2/8 Sami PMPS 55; +3 46 - NEED ADVICE

[Tina & Sammy]

Yesterday's Condo

This is the first time in a number of days that Sami has actually gone up for +1. Last night I started giving 2 mini meals at AMPS because she was dropping so quickly in her cycle. I guess I will see how today goes, but I might go back to just 1 MM at AMPS and one a +.5.

Other than that, Sami had another great night. Since mama bean didn't freak out and give HC dry food she didn't jump up into the blue.

She did earn another dose decrease last night so this morning she is on .50 units. Hopefully it will hold and she will stay in the green all day today also.

 

[Nicole & Baby]

Re: 2/8 Sami AMPS 64; +1 74

(((Tina & Sami))) Good morning! Sami is looking no less than the very best, Tina! Yay! So happy for the two of you… I hope you both have a blessed day at the office.. Everything is going so well & I hope this week continues on nicely

 

[Tina & Sammy]

Re: 2/8 Sami AMPS 64; +1 74

(((Tina & Sami))) Good morning! Sami is looking no less than the very best, Tina! Yay! So happy for the two of you… I hope you both have a blessed day at the office.. Everything is going so well & I hope this week continues on nicely

Thanks Nicole, you and Baby will be following in our foot steps soon.

 

[Tina & Sammy]

Re: 2/8 Sami AMPS 64; +3 47; NEED ADVICE

Here is a recap of the last few days:

Thursday: Dose 1.25 Units. Sami earned a decrease during her PM cycle

Friday: skipped morning dose because she was 46 at shot time; PM cycle reduced to 1 unit EARNED DECREASE #1. Sami remained under 100 all day even though no shot was given in the AM.

Saturday: at 58 at AMPS but shot 1.0 and she earned another reduction to .75 EARNED DECREASE #2; For her PM cycle Sami was low again in the 40's so I was reluctant to shot so I only gave .5 units instead of the .75 that she earned. We battled a low for 5 hours that night. Also note that Sami was given HC Dry food in both her AM and PM cycle today. I don’t know if technically she earned an additional decrease, but I didn’t give one.

Sunday: I shot the .75 that she had earned in the AM cycle on Saturday because I was figuring that the PM cycle was clearing out some of the shed, and because she was still a little high from the HC dry given the day before; PM Cycle shot the .75 units and by +2 she was at 47 so EARNED DECREASE #3

Monday: This morning Sami got her newly reduced dose of .5 Units and at +3 she is at 47 again, and at + 6 she is boarding on dropping below 50 again. EARNED DECREASE #4

So in summary, in 4 days Sami has earned 4 decreases.

Now my question is, do I give a dose of .25 tonight, or are all these lows and decreases telling me that Sami's pancreas is working on it's own. I don't know what would happen if I started an OTJ trial. I really don't want her to relapse, but all the testing is really taking its toll on her poor little ears. I don't have a problem continuing to reduce the insulin, but I just wonder if that is what we should do.

So please advise our best option in this situation. Thanks.

 

[Ronnie & Luna]

Re: 2/8 Sami AMPS 64; +3 47; NEED ADVICE

Looks really good for Sami,
let's see what the more experienced ones have to say thru the day!
They can give you the best options for a successful (antijinx) path to take.


:mrgreen:

 

[Spacey & Ella]

Re: 2/8 Sami AMPS 64; +3 47; NEED ADVICE

As I understand it it isn't wise to just stop, but one should go down step by step. Because the shed needs to decrease slowly.
Something like that.

So you would go to 0.25 this evening.
The next step is 0.1.
If you for two weeks in the green holding 0.1 you can start OTJ trial.
Not earlier.

Good luck!

 

[Tina & Sammy]

Re: 2/8 Sami AMPS 64; +3 47; NEED ADVICE

As I understand it it isn't wise to just stop, but one should go down step by step. Because the shed needs to decrease slowly.
Something like that.

So you would go to 0.25 this evening.
The next step is 0.1.
If you for two weeks in the green holding 0.1 you can start OTJ trial.
Not earlier.

Good luck!

Okay, but what happens if Sami goes below 50 and she is at a dose of .10 units?

 

[Tina & Sammy]

Re: 2/8 Sami AMPS 64; +3 47; +8 55; NEED ADVICE

Sami has been surfing the 50's all afternoon. I plan to get a +10 shortly, but I am still a little confused as to what I should do tonight.

Should I go ahead and give the .25 dose or not give a dose and try OTJ. I know a lot might change with your glucose between now and PMPS, but I am still wondering if all the decreases the past few days should be coming this fast and if her body is doing most of the work.

Also, on the protocol, when do you go from Phase 3: Holding the Dose to Phase 4: Reducing the dose.

Phase 3 says if the BG is <50 reduce the dose by .25
Phase 4 says if the BG is <40 reduce the dose by .25 or if the BG is 40 - <50 at least three times on separate days reduce the dose by .25

How do you determine if you should be reducing when the BG falls below 50 or if you should wait until the BG falls below 40?

 

[Chris & Mally]

Re: 2/8 Sami AMPS 64; +3 47; NEED ADVICE

With Mally, even though she was earning decreases one after the other, I continued to take her down one step at a time. The last step was when she was on the .1 dose and went down 40 during the third cycle of that dose. After that some suggested that I try the one-drop dose for a while, but I didn't feel confident that I could accurately measure that type of dose so I opted to stop her shots.

Tonight Sami gets the .25 dose for her PM cycle. I think you will have to monitor her closely and see where this dose takes her. You mentioned in one of Nicole's condos that Sami had been on insulin before and you thought she had gone into remission only to find that she had to go back on it again. I don't know what type of protocol you followed the last time but hopefully this time around when Sami goes OTJ it sticks and she can stay in remission.

 

[Tina & Sammy]

Re: 2/8 Sami AMPS 64; +3 47; NEED ADVICE

With Mally, even though she was earning decreases one after the other, I continued to take her down one step at a time. The last step was when she was on the .1 dose and went down 40 during the third cycle of that dose. After that some suggested that I try the one-drop dose for a while, but I didn't feel confident that I could accurately measure that type of dose so I opted to stop her shots.

Tonight Sami gets the .25 dose for her PM cycle. I think you will have to monitor her closely and see where this dose takes her. You mentioned in one of Nicole's condos that Sami had been on insulin before and you thought she had gone into remission only to find that she had to go back on it again. I don't know what type of protocol you followed the last time but hopefully this time around when Sami goes OTJ it sticks and she can stay in remission.

Chris, yes, before Sami was on vetsulin and she was only on it for 3 weeks, and then we took her off completely for about 4 weeks. When her glucose went back up again we put her on Lantus. I also hope that if Sami does make it to OTJ it stick this time. I think the diet change will be the key. When she was on insulin before and for the first two months of Lantus, Sami was on a 100% HC dry food, and she was free feeding. Now she is on 100% LC wet food with a more structured meal plan. I think this new diet is the key to what we are seeing with Sami's numbers. The first two months on Lantus we were really struggling to get her numbers down, but as soon as we switched the food we saw improvement. Since we went to the mini meals Sami has only seen GREEN, except those few blues because mama bean gave her some HC DRY.

 

[Libby and Lucy]

Re: 2/8 Sami AMPS 64; +3 47; +8 55; NEED ADVICE

Here’s what I would suggest:

Take a couple of steps back from the computer and kind of squint your eyes and look at Sami’s spreadsheet (here is where the colors come in handy). What do you see? I see about a week’s worth of GREAT numbers, and I see yellow less than a week ago and pink 10 days ago. Sami was previously OTJ, correct? IMHO, she would benefit by being kept on insulin for as long as possible so we can get her as far away from those yellow/pink numbers as we can. How long will that be? It’s up to her! Did you read this post I made to Paige a few days ago? viewtopic.php?f=9&t=5359 That should be your goal too, to give Sami’s pancreas as much healing time as possible before putting her out on her own, to have the best possible chance at a remission that will stick.

Basically my advice is to do the best you can to feed her curves, and don't rush off of insulin. You're sooooooo close, just push through for a little while longer. Trust me, we've had cats get into their countdown and have to go back on the juice in the middle of the countdown (or shortly thereafter), and there is nothing we hate more than seeing somebody have to abort their OTJ trial because it isn't working.

 

[Jill & Alex (GA)]

Re: 2/8 Sami AMPS 64; +3 47; +8 55; NEED ADVICE

Here’s what I would suggest:

Take a couple of steps back from the computer and kind of squint your eyes and look at Sami’s spreadsheet (here is where the colors come in handy). What do you see? I see about a week’s worth of GREAT numbers, and I see yellow less than a week ago and pink 10 days ago. Sami was previously OTJ, correct? IMHO, she would benefit by being kept on insulin for as long as possible so we can get her as far away from those yellow/pink numbers as we can. How long will that be? It’s up to her! Did you read this post I made to Paige a few days ago? viewtopic.php?f=9&t=5359 That should be your goal too, to give Sami’s pancreas as much healing time as possible before putting her out on her own, to have the best possible chance at a remission that will stick.

Basically my advice is to do the best you can to feed her curves, and don't rush off of insulin. You're sooooooo close, just push through for a little while longer. Trust me, we've had cats get into their countdown and have to go back on the juice in the middle of the countdown (or shortly thereafter), and there is nothing we hate more than seeing somebody have to abort their OTJ trial because it isn't working.

i couldn't agree with libby more. looking at the numbers, doses, etc., if sami were my cat i would be shooting 0.5u tonight. libby feels the same. however, that doesn't mean she won't earn another dose reduction tonight. take a look at alex's levemir ss (link in my signature). that's what you'll want to see before attempting an OTJ trial...

 

[Tina & Sammy]

Re: 2/8 Sami AMPS 64; +3 47; +8 55; NEED ADVICE

Sami was previously OTJ, correct?

Yes, as I mentioned to Chris in an earlier post, Sami was on vetsulin in September for 3 weeks. But so much has changed since then, primarily her diet. Within 12 days of converting Sami to a completely LC wet food diet she started to see some improvements. This was also the same time that we got to her highest dose. Then immediately after we implemented the mini meals Sami completely stabilized and she hasn't see a number over 100 since then. Other than the few blues on Saturday and Sunday morning, but as I understand it that was caused by the HC dry food I gave her.

I did shot a .25 tonight because I didn't have a chance to check the posts before I gave Sami her shot. I guess we will see how it goes tonight. If she doesn't surf the 50's tonight like she has been the last few days then I will go back to .5 tomorrow morning. If we do go back to .5, at what point do we decrease to .25?

 

[Nicole & Baby]

Re: 2/8 Sami AMPS 64; +3 47; +8 55; NEED ADVICE

*Boo* droppin thru too check on you & Sami.

High hopes for a beautiful evening & future ahead :YMHUG:

 

[Tina & Sammy]

Here’s what I would suggest:

Take a couple of steps back from the computer and kind of squint your eyes and look at Sami’s spreadsheet (here is where the colors come in handy). What do you see? I see about a week’s worth of GREAT numbers, and I see yellow less than a week ago and pink 10 days ago. Sami was previously OTJ, correct? IMHO, she would benefit by being kept on insulin for as long as possible so we can get her as far away from those yellow/pink numbers as we can. How long will that be? It’s up to her! Did you read this post I made to Paige a few days ago? http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=5359 That should be your goal too, to give Sami’s pancreas as much healing time as possible before putting her out on her own, to have the best possible chance at a remission that will stick.

Basically my advice is to do the best you can to feed her curves, and don't rush off of insulin. You're sooooooo close, just push through for a little while longer. Trust me, we've had cats get into their countdown and have to go back on the juice in the middle of the countdown (or shortly thereafter), and there is nothing we hate more than seeing somebody have to abort their OTJ trial because it isn't working.

Libby, did read this post before, but I just re-read it. And I am assuming that you want me to try to feed Sami so she doesn't fall below 50. Is that correct?

The thing about it is, I think I have been doing that. Sami gets food every hour for the first 4 hours of her cycle and she still falls below. I have tried to feed only LC food by she continues to drop. Again tonight even on .25 units Sami has fallen below 50 at her +3. I just gave her some HC food to bring her back up. I know from previous experiences that LC doesn't do it for her so once she is below 50 I have to give her HC food or she will just continue to drop. Even when I let her eat an entire can and a half of LC food a week ago she was still dropping.

So I pose the question yet again. Do I continue at .25 and try to keep her above 50, which might mean feeding her HC food at +2 instead of LC. Or do I give her yet another decrease to .10 and see where she goes from there.

I totally understand keeping her on insulin as long as possible, but I don't want to risk her going below 40, and seeing how she has gone below 50 in just about every cycle since Thursday it just seems like she might be ready to take off the training wheels.

Here is a different look at the last few days.

Thursday PM Cycle - Fell below 50
Friday AM Cycle: Skipped shot completely and still was below 50 for the first 2 hours of the cycle
Friday PM Cycle: stayed above 50; previous shot skipped
Saturday AM: fell below 50; had HC Dry and was below 50 before PM shot
Saturday PM; fell below 50 after PM shot; even with a reduced dose
Sunday AM: Stayed above 50; reduced dose for previous shot
Sunday PM: fell below 50
Monday AM: fell below 50
Monday PM: fell below 50

So in summary, she fell below 50 in every cycle, except the cycles where the previous cycle had a skipped dose or a reduced dose other that what she was on at the time. And twice since Thursday she was below 50 at the time of her next shot. Friday Am and Saturday PM.

So please help me decide what I should do. I want to give Sami time to heal, but I don't want to take unnecessary risks.

 

[Ronnie & Luna]

Not advising, just talking out loud
I'm kinda wondering if she might benefit from MC food instead or at least a higher LC than what u are using.

I know we had to do that when we were on EVO (2% carb) it was dropping Luna too soon, even if I did feed him, so we went up to Wellness (4-6%) still considered LC but not as low as EVO, the slight rise in carb stuck.

I'd like to know what Jill might think about what Sami is doing. yup yup :mrgreen:

 

[Tina & Sammy]

'm kinda wondering if she might benefit from MC food instead or at least a higher LC than what u are using.

I have tried to get Sami to eat some MC food, but she just doesn't like it. She doesn't seem to like anything with the gravy other than this one HC food that I have been getting. I did pick up some different HC food today that is minced, which is what she prefers, but I haven't tried it yet. When I do give the HC is is about a half a teaspoon, if it is even that much. My only intent is to bring her back up over 50, and in most cases the tiny bit of HC I give her usually does the trick. All I know is that in the past when she has fallen below 50 when I have given LC she doesn't come up she just continues to drop. The HC will usually bring her up to the mid 50's and even after that she will usually drop back down a little, but most to the time it isn't below 50 again. At least that has been the case after the last few dose reductions. A few days ago when she was at 1.25 and 1.0, she fell below 50 multiple times within the same cycle, even after having HC food.

 

[Tina & Sammy]

I know we had to do that when we were on EVO (2% carb) it was dropping Luna too soon, even if I did feed him, so we went up to Wellness (4-6%) still considered LC but not as low as EVO, the slight rise in carb stuck.

By the way, I do try to very the food that Sami gets. Most of the food she has been getting has been between 2-4% carb. I mark the top of the cans with a marker so I know what the carb content is without having to look up on the list. I could try giving a slightly higher carb content, but in the past I haven't noticed much difference in numbers. But that was before we switched the mini meals and before she was ALL GREEN. I do have some different foods that ar4 6-8% carbs that I could try.

 

[Jill & Alex (GA)]

just something i'm going to throw out there for your consideration...

one dose can affect up to the next 3 days worth of doses. in other words, the dose 0.25u dose shot tonight was not working alone. it had the residual effects of the prior higher doses working with it, kwim? libby's already explained how and why you want to hang onto a dose as long as possible. having said that, you have to be comfortable with whatever dose you're shooting...

 

[Libby and Lucy]

Sami is your cat, you can try 0.1 if you want to. It might work.

Don't forget that Lantus has a shed, so the effects you see on each cycle are affected by the last several cycles. In other words, tonight's 0.25 cycle isn't a "pure" 0.25, it has a lot of effect from the 0.5 cycle this morning, and also from yesterday's 0.75. Sami has gone from 1 unit to 0.25 in two days, so the shed is very over full right now. We don't know what will be left when the shed finally catches up with us. It may be that Sami DOES need a smaller dose, or it might be that she'll be left with too little insulin. Even if you shoot 0.1, or even if you skip, Sami will probably stay low for at least a cycle or two because she'll be running on shed action, before we see what's left once the shed drains. That's why I suggested food as a way to keep her numbers steady while we try to get ahead of the shed.