12/29 Quintus: PMPS=85 +1=68

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Steph & Quintus & L & O

Steph & Quintus & L & O

Member Since 2017
condo: http://www.felinediabetes.com/FDMB/...e-green-and-honey-and-what-to-do-next.188673/

So, after yesterday's excitement in the lime greens (on an 18h cycle!) and four out of five mornings where Quintus was too low for me to shoot, I have taken drastic measures: reduction to 1ui :)

This morning his AMPS was 329 -- but I'd like to note that was a +19 AMPS, 19 hours after the 1.5ui shot that itself was 18 hours after the previous 1.75 shot. Is somebody on the slide or what? He was even lower than when I went to bed at +13=353.

So, sure, he's a bit higher than he was these last days. But I'm happy that even with the overcarbing I did because I had to leave him alone for a bit, he didn't go higher than 466. The last time I saw him that high was on the evening of the 24th, after his first official "lime green AM NS".

I'm hoping that the 1ui dose is going to allow me to shoot at 12-hour intervals for a few days. Fingers crossed...
 
I'd be interested in how more experienced members would deal with this situation. I'm inclined to give 0.5 tonight (I do not want to be getting up at 3 or 4am to keep his pretty face covered in honey). Certain this is not in the rulebook but Quintus doesn't seem to want to follow it either.

Thoughts? Comments?
 
If you want to shoot but still stay on the safe side you can still give him high carb food before he goes to low.
High carb food are those with gravy. Reducing can make you lose the momentum of this 1 unit dose.
You won't know know if this is the right dose except if you give it some cycle.

That's an idea within others.

Good job with the monitoring, no data is luxury when seeking for the right dose.

Sébastien
 
Photorecon said:
If you want to shoot but still stay on the safe side you can still give him high carb food before he goes to low.
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So the thing is, next cycle is the night cycle, and I would rather not be up monitoring as I am still ill and very much in need of recuperation. I would also rather (if possible) try and find a dose which I can give him without having to "feed him out of the lime greens". I agree with what you say regarding holding a dose for a few cycles, but I think usually we are faced with a dose that is maybe "too low" and we want to see if we increase it. Here, I have the impression Quintus is already telling us pretty clearly that the dose is a bit on the hefty side. No?
 
How are you feeding these drops when he is obviously clearing a bounce? It doesn’t look from the Remarks in the SS that he is getting much food.
 
+10 he's at 61

@Marje and Gracie no I haven't this time around. Should I? Not 100% sure what you mean by "clearing a bounce" -- you mean he bounced last night or this morning and how he's dropping lower than he would normally?

He seems to be surfing quite flat so I wasn't really worried. I'm going to get him to eat the rest of his portion now.
 
Stephanie & Quintus said:
+10 he's at 61

@Marje and Gracie no I haven't this time around. Should I? Not 100% sure what you mean by "clearing a bounce" -- you mean he bounced last night or this morning and how he's dropping lower than he would normally?

He seems to be surfing quite flat so I wasn't really worried. I'm going to get him to eat the rest of his portion now.
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Looking at his SS, IMHO, the issue all along has been that he is in a dive bounce cycle. He goes low, he bounces high, he clears the bounce but the drop isn’t fed so he goes low again. He bounced again last night and is clearing today and, yes, he’s going lower than he should because of it.

When a cat drops fast as he does, goes low as he does, or experiences lower numbers than they are used to, they bounce.....the BG goes way up as the body’s way of protecting it from hypoglycemia. With a bounce, what goes up must come down and bounce clearing cycles are very active. Every time he’s gotten into green, it has been on a bounce clearing cycle.

Shooting 18 hour cycles and letting him dive and bounce are not the way to work this insulin to his benefit. His SS does not even remotely look like one of a cat whose pancreas is working.

The goal is to flatten him out so he doesn’t go so low and you do that by feeding the drops to slow them down and prop up the nadir.
 
Marje and Gracie said:
With a bounce, what goes up must come down and bounce clearing cycles are very active.
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Marje and Gracie said:
The goal is to flatten him out so he doesn’t go so low and you do that by feeding the drops to slow them down and prop up the nadir.
Click to expand...

So, to be sure I understand the second part of bouncing (I got the "drop low, go up high behind" part). When a cat has been "artificially high" because of a bounce, he then comes down "artificially low" following that "artificially high". So we prevent the cat from going artificially low by feeding during the first part of the cycle. Is that correct?
 
Marje and Gracie said:
Shooting 18 hour cycles and letting him dive and bounce are not the way to work this insulin to his benefit. His SS does not even remotely look like one of a cat whose pancreas is working.
Click to expand...

Right, so as it seems I am Doing It All Wrong, I would appreciate advice on how to Do It Right or at least Do It Better.
Bonus points if it is compatible with me sleeping at night :D
 
Marje and Gracie said:
That one works since it was written by my mentor :)

Stephanie...I’m just getting started on some cat chores but when I’m done, shortly, I’ll make some specific suggestions.
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The whole feeding the curve things seems way too advanced given how little time I've been at it, not to say incompatible with my current health requirements. I would love to have a number that I can shoot before going to sleep or before going to work (that is going to start happening again soon) with relative confidence that Quintus will be safe while I'm not around to put food in his face.

Looking forward to suggestions, thanks.
 
+11.5, still low (not a big surprise without any extra food).

A bit at a loss what to do. Supposed to feed because of lime green numbers but not feed because shot time approaching. But how on earth will the numbers come up without food?
 
So today, and just for future reference, since obviously you don’t own a time machine, I would have fed HC or at least MC at +8, I would have tried to get a dark green number and hoped for a ride from there as the lantus should have been wearing off. It would put you in a good position to shoot at +12 and not compromise the no food 2 hours preshot window. Now that you’re past that, it’s tricky, and it’s not really spelled out in the type of detail I would like in the protocol, not sure about SLGS. You have the same options as always: skip or stall. I always lean away from a skip, but that’s me, I know Asia doesn’t do well when I skip and it sets her back too long for my liking. If you stall, I think you can feed LC and see if he will come up to an acceptable number for you to shoot, and then if you do, monitor very closely, if it were me, I’d even feed HC/honey right after shot time, just to give a higher number to drop from. And then look for drops in the +1 through whatever (it’s +3 for me, but ECID) and give some MC or HC when you catch the big drop to slow it down. You can also feed HC to get him out of neon green and wait a couple hours for the food influence to wear off to see what you’re dealing with before you shoot. It’s easier to deal with it before getting to shot time, for sure, but you do what you can do. :bighug:
 
Stacy & Asia said:
I would have fed HC or at least MC at +8, I would have tried to get a dark green number and hoped for a ride from there as the lantus should have been wearing off.
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So in this case, he actually got his food at +7 -- he ate a good amount of a quarter portion of his daily allowance. There wasn't much left when he finished it at +10. Doesn't seem to have done much for him -- or maybe it kept him in the high lime greens rather than the low ones?

Stacy & Asia said:
You have the same options as always: skip or stall. I always lean away from a skip, but that’s me, I know Asia doesn’t do well when I skip and it sets her back too long for my liking.
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I don't like skipping. The times when I've skipped he's ended up way high.

Stacy & Asia said:
If you stall, I think you can feed LC and see if he will come up to an acceptable number for you to shoot, and then if you do, monitor very closely
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So usually, I always feed a mix, because now he has the wet (LC) food he will only eat the dry (HC? MC?) kibble alone if he's starving, and if he only eats the wet food I end up with poopy paws on my face at 4am.

What I'm tempted to do is test again at half past, and if he still seems on the way up, maybe shoot something symbolic like 0.25? Or 0.5, which is what I'd be tempted to shoot tomorrow morning anyway? I can keep an eye on him these next hours and make sure he gets food at +1, +2, etc.
 
Stephanie & Quintus said:
So in this case, he actually got his food at +7 -- he ate a good amount of a quarter portion of his daily allowance. There wasn't much left when he finished it at +10. Doesn't seem to have done much for him -- or maybe it kept him in the high lime greens rather than the low ones?



I don't like skipping. The times when I've skipped he's ended up way high.



So usually, I always feed a mix, because now he has the wet (LC) food he will only eat the dry (HC? MC?) kibble alone if he's starving, and if he only eats the wet food I end up with poopy paws on my face at 4am.

What I'm tempted to do is test again at half past, and if he still seems on the way up, maybe shoot something symbolic like 0.25? Or 0.5, which is what I'd be tempted to shoot tomorrow morning anyway? I can keep an eye on him these next hours and make sure he gets food at +1, +2, etc.
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Maybe his regular food just doesn’t boost him enough (not a bad thing, at all). I found with Asia the gravy and honey didn’t do too much (20 points an hour boost on average), with Karo syrup and gravy I can send her to yellow on 4 or 5 drops! Find a type of sugar you can give him or add to the food and see if the sugar can boost and the regular food can sustain.
 
Stephanie & Quintus said:
85
20 minutes later, no food since +10
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If he were mine, I’d shoot his full, current dose and feed.

ETA: A 77 on an AT is not too low to shoot but you are going to have to feed him differently than you usually do. Stacy has some good ideas.

You don’t want to carb him up to shoot...that’s not a good idea; but you can shoot and then give him some HC food. She’s right about testing at +1 and +2 to be sure he’s headed up and if he isn’t, feed him an appropriate % carb depending on where he is. If he’s still dropping, give him more of the higher carb food. The goal, as she said, is to get him to a little higher number from which to onset. ahead of the drop.

I’m working on a longer informational post for you.

Stalling is for you, not for him.
 
Stephanie & Quintus said:
+11.5, still low (not a big surprise without any extra food).

A bit at a loss what to do. Supposed to feed because of lime green numbers but not feed because shot time approaching. But how on earth will the numbers come up without food?
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You likely need to get in the habit of checking him at +10 and if he’s not headed up, give him a good helping of LC food to start with and see if that stops him from dropping into the next PS. Feeding LC at +10 is fine and won’t cause too big of a jump in his PS but will help to keep him flatter. You might determine that he needs more along the lines of a higher LC at +10. And this might change. Right now, we just need him to flatten out and spend some good time in healing numbers.

It’s also important that you learn the difference between a dropping number and a second dip. Lantus is known for giving some cats a second dip at PS. The way to know the difference is it’s a dropping number if the BG starts higher during the previous cycle and just continues to drop to the next PS so the nadir is at +12. A second dip means the BG comes down to a nadir around mid cycle and then goes back up but at the next PS, drops down again but not below the nadir of the cycle.

Stephanie & Quintus said:
The whole feeding the curve things seems way too advanced given how little time I've been at it
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It isn’t that advanced but it does take time, some work, and the desire to learn about your cat as well as do some experimenting. It pays off in spades. I can only imagine how he must feel with these dives and bounces. It can’t feel good and I’ve had diabetic friends who have told me that it does not.

The goal in managing the curve with food is to flatten the curve out. Even if it flattens out at a higher level and you have to raise the dose, that’s ok. Flat is much better than what he’s doing. As the overall curve comes down, then the bouncing and diving can stop and you can get a better idea of what his BG actually is. With my Gracie, early on, once I knew her patterns better and how she responded to food, I rarely gave her reductions on bounce clearing cycles because she could be very active. As we learned more about the foods that worked for her, I was able to manage her bounce clearing cycles better so she didn’t go so low.

I would suggest you start by determining how much food you feed him in a cycle. Is it enough calories to keep his weight stable or does he need more or less? Then divide that into four portions that you feed at PS, +1, +2, +3. You can start by giving him equal portions but you might find, at some point, that he needs more earlier and less later or vice versa. This is the part where experimentation comes in. We’ve also found that it helps a lot of cats like this if you feed a higher LC food such as a 10% instead of a 4%. You also need to determine what amount of drop is too much for him. Again ECID. With my Gracie, anything over 50 mg/dL was too much for her but that is not standard.

The other thing that is really important when you are trying to get this under control is to test at PS, +1, +2, at least every single cycle that you can so you can see where he’s dropping and address the drop from the beginning. Note that cats rarely drop at a steady rate. If you wait until +3 to test and he’s dropped 150 mg/dL, that doesn’t mean he came down steadily and will continue to do so. Maybe he got a food spike at +1 and then dropped 40 between +1 and +2 and then onset and dropped the rest. You have to be an investigator. That doesn’t mean you will always have to do this but just until you get him flattened out more.

If you can get him flatter early on in the cycle past his onset and when he really kicks in, then you can leave the appropriate amount of food and carbs out for him so you can sleep.

It’s a lot of info at once. If he were mine, I’d try to take the advice I’ve seen you give other CGs and shoot as consistently at +12 as you can; yes, there can be a little variance but try to be close to +12. As I said earlier, stalling, shooting reduced doses, and skipping unless the number is too low to shoot or the CG cannot monitor or doesn’t have supplies is more for the caregiver than for the cat. We do expect new members to do all of those things until they feel more comfortable shooting lower blue and then green numbers but, for Quintus, the first step is getting him to flatten out so he doesn’t give you really low PSs.

Questions?
 
Thanks for all the info. Some comments, because there are a number of points which, although they make sense, do not seem to be things I can realistically do. I'm sure what you present works, but I need to fit the way I manage Quintus's diabetes within the constraints we have, both him and me.

Marje and Gracie said:
get in the habit of checking him at +10
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This is "more or less fine" during the next week or so when I'm at home. When work resumes this is completely impossible. It would mean waking up at 4 am (shoot time will be 6.15), and at the end of my work day I get through the door just in time to shoot.

Marje and Gracie said:
give him a good helping of LC food
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As I mentioned above, for the time being at least I am stuck with a mix of LC and HC (or is it MC?) food that I can't really separate. When I give him a helping, he eats a bit more LC (paste) at the beginning, and there is more kibble in the end of the helping. But if I give him paste on its own, I'll never get enough kibble in him to keep him from having diarrhea.

Marje and Gracie said:
The way to know the difference is it’s a dropping number if the BG starts higher during the previous cycle and just continues to drop to the next PS so the nadir is at +12. A second dip means the BG comes down to a nadir around mid cycle and then goes back up but at the next PS, drops down again but not below the nadir of the cycle.
Click to expand...

Good to know, thanks!

Marje and Gracie said:
It isn’t that advanced but it does take time, some work, and the desire to learn about your cat as well as do some experimenting.
Click to expand...

I hope you're not implying I'm not willing to learn about my cat or experiment. I have been doing that like crazy, even before he was diagnosed. The reason we diagnosed his pancreatitis and then his diabetes is because I knew my cat well enough to know something was off.

Time and work? well, maybe. I need to earn a living. I live alone. I work nearly an hour away from home. My whole life these last weeks has been revolving around Quintus's ears and spreadsheet numbers and sticking food in his face. I wrote about this in a thread the other day -- I am not willing to lose my relationship with my cat and end up with only an illness to manage.

That said: yes, I'm sure it's doable. But I don't think at this stage I have the data or means to do it well, both in terms of experience of how his BG reacts to food or insulin, and of food options I can play with.

Marje and Gracie said:
I can only imagine how he must feel with these dives and bounces.
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Are you seeing that many dives and bounces since the 25th? I'm seeing a small one on the 27th, following the NS (one of the reasons I want to stay away from NS). He hasn't touched red since 24th evening -- excepting of course yesterday when I overdosed him with honey.

I have no doubt the diabetic ups and downs are unpleasant. And I can see the swings or dips are tiring. But observing how Quintus is doing compared to a few weeks ago, it's clearly way better than swimming in black and red levels of glucose all day. He's going outside and being more active than I've seen him in months. He's playing. He's alert. He's using his scratching post. He's grooming. He's climbing all over me to purr on my lap and my arms.

Marje and Gracie said:
I would suggest you start by determining how much food you feed him in a cycle. Is it enough calories to keep his weight stable or does he need more or less? Then divide that into four portions that you feed at PS, +1, +2, +3.
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That's doable now during the holidays, and maybe for the evening cycle once I'm working, but impossible on work mornings as I'm out the door as soon as the needle is out of the cat.

FWIW this is pretty much what I did after yesterday's shot, and we ended up in honey-level lime greens. Which brings me to say I really think the dose was still too high, and that what we're dealing with here is not just my lack of technique and bad management, but also a cat who struggled to stay out of the reds and blacks and barely touched green on 3ui 2 weeks ago, and now can't keep out of lime green on 1ui. I understand the depot comes into play, but all in all, I struggle to interpret this differently than his pancreas is improving. I'm aware I can be mistaken on this, and if that's the case, would really like to understand what I'm missing.

Marje and Gracie said:
If you can get him flatter early on in the cycle past his onset and when he really kicks in, then you can leave the appropriate amount of food and carbs out for him so you can sleep.
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Makes sense, and it's what I've been trying to do, though less systematically. We'll see how I manage tonight.
 
Stephanie & Quintus said:
The whole feeding the curve things seems way too advanced given how little time I've been at it, not to say incompatible with my current health requirements. I would love to have a number that I can shoot before going to sleep or before going to work (that is going to start happening again soon) with relative confidence that Quintus will be safe while I'm not around to put food in his face.

Looking forward to suggestions, thanks.
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The reason I wanted to find the post Marje wrote is because the one I linked to suggests manipulating the curve with food is an advanced technique and it’s best not to attempt it, and I know if it were me, and I were pretty new at the time, my mind would have shut off reading after I saw that. “Me advanced? I don’t think so, I hardly know what I’m doing! Feeding the curve isn’t for me.”

So I don’t think it’s an “advanced” technique, per se, it’s just one that is hard to get your head around and employ, like Marje said, it requires more investment of time, work and experiementing. I don’t think she was implying you weren’t willing to do that, I think she was just clarifying what makes it “advanced” and how it still can apply to you even if you don’t put yourself in that category. I wouldn’t use that word at all, I would just say feeding the curve is very useful once you’ve had a little bit of time, a little bit of data, and you are frustrated that the dose gets the nadir where it should be, but everything else is a mess. FWIW, I didn’t choose to start manipulating with food, Asia made me do it and I just listened to her when I saw it working and began to feed more than just neon green numbers.
 
Stacy & Asia said:
I think she was just clarifying what makes it “advanced” and how it still can apply to you even if you don’t put yourself in that category. I wouldn’t use that word at all, I would just say feeding the curve is very useful once you’ve had a little bit of time, a little bit of data, and you are frustrated that the dose gets the nadir where it should be, but everything else is a mess.
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Shouldn't this kind of thing be in the stickies? Or did I miss it? I remember clearly reading about how to react when faced with neon numbers, the whole "take action" stuff. But until today I do not recall (except when you mentioned it to me in passing the other day) reading anything about the importance of "slowing" drops with food, even if the low number is not going to be dangerous (= hypo-dangerous), to minimise bouncing.
 
Stephanie & Quintus said:
Shouldn't this kind of thing be in the stickies? Or did I miss it? I remember clearly reading about how to react when faced with neon numbers, the whole "take action" stuff. But until today I do not recall (except when you mentioned it to me in passing the other day) reading anything about the importance of "slowing" drops with food, even if the low number is not going to be dangerous (= hypo-dangerous), to minimise bouncing.
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So many things should be in stickies, but aren’t. I think there would be at least 50 of them up there if they were all stuck to the top. They are threads that just get written and lost and bookmarked and bumped up by people in the know. If I had a magic wand, I’d have a separate forum called LL resources and it would contain only stickies. There’s a “where can I find” link I think in the new members start here post, it has a ton of great stuff in it, but also, a lot is missing, some links are broken, etc.

It’s funny about this board, from an anthropological standpoint, it acts a lot like old school oral history societies, there’s not a tome of everything written down, there are people who pass on what they know to the next people that come and so on and on and on. Everybody is far too busy with their FD cats, paying jobs, and lives to take on the volunteer position of tech writer/editor/librarian, etc. A lot of amazing stuff still gets written down, but it’s not organized in a way for easy finding.

I also find experienced people come and drop these little gems just at the right time when I need them. If I got all the info up front, for sure I would have been completely overwhelmed to the point of shutting down (it was overwhelming enough just to get the diagnosis and start here and read the stickies) and would have been in one ear and out the other. ;)
 
61, carb it up! whatever you did yesterday probably wouldn’t hurt here, he was about past nadir when you halted him, but today is a very different scenario. Maybe go a bit less than yesterday, but do something similar for sure.
 
Feeding the numbers isn't too hard. I am doing what you are doing. Mixing some HC into his LC. More HC mix on the top vs. the bottom.

Jones free feeds but I know he eat most of his food from +2 to +6. I just watched him over the weekends to see patterns. He will then eat a small snack around +10 to +11. Before adding in the additional carbs, he would drop from yellows to the green's then giving me high yellows and a few pinks for several cycles after. Took a bit, dried extra whiskas, dried EN food and now I just have some HC wet I mix in. I started on 12/19 - didn't take long to have higher flatter cycles though. Then the advice was to up the dose and within a few days he is looking better already.

About 10 days in total to get things figured out.

I wish you speed and luck figuring it out.
 
Yesterday was at +3 because I'd shot at +18
I gave him a little of the mix I prepared yesterday "just in case" and didn't use, I stuck it in the fridge. Gravy + some honey + some LC + some HC -- a real mix. I let him lick some and take a few bites. For anybody following I add everything I do in the SS notes first.
 
Stacy & Asia said:
from an anthropological standpoint, it acts a lot like old school oral history societies, there’s not a tome of everything written down, there are people who pass on what they know to the next people that come and so on and on and on
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I've always been fascinated by online communities. Discovering chatrooms in the late 90s is what led to the job that sustained me 10+ years.
 
Tracey&Jones said:
Jones free feeds but I know he eat most of his food from +2 to +6. I just watched him over the weekends to see patterns. He will then eat a small snack around +10 to +11.
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Quintus has been a free-feeder all his life. I've tried observing but it varies from day to day. Initially I thought he ate more during the night. Then he ended up not eating during the night. Last night he ate a lot, and today he snacked. I also have been struggling with quantities: he loves the wet LC food, so he's likely to eat more than he needs. He had pancreatitis and had lost weight, so I was trying to get everything I could into him. Now I think I have a rough idea what his daily allowance should be (but we'd have to wait a few weeks and weigh him to be sure) but I'm not so sure about when he'll want to eat it. I thought I'd noticed he liked to eat around +6, but then no.

Tracey&Jones said:
I wish you speed and luck figuring it out.
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Thanks!!

Tracey&Jones said:
I started on 12/19 - didn't take long to have higher flatter cycles though.
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I'm envious! What didn't help me is that I started "from up above", with a dose that was probably way too high, and a food transition that I couldn't manage really well.
 
And a test at +2 which I’m sure you were already planning on, but just to see what the carbs did and make sure he’s trying to come up a bit.
 
Stephanie & Quintus said:
Indeed. 70. And another "quarter of his PM allowance"
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So what you fed him at your +5 yesterday (+11 on SS) took him up almost 100 points but now it’s just 9? :eek: I would give him more HC, quantity of food isn’t the issue, use honey by itself if you need to, but get the numbers up higher as soon as you can or it’s going to be a very long night. And yes, it does feel like feline hospital, not quite ICU for me, that would be scary. I have amassed some odd medical supplies and her drug bin is far larger than the one that has the meds my whole family of humans takes!
 
Stacy & Asia said:
So what you fed him at your +5 yesterday (+11 on SS) took him up almost 100 points but now it’s just 9?
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No, no! Yesterday I gave him a TON of honey because I was leaving the house. This mix has just a little bit of honey diluted in, and he licked it 10 times and ate three little pieces. Yesterday he got multiple spoonfuls swimming in honey.

This is what I had left on the ground in case I got in trouble and wasn't coming back when I thought.
 
Stephanie & Quintus said:
No, no! Yesterday I gave him a TON of honey because I was leaving the house. This mix has just a little bit of honey diluted in, and he liked it 10 times and ate three little pieces. Yesterday he got multiple spoonfuls swimming in honey.

This is what I had left on the ground in case I got in trouble and wasn't coming back when I thought.
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Okay, well he needs some more honey then, maybe not a ton like yesterday, but definitely more. He’s going to continue to drop until whenever he doesn’t, which could be nadir and hours from now, you want him to have room to drop without dropping in to lime green.
 
Stephanie & Quintus said:
So I need to get him higher than we are now, even if for now I've only given him a tiny taste of the magic mix?
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Yes yes yes. If he drops from 70, there’s no good place to go, let him drop from 90 or 100 and you’re in a much better position. You want to beat he onset of insulin, and it will be soon if not now.
 
He could just surf this, but he could also keep dropping, I would play it safe and give a wee more honey and then see where he goes from there
 
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