Opie and the Learning Curve

Discussion in 'Prozinc / PZI' started by LovingOpie, Jul 3, 2023.

  1. LovingOpie

    LovingOpie Member

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  2. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I see Opie is back to work today.
     
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  3. LovingOpie

    LovingOpie Member

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    If you mean Opie is clearing a bounce then yes, but the way I see it, Opie could be back to work when he does a bounce since it is what he does well.
     
  4. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I saw a nice blue on his SS and was happy. Now I see he spent even more time in blue since then.
     
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  5. LovingOpie

    LovingOpie Member

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    Opie went BLACK at +2!!! I am very upset to say the least. . . he ate 3/4 can FF LC 3% between AMPS and +2. This must be a HUGE bounce.
     
  6. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Ugh, Opie. What are you doing up there? Let’s just hope this is the high before the break. It can take up to six cycles to clear a bounce and sometimes, we see a high BG right before the bounce clears so be on alert for that.

    I’m thinking, unless Opie astounds us during a bounce-clearing cycle and then we will just have to see, he’s going to need a dose increase tomorrow morning.

    I know you have said (I think I’m remembering this correctly) that you don’t want to switch insulins. However, Opie has been on PZ a while and it might be time to think about switching. Our gurus before us, Jill and Libby, used to say if you don’t see really good response from an insulin in six months, it might be time to switch it up. When you finish what you have of PZ, I’d suggest switching.

    Personally, I loved Levemir and many do but you have to decide if the action times of the insulin fit your life because it generally insets closer to +4 and nadirs +8 - +12. I found it to be even gentler than Lantus and Gracie did much better on it. It does teach you to shoot lower (always above 50 or 90 for those doing SLGS) because the nadir could be at PS. Also, Gracie could have duration issues on Lantus and Opie also has some duration issues. With Levemir, Gracie would often not nadir until +15 so she got great duration.

    Something to think about.
     
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  7. LovingOpie

    LovingOpie Member

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    Thank you, I was wondering about an increase but sincerely hope I don't have to do it. The insulin I am using is from 5-22 and I recently bought a new bottle as back up. We will have to see what Opie does and will consider switching if you really think it will make the difference.
     
  8. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I think it cannot hurt and you might see a good response. Look around the LBL insulin support group and some of the SSs.

    I see he’s slowly coming down. It’s possible he will be more active tonight. If he’s not, I would suggest the increase to 2u in the morning barring he gives you a much lower BG at AMPS.
     
  9. LovingOpie

    LovingOpie Member

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    Opie is still on his way down at PMPS. Doing MPM as I am, I do not feel that he has had a long enough time on this dose because he is a big bouncer and it says that those type need a longer time on the dose before moving. Correct me if I am wrong but I don't think I have given the bounce 6 cycles either. Please don't think I am telling you what I should do, but tell me what you see and why ok? This is the learning curve after all. :bighug:
     
  10. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Hi Marje and Julie. I am thinking that Opie started his last bounce yesterday on July 4? So are you suggesting that if there aren’t low numbers tonight that Julie shoot through the bounce with an increase? Or that we wait and see what he does tonight and that if he doesn’t go to a lower green that Julie should increase?
     
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  11. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    They can certainly bounce from blue but they can also start to clear a bounce and then rise. I was counting from the 77 on a.m. cycle 7/2 but also see below, please.

    Julie…you are correct that the morning will be six cycles so that would have you raise the dose tomorrow night if you waited a full six cycles. While I said a bounce can take up to six cycles to clear it doesn’t mean an experienced CG has to wait to increase the dose. You have that option ; typically, we would have a new member with no data wait for six full cycles after a bounce, unless it is obvious the bounce clears in less time, before increasing. Once you have data, you don’t have to wait.

    Here’s my reason for not holding the dose longer: he has barely seen any green on this 1.5u dose this time and not nearly as much as he saw on it last time. While I don’t believe I’m chasing green numbers, I also hate to see a cat that looks like he needs more insulin , not get it.

    Having said that, you hold the syringe and you are with him. That means you know him better than I do. In a case such as this, I’m certainly not going to be concerned or upset if you don’t follow my advice. Obviously, if a cat is high and flat all the time and the CG doesn’t want to increase, that’s an issue just like a CG who doesn’t want to decrease when it’s a safety issue. If you want to wait longer, that’s up to you and I support your decision, in this case.
     
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  12. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    This I definitely agree with. Looking at Opie’s spreadsheet, I was thinking— I am not sure how Marje is counting the cycles here - from the bounce occurring after the 77 or later — but it doesn’t matter either way because — overall (big picture- even though he has bounced a lot during this dose) it is apparent that he does need more insulin because that 77 was about the only really good number he has seen on this dose (you had a few blues). You have plenty of room to do an increase safely with the level of testing that you always do. So I definitely agree with Marje that an increase looks to be warranted and that you can safely do the increase tomorrow morning with monitoring of his BG.
     
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  13. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Having said all that to Julie and Marje — I want any others reading along here to know that this advice about doing the increase is because (1) Opie is following the MPM protocol, (2) is a long-term diabetic with a lot of data on his spreadsheet, and (3) his mom carefully monitors his blood glucose with quite a bit of daily testing.
     
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  14. LovingOpie

    LovingOpie Member

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    Suzanne and Marje, I want to thank you both for being up front and honest with me. It also means a great deal that you both consider me a good CG. I will do as you suggest and increase in the morning. The only reason why I backed off is that I get scared that a higher dose means he is not doing well. I have to just think of it as a means to getting him healed. You know that I will do whatever it takes. Hugs to you both from Opie and me.
     
  15. LovingOpie

    LovingOpie Member

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    This morning AMPS started just in yellow and at +1.5 he is slightly lower. I wonder if I really need to test before the +3 because he rarely, if ever changes much in that time. Of course, the day he went down to 30 and yesterday going up to black were the exceptions. Anyway, raised the dose so we shall see what happens. . .
     
  16. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Personally, I would try a +2 for Opie’s first test, unless he starts out in mid to low blues at preshot- then I would opt for the earlier test to make sure I know where he is heading.
     
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  17. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Oh … almost forgot… nice blue at +3. Do you think we will see green today?
     
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  18. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I understand about the higher dose but it doesn’t mean he’s not doing well. For one, because he was diabetic a long time before you found us, he might have just a touch of insulin resistance which might mean he needs more insulin. It’s not a big deal at where he is. The goal is to give a kitty the insulin it needs. So…yes, you are correct; he needs what he needs to heal. We know you always have his very best interest in mind.

    It took him a bit to clear the bounce but do you see the pattern? He was bouncing and then went up to black…the high before the break, as I mentioned. Then he started breaking. He might have a bit of an active cycle today.
     
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  19. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I’m hoping you have tested him some more since the 126. It’s almost +6 now. I was just checking in.
     
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  20. LovingOpie

    LovingOpie Member

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    PMPS he was 343, so higher than this morning. I don't honestly know what to expect tonight. I will test at +2.
    I learned that he is very sensitive to carbs. Giving only 6% made him go high enough when he went down to 44. Maybe even the 3% that I normally give him is too much.
     
  21. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I would get a +2 tonight and maybe a +4, unless it's very obvious that he's going higher.
     
  22. LovingOpie

    LovingOpie Member

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    I want to say that I hardly ever get an email notifying me that someone has posted on this thread. Consequently, I am always behind in answering or getting the info I need for the time I need it. A lot of times I look here but nothing shows. I don't know why that is but that is what happens to me and it helps if you are aware of it.
     
  23. LovingOpie

    LovingOpie Member

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    don't I also need the +3? I already planned on the +2.
     
  24. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Well, depending on what you see at +2, then you may want to get a +3. I'm just wondering how high he will go and if you will need to test a whole bunch tonight.
     
  25. LovingOpie

    LovingOpie Member

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    +2 is 292, what makes you think he is going to go high tonight?
     
  26. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    You will not get any email notifications when people post unless you select “watch thread” at the top of the first post and then select to receive emails.

    Keep in mind if he is clearing a bounce and he starts in yellow and is blue in 2-3 hours, you need to test an hour after that blue. Any time he drops suddenly and low like this, he’s going to bounce hard and probably high. He definitely lost duration today.
     
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  27. LovingOpie

    LovingOpie Member

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    I do watch the thread and I am supposed to receive emails.
    Do you mean this morning when he went from yellow to blue to low green?
     
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  28. LovingOpie

    LovingOpie Member

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    How do you know if it is lack of duration or a bounce?
     
  29. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I’m not sure why you aren’t receiving email notification if you have it designated. Only the Webmaster can fix that.

    second question: yes. In my post 18 above, I indicated he might have an active cycle. Almost all bounce clearing cycles are active.
     
  30. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Any tests this morning? Since AMPS? It’s almost +3 now.
     
  31. LovingOpie

    LovingOpie Member

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    sorry didn't get this message, he was high so I didn't test again until +3 and then again +6, he was higher at +3 than AMPS and now at +6 he is lower . . . a bouncing ball
     
  32. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Fairly flat with 20 percent meter variance. Hope it won’t last
     
  33. LovingOpie

    LovingOpie Member

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    he is flat as a pancake
     
  34. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    He sure is!
     
  35. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Sorry to just get back to you. If the BG shoots up quickly like yesterday (44 to 151 in two hours), it’s lack of duration. It starts there and by PMPS, the lack of duration makes the starting bounce even higher. Frequently when he’s been in green, he loses duration and then bounces.

    There have been several days he’s dropped quit a bit from AMPS to +3. I’m going to give you info but it’s a lot to take in so you might need to read it a few times. Ask questions.

    When we see a cat with such fast dives and hard bounces (and I do believe that kitties that dive fast have harder bounces than those that just go lower), we try to get the curve to flatten out with food. We call this “using food to manipulate the curve”. The process is like this:

    manage the curve with food ----> flatten the curve ------> adjust the dose (if necessary and it usually is).

    This process or method is feeding so that we prevent the kitty from dropping too fast and/or too low. You can imagine if you aren’t careful with it, you can overfeed the kitty so it’s important to:
    • recognize this is a process that doesn’t change things overnight
    • requires that you, in general, feed the same amount of food kitty needs to maintain its current weight (assuming kitty is not under or overweight); obviously, if you’ve fed Opie his food for the cycle and then he fools you and takes another dive, you might have to feed a little more depending on where in the cycle he drops again.
    • requires consistency and some extra commitment at the beginning
    • requires that you know your kitty; what are his onset, nadir, duration
    Typically, unless the kitty is taking a huge dive or drops below 50, we try to use LC to manage the curve with food. Obviously, if he is coming down really fast early in the cycle and if we know LC doesn’t slow him down, you might have to up the “ante” (i.e. the carbs). However, we do not typically feed a higher carb food at shot time unless you must have the insulin start its onset from a higher number, for example, in the case where you might not be able to monitor. Opie drops quite a bit but he doesn’t usually do a nose dive.

    There are important things to consider when you are determining whether to feed lc, mc, hc:
    • where are is he in the cycle? If it’s early in the cycle and he’s dropping fast, you probably want to use higher carb food; if it’s nadir or later in the cycle and nadir is above 40, you might want to try LC.
    • how carb sensitive is he at different parts of the cycle? Some kitties never need more than LC food even when they take a steep dive or go lower. Others need the big guns if they drop fast early in the cycle. This is going to be up to you to figure out and experiment with. You do know he’s very carb sensitive later in the cycle.
    It’s also important to know why we manage the curve with food. The goal is to get the curve to flatten, as shown in the diagram above. If we are consistent and do it right (and it’s ECID and trial and error as to what is “right”), then kitties will typically flatten out at a higher BG. Flattening prevents those dreaded dives and huge bounces. Flattening also will allow you to get more insulin in the kitty safely.This can, in turn, allow you to hold a specific dose longer. However, for a bouncy cat, more insulin can help bring down the numbers. It also helps to offset the loss of duration and food spikes very carb sensitive kitties get in response to food.

    For anyone reading this who then thinks, “well, if I just give my cat more insulin, the bouncing will stop”. No it won’t and it’s not safe to just increase the dose to stop bouncing. It’s the process of managing the curve with food specific to your cat that keeps it safe to increase the dose. That entails:
    • knowing your cat and having the time and commitment to experiment with feeding
    • feeding the correct amounts of food at specific times to bring the over all curve up
    • flattening the curve at a higher BG
    How do we do this?
    • start by dividing the kitty’s normal food portion into four minimeals each cycle which are fed consistently at PS, +1, +2, +3, at first.. As you get more data, you might need to adjust those feeding times especially if your kitty onsets later and you might find you have to feed at different times to address the difference in cycles.
    • determine if kitty needs to be fed the same amount at each meal or if he/she needs to be fed different amounts at each meal. As an example, I studied Gracie’s SS when she was on lantus and figured out when she onset and when she took her steepest dive. I then determined I really needed to “frontload" her cycle with food. This had me fine tuning not just the times I fed her but feeding the majority of her food at PS and +1 and a little less at +2 and +3. Over time as I got more data on how she did with that, I changed the amounts of food and also changed the feeding times. When I switched her to levemir, I had to do the same thing all over again.
    • test more at first to catch the drops. And did I say test? When you are first starting manage the curve with food, I would suggest you test every cycle at PS, +1, +2, +3 because that is most likely when the dives will occur. You need to figure out exactly where he drops so you know exactly when and how much to feed to prevent the drop. Don’t get complacent if he’s higher at +1 than PS and think “I’ll test at +3”. This will not be forever. This is just to find out where he drops so you can then manage the curve appropriately to flatten him out. Over time, as you start at a lower and lower PS, the dives should stop and you can get back to regular testing.
    • realize that even after it works, he might, at some time, revert. Gracie did occasionally. I would start testing more to find out where she was dropping and then I could get proactive to adjust feeding the curve to prevent the drop. (Keep in mind, once I started managing the curve with food, I always did but patterns change from time to time and you have to be flexible and realize what worked for one pattern, might need a bit of fine tuning for another).
    In summary, learning to manage the curve with food involves learning how Opie responds to different carbs at different times during the cycle. You have to be a scientist and an investigator. Write everything down. What kind of a bump does he get from LC, MC, HC early in the cycle and late in the cycle? Using this info, you can guide the cycles. Again, remember you might find that you have to steer the cycles differently. Any time you make a change, leave it for 3-4 days and give him time to adjust before you make another change.

    That’s a lot of info at once but you can bookmark this and come back to it.
     
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  36. LovingOpie

    LovingOpie Member

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    Opie went green and is keeping it for a while now throughout the night, moving very slowly. If this continues without a bounce, it may be low in the AM which would mean shooting low. . most likely he will go up in pink but there is always a chance. Who knows? another B.O.S. could be around the corner. . . I know, . . . wishful thinking
     
  37. LovingOpie

    LovingOpie Member

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    it was definitely wishful thinking. A big bounce for today. . .
     
  38. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Glad to see the green but sorry he kept you up all night. I’m sure you are tired. He’s come down quite a bit this morning.
     
    Last edited: Jul 8, 2023
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  39. LovingOpie

    LovingOpie Member

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    yes tired but not more than normal ...thanks for the information about making a curve with food, there is a lot to look over:) and he went down to green again today!
     
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  40. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Yes, it’s a lot but it can result in a flatter curve if you are able to sort it out for Opie.
     
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  41. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I looked at his SS this morning and that you fed 1/4 can at +6. It seems that even that affects his duration as he started up within two hours. Opie!
     
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  42. LovingOpie

    LovingOpie Member

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    Opie isn't really doing much better with the dose increase. Although he went down to blue for awhile, he still goes up to pink beginning and end of each cycle. I also don't think I am able to manipulate the food in such a way as to flatten the curve. He is a fussy eater and getting him to eat something just because I want him to at a specific time just isn't going to happen. Today between the +3 and +6 i got him to eat a whole can of a LC FF at 1% which I thought would help the duration but which ended up shortening it and making him go high early in the day. I am feeling rather down about it all at this point.
     
  43. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    You can try not to feed him a little earlier- like stop at +4 or +5. Unless you are at a point where you need to feed to bring his numbers up, of course.
     
  44. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I see he still was blue at +8.5 This is good. When did you last feed? It looks like from your comments it was +6?
     
  45. LovingOpie

    LovingOpie Member

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    I fed him until about 1/2 hour before +6. He stayed blue and as I thought, he only went up to yellow at PMPS so I am thinking he might see green tonight. Maybe after 10 cycles of 2u he is starting to settle in.
     
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  46. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    So do you think you want to hold at 2 units for now? He had a pretty nice run in blue today? Don’t want to go for green?
     
  47. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Do your notes in the comments section mean that he is eating better/more reliably?
     
  48. LovingOpie

    LovingOpie Member

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    Yes, I want to go for green but I think that having him get accustomed to a steady blue before raising it would be a better choice. He never gets a chance to stay in blue or green without bouncing like crazy. If he doesn't stay steady like today then I will raise it. And the comments in the green mean that I got him to eat, that doesn't always mean that it was easy.
     
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  49. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I think it’s okay to hold at 2 for a few more cycles if you want to see if he will stabilize and get more accustomed to blue numbers. Hopefully, he will have a lot more blue - maybe green.
     
  50. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I see he bounced hard and is in the red this morning. I think it may be a hard bounce because of the drop yesterday where he went to 64 at +3 …. But maybe it’s just the long run in greens (which was beautiful.) Maybe try that feeding every half hour thing that you said you did last night? I know he is high now, but I would still try getting a +2 today to head off any surprises (I’ve seen it happen.)
     
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  51. Shelley & Jess

    Shelley & Jess Well-Known Member

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    I was looking at that too - about 65% drop in 3 hours - oucharooney! But other than that, yep, a lovely cycle:)
     
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  52. LovingOpie

    LovingOpie Member

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    It is a mustard and ketchup start to the day, red and yellow. . . :confused: you mentioned the 64 yesterday but doesn't a bounce start pretty much right after that? I mean, would it finish off a nice cycle and then say, oh yeah. . . I did go low sometime this morning so maybe I should bounce about now? He dropped over 200 from AMPS to +3 this morning but yellow not green. Will that start a bounce as well? I am feeding little and often but this morning he gobbled a whole can of FF 1% in one sitting. I figured it was only 1% so maybe that will be ok. When he is in red he sometimes is ravenous.
     
  53. LovingOpie

    LovingOpie Member

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    It was a nice treat wasn't it?
     
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  54. Shelley & Jess

    Shelley & Jess Well-Known Member

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    No, bounces don’t start within a couple hours - when he shoots up quick that's loss of duration.

    You know he might be starting a bounce at onset the following cycle.

    If it was just loss of duration he should come back down the next cycle, but if he bounces on top of loss of duration the bounces can look even worse.
     
  55. LovingOpie

    LovingOpie Member

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    loss of duration means that the insulin is not working, like at the end of the day and not lasting the 12 hours? Could you explain more of what that is exactly? I should know this by now but somehow it isn't clicking today. . . .
     
  56. LovingOpie

    LovingOpie Member

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    I just shot my lowest PMPS ever!!! 90!
     
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  57. Chrispooky12

    Chrispooky12 Well-Known Member

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    Ya go Opie :D I had a feeling looking at his spreadsheet if he was going to have a green preshot! Hopefully he stays flat or has an active green cycle finger & paws crossed
     
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  58. LovingOpie

    LovingOpie Member

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    Thanks Christina! Opie is finally getting somewhere. He has gone up right now but hey. . . we had a great cycle.
     
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  59. LovingOpie

    LovingOpie Member

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