4/19 Ivy Amps 226, +3.25 150,+5.5 112, +8.5 150,+10 200, Pmps 258,+3 199 Libre, Feed/late Nadir?

4/18/24
Amps 226 Libre
Good morning,
Last night was a high bounce for numerous hours after her low start to the day. Seems like she bounced big time and lost duration.

I have a question about recent, late nadirs very early into the next morning cycle around +9 and +10.
Am I doing the right thing by giving her a teaspoon or two of low-carb food at that hour?

My goal is to try to bring her up a little so that there’s no danger of being able to shoot and wanting her to be at a shootable number.
(She doesn’t really get much of a bump, though from 6% that I have fed, maybe slight bump for 30 minutes, but then she just drops back down again.

Is there any merit to feeding her another round of 6% an hour before AMPS, or is that a definite no no?

Lately, When she’s in these low numbers at AMPS I’ve been feeling 9% food instead of her normal 6% to try to start her a little bit higher point. Does that seem like the right strategy?

I hate trying to make these decisions at 3 and 4 AM in the dark by myself, you know what I mean? Better to have a plan ahead of time.

Have a good day everyone

 

Hi Staci
You're such an artist with the fine tuning to every detail in Ivy's health.
I hope you receive some answers for your questions.
Hopefully Ivy will come down quickly and safe from the bounce yesterday.
Sending you both hugs and kisses from me and the boys

 

Hi Shelly, thank you. I’m constantly trying, for sure.
I hope you, Fistuk and Prince are doing well and will have a lovely, peaceful weekend. Hugs and kisses back

 

Wow, Staci, those are awesome questions!
And I agree, having a solid plan is the best particularly when you have to act in such wee hours.
I wish I knew the answers - I'll tag @Angela & Cleo, who has helped many of us with her fantastic carb management comments.
Hope Ivy gives you solid yet safe curves today!

 

Thanks, Kit. I wasn’t sure who might have good experience with that kind of question.
Hopefully Angela has some good ideas of how she’s handled it.
I feel like I’m just guessing at what’s the best strategy and don’t want to make things any worse.

I’m trying to set us up for a better outcome to the cycle and I agree having a plan is the way to go if possible.
Wishing you a wonderful day ahead.

 

Hi Staci, looks like you got some sleep last night
I hope so. .
I know I could be a pain in the ass lol just wondering if you wanted to add
the 150 @3.25 ? Feel free to tell me to mind my bees wax
I hope Angela or Marje will come along with some advice

 

Good meowning Staci and Ivy!

Looks like Ivy is hanging out in the sunny land this am. She had nice cycles yesterday, and although she bounced at PMPS she cleared that super fast. I wonder what today brings. I hope you get your answers re:feeding. If you like I could tag few more members to see if they can help.
Hopefully you also got some more sleep the last couple nights.
Wishing you and Ivy a nice furiday!!!

 

@Wendy&Neko @tiffmaxee @Bandit's Mom

 

Feeding the curve to steer the numbers is like learning to play Stravinsky or Chopin on piano . Practice, Practice, Practice!

Next, you need a good grasp of the basics. In FD that would mean onset, nadir and carb sensitivity. (Easier said than done ...trust me, especially since patterns change).

I Absolutely Do this too! The reason I do it is to continue the surf in the greens. I stick with LC (usually <3%) so as to avoid shortening the duration of the insulin.

I wouldn't want a food bump. Like I said above, I want a green surf within meter variance. In TR, the shootable number is 50+ and in SLGS its 90.
Since you're custom dosing, you'll have to determine what that "shootable number" will be.

Nothing is definite in FD LOL. Its suggested to NOT feed in the two hour window so that you're not shooting a food influenced number and also until you know the patterns of your cat, ie how much of a food bump drives the number and for how long. I have given Cleo a tsp of LC at +11 a few times when she asks for it. I do so because (1) if she's hungry then she's hangry ; (2) she will occasionally vomit if she goes too long without eating; (3) she's in a bounce clearing cycle and looks like she will nadir at onset of the next shot ... limes. The +11 SNACK will usually be the LOWEST LC I have (0% - 3%) for a lantus double dip or 6% in a late nadir cycle. Again, my goal is to continue the surf, not bring her into high greens/low blues. When I say "feed" I mean a teaspoon of her wet food and/or sometimes just freeze dried treats.
The other thing to keep in mind at the tail end of a cycle is to determine if kitty is in a bounce clearing one with late nadir OR is it that Lantus double dip.

If its working, then its a good strategy! Cleo's onset used to be at +1-+2 and feeding the slightly higher end of LC at AMPS worked well. Now she onsets between +2-+3 so I've moved the higher end LC (about 8-10%) to right before onset in an effort (and hope) that she won't dive (which we all know will trigger a bounce).

Figuring out all the above and trying to make a decision at 3am is...well....

So a typical FD Cycle, Cleo will get 6%ish at shot time, 6-8% between +1-+4, 3-5% between +5-+6, and low carb/no carb after UNLESS she does a dip into lime then all bets are off . I keep this schedule for her consistency and my sanity and based on how well I know her patterns.

I have also learned that Cleo is carb-type sensitive. In other words, not all carbs are created equal. For example, I have higher end LC (7-10%) with the "carb source" mainly potato starch, pumpkin or chickpeas and I also have the same % with the "carb source" from tapioca starch and a third with "carb source" from soy, wheat gluten. The potato starch/chickpea barely moves her BG, the tapioca has a more immediate effect and will bump her up a bit; the soy, wheat gluten will send her BG skyrocketing.

Ivy has a few other things going on besides FD bighug I hope you find something that works for you guys

 

(Not to derail the condo!)
How are you feeling with custom dosing, Staci? Are you getting some more rest and food in?
I admire your dedication to Ivy so much. You are doing so well customizing her care!

 

Really comprehensive and great guidance. Thanks @Angela & Cleo !
I've taken notes!

 

Hi Diane, I took your suggestion and added it. Good idea
I did get in bed as soon as I saw she stayed high. Ran right to bed at 10 pm! Zzzz. Set my alarm for 3:30 am to check on her on my phone.
Hope you’re having a great day

 

As Angela said, know how carb sensitive your cat is, when she onsets and nadirs and duration too.

I never fed carbs after +10. And even then (usually more like +9.5 really), the slightly higher carbs only if she was trending down at that time and in the 50's. (hand held meter). I followed TR. She was on Levemir at the time, and could nadir as late as +15. Neko was also carb sensitive, a light touch was enough at +10. That would hold her off until shot time meal which would boost her up if her nadir was going to be late - typically it was +9-+12, those even later nadirs didn't happen that often.

I suggest testing Ivy with a BG meter before giving snacks at a Libre Lo late in the cycle.

 

Hi Z, I’m still trying to figure out how I’m handling things. But the past few days have been better since I lowered her dose one increment down to 4.5 units. She’s had a few bounce cycles so I’ve gotten a bit of sleep from that instead of her all night active cycles.
Thank you for your support. It’s a lot to handle with my Ivy.
I hope you and Falafel are both doing well

 

Hi Karolina, thanks for you help today. I hope my asking questions helps me and Ivy, but also others who may have similar questions. I can’t be the only one who sees these Lantus cycle patterns.
Hope you and your boys are having a great day!

 

Looking good so far Staci

 

Hi Angela, wow that’s a novel of information. Thank you for taking the time to explain all of this. I wish I had as vast and understanding of all of these things as you do. I can barely answer some of the questions that you raised.
I know that Ivy is not very carb sensitive to the 6% food I feed at meal time. And when she’s dropping, it really doesn’t do too much to raise her. I do need to go to 9% or 12% which are the only other recipes that I have, since I make her food I don’t have the option of 0 to 3% or higher than 12.5%.
I would have to add Karo or honey to increase carbs which I don’t regularly do, couldn’t even tell you the last time I added anything.
I’m still not sure if I can clearly tell at the tail end of a cycle is how to determine if it’s a bounce clearing one with late nadir OR is it that Lantus double dip. Like you said, at 3 am… it’s rough to see clearly what’s going on.

I just see her going lower and want to make sure she’s not going to be too low at Amps. And I always hesitate to use higher carbs than 6% since at the end of the cycle even though the 6% carbs don’t hold her up for long at all).

I only feed 6% at +1,2,3 (unless she’s really diving then add higher carb) but I see you are feeding higher carbs for the first four hours. (Do you feed Cleo hourly)? And you also feed normally until + 5&6 also?
(I stop feeding at +3).
Why are you feeding all the way until +6? Just curious. I’ve been advised to stop feeding at +3 in the past.

Lots to consider. Thanks again for the information

 

Hi Wendy, thank you for the input. The cycles of Levemir are so different than Lantus.
What I am seeing when Ivy’s going lower at the last few hours of a cycle (I assume a double dip or a late nadir into AMPS) is the concern that she will keep dropping.
I try not to be feeding at the end of the cycle. Just wanted to see how best to handle these situations.
Thank you

 

Definite no unless she is verified on a handheld meter of being lower than 40. If you hand test her and she’s in the 40s, don’t feed, retest in 30 minutes and if she’s still low, feed one tsp of LC food. But, you can’t do all that testing so that is an issue.

We don’t ever feed after +10 to bump up the pre-shot unless they are in the 40s.

I can’t tell if it’s really helped, honestly. She was at 41 on 4/17 and 51 at AMPS and that was on the Libre so who knows how accurate it was? On 4/15, it didn’t seem to help as she dropped from +10.5 to AMPS and that was on the Contour. But then, she was at a shootable number.

If you want to feed a 9% snack, you can but not past +10 unless she’s really low.

Does that help?

 

This is not hard to tell the difference.

If she’s low because she’s clearing a bounce, the nadir will be at the end of the cycle. If she’s lower because of a second lantus dip, the nadir will be lower than the second lantus dip; in other words, she would have already nadired, come up a bit, and then dropped a bit but not as low as nadir.

 

This is super interesting to me. I've always wondered why some MC food seems to bump Shooter up quick and others seem to take much longer if they affect him much at all. I'll have to pay attention to this.

 

A Lantus double dip is a lower number but not as low as nadir. A quick glance at the SS should be easy to determine.
I'm sure others will chime in too to help with the other Q's

 

So much good info in this thread!

Nice to see you got some sleep, Staci. I hope you two have a restful evening.

 

Ok, thanks for that explanation, Marje!

 

Ok I see.

I fed 9% as her breakfast meal to start her at a little higher for the cycle because she was having such a late nadir and I thought she would keep dropping into the next cycle with the onset of that new shot.
(I didn’t give 9% at +10 when she was having the late nadir). I thought I should keep the carbs as low as possible at the end of the cycle since insulin should be waning).
I didn’t realize a higher carb like 9% was an option before +10.

 

Yes, it is as it’s still LC but I wouldn’t use it unless you know she is lower and I wouldn’t use it past +10. Just remember as the insulin wanes, carbs will affect the duration but…that’s what you are trying to do anyway