2-4 Gizmo AMPS=308; +2=217; +3=157; +5=70; +6=75; +8=73; +10.5=103; PMPS=119; +2=136; +3=117; +5=151

[Chubba (GA)]

Yesterday

I noticed that it seems to take Gizmo 9 cycles to earn a reduction. The “pattern” (don’t tell Gizmo I said that ) starts on Jan 19th. He started 9 units. 9 cycles later, he earned a reduction. Then 9 cycles later, he earned another reduction. On 8 units, he was higher most of the time and I assumed it was a failed reduction. Only waited to increase him due to our work schedules and being unable to monitor. Then 9 cycles later, he earns another reduction. So even though he hasn’t hit green on 7.5 units, I’m thinking I should hold this dose for 9 cycles to see what happens.

Is this showing me that Gizmo takes more than 6 cycles to know what a dose does? Should I be waiting the 8-10 cycles before making dose decisions? And should I be decreasing when he is high most of the cycles and just drops once into lime green? He is very near being “a long term diabetic.” His one year anniversary is coming up on Feb. 10th.

Just looking for some advice moving forward to make sure I’m doing what is best for Gizmo. We are using an AT2 meter. He has Acro and is on cabergoline. Thanks everyone for all of your advice, support, and encouragement over the past year (it seems so much longer).

 

[Steph & Quintus & L & O]

I think I read somewhere (?) that the depot can take longer to stabilise on larger doses. That would fit with what you are observing.

 

[Bobbie And Bubba]

Nice that he has revealed a pattern to you. And that said,he can change or at any time. I would let the numbers you get be your guide as to when to increase and not what cycle it is.

 

[Stacy & Asia]

My opinion, he is not spending nearly enough time in greens and low blues that those reductions make a lot of sense. He is very briefly in greens, and that's when he goes below cutoff. It it were me, I would watch him like a hawk when he shows some greens, and keep some food, maybe a slightly higher carb food, in him so that doesn't happen and see if you can get some longer stretches of better numbers.

That being said, he is a high dose kitty, I don't think the rules apply differently to this, but I would defer to @Wendy&Neko 's opinion here.

 

[Beenie (GA)]

I agree with Stacy. It looks like you get enough tests in to do this. Would be better for Gizmo to stay in some greens and low blues longer so his body gets used to it. Being you're coming up on the year mark you could go by the "rule" of reducing after three drops. But with Acro and Cabergoline in the mix it gets tricky. I only suggest this if the bean can monitor closely. On 1/28 I feel Giz clearly earned that reducie. But this last drop to 67 on 2/1 only took 2tsp of MC and that was the end of that drop. I'm inclined to say I would have not reduced, especially considering meter variance and Gizmo's tendency to creep back up.

Not sure if its been discussed but have you ever considered Lev? Some kitties flatten out and do better. Some don't but just wondering if its something you've ever considered? I've seen some with great results since switching and wonder if Gizmo would do the same.

 

[Wendy&Neko]

I haven't had my yet, but had to weigh in on this. Sorry if I'm not coherent yet.

First, the "rule" of reducing after three drops is an option for kittites that don't do reductions well. If you look at the TR Sticky, the guidelines for long term diabetics for reductions is going under 40. Now this for human meters - I have no idea what 40 equals on the AT so I'll talk in terms of the human meter numbers for now.

You have to decide what works for Gizmo. ECID is true, even more so for an acrocat. The way you find out what works, is by carefully experimenting. The 9 cycles could be a thing, or not. It could be that's how long it takes the cabergoline to slowly whack some of the tumour cells. It could be related to tumour life cycle. It could be because Gizmo's a cat and he wants to lull you into thinking he's predictable. I don't think it's related to the depot. When Neko was on that sized dose, sometimes she would go less than 6 cycles between reductions. Even though she had what we would call back to back reductions, they held, so that's what counted.

Having said all that, it would be nice to get rid of some of the pink in Gizmo's spreadsheet. If you want, you could experiment with a couple of things. The first is trying just a 0.25 unit reduction. The second is waiting for a little lower number before reductions. Last time was a 67, so he just barely squeaked in earning that reduction. The third option is waiting for more than one under 68. At one point I went to 2 times under 50 (I used a human meter) to try to reduce some bounciness. It seemed to help. But if you do any of the above options, you do have to be prepard to need to monitor quite closely. And pick just one option, and try it for a while, unless you can see it's an epic fail. I tried the 0.25 unit decrease just once when Neko was over 5 units, and got rewarded with a number in the 20's. But that was after SRT so lesson learned. I have seen smaller reductions work for some acros - ECID. When Neko's dose got smaller, it worked better for her to shave the dose down.

 

[Chubba (GA)]

My opinion, he is not spending nearly enough time in greens and low blues that those reductions make a lot of sense. He is very briefly in greens, and that's when he goes below cutoff. It it were me, I would watch him like a hawk when he shows some greens, and keep some food, maybe a slightly higher carb food, in him so that doesn't happen and see if you can get some longer stretches of better numbers.

I agree that he isn’t spending a lot of time in blues and greens, but then he dives and earns a reduction. That’s what is confusing to me. But with that being said, I don’t really understand/agree with feeding higher carb foods to continue giving a higher dose of insulin. I’m not saying it doesn’t work, just seems backwards to me. Plus with trying to find food that he will eat and that is lower in phosphorus... It is very difficult to change his food. I’m not ruling out this option, but for me it will probably be a last resort.

.On 1/28 I feel Giz clearly earned that reducie. But this last drop to 67 on 2/1 only took 2tsp of MC and that was the end of that drop. I'm inclined to say I would have not reduced, especially considering meter variance and Gizmo's tendency to creep back up.Not sure if its been discussed but have you ever considered Lev? Some kitties flatten out and do better. Some don't but just wondering if its something you've ever considered? I've seen some with great results since switching and wonder if Gizmo would do the same.

I think what I need to do is not be so rigid in his reduction numbers. I’ve always wondered about the “cutoff” numbers and have strictly went by them. However, I knew Gizmo barely earned that reduction compared to the previous one where it took a bit to get him back up. Maybe I need to look at each individual circumstance instead of just thinking about the cutoff number. I’ve just always been too “afraid” to not take a reduction that was “earned” per the protocol. I have thought about lev, but really haven’t considered it much beyond that. Might bring it up at Gizmos next vet appt.

 

[Chubba (GA)]

I haven't had my yet, but had to weigh in on this. Sorry if I'm not coherent yet.

First, the "rule" of reducing after three drops is an option for kittites that don't do reductions well. If you look at the TR Sticky, the guidelines for long term diabetics for reductions is going under 40. Now this for human meters - I have no idea what 40 equals on the AT so I'll talk in terms of the human meter numbers for now.

You have to decide what works for Gizmo. ECID is true, even more so for an acrocat. The way you find out what works, is by carefully experimenting. The 9 cycles could be a thing, or not. It could be that's how long it takes the cabergoline to slowly whack some of the tumour cells. It could be related to tumour life cycle. It could be because Gizmo's a cat and he wants to lull you into thinking he's predictable. I don't think it's related to the depot. When Neko was on that sized dose, sometimes she would go less than 6 cycles between reductions. Even though she had what we would call back to back reductions, they held, so that's what counted.

Having said all that, it would be nice to get rid of some of the pink in Gizmo's spreadsheet. If you want, you could experiment with a couple of things. The first is trying just a 0.25 unit reduction. The second is waiting for a little lower number before reductions. Last time was a 67, so he just barely squeaked in earning that reduction. The third option is waiting for more than one under 68. At one point I went to 2 times under 50 (I used a human meter) to try to reduce some bounciness. It seemed to help. But if you do any of the above options, you do have to be prepard to need to monitor quite closely. And pick just one option, and try it for a while, unless you can see it's an epic fail. I tried the 0.25 unit decrease just once when Neko was over 5 units, and got rewarded with a number in the 20's. But that was after SRT so lesson learned. I have seen smaller reductions work for some acros - ECID. When Neko's dose got smaller, it worked better for her to shave the dose down.

Thanks, Wendy. I think I might try the 2 drops under 68 or maybe one drop into the 50s (my best comparison to the protocol). I’ve been kinda leaning towards trying the 3 drops under 68, but wasn’t sure if I should since he wasn’t technically a long term diabetic yet.

Oh and while we were all discussing this ... Gizmo threw me a 70 at +5 and 75 at +6. Maybe we have convinced him to surf greens for a bit.

 

[Stacy & Asia]

I agree that he isn’t spending a lot of time in blues and greens, but then he dives and earns a reduction. That’s what is confusing to me. But with that being said, I don’t really understand/agree with feeding higher carb foods to continue giving a higher dose of insulin. I’m not saying it doesn’t work, just seems backwards to me. Plus with trying to find food that he will eat and that is lower in phosphorus... It is very difficult to change his food. I’m not ruling out this option, but for me it will probably be a last resort.

I understand and I'm with you on that, it really doesn't seem make sense to give carbs (sugar) to a diabetic to help have better regulation. I had a hard time with the concept too, and I also didn't want to feed her foods other than one I had painstakingly researched and selected for her to eat. I settled with using different amounts of honey/Karo instead of different foods.

I was reluctant, but I ended up really having no choice. When Asia has a good workable dose, it's inevitable that she will dive somewhere and earn a reduction, it's just what she does. I make distinctions between the barely one number under reductions vs the prop them up all day with sugar obvious ones. Anyhow, she would earn the barely under one number only reductions rather consistently if I didn't prevent them. The surrounding numbers told me if the reduction would make sense or not. This is how I reconciled it, if I know that she drops an average of 20 points from hour to hour in the first 3 hours of a cycle, say her +2 is a 70, pretty good chance if I let the chips fall, good chance that +3 will be 50 or less. I would have to give her carbs one way or another, either because she went below the safety number, or in advance to stop her from going below the safety number. Seemed an obvious choice in those instances, because carbs are inevitable, except one of those options let's me keep a dose if it makes sense to keep a dose. So that's how I reconciled it anyway.

Hope you find something that makes sense and works for both of you.

 

[carfurby (GA)]

I hope you can figure out something that works for you and Gizmo to keep him in good, but safe, numbers.

 

[Christie & Maverick]

I'm going to come at this from a different angle, because I have used the AT2 and am now following a human meter. Yes, there are a few pinks in there, and it would be better to see more blues and greens, but everyone here is so used to seeing human meter readings, that they don't register the significance of low blues on an AT2 (ie likely green), and those pinks on AT2 are more likely yellows, possibly high blues on a human meter. It's just an observation, could Gizmo's cycles be better, sure, there is always room for improvement , but who's cat is perfect!? Mine sure isn't lol

I'll suggest something that was pointed out to me, which really has helped me in trying to figure Mav's patterns. I'd go back to getting +2s which may indicate where Gizmo is headed...today is a great example. If there is a sharp drop, you can maybe flatten things out with some 6-9% food, then re-check +3 and feed based on that number. On Jan 28th am cycle, a +2 might have prevented the later limes...or not...if Gizmo really wants a reducie, he'll earn one. it might help to get out of the bouncing cycles? Just a thought.

Last comment, I wouldn't feel comfortable using 50 on an AT2 meter as a reduction point. Mostly just my gut feel, but I've hit 30s on a human meter which was 68 on an AT2...I'd be worried under 50 on AT2 you'd see symptomatic hypo.

ETA: sorry, I misread earlier, you mentioned "one drop in the 50s" not under 50...but that's still chancy to me.

 

[Chubba (GA)]

I understand and I'm with you on that, it really doesn't seem make sense to give carbs (sugar) to a diabetic to help have better regulation. I had a hard time with the concept too, and I also didn't want to feed her foods other than one I had painstakingly researched and selected for her to eat. I settled with using different amounts of honey/Karo instead of different foods.

I was reluctant, but I ended up really having no choice. When Asia has a good workable dose, it's inevitable that she will dive somewhere and earn a reduction, it's just what she does. I make distinctions between the barely one number under reductions vs the prop them up all day with sugar obvious ones. Anyhow, she would earn the barely under one number only reductions rather consistently if I didn't prevent them. The surrounding numbers told me if the reduction would make sense or not. This is how I reconciled it, if I know that she drops an average of 20 points from hour to hour in the first 3 hours of a cycle, say her +2 is a 70, pretty good chance if I let the chips fall, good chance that +3 will be 50 or less. I would have to give her carbs one way or another, either because she went below the safety number, or in advance to stop her from going below the safety number. Seemed an obvious choice in those instances, because carbs are inevitable, except one of those options let's me keep a dose if it makes sense to keep a dose. So that's how I reconciled it anyway.

Hope you find something that makes sense and works for both of you.

Thanks for explaining this in more detail. I would have never thought to add honey to his regular food. Plus I was thinking you fed Asia higher carb food all the time. But it seems you only use it to avoid a reduction you don’t think she is ready for. That makes more sense to me. Often Gizmo is heading towards a reduction (today for example) and I really don’t think he needs one just yet.

 

[Chubba (GA)]

I'm going to come at this from a different angle, because I have used the AT2 and am now following a human meter. Yes, there are a few pinks in there, and it would be better to see more blues and greens, but everyone here is so used to seeing human meter readings, that they don't register the significance of low blues on an AT2 (ie likely green), and those pinks on AT2 are more likely yellows, possibly high blues on a human meter. It's just an observation, could Gizmo's cycles be better, sure, there is always room for improvement , but who's cat is perfect!? Mine sure isn't lol.

Thanks for pointing this out. I often forget that his numbers would “look” much better if I switched to a human meter. Something that I have often considered, but ultimately keep deciding against. Now a human meter once again seems like the obvious choice, except I just ordered more alphatrack strips because of the 10% off this weekend. So I now have 500 strips, plus another 400 on the way. I had to pay to overnight strips once ... lesson learned. Lol

I'll suggest something that was pointed out to me, which really has helped me in trying to figure Mav's patterns. I'd go back to getting +2s which may indicate where Gizmo is headed...today is a great example. If there is a sharp drop, you can maybe flatten things out with some 6-9% food, then re-check +3 and feed based on that number. On Jan 28th am cycle, a +2 might have prevented the later limes...or not...if Gizmo really wants a reducie, he'll earn one. it might help to get out of the bouncing cycles? Just a thought.

Gizmo is never consistent on the +2s. At least I don’t think he is. Sometimes the +3 is a better indication of his cycle. It is something that I can definitely try again. I’ve been getting +3s in the mornings and +2s in the evenings to see if I can see any patterns.

Last comment, I wouldn't feel comfortable using 50 on an AT2 meter as a reduction point. Mostly just my gut feel, but I've hit 30s on a human meter which was 68 on an AT2...I'd be worried under 50 on AT2 you'd see symptomatic hypo.
ETA: sorry, I misread earlier, you mentioned "one drop in the 50s" not under 50...but that's still chancy to me.

Maybe that isn’t a good idea ... that’s kinda why I threw it out there to get some feedback. It seemed like a reasonable number based on the protocol being 3 drops under 50 or 1 drop under 40. So I just went with the 10 points less. I know it doesn’t really work like that, but I’m not sure what it would look like on an alphatrack meter.

 

[Christie & Maverick]

LOL, I think you are covered on the strips...glad you got some on sale! Always better to have more than less . The weird thing with the human meter, for me anyway, is that the +2s actually started to become more "effective" in telling me where Mav was headed.

If I recall, you have a different feeding schedule I think, than I do? Do you feed at +3 regularly, or is it a smaller meal around +4?

 

[Chubba (GA)]

LOL, I think you are covered on the strips...glad you got some on sale! Always better to have more than less . The weird thing with the human meter, for me anyway, is that the +2s actually started to become more "effective" in telling me where Mav was headed.

If I recall, you have a different feeding schedule I think, than I do? Do you feed at +3 regularly, or is it a smaller meal around +4?

I feed a meal at +3 and +6. But today I split his meals between +2 and 3 and +5and 6 to help him ease the drop.

 

[Christie & Maverick]

P.S...nice solid surf there Gizmo

 

[Christie & Maverick]

I feed a meal at +3 and +6. But today I split his meals between +2 and 3 and +5and 6 to help him ease the drop.

I think that +2 feed today helped...today's cycle looks picture perfect ...well except for the AMPS lol

 

[Stacy & Asia]

Thanks for explaining this in more detail. I would have never thought to add honey to his regular food. Plus I was thinking you fed Asia higher carb food all the time. But it seems you only use it to avoid a reduction you don’t think she is ready for. That makes more sense to me. Often Gizmo is heading towards a reduction (today for example) and I really don’t think he needs one just yet.

Yes, I use it mostly to avoid reductions and I also use it occasionally if there is a big drop (for Asia), her average is up or down 20 points an hour, so if she drops 70 points in an hour from a number roughly under 200, I give a little bit of Karo there to slow her down in an effort to prevent a big bounce. It's slightly more complicated than that because I know she reacts to sugar differently in an am cycle vs a pm one and on numbers that are falling at shot time vs rising. But that is the gist.

Asia also won't eat her regular food with sugar in it, so I either feed her Karo from a syringe or I use a tiny bit of gravy as a conduit for eating Karo. She will eat the gravy with Karo in it for some reason, but lately I've just been giving Karo from a syringe for the same reason you said: phosphorous.

 

[Wendy&Neko]

and those pinks on AT2 are more likely yellows,

Yes, and more than likely over the renal threshold which is why I don't like seeing them on any meter. My goal was always to try get as much under renal threshold time as possible. Acromegaly is hard on kidneys by itself. I didn't want high numbers adding to it.

I think I tried the higher carb/feeding the curve experiment with Neko once or twice. That went into the category of epic fail. She didn't respond any differently to 8% vs. no carb. Yet she was sensitive to carbs over 10% to the point that often MC was enough to bring her up from lows. I chalked that up to the working acro pancreas.

I think this just means you have to experiment and find what works for Gizmo. Obviously you got a nice surf going today. So that worked!

 

[Steph & Quintus & L & O]

I agree that he isn’t spending a lot of time in blues and greens, but then he dives and earns a reduction.

tagging @Kailee § Dallas, @Mel & Caramel, @Marie Dagobah&Nikita, who are trying to follow SLGS but are faced with this issue of a cat's numbers being "not that great" but suddenly there is a "below 90" and a reduction is earned. I think this thread might be interesting to them.

FR version (as they are francophones):

On a ici le cas d'un chat qui descend "assez bas" pour avoir une réduction de dose, alors que dans l'ensemble ses valeurs ne sont pas super. Je pense que la discussion peut être intéressante pour vous, donnez-la à manger à Google Chrome et traduction!

But it seems you only use it to avoid a reduction you don’t think she is ready for. That makes more sense to me. Often Gizmo is heading towards a reduction (today for example) and I really don’t think he needs one just yet.

Yes, I use it mostly to avoid reductions and I also use it occasionally if there is a big drop (for Asia), her average is up or down 20 points an hour, so if she drops 70 points in an hour from a number roughly under 200, I give a little bit of Karo there to slow her down in an effort to prevent a big bounce.

So, would there be a difference (except formal), between not giving a reduction because we fed karo and kept numbers up, or watching numbers go down (obviously intervening if they fall out of the safe range, but let's imagine they don't for the sake of the thought experiment), and deciding that although theoretically the cat would have earned the reduction, it's not going to be for this time? This seems to fit with the "x times under threshold" guideline.

I do completely see the point of feeding karo to prevent a drop that will result in a bounce.

 

[Bobbie And Bubba]

I was reluctant, but I ended up really having no choice. When Asia has a good workable dose, it's inevitable that she will dive somewhere and earn a reduction, it's just what she does. I make distinctions between the barely one number under reductions vs the prop them up all day with sugar obvious ones. Anyhow, she would earn the barely under one number only reductions rather consistently if I didn't prevent them. The surrounding numbers told me if the reduction would make sense or not. This is how I reconciled it, if I know that she drops an average of 20 points from hour to hour in the first 3 hours of a cycle, say her +2 is a 70, pretty good chance if I let the chips fall, good chance that +3 will be 50 or less. I would have to give her carbs one way or another, either because she went below the safety number, or in advance to stop her from going below the safety number. Seemed an obvious choice in those instances, because carbs are inevitable, except one of those options let's me keep a dose if it makes sense to keep a dose. So that's how I reconciled it anyway.

This is a great explanation of why we would try to hang on to a dose and prevent a reduction.

 

[Chubba (GA)]

I think this just means you have to experiment and find what works for Gizmo. Obviously you got a nice surf going today. So that worked!

That is basically what I concluded as well. I’m just going to have to keep trying things and see what works for Gizmo. I’m hoping his surf from this morning continues ...

 

[Christie & Maverick]

I'm liking that +3! Good job Gizmo, let's see a little dip to the lagoon, nice and easy now