had some solid blue cycles, so he's definitely not quite ready for that next step down. Reminder: *earning* reductions and starting OTJ trials

What is Herman's feeding schedule now?

If only you could put that drop in Herman instead of leaving it in the syringe. Might be all the extra juice he needs. Could you mark the spreadsheet to show the day you started calipers, and thus possibly a bit smaller dose?

 

Ha ha! I have read that sticky a million times myself! I think the “lowest BG” is definitely the nadir. I think staying below 100 overall just means all readings are below 100- not that a daily average is below 100? I mean you could get an average below 100 with some pretty high readings if you also had very low readings?
It is more strict than the guidelines for remission which allow for a few readings above 100, and of course IDEXX considers any reading below 120 to be normal. Maybe this makes sense that a reduction could only happen if your cat is at the low end of normal.
Anyway, if not now it seems like Herman should be in the running for a reduction soon? I will be following along and cheering for him!

 

Thanks for this! Appreciate the clarification on the staying under 100 - makes sense. I started with calipers on the 25th, I’ll mark it more clearly on the ss. And yes…could it be he just needs that extra drop? I was thinking if anything he needed an increase not reduction, but per my long winded initial post I’m nervous about increasing as well.
As for food, I’ve created a monster. Stems from the days of trying to preempt drops and minimize bounces….it really worked! But now he seeks me out pretty much hourly for a snack, and with the colder weather setting in and him indoors for the majority of the day he’s getting more annoying, when the weather is better he stays outside more and gets distracted with birds etc. He eats less at night though…. I also can’t feed him more at his meals in an effort to keep him fuller longer as he is a major scarf n barfer, too, but not sure that would help anyway, I’m certain the bugging me for food is a boredom busting thing, and less about hunger. He like to be a very active cat so the winter is hard on him. I have an auto feeder I’m just trying to figure out so we will see.

 

He has more blue AMPS than PMPS. AMPS are typically the last to come down, so I was wondering more what his PM schedule for food is.

 

Reposted replying to @Wendy&Neko

 

His pm cycle is typically a snack at +1, 2, 3/4, 5/6 and 8/9. (Where I used / it’s one or the other ie at +3 or 4).

 

Thanks on the food info. I was trying to figure out why his all blue sessions tend to be at night. But nothing leaps out at me. Other than

 

I am following along and commiserating! I also struggle with the last drop in the syringe. Maybe it’s the type of syringe- and sometimes there is nothing left but there usually is. I don’t know how I’m going to get the “drop dose” in him if we ever graduate to that!

I also struggle with the air bubbles. I’ve used different syringes and always had that issue though. But there is probably a syringe that is better for that.

 

Nice to know I’m not alone!