12/17 Quintus AM+8 65 PMPS 583 +2 677 How high can he bounce?

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Steph & Quintus & L & O

Steph & Quintus & L & O

Member Since 2017
condo http://www.felinediabetes.com/FDMB/...-340-4-5-94-6-221-i-think-i-can-sleep.188115/

So, after these last two days big active cycles in the evening, it looks like this morning is in the yellow. I slept so don't have anything between AMPS and +3.5. I took a dose reduction (from 3 to 2.5) in prevision of the week as I won't be able to monitor much and am continuing with food transition (I need to make a table for that because I think I messed up my quantities).

My plan is to try and not feed Quintus actively during the cycle -- let him go for his food as he usually does, and monitor. This will be closer to the situation regarding food tomorrow, when I'm gone from straight after the AMS and will be in bed by PM+3 and asleep by +4. I can find a neighbour to put him in front of his food (or put his food in front of him) in the AM, +3 for example, or +5.

Questions:
- are we happy or concerned to see yellow this morning?
- given the +3.5 245 what would you suggest be my next test point for this morning? (I'd like to get a good idea of the curve, also to show my vet, but if I can avoid testing all day I'd be happy)
- should I consider giving him a higher HC content in his food tonight and tomorrow morning, just to be on the safe side while I'm at work and need to sleep?

PS: I've created a graphic chart in my SS -- more for fun than anything else, but if anybody wants it feel free to steal it
 
I would test at +5 or 6 for data gathering purposes, but it'll likely be a quiet day. He may bounce from yesterday's green. No opinion on the yellow, you still have the 3.0 unit depot in play. Good idea to do food as you would while you are gone, so you can observe.

I wouldn't give high carb unless the numbers show he needs it. Maybe decide tonight after a +2 test.
 
Good grief, now that I've done a sheet on my food transition I have confirmation I've been completely messing it up, actually giving him MORE than what would be his daily quantity of wet food mixed in with 1/4 of his HC ration. No wonder he hasn't been finishing it and I've had to stick the food under his nose for him to eat mid-cycle. And no wonder he's been running down the ladder. And that his poop went soft.

My next step is therefore to get back to "proper" food transition rations...
 
An hour should be fine you're still a ways from 68. I only test on the 30 if a drop below the action number (68 for you), or if she's within a range of that action number that I know her capable of dropping to when she's on the down slope of the insulin. If you get worried, you can always do the 30 though.
 
Thanks, Stacy! Not too worried as he's just eaten. He's basically been stuffing himself with LC food these last days. No wonder he's sleeping and sleeping. At least he's not being starved!

Question though: can a sharp drop in BG (like what he's going through, compared to where his baseline was just a few days ago) make a kitty tired?
 
Stephanie & Quintus said:
Question though: can a sharp drop in BG (like what he's going through, compared to where his baseline was just a few days ago) make a kitty tired?
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I would think so. It's a lot of change, and it's sudden. Even if he is in better numbers now, it probably still feels very wrong to him in his body until he makes it his new normal. Asia got very sleepy in low numbers at first, I just assumed it was jarring. Human diabetics feel like crap when they are too high, too low, or have a steep drop as well. I think they get quite the internal workout, even if they physically aren't doing, much trying to handle all this stuff.
 
I'm wondering if there would be any interest in my getting a PM+11 on work days in addition to just the AMPS, PMPS, and a +2 or +3 in the evening. Here's the reasoning:

I need to be out of the door at 6:15 -- shot time is 6:00 (also because I get home just in time for 6pm). Doing some calculations to figure when I need to set my alarm to do all my "morning stuff" before I leave, including the shot and feeding routine. And I'm arriving somewhere around 5am. If I'm up at 5am, I could quite easily test a +11. But is it interesting to do?

Also, with my new "up at 5" the chances of me being able to do a +3 are slimmer. I might want to be in bed before that.

On days when I can cycle down to the station (ie, no snow or ice, not sure I can count on those these days, and in any case I'm not cycling tomorrow, not well enough after my illness) I leave at 6:30 sharp and will probably wake up at 5:20, so there would be no +11 on those days.

Thoughts?
 
Stephanie & Quintus said:
I'm wondering if there would be any interest in my getting a PM+11 on work days in addition to just the AMPS, PMPS, and a +2 or +3 in the evening. Here's the reasoning:

I need to be out of the door at 6:15 -- shot time is 6:00 (also because I get home just in time for 6pm). Doing some calculations to figure when I need to set my alarm to do all my "morning stuff" before I leave, including the shot and feeding routine. And I'm arriving somewhere around 5am. If I'm up at 5am, I could quite easily test a +11. But is it interesting to do?

Also, with my new "up at 5" the chances of me being able to do a +3 are slimmer. I might want to be in bed before that.

On days when I can cycle down to the station (ie, no snow or ice, not sure I can count on those these days, and in any case I'm not cycling tomorrow, not well enough after my illness) I leave at 6:30 sharp and will probably wake up at 5:20, so there would be no +11 on those days.

Thoughts?
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Your schedule is the same as mine. I’m out the door at 6:15 not back until after 6. I feed test and shoot at 6 and 6:30. It’s as close as I can get to 12 hrs apart on work days. I don’t free feed and in the evening if I’m home I’ll get a before bed test around 10pm. If the preshot is low I’ll grab a +2 and maybe stay up a bit late if I can.
 
+11 can be very useful to let you know if the AMPS is a rising number or a falling number. It might guide you on what food to leave out (MC vs LC). And could also tell you if you need to skip a shot if the number is a bit lower than you're comfortable with and you know from the +11 that it's falling instead of rising.
 
He was pretty active once he woke from his nap, had a poop, and followed me around (food anybody?). Ate a bit of his mix (mostly kibble in there). Tested just in case (+8): 74. Got another reading: 61.

Panic? Honey? open one of those pouches of NF he loves but that give him bloody stools?
 
Whew! Exciting! Yes, the effects of the 3 u depot are showing. Also, a dip into quite low numbers can make them a bit insulin sensitive for a cycle or so afterward. Are you OK to stick with the plan?
 
Those numbers for +8 are all within meter variance. Did you feed him anything? I would probably just test again in an hour to make sure he is not still dropping. Maybe even 30 minutes if you are really worried. Hopefully someone with mor experience will stop by soon.
 
Kris & Teasel said:
Are you OK to stick with the plan?
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You mean, sticking with 2.5? Yes, but I think I'll up the kibble ratio in his food just a little. My neighbour will drop by AM+3 to make sure he eats some more after the shot feeding.

Chubba said:
Did you feed him anything?
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He ate some of his kibble/wet mix just before I tested him. After I saw the numbers I put a little more kibble in the mix, brought the plate to him, and had him eat.

I'm not too worried for now. But I'm concerned about tomorrow, because he'll pretty much be alone all day. The neighbour will prod him to eat in the morning but other than that he'll be on his own.
 
Stephanie & Quintus said:
You mean, sticking with 2.5? Yes, but I think I'll up the kibble ratio in his food just a little. My neighbour will drop by AM+3 to make sure he eats some more after the shot feeding.



He ate some of his kibble/wet mix just before I tested him. After I saw the numbers I put a little more kibble in the mix, brought the plate to him, and had him eat.

I'm not too worried for now. But I'm concerned about tomorrow, because he'll pretty much be alone all day. The neighbour will prod him to eat in the morning but other than that he'll be on his own.
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Totally understandable. It's good that your neighbour can drop by. There's no way around this anxiety except to prepare as well as you can (dose, food) and then live through these days. As the days where he gets by unscathed mount up you'll feel more and more confident that he'll be OK. Always err on the side of caution. Conservative dosing and SLGS will help.
 
Stephanie & Quintus said:
I'm hoping 2.5u is conservative enough here. Or do I go "really safe" and drop him to 2? What would be the consequence of dropping 1u so fast?
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No particular consequence. The current depot (still influenced by 3 u) will gradually deplete over a few cycles and then his numbers will rise. I think that going up by too much at once is more fraught with possible problems like diving too low. We always worry more about very low numbers than a short time spent in high numbers.

It's your cat and your call. If you have half unit marks on your syringes you could split the difference and try 2.25 u. However, if 2 u feels safer, do that and get some evening tests in if you can. A full curve next weekend should give you some data to decide where to go next. So much of this is guesswork - try something and see what happens.
 
Kris & Teasel said:
No particular consequence. The current depot (still influenced by 3 u) will gradually deplete over a few cycles and then his numbers will rise. I think that going up by too much at once is more fraught with possible problems like diving too low.

It's your cat and your call. If you have half unit marks on your syringes you could split the difference and try 2.25 u.
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Thanks, that's reassuring. Hadn't thought of doing 2.25u, I could.

Next day I can "keep an eye on him" is Wednesday. If I stick with 2.5u, that means that by Wed we'll have had 6 whole cycles on the same dose, so I can see what it's doing. But if it is indeed too high, that leaves us with (what I see as) hypo risk tomorrow and Tuesday when he is all alone. Not sure yet what I want to do. Feedback, opinions, advice and ideas that I can factor in my decision most welcome.
 
Stephanie & Quintus said:
Thanks, that's reassuring. Hadn't thought of doing 2.25u, I could.

Next day I can "keep an eye on him" is Wednesday. If I stick with 2.5u, that means that by Wed we'll have had 6 whole cycles on the same dose, so I can see what it's doing. But if it is indeed too high, that leaves us with (what I see as) hypo risk tomorrow and Tuesday when he is all alone. Not sure yet what I want to do. Feedback, opinions, advice and ideas that I can factor in my decision most welcome.
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Let it percolate through the day today and then let your gut guide you. You have to be comfortable giving the dose. The guidelines are great but you also have to factor in your kitty's situation, your ability to tolerate risk at the point in the FD marathon you're at, etc.

Re other dose fractions: dose changes of 0.25 u at a time are generally recommended unless a kitty is at a high dose or has been in very high numbers a long time. I'd encourage you to use 0.25 u changes. Eventually you might have to fine tune by giving what we call "fat" or "skinny" doses (just under or just over the black line). Some kitties respond to changes that small - I have one like that. ;)
 
Kris & Teasel said:
I'd encourage you to use 0.25 u changes. Eventually you might have to fine tune by giving what we call "fat" or "skinny" doses (just under or just over the black line).
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Yeah I've read about fat and skinnies.

My gut tells me that when all is said and done Quintus will end up somewhere around 2, or 1.5 -- based on the low reading he got on Dec 5th. He'd had only 1ui the morning and 2ui the evening before, but had barely eaten. So once he's on low-carb food, I think we might be around there. Or, maybe, 2.25.

Much as going down too much seems a shame if it means we need to wait weeks to climb back up, I feel a bit jittery keeping him on a dose I think will end up being too high, and therefore worrying he'll go in too low numbers when there is no way I can be there to keep an eye on him and make sure it doesn't go into dangerous territory.

I'm also concerned that I've made a mess of the food transition and therefore am not really certain what fraction of HC and LC he's been getting these last two days. But obviously, he's been getting a lot of LC (he tends to eat more of the wet food and leave the kibble bits for the end).

I think 2.25 and 50/50 food is a safe bet. Maybe too safe, and I might regret it when I see higher numbers later this week. But I'd rather regret having higher numbers than a dead kitty.
 
Stephanie & Quintus said:
based on the low reading he got on Dec 5th. He'd had only 1ui the morning and 2ui the evening before, but had barely eaten.
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There's no guarantee this will be repeated. The insulin response is dynamic, not static. The SS data give you a great overview and you'll see trends but surprises will happen. You'll often read comments here to the effect that a BG number more than a week or two ago is ancient history.

Stephanie & Quintus said:
I feel a bit jittery keeping him on a dose I think will end up being too high, and therefore worrying he'll go in too low numbers when there is no way I can be there to keep an eye on him and make sure it doesn't go into dangerous territory.
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These are valid feelings. You have to factor in your current confidence level.

Stephanie & Quintus said:
I'm also concerned that I've made a mess of the food transition
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Heck no! It's another thing you're trying to figure out. You'll get there. Don't be too hard on yourself.

Stephanie & Quintus said:
I think 2.25 and 50/50 food is a safe bet. Maybe too safe, and I might regret it when I see higher numbers later this week. But I'd rather regret having higher numbers than a dead kitty.
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This is worth trying, then. Think of it as your first week of feeding and dosing with a specific plan in mind. Stick to the plan, breathe through the high BGs if they happen and be prepared to adjust the plan in a week. No sudden moves! ;)
 
+9 90 -- so, this "post-nadir-time" dip, what is it? Does it have to do with food? as it's a mix, and he tends to lick the paste of the kibble, he tends to eat more paste initially and the leftover has been kibble. Also, as I put way too much paste in, he might have managed to eat "enough" without getting much of the HC kibble. Could that explain things?
Wondering if I should soak the kibble and mix it up real well with the canned food as I did at one point.

@Kris & Teasel, thanks a lot for your answers and support!
 
Stephanie & Quintus said:
+9 90 -- so, this "post-nadir-time" dip, what is it? Does it have to do with food? as it's a mix, and he tends to lick the paste of the kibble, he tends to eat more paste initially and the leftover has been kibble. Also, as I put way too much paste in, he might have managed to eat "enough" without getting much of the HC kibble. Could that explain things?
Wondering if I should soak the kibble and mix it up real well with the canned food as I did at one point.

@Kris & Teasel, thanks a lot for your answers and support!
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It looks more like a continuation of the nadir "range". A nadir can drag on for more than an instant in time. The 90 is a great number. As far as explaining every individual number - almost impossible.
 
Stephanie & Quintus said:
Thanks, that's reassuring. Hadn't thought of doing 2.25u, I could.

Next day I can "keep an eye on him" is Wednesday. If I stick with 2.5u, that means that by Wed we'll have had 6 whole cycles on the same dose, so I can see what it's doing. But if it is indeed too high, that leaves us with (what I see as) hypo risk tomorrow and Tuesday when he is all alone. Not sure yet what I want to do. Feedback, opinions, advice and ideas that I can factor in my decision most welcome.
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I'm assuming you don't have an autofeeder, since a neighbor is checking on him. But if he is food motivated (like Gizmo), using an autofeeder is an option. I'm still not comfortable leaving Gizmo. Thankfully I don't have to do it often and my mom will usually check on him throughout the day. But when I do leave him, I split his daily food up and have his feeder turn every hour. I feel somewhat safer knowing he has food available at "all times." I'm a bit of a worrier so I also set up my video camera so that I am able to watch him on my phone. Keeping food in his feeder assures he will stay close by through the day (so I can see him). Good luck and Quintus will be fine (not that it makes it any easier on you). :bighug:
 
Chubba said:
I'm assuming you don't have an autofeeder, since a neighbor is checking on him. But if he is food motivated (like Gizmo), using an autofeeder is an option. I'm still not comfortable leaving Gizmo. Thankfully I don't have to do it often and my mom will usually check on him throughout the day. But when I do leave him, I split his daily food up and have his feeder turn every hour. I feel somewhat safer knowing he has food available at "all times." I'm a bit of a worrier so I also set up my video camera so that I am able to watch him on my phone. Keeping food in his feeder assures he will stay close by through the day (so I can see him). Good luck and Quintus will be fine (not that it makes it any easier on you). :bighug:
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Quintus isn't hugely motivated by food. He likes it, and has a good appetite, but it's not what makes his world go around. He's always free-fed. So, he's used to having food available and that hasn't changed.

But he's also a champion napper. And with old age and illness, he tends to sleep a lot, possibly through what would have been his meals a few years ago. If somebody comes by and wakes him up, he'll go "oh! I'm hungry!" and eat. But if nothing is going on he might just sleep right through it.
 
Stephanie & Quintus said:
. If somebody comes by and wakes him up, he'll go "oh! I'm hungry!" and eat. But if nothing is going on he might just sleep right through it.
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Lol - my civvie is like that. When I first started giving Gizmo a snack at midnight, I would wake her up and drag her to eat also. She left me know real quick that sleep was much more important than food at that hour of the night. Lol. Sometimes she will wake up if I am testing him and come out for a treat, but most times she just waits in bed for me to return. :p
 
One thought to consider...

When you're going to be home, lower the dose and eliminate the HC food. It will give you a more reliable read on what's happening and you don't have to worry about the transition. Most people do find it easier on the nerves if their cat is in a bit higher numbers and is gradually coming down as doses are increased vs having their cat speed down the dose ladder. (That said, no matter how experienced you are, if your cat decides that he's tired of being on a particular insulin dose or any insulin, for that matter, it's stressful.)

Gabby was also a champion napper. My strategy would be to carb load if she was in lower numbers and I had to leave for work. She had an early nadir which helped ease my anxiety. I could also run home at lunch time if necessary. (And, there were some mornings where I had a "migraine" and went in late.)

 
Sienne and Gabby (GA) said:
When you're going to be home, lower the dose and eliminate the HC food.
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Not sure I understand, you mean next week-end? Or Wednesday?

The tricky bit here is that I cannot 100% control the transition as it depends on how his digestive system is accepting the new food (pawful of **** in the face at 4am, remember?)

I'm leaning towards sticking with 2.5 and "carb loading" these next two days -- that is, backtracking slightly on the transition and giving 50/50 HC/LC again.

On Wednesday, if poop agrees, I could move down to 2.25 and 1/3-2/3, or even 1/4-3/4. Also depending on the numbers: if they're very high by then, maybe I just change the food. If his poop is not great, 1/3-2/3 rather than 1/4-3/4.

Then he'll have Wednesday with less carby food where I can be around and make sure all goes well, Thursday-Friday I'll be away again, and then if poop agrees I can try and wean him off the dry food completely during the week-end (but I suspect that will be too fast).

The good news is that between Saturday and Jan 3rd I'll be home, so I can monitor closely.

How does that sound?
 
If I were going to make a rapid switch, I'd do it when I'm going to be around -- a weekend or off for the holiday. I did switch my cats to raw food literally overnight. I had a few days of semi-formed poop but it wasn't awful. I would have done this more gradually but was less well informed at the time.
 
PMPS 583. Looks like a bounce? Hold the dose at 2.5? how long do I expect him to stay "high", and will he come crashing down after the bounce?

The food mix with the right proportions clearly looks better than what I fed him yesterday and this morning.
 
Stephanie & Quintus said:
PMPS 583. Looks like a bounce? Hold the dose at 2.5? how long do I expect him to stay "high", and will he come crashing down after the bounce?

The food mix with the right proportions clearly looks better than what I fed him yesterday and this morning.
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Yes, it's a bounce. You'd hold the dose if you've decided to stay with 2.5 u. Or you can begin your plan discussed above and reduce to 2.25 u. They usually ease down after a bounce over the course of several cycles, generally up to 6 but more or less in some cats. With consistent dosing over time you'll learn to recognize these bounce profiles, how long they tend to last and what they look like when they're ending ("clearing").
 
Kris & Teasel said:
Yes, it's a bounce. You'd hold the dose if you've decided to stay with 2.5 u. Or you can begin your plan discussed above and reduce to 2.25 u. They usually ease down after a bounce over the course of several cycles, generally up to 6 but more or less in some cats. With consistent dosing over time you'll learn to recognize these bounce profiles, how long they tend to last and what they look like when they're ending ("clearing").
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So, I shot 2.5u -- particularly if it might take a few cycles to clear the bounce, then that kind of takes care of my hypo worries for tomorrow morning, right?

His food is more carb-loaded and he's eaten with appetite.

I'll take a +1 to see how things are going and expect to see higher numbers these next two days, then. With a bit of luck he'll start clearing the bounce Tuesday evening and I can see what's going on with the new dose on Wednesday.

:cat:
 
So, with a +2 at 677, a reduced dose (by 0.5ui) since this morning, and more carbs in his food since this evening... how high is he going to bounce? And how bad is it? Do I need to immediately worry about ketones with values like that? (He was tested negative last week.)
 
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Well, given that I don't recall that Quintus had ketones with all of those days in the 300 - above 500 range, I think ketones are unlikely. His numbers are also coming down this cycle. It actually looks like he's clearing bounces and getting out of those ugly numbers pretty quickly. Which speaks to your question about not worrying about his going low. The best advice I can give you is to not be complacent. The minute you think you know what your cat is going to do, he'll do something completely different simply because he's a cat. That's what they do!

 
Stephanie & Quintus said:
So, with a +2 at 677, a reduced dose (by 0.5ui) since this morning, and more carbs in his food since this evening... how high is he going to bounce? And how bad is it? Do I need to immediately worry about ketones with values like that? (He was tested negative last week.)
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Looks like our kitties are bouncing together. They can keep each other company.
 
Thanks!

He was back down to 391 this morning, the neighbour has been in twice and he has eaten and seems well.

As one thing is settled, another comes up: realises that Friday I will be back home 14h after shot so need to figure out if I can find somebody else to shoot (blind), if I skip the shot, or if I do it 2h late and therefore shift his shot times by 2h during the holidays. (Which, if I do that, will create problems with the arrangements I’ve made so he can get his shot on xmas day)
 
Stephanie & Quintus said:
Thanks!

He was back down to 391 this morning, the neighbour has been in twice and he has eaten and seems well.

As one thing is settled, another comes up: realises that Friday I will be back home 14h after shot so need to figure out if I can find somebody else to shoot (blind), if I skip the shot, or if I do it 2h late and therefore shift his shot times by 2h during the holidays. (Which, if I do that, will create problems with the arrangements I’ve made so he can get his shot on xmas day)
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You could start shifting shot times ahead starting today so the +14 time on Friday works. Then, shift it back to as close to normal as you can get for Christmas Day. If you don't quite get there he should be OK. Just count how many cycles you have ahead and work out what increments you need, not exceeding 30 minutes total per day.
 
I can’t do that unfortunately because until Friday morning I am stuck with an AM shot at 6 at the latest (I’m out of the door at 6:15 or I miss my train)
 
Stephanie & Quintus said:
I can’t do that unfortunately because until Friday morning I am stuck with an AM shot at 6 at the latest (I’m out of the door at 6:15 or I miss my train)
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If I was in your shoes, I'd go against the guidelines and tweak doses up or down a little to correspond with shorter/longer between dose intervals. It's going to affect the depot somewhat but you have to work within your particular schedule constraints. If you maintain a consistent dose the longer or shorter between dose intervals will act like decreased or increased doses anyway.
 
Stephanie & Quintus said:
Thanks!

He was back down to 391 this morning, the neighbour has been in twice and he has eaten and seems well.

As one thing is settled, another comes up: realises that Friday I will be back home 14h after shot so need to figure out if I can find somebody else to shoot (blind), if I skip the shot, or if I do it 2h late and therefore shift his shot times by 2h during the holidays. (Which, if I do that, will create problems with the arrangements I’ve made so he can get his shot on xmas day)
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If it were me I’d skip Friday night’s shot. Yes he’ll run a little high next cycle but I’ve had to do that when I’ve missed my train. Count it as a fur shot. Same effect.
 
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