12/04 Gizmo PMPS 285, +2=312, +4=205, +5=234

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carfurby said:
Nice surfing last night for Gizmo. You did a good job handling things. I hope he keeps surfing today.
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Thanks. Going to have to seriously consider what to do re: dose going into the work week. I will be changing the auto feeder to +2, +4 and +6 for both AM & PM but not sure if that would be enough to keep him safe while I am not here.
 
LizzieInTexas said:
Thanks. Going to have to seriously consider what to do re: dose going into the work week. I will be changing the auto feeder to +2, +4 and +6 for both AM & PM but not sure if that would be enough to keep him safe while I am not here.
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I think that's a good idea. How many feed slots does the auto feeder have? just three???

Looking at your working week, it seems you manage to get a +1.5, which is great, to make the food go further to speak I might be tempted to feed at +1.5, which if he is the same or lower I would give him MC or HC at that point, getting in early before the insulin truly hits can be useful in helping them to surf.
Then if the numbers make you nervous you could set the feeder with HC or MC, again if he were to be dropping significantly and you were nervous instead of two hour intervals, hourly intervals might be better.

If on the other hand he was up then your plan of +2 +4 +6, is a good one, I think with regards to his feeding schedule I would try and remain flexible and let the numbers and your gut guide you. When I had to go out I would err on the side of caution with regards to carb content, sure that might see him a bit high BIPO by the next PS, but in mosts instances for me that was preferable to messing with the dose, and I had data to support my decisions.

You've been getting good data on your working week, those +11 will be really helpful in helping you decide what to do come amps, if you suspect his amps is falling that's a time to be extra cautious, and think carefully what to do regarding dose/ shoot not shoot/ and what foods to leave out.

He has had an awesome 24hrs, I suspect that he may let you know what he thinks about this dose soon enough.;):)
 
Gill & George said:
How many feed slots does the auto feeder have?
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It has five. I have been putting his AM feeding in slot 1, +3 in slot 2, +6 in slot 3 and @+7 5ea freeze dry snacks in slot 4.

I don't have to put his AM food in a slot, I can use a separate bowl.

So, normal AM feeding is @ 4:30a. Shoot @ 4:35-40a I leave for work/test +1.5 @ 6:05-10a.

What is a good MC fancy feast? It would be easier to just add 1/2 ts HC to his LC food already in his auto feeder.
 
You did great last night and so did your little surfer boy. I couldn't imagine trying to make last minute food decisions with the limited amount of time you have in the morning. Honestly the +1.5 is good to get but I don't think it's a great indicator of how the cycle will really go....just my 2 cents. He does look good on this dose but no one can say feeding at 2, 4 & 6 would keep him safe or not. Now you know this dose can get him into the 60's so it's something for you to decide on whether to reduce per SLGS or hold the dose.
 
@Gill & George Thanks for the input. I think I will reprogram the feeder no matter what I decide.

@Doodles & Karen if I decide to decrease would you decrease tonight PM or tomorrow AM? Decide at +11 or PMPS tonight?

This sucks. I have two more weeks at work and then I am off again for two weeks. Maybe he will drop below 50 and make the decision himself (I know, wishful thinking).
 
LizzieInTexas said:
I reduce by 0.25U - correct
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Yes, that's correct. Since you were feeding the little drop last night with a bit of gravy that tells me you're not comfortable with him in the 60's yet. It's OK to reduce, you can always go back up. As much as all greens are nice with of course remission as a goal sometimes it can take a little longer simply because of life.
 
I would have to disagree with Karen regarding the +1.5, at least in Georges case, and I see a similar pattern with gizmo, when that +1/+2 is significantly lower you have had to steer with food to get him to surf, so to me that would be a heads up to leave HC/MC food down. As to making decisions on the fly, that kind of depends on you, I had no problem with it, if I was in any doubt I went with more carbs. But Karen is right in that it might not be an easy thing for everyone to do, it the morning schedule is hectic.

A couple of recent examples for this in Gizmo's SS where that +1/+2 gave you a heads up are
Last night 12/4 at +1.25 dropped to 86 from 118 @+1.25, and how that went is no doubt fresh in your mind.
Another would be on 12/1 again by +2 he had dropped 70pts and he continued to drop later into the cycle having an active cycle, not as low as last nights, but active non the less.

On the other hand when you've shot low and got a significant food bump by +1 your cycle has been less exciting, sometimes bouncing and sometimes staying flat.
Like today, a reasonable food bump at +1 but he has dropped gently into blue.

So I would continue to use that +1.5, and the +11 to be your guide, regardless of whether you reduce the dose or not. Both of those will give you the best shot of determining where he is heading, when you compare them to the amps, and give you time to make reasonable choices.

One other thing I wanted to comment on was, in case you haven't noticed is that Gizmo has gone close to 60 hours without showing you a pink he's been yellow/blue/green, trending to blue/green, slowly but surely, I found that when that happened on Georges ss, his cycles became more predictable, with less wild swings. He is making great progress.

LizzieInTexas said:
If I decrease - which is what I am leaning towards - I reduce by 0.25U - correct?
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Yes it would be a 0.25 reduction should you decide to decrease. :)
 
Doodles & Karen said:
Since you were feeding the little drop last night with a bit of gravy that tells me you're not comfortable with him in the 60's yet.
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I don't know if Lizzie was nervous or not, but I just wanted to point out, that when you get a drop into the 60's like she got last night, I think it's perfectly acceptable to use MC (which is essentially what Lizzie did with the mix) to try and get ahead of the curve, in doing that, you can flatten the curve (and that is in fact what happened), that's useful in getting kitty to spend more time in the healthy range holding on a dose for longer and can also help with the bouncing. My George needed that sort of intervention too, he wasn't hugely carb sensitive, in the early days when I didn't intervene with MC or HC early enough in the cycle, I faced hours of fighting the insulin, and George stuffing his face with junk food :rolleyes:. Another case of ECID.

Lizzie take a look at this post where Jill describes using food to manipulate the curve (if you haven't already) for me at any rate it was an eyeopener. Over the weekend, whilst you have been using the food proactively to help manage his cycles, he has flattened out. So personally I don't necessarily think that taking the MC when he drops fast into the 60's early in the cycle is a question of you being nervous or not, but rather a good idea if you want to achieve a flat Lantus cycle. The discussion in that thread at any rate is real interesting.

I particularly like her following comment, it really resonated with me
'all too often we've seen failed reductions and then the need to take the dose right back up after a single drop under 50. personally, i'd rather see kitty "earn" a reduction from maintaining lower BGs with a flatter cycle for a week than to reduce the dose based on a single drop below 50 when the rest of the cycle's numbers remain high.'

:cool::cool::cool:
 
Doodles & Karen said:
Since you were feeding the little drop last night with a bit of gravy that tells me you're not comfortable with him in the 60's yet
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I am not sure that was the case. Bobbie (and myself too) felt he was dropping pretty fast for that early in the cycle. Since I have limited experience with how to handle it was deferring to someone more knowledgeable.

Bobbie And Bubba said:
I am thinking if you have any MC food to give a tsp also. This is really early in the cycle to be dropping that much. We want to keep him in greens without any big drops and you have to remember that the outset probably hasn't even happened yet. If you don't have any MC food I would give another LC tsp of food and let's slow him down.
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I am not sure which FF is MC so I used 1/2 LC and 1/2 HC.
 
LizzieInTexas said:
I am not sure which FF is MC so I used 1/2 LC and 1/2 HC.
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Is there a variety called grilled??? I think that may be MC. (get someone to confirm that with you, remember I'm across the pond so we don't have FF)

FWIW I used to mix HC and LC to make MC
and MC with LC to make higher LC
It just depended on what I had in the store cupboard.
LizzieInTexas said:
I am not sure that was the case. Bobbie (and myself too) felt he was dropping pretty fast for that early in the cycle. Since I have limited experience with how to handle it was deferring to someone more knowledgeable.
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I would have done the same thing. It's what I did with BFG.
 
LizzieInTexas said:
I am not sure that was the case. Bobbie (and myself too) felt he was dropping pretty fast for that early in the cycle. Since I have limited experience with how to handle it was deferring to someone more knowledgeable
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You did the right thing....my question is would he have surfed on his own with regular scheduled feedings or dropped below 50. In any case, I'm more conservative when someone isn't home during the week to test a bit more. That's just me being conservative....and sometimes too conservative.
 
Gill & George said:
I don't know if Lizzie was nervous or not, but I just wanted to point out, that when you get a drop into the 60's like she got last night, I think it's perfectly acceptable to use MC
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I totally agree. It's a peer reviewed board so I'm simply stating what I'd do if it were me and not able to test hardly at all mid cycle during the week. Many are fine with it and it can/does work especially with the auto feeder.
 
Great cycle last night Lizzie! And good job flattening out the curve in the early part of the cycle when he was dropping quickly. The link Gill gave you above about using food to manipulate the curve was exactly what we were doing in the early part of last night's cycle. And adding a bit of HC gravy to the LC basically was making MC food. To answer you question about MC Fancy Feast food, they would be the Roasted ones. They are somewhere around 12% carbs. That is what I use for my MC food.

Nice continuation today and if he's bouncing from last night's green, blue is a beautiful bounce!

Gill gave you some good advice about what to do for the feeder tomorrow an the way tonight's cycle plays out will help you to make that decision.

And I would reduce rather than skip tomorrow. UNLESS he throws you a crazy low number tomorrow AM then skipping would be best.

He is looking so good!
 
Doodles & Karen said:
I totally agree. It's a peer reviewed board so I'm simply stating what I'd do if it were me and not able to test hardly at all mid cycle during the week. Many are fine with it and it can/does work especially with the auto feeder.
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I think that given it was the weekend it was ok to give gizmo the chance of surfing in green for as long as possible, who knows how much difference those extra hours can have on a kitty's beta cells, but sometimes it just does seem that one cycle can be a real turning point for a cat. But I do think that you made a valid point that with being away during the week, when considering the dose for Monday...... to hold or not to hold, I think that it is potentially manageable to hold, but not having been in that position myself, I cannot put my hand on my heart and say that would be what I would do.

LizzieInTexas said:
Which scenario is worse? Reduction or a skipped dose?
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A very good question....
There's probably not a straight answer.
The way I look at it, a premature reduction may see him stay in high numbers all week, some kitties are more sensitive to this than others, George wasn't particularly, I took reductions of 0.25 and 0.5u when I was going away on vacation for a week, when I got back home we went back to the old dose and George didn't seem to loose much momentum he would start working the dose pretty quickly.(within two cycles), I have seen others where they loose momentum and it can take weeks to get back to where they were.
The skip is useful tool if you are absolutely unable to monitor and the am shot is just too low, which may of course happen even if he gives you a reduction.



With Gizmo seemingly deciding to go flat blue if he stays that way into pmps I think he may well earn a reduction whether you reduce tonight or not.
Reducing the dose tonight will give the depot some time to drain, that gives you a better chance of the am cycle not being as active, even if you do reduce tonight remember the depot may still be impacting the next 3-4 cycles, so even if you reduce, you might find yourself in a situation where you will be considering a skip.
The food side of this equation can help you keep him safe, try to keep that in mind. As long as you can rely on Gizmo eating, I never had to worry with George, it really is a useful tool to have in your box.
 
Ok, here is my plan. I am going to hold the dose. If you look at his spreadsheet/history - after he has dipped his toes in the green he bounces (which he is doing right now) Those bounces have lasted 6-10 cycles and then the drop back down to low blues/greens have been fairly gradual. I don't want to lose momentum.

I have changed his auto feeder so that he will get his AM/PM and then +2, +4, +6 and his freeze dry snack @ +7. If I feel there is a need I can put another snack down when I leave @ 1.5 (then he will get his +2 about an hour later) and/or add HC to his LC snacks in the feeder.

Let me explain the feeding - I have it set so that it turns to a new bowl about 20 min after the previous hour "anniversary" (i.e., +2 is actually +2.5). The reason for this is so when I test I am testing w/o food influence so I can see what his numbers are actually doing (for now).

Another thing - I don't think he has "earned" his reduction. Again, look at his history. Heck, even as of Thursday PM we were contemplating a dose increase.

Finally, if I really feel that there is a danger - I can always skip or decrease later OR just take the morning off or the entire day off. There is no reason I HAVE to take the balance of my time the last two weeks of the year. I can spread them out if I choose to (though it would be nice to take the full two weeks off all together).

What say you guys?
 
On SLGS he did earn a reduction regardless of what he did a few days ago. On TR he did not earn the reduction and you hold the dose. Dosing is based on how low it will take them. Just wanted to make that clarification.

Your fine holding and following TR. surf safely little man.
 
Sorry he's bounced to pink hopefully he won't stay there long.

Looks like you are sticking to TR for the time being then.
Your feeding schedule seems a reasonable plan.
 
+5 234

I chickened out. I will reduce dose in the AM to 1.25U. I just can't do it without being able to check on him.

Thanks for all the input and food for thought. I really learned a lot from the discussion.

Surf safe kitties. Sleep tight beans.
 
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