7/27 Harley AMPS 256, +5 297

Morning,

I'm glad to see a yellow. I will be getting a mid cycle test today. I'll post after lunch.



Yesterdays News
viewtopic.php?f=24&t=20740

 

Re: 7/27 Harley AMPS 256

yes, and a nice shade of yellow it is!

 

Huummm. +5 297? Could be a food spike, he does free feed and he wasn't in his usual spot when I got there.

 

HMMMM, yes that is interesting.....like he did'nt pick up that dose. sure it was'nt a fur shot?
well, as dissapointing as it is, and strange, lets see where this goes.

 

No it wasn't a fur shot, I always check. Tonight will be interesting.

 

I don't want to beat it to death (well maybe a little bit) , just curious why you aren't shooting something pretty close to 1.4? I totally support you doing what you need to to make sense of all of it and get the data you need, I certainly did that myself along the way. I'm just wondering if maybe your concerns are something that can be addressed without losing progress.

Like maybe you are worried about hypo? Or maybe there are things in the #s that I can help you make sense of?

To me the data looks fairly clear. There are some cats where the #s are all over, or are inconsistent, and it's confusing and hard to know what to do. When I look at Harley's #s I don't feel like he's in that category. Yes the #s move around a little, but it makes sense to me what is going on when I look at the #s relative to the doses - for the most part the #s look explainable to me, with reasonably clear cause & effect. I hate to see you possibly lose ground when to my eyes you are super-close to really good #s, and the dosing to me looks clearcut as to what to do.

Sorry if I'm being a pain about it, I just want to help if I can. If there's anything that I can explain, or fears like hypo that I can help you tackle, just let me know.

 

Thanks Joanna, I thought you had to hold a dose for 3 cycles. But there is always that unless. I do worry about hypo's because I work full time and can't get a mid cycle test everyday.

When looking at his ss he always goes high after having a good day so I was thinking that I had been a) raising the dose too fast pr b) It was too much insulin.

I'm off to the shower, I'll check back in a few.

 

well, today did'nt go so well so i'm inclined to agree with joanna but 1.2.
joanna i so hate to dissagree with you, sometimes i wish we had 'go to meeting.com' so we could all study ss together and discuss our experiences at the same time.
I think today's +6 was a total abberition(?)
sooooo...
pick your # robin and i'm sure you know you have our most heart felt support.
no hard feelings for disagreeing joanna, i hope? i jhave nothing but respect for you. just seeing it a bit different.

 

Seriously, is it 3 cycles or 3 days, the start low and go slow says 1 week and I can't find anything on the Prozinc website that gives any real information about duration, etc.

I was a little panicky at first and wanted him regulated and otj NOW. But I'm realizing that the second time around might be harder than the first. I know, I know, it's a marathon not a sprint. That has finally sunk in. But the protocol 1 year ago was much different than it is today.

I was afraid that by upping the dose every 3 cycles I may have zoomed past the perfect dose by not letting it settle long enough. (So back to "Seriously, is it 3 cycles or 3 days" I don't remember) I was afraid that by upping the dose every 3 cycles I started a roller coaster ride that you can't get off of.

So, any and all advise and explinations of why are sincerely appreciated. I keep going back over the previous advise given hoping that it will stick in my long term memory.

I will keep reading.

 

No worries Lori, I think it's good to have open discussion, and the more we can get the interpretations out there, the better I think it is for everyone! Today's #s just look to me like not enough insulin. I think his body has already decided 1u doesn't give it enough of an insulin high. :mrgreen: (to use your (was that you?) drug addict analogy...)

The million dollar question! :lol: Everyone has their own view really. PZI's flexibility is awesome, but it can be a headache in some ways. In my mind, you can change the dose with every shot if you want. I don't usually recommend that when people are starting out, b/c it's a nightmare to interpret the data if you are doing that, and it can be hard to get good results. But for those who can make it work, it can be useful. To me the value in holding a dose is to allow any possible overlap to build up. Some cats get some, some don't. For Bix, I would often see better PSs by cycle 3 of a new dose, so I liked to hold for 4 cycles before raising again (and his breakthrough moment came on cycle 4).

You can throw out the 1 week in SLGS, I think everyone will agree on that. That is old-school, and also I think SLGS says you are getting curves at the vet, so it's not even talking about home testing, where you can see each day what the dose is doing and make decisions.

I think sometimes we end up confusing people on things we agree on more here than it sounds like (maybe?). I think for the most part, we all agree that if a dose does not appear to have stabilized out - maybe PSs are improving, or nadirs are improving - then you should continue to hold that dose. If it's crystal clear that a dose isn't enough after a few days and there are no signs whatever of progress, then it's time to raise. I usually say 3 - 5 days, moving faster (raise every 3rd day) if your cat is not doing well, and if you have ketones you may need to go even faster than that.

The point IMO of waiting say 3 cycles on a dose is not because you CAN'T raise faster than that, it's b/c the results may improve on cycle 2, 3, or 4 (or possibly later). So unless you have ketones, why not wait and see before raising. But there's nothing IMO technically wrong with raising faster, you just need to be on the lookout for dramatic improvement in the #s, and I don't think most people want that stress.

And for most people, I wouldn't push to go as fast as 3 cycles unless their cat is really not doing well. If someone wants to wait 5+ days and their cat is doing ok, go for it. The reason I am pushing with Harley is b/c you got some great #s on 1.4, and I'm so excited about that LOL that I don't want to see him get stuck in pinks & yellows when the blues are right there for the taking (not saying you should be shooting quite as much as 1.4 though).

That is liver-training. They see good #s they aren't used to and their liver freaks out. Raising the dose slower won't help as far as I know - the only thing I know of to get them through liver training is to force them to stay in good #s for extended stretches of time, and then the liver starts settling down.

If however you saw high #s after a true hypo #, or after a really sharp drop, that could be real rebound rather than liver training, and a sign the dose is too high. I haven't seen that in Harley's #s.

That can happen, but you would see it in the #s. You would either see rebound #s, or you would see highish flat #s. There might be other patterns too. But I don't see that in Harley's #s, because you are seeing a great response on 1.4, and then you can see where you pull back to 1.2 say, that the response isn't as good, and then when you shot 1.4 again you got a pattern suggesting the dose is a hair too high (+12 lower than mid-cycle #) but you still got good action. To me it confirms that 1.4 is the closest you've seen to the right dose for him, but is a tiny bit too high. I'm not seeing any roller-coaster in the #s.

 

p.s. On the hypo question, I agree that if you aren't home to monitor, it makes sense to be a little more conservative in what you shoot. Since I'm home too much I forget not everyone is, sorry about that. One thing you might want to do is pick a dose that seems close, but no scare factor to it, maybe 1.2 or a fat 1.2, and shoot that for the rest of the week (lowering of course if the #s were to earn him a decrease). Then you could experiment a bit more on the weekend (if you are home), and see if something like a fat 1.3 or skinny 1.4 works better, when you know you can test more - maybe start a new dose Friday night and then see where you are by Sunday.

I don't recall if Harley free-feeds or not? If he does, or if you use something like a food timer, it takes a little of the hypo fear out of it, b/c if you were to overshoot by a little, nature will generally send him straight to the food bowl. If he doesn't have that option though, then yes I would want to shoot a little more conservatively so as not to risk putting him too low.

 

As far as the week to settle thing i think that only applies to the very first week you are on insulin.
as far as dose changing. I still think shoot the #. That's my philosphy and it's the old school way of handling it. I think human diabetics shoot the # don't they.
this means it all gets real easy. high # larger dose, low # lower dose.
the only time this does not apply (and we discussed this) is if the pmps is lets say lower than the +6...at that point since you may still be going down you would either wait and test again or def. lower dose. you just never know when pancreas is going to take over again.
so that is where the cheese stands alone. I'm all for sliding scale if by that it means shooting the #.
your plan was to shoot 1unit for everything except under 200, then slide scale under that. all the way to micro doses at 130.
I think today was some aberition so you could keep your 1 u for another round to double check or you could go 1.2. i think giving 1u one more day would clarify alot.
thank you for listening.
joanna, i feel like robin is our new angela and harley is the new pzi poster boy!

 

shoot the # works for me too Lori if Robin is up to it... I got lost though that she has decided on a sliding scale approach... did I miss a post somewhere, or maybe the scale is in the SS? I don't have any issue with a scale, but I think the doses are too low - she shot 1.2 on a PS something like 170 (7/22) and got flattish #s, so to me that says any PS there or higher needs more than 1.2....

I would also keep a 150 NS (or Robin, are you still using a no shoot higher than that, like 180? that is fine too) - the dosing still seems too uncertain to me to tackle riskier shooting, and he's not having any issues so far with rising as far as 150, so I'd still wait for that to shoot on if it comes up...

just my 2c

 

oh she has'nt agreed to sliding scale, only when under 200. she had shot rather large doses into small #'s just to keep a steady dose going, and i suggested at least to slide down when that happens. like 180--.8 150--.5 i even said 130 .2
you think thats too dangerous? I did'nt think .2 could do any harm as she would have to drop 90+ points to hypo, and yes harley does free feed, he's a grazer.

 

ok, I got cha... I can't imagine that would be a problem at a 130, personally I'd let the PS rise some and shoot a bigger dose though since I think on anything under 1u he'll probably just go high like on that last 0.5 shot... but up to her how she wants to handle stuff like that, that's just how I'd do it - I shoot lower #s for Bix, but it's b/c he rarely zooms so it's a matter of hours usually before he would be shootable...

 

sent you a pm joanna