Re: 9/12 Max AMPS 82 +1 87 +3 53 +4.25 60
max&emmasmommie said:
Ok, trying to understand this -- The Emperor Karre's inverted curves, to describe them, were: Example 1 (
8th September 2008 on Karre's SS) A steep drop from PS until +2 (no food spike) followed by a steady rise to above 100 at +9 and a drop back down to surfing by +11 (a surf that lasted through the next cycle); OR Example 2) (
11th November 2008 on Karre's SS) a surf from PS to about +3 and then a steady rise to above 100 until +8 at which time there was a drop down to the same surfing zone he surfed before +3 (and this surf lasted an entire cycle). I can't post them here, but you can see them in about the 20th post on this thread:
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=78679
Jane, What do you think of this cycle with the 115 at +9 (last night's cycle)? If it's not an inverse curve, can you help me see the differences between what Max's BG did and what Karre's BG did in example 2? Is it the timing of the peak? Or is it the "higher degree of the angle" created by the linear lines on either side of the peak that indicates this is not an inverse curve? (Or both?) In other words, should the rise and drop be steeper for a true inverse curve and anything with a degree of angle that is this gentle is a "surf". Thank you!
Hi Dale
To answer your question in the other condo (7th September), yes, that was a typo, it should read :curve", no "cure". Sorry! And yes, when Karre threw us 3 inverted curves in 3 concecutive AM-cycles on 0.1u of Lantus. Team J as they were known back then (Jill and Jojo) decreed *those repeated inverted curves* to be a collective sign that Karre was getting "too much" insulin, i.e. that Karre was ready to go OTJ. It's always specific to each individual case and cat of course.
Now about Max's cycle with that 115 last night. To me, that cycle (11th September, PM cycle) doesn't look like a *clear* inverted curve (which isn't to say it definitely is *not* one - it's just wouldn't count as an easy-to-define one).
The shave on the preceding AM-cycle aside, Max had been on the 0.25u for a few days already, enough for him to settle into this dose and start showing what his body thinks about it, and as we've covered, inverting curves *can* be a sign that a cat could be ready for another little bit less insulin. Rhythms in cycles shifting as they can (e.g. when the nadir travels), I think the timing is hard to nail down as a deciding factor - as you've seen from Karre's inversions, the peak can happen at (+6) or (+9) or, though that didn't happen with Karre, an hour or two before mid-cycle too. To me, the way Karre's curves were defined as inverted rode on the fact that the rises and drops were relatively steep (8th Sept: Peak 131, Low 68 --- 11th Sept: Peak 113, Low 72, etc.) and
outside that maddeningly elusive factor of meter variance.
As Libby elaborated earlier, inverted curves (especially if they happen only *once* and not several cycle in succession) are 1 factor among others that can help us interpret an SS, and spot trends in numbers and possible changes in insulin needs even when arguably clearer signs (like sub-50 or sub-40 drops) are absent. The 115 in the PM cycle on the 11th was 1 single number in 1 single cycle. It just isn't enough to base a dose change on yet, given the context (green, green, green, and all sub-120 for days). Back around the 6th/7th of September, Max threw several inverson in a row. Looking at that as part of a wave of action in a block of a few days, to me, that *was* a sign of him asking for a dise shave, which he got, and which worked. (This is where my analogy of treating FD being the like the job of an
interpreter comes in - interpret appropriately, and the results show you "got it right" for that specific situation, at that specific time, with that specific cat. Interpret inapprorpiately, and the results will often show that you need to go back a step and think again.)
Max has shown that he *can* demonstrate a need for a dose shave with a run of inverted curves, meaning that if he has *another* run of them, we can think about whether that once again means he could handle another dose shave or dosecrease. Look for trends on the SS rather than singulary evident signs (like a single rise, in a single cycle). He may not dip to sub-50 (Karre never once did that), being that his dose is already so very low. He may go for "1 whole week below 100", or he might throw some more inverted curves, or combine both, or do a whole new thing. I would relax and wait for Max to show more clearly that he's ready for his dose to be re-considered (which in itself doesn't *have* to mean that the dose is changed - just that the SS is looked at again for signs of an impending change in Max's needs and progress). That's part of what I meant in the 11th-Sept thread (and what Libby then reiterated and expanded on too). Just remember, this whole time, that Max is doing spectacularly well and has every chance of making even further progress. We all know what that means. :mrgreen:
I hope this helps?
Hugs
Jane
P.S. You *can* actually re-post images from other threads. For Karre's graphs, all you'd need to do is go to the thread where they are posted (Max's 7th September), right-click on the image, select "Copy Image Location", go back to *this* thread, select the "Image" button (which will put the cursor between the two sets of square brackets automatically), and press "Control" and "V" on your keyboard.
When I started composing my silly answer, your thread had not yet taken on the serious tone... but I took so long to write that by the time I posted , much to my embarrassment, my fluff ended up in the middle of your serious conversation. 
