22/2 Chico AMPS 247; +1 211; PMPS 232; +1 178

I keep on looking at the numbers today to understand what gave you doubts, clearly you have a more trained eye to understand the trends so i don't want to ignore your message and wanted to make sure we are not missing anything. Additionally i definitely doubt my shootings as well considering that most of the time when i shoot he is bouncing or just has a weird BG day

I often stare at Chnoudi's spreadsheet and i try to find the same "anomalies" there as we see with Chico and if i manage to find them i calm down Chnoudi was quicker at stabilizing than Chico but he started from lower BG in the first place. What i compared is:
- bouncing "schedule"
- days when they start from a lower PS, go to higher AS and then slowly go lower but not really low

Chnoudi was bouncing for a long period only in the night, which, let's be honest, is much more comfortable than bouncing during the day but he was pretty "consistent" in it just like Chico so that kind of calms me down (at least for now)

Second thing, i can't really understand the days when Chico starts from low PS, goes to higher AS (which makes it look like a bounce) but then lowers again but not too much. I found in Chnoudi spreadsheet on the 30/11/2020 PM Cycle the same trend (sure, Chico gets it more often than that and higher as well), but again for now that kind of gives me peace of mind

I am very grateful that you are looking into Chico's trends and i really appreciate you questioning our methods, we don't want to waste his time for mistakes, so please if you think these or some other trends seem odd let us know and we will look into what could be the cause.

We will start filling the syringes before shooting only

Previous day thread

 

Hi Marina,

I am not the super experienced person you would like, but I thought I would chip in in case ithelps. Chico is definetely a bouncy cat! and it is so frustrating! Chnoudi progression was amazing, but I wouldn't say typical. Look at Casper's SS and you will feel that Chico is not that bouncy after all

Hercules was super bouncy and seemed to have calmed down a bit. Might have been the right insulin, the right dose, or time. We've been at the dance for >6 months. You'll get there!

 

So on 11/30
In the am cycle, the bounce started to clear somewhere midcycle, dipped to blue late in the cycle, but probably didn't clear completely, the duration of that cycle was maybe a bit short so you see the rise to yellow (low yellow), Chnoudi gets his shot, that takes about 2hrs to onset, in the meantime he has had his pmps meal and snacks, so of course the BG rises, onset maybe a bit later than +2 perhaps on this day, as the pm shot onsets you start to see the numbers come down and then go up.

The reason we see this pattern is that though the duration was good, there was not enough overlap of the cycles.
The lantus cycle can last longer than 12hrs, when this happens it 'covers' the time from insulin shot to it's onset, when we start to get duration and overlap that's when we see the cycles level out.

Chnoudi didn't bounce as much as Chico, and she did level out quite quickly.

Have a look at this other ss this is one of a bouncy cat called Ivana, she went OTJ one week before George. She had a tendancy to dive into lime green, forcing a reduction and then the reduction would fail. She bounced all the way OTJ in 2016 it took 7months to get there, she only flattened a couple of weeks before she started her OTJ. Tara had to adopt a different approach to taking reductions to make them stick, and she also tried to mange the curve with food.

George took 6months to get to OTJ, he wasn't very bouncy, he got regulated and then earned his reductions quite slowly, by being a week in solid green numbers. In some ways more similar to chnoudi, but chnoudi just earned them much quicker.

I just always question and sometimes their might be an obvious reason for some pattern we see on the SS, we have seen CG hand over shooting duties to a petsitter or other family member, and found something strange happened and it turned out a mistake was made with the dosing. I didn't think that was the case with you, but the thought popped into my head and that's why I asked the obvious question. Some people for instance find they get a difference in the cycle depending where on the cat they give the shot, scruff or side of body, I can't say I noticed a difference, I used to move the shot round so George wouldn't get sore.

I think that Chico is starting to see better duration, that's why you are now starting to see those lower PS on the PS following a nice active cycle, but I don't think he is getting a significant amount of overlap yet, so he starts of with a lower PS, like that blue yesterday 21/02, his numbers start to rise, from the food and lack of duration and he has also started a bounce so the shot onsets, he drops a little and settles into a yellow bounce cycle. PMPS on 21/02 he spikes to red then dips into flat yellow, some cats give you this spike (high) before they drop into flat yellows/blues signalling an active cycle coming up. When I saw that yellow this morning I suspected you would have an active am cycle, and he did, just when we are thinking 'is there anything different going on?'

What I hope will happen is that when he gets to a good dose you will see better duration and overlap, he will spend more time in low numbers and the bounces will reduce. But even if the bounces don't stop they are not something to worry about, it's his bodies physical reaction to the lower than normal numbers, just ignore those (I know it is hard) and keep looking at the nadirs.

BTW as he saw green on this dose and it's been a while you should hold on to this dose for at least 10cycles, he didn't make it back to green today, but lets give him some time to settle in and see if he gets there.

Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
• when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
• if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
• Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
• Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

 

Thank you very much for your input. First of all congratulations on Hercules progress, looks like he has a real nice progress lately. Can i ask you how can you ensure such fine dosing? we are struggling with making sure 0.25 is consistent )))

Yeah, Chico really likes his bouncing but at least he bounces for 1 max 2 cycles, i see some cats bouncing for 3-4 cycles, that must be very difficult to "ignore".

Thank you for the Casper's SS, this one has much more information to digest ))) I liked Chnoudi's because of the obvious quick progress ))) but mainly because it was easier on my beginner's understanding, clearer progress with change of dosing and so on. I have to start looking into more spreadsheets and Casper's and Herculese's are very good ones to analyze

What insulin di you switch from in December?

 

I am using calipers to dose, It took me a while to get used to it, and it felt a real faff. But as with everything else it is now pretty easy, and I can't imagine going back to relying on syringe marks. Using calipers you realize how much error in the printing goes on. I guess it makes little difference when someone is giving higher doses, but on smaller doses it can make a huge difference.

Hercs was originally on prozinc, and after much moaning I convinced the vet to give us a prescription for Lantus. So much better for him!

 

https://petdiabetes.fandom.com/wiki/Overlap
The above link describes overlap, from it there are links to describe carryover, depot etc, it helped me to visualize Georges cycles.

 

i see what you mean with the overlap and i understand why the numbers go up after the shot.

Thanks for Ivana's spreadsheet, a lot of information there, i thought it was interesting how she went very low at the first shot of increased dose, which forced Tara to reduce the dose when she clearly didn't need a reduction yet. I believe this is what we see with Chico, and i believe that more we approach the correct dose the more "tricky" it will get to not let him dive too low in the second cycle.

we can already see the Chico's cycles flattening with lantus, it is slow but there are less and less red preshots and we are learning to accept the bounces even though they are not nice. i believe it is the price we have to pay for starting at such high BGs.

6 months for George's OTJ is very nice, i know it was already a while ago but it is an achievement which must still keep you happy

thanks for the explanation. i still don't understand though how do they get better overlap? is it gradually getting there or really the correct dose will be decisive? i am wondering if Chico's metabolism is faster than usual and makes it more difficult for him. I was thinking abt it even when he was on caninsulin: there must be cats that are able to function on Caninsulin and he was just swinging from up to down

he had a yellow preshot again so we hope for a nice cycle tonight

 

i didn't understand from the article how people use the overlap to control the curve, the overlap is there or its not, you have to consider with it but to use it:-?

 

Calipers? really? i didn't even know there are such fine calipers, i guess it must be very useful closer to OTJ, when you don't want to jump from 0.25 to 0.

I though prozinc was a long lasting insulin as well, what was Hercules reaction to it? Chico was initially on Caninsulin and he was swinging from 500 to 100 in almost every cycle. Even though he is still not regulated we see much better reaction to lantus

 

Have a look at this thread: https://www.felinediabetes.com/FDMB...he-day-pmps-81-2-77-3-77.240723/#post-2708806

My experience since start using is similar... the "zero" varies by 0.5 units between syringes... so if you are trying to meassure 0.5, that on its own will have a huge effect.

My setup is to have the caliper locked in place while we are at the same dose, always on the counter where there is good light, then I put my phone on top of a cup, and use the zoom function as a magnifying glass. I use to take pictures and zoom in again to make sure it was right.... but I don't do that as much anymore.

Prozinc is supposed to be a bit longer lasting than caninsulin, but no depot. I suspect is the depot action that keeps things less variable. You can have a look at Hercs SS from last year... he was all over the place! I switched mostly to try and get a gentler more predictable cycle. Not sure I got that.... but his number on Lantus are night and day to where they were with prozinc.... but ecid...I've seen some cats do well in prozinc.

 

Following the dosing protocol, you are learning everything you need to know to allow you to safely use the overlap.

Chico hasn't been quite getting the duration so you are not using it yet.
When you start to see him stay relatively towards the end of the cycle with respect to the nadir, that is when you will use the overlap.

So Today, it looks like the depot is giving you some carryover, so some action after the expected 12 hours, because he hasn't shot up to pink or red, but it doesn't look like overlap (or at least much of one) because he came up some 100pts at PS from his nadir, so it looks like the insulin action for the cycle was petering out.
The depot is getting fuller now, and that is giving you some carryover, so that is helping to keep the PMPS down, dipping into blue at +1 could be he onset early, or there may be a little overlap/carryover starting to come into play.

Looking like a nice PM cycle he seems to like the blues, Nice when you start to see consecutive active cycles.

 

Excuse the hijack Marina

Yes it is, and I see hercules has got his depot working on his new dose, I was starting to wonder if he had failed the reduction, I was looking for your condo earlier. Nice pmps.