? Yemala 10/25; AMPS 191; +4 34;+ 5 46; +5.5 70; +9 140; PMPS 165; +2 161; +3 101; +4 72; +6 86

Her +4 is 34. I will wait 15 minutes and retest to verify the number, but Mala is currently eating lc food.

I have some medium carb food that she will eat, if necessary.

A CG is only on hand today until noon. A quick check can happen around two, but no one will be on hand between noon and 3:30 or 4.
 
For a number in the 30's, bust out the HC or add a drop of the karo/honey. Don't fill her up on LC, you may need her to eat later.
 
It takes 20-30 minutes for carbs from the plate to hit the BG, so testing after 15 might not show anything.

Oh, and that's how a reduction is earned. UP now Mala!
 
Mala won't eat HC food. The best I can do is a medium carb and add some honey or karo.

I had figured this would get her a reduction.

No worries that her appetite might be down. This is a point in her day when she's always ravenous.

Giving more medium carb stuff, this time with some honey mixed in.
 
She has had 2 T medium carb, the second with honey. She ate almost all of it. Will test again at 11.
 
Just shy of +5, she's now up to 46. I know that's the food talking.

I will check again in 20-30 minutes.
 
I got her to eat 2 more bites of MC, added her favorite lc to the mix, she nibbled.

She's not inclined now to eat more. On any other typical day, she devours up to 2-3 T of lc food this time of the morning.

god, torties.

I got a 70 at +5.5.

Davey is home for about an hour, and will continue with testing and feeding as necessary.
 
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+6.5 is 65, and +7 is 72...then a 69 at +7.5, followed with a little more foodin' up. And with that, I've gotta skedaddle back to work.
 
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Now that the numbers are up, I’d like to answer some questions from yesterday’s condo.

Bron and Sheba said:
Hi @Marje and Gracie. Good to see you!
I just wanted to comment and clarify a couple of things you said above, as I was the one who suggested Renee not shoot the 55.
I was surprised you said she could have shot that number without even stalling. Also that both you and Wendy were happy for her to shoot the 55 even though she had not shot a higher green before and the number wasn't rising.
Her previous lowest preshot was 113 and she has had no green preshots at all, this time around. She had also given a small amount of food without realising what stalling meant and after testing twice the bsl hadn't moved........I know that not having food at this point can keep the number down but I felt that given that she had not shot a high green before and the number wasn't moving, even with a small amount of food, it would be safest to skip ( and I couldn't stay with her as it was late at night here). I know she has lots of data........
I'm just wanting to understand it all..............it is not unusual to find myself being the only one on the board, that I can see, with any experience to help in these situations, or who is willing/ able to help someone with a very low preshot (when you are all asleep on the other side of the world) and I don't want to give incorrect advice.
Thanks Marje.
Bron
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Hey Bron!! I know I speak for many of us experienced US members that we are so appreciative of you being online to help others while we are all getting our beauty sleep! I also want to, again, just state that any comments I offer have no intended criticism at all but are just designed as another approach and/or learning experience for all involved.

The reason Wendy and I suggested that Renee could have shot was because she is an experienced CG dealing with a cat back from the Falls. Yes, it’s been a while since she and Davey dealt with FD and shot lower numbers but they have done it before. And while Mala’s response to carbs “might have” changed, they are not newbies starting from scratch. This is part of “being more aggressive” because Mala is back from remission to which Wendy and I referred. Renee would have known that if she shot the 55, she would need to be on top of the feeding and testing from the get go. Of course, Renee might disagree with her comfort at shooting that number and that’s fine. She and Davey are the CGs and they know what they were looking at yesterday in terms of being able to monitor Mala and whether they had the supplies they needed to shoot that 55.

Also, for an experienced member, I really don’t see any issue with her having fed a small amount of LC food because, as you noted, the food wasn’t affecting her numbers. It’s not like she fed her, the BG came way up, and she would shoot a food spike. In a perfect scenario, she would have shot, fed a good solid meal of maybe even some MC food, and tested at +0.5 to be sure the numbers were coming up with the food.

It is absolutely correct that if this was a new member who had only been on here for the length of time Renee and Davey been back with Mala, options to shooting a 55 would have been important: stalling, skipping if no one was around to help, etc. especially since the 55 appeared to be a dropping number.


Hroswitha said:
+ 7 is 88.

Feeding schedules?

Okay, that's a good question to ask. Let me give you her feeding schedule now.

Yemala is fed small amounts of lc food quite often. She's a nibbler, and will never eat more than about 1/3 to 1/2 what she is presented. When she's finished, we remove access to the food and wait.

So on average, Mala will get food at 6 AM. She'll eat some, but not finish a full portion. She walks away and attempts to investigate the dishes of other cats, but we try to stay on top of her and remove unfinished dishes left by the civvies in our care. Eventually, she'll make her way back to her own dish, and nibble a little more before walking off to bathe and nap.

About 2 hours later, she's awake and hungry again. She'll get around 1 T of lc food, and she typically eats all of that. Rince and repeat through the morning.

On average, she will eat around 5-6 ounces of lc food which is also low in phosphates but high in protein. She eats Nature's Recipe grain free chicken and chicken liver in broth and Weruva chicken frickazee. Both fall into reasonable ranges given her CKD and diabetes.

We are particularly focused on feeding her when she's surfing to keep her numbers from falling too low and the bounce from jumping too high afterwards.

If any of this is incorrect, we can do some adjustments. But Mala is a particularly focused and demanding kitty when it comes to food. When she wants it, she won't accept a no. I have to physically leave the house to get her to stop - it's head butts, paws slapping at my face, howls at close range, total torti stuff. Theoretically, we could train her to eat more at meal time, but she has been in this pattern for some time.

So if I understand the protocol correctly, we were holding the .5 dose for too long, which I had suspected. She should have gone up to a 1 u dose before we took here there, and she didn't earn a reduction to .75 when we took her down. We should try to hold the .75 for at least 6 cycles and see where the numbers take her as the depot fills up again. If she doesn't drop below a 40 at nadir, we maintain. Decrease only comes from a below 40 nadir or roughly a week of greens with a few blues.

Going forward, unless she drops below 40 as noted, hold the .75. If she slides back into pinks or reds, increase the dose after roughly 6 cycles to 1u and hold for another 6 cycles unless she earns a decrease legitimately. We need to be more aggressive and more courageous in dosing low numbers, as long as someone can check on her during that cycle.

Am I even close?
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I’ve got an appt and have to get out the door so I can tell you more about feeding schedules later as it can be detailed but I did want to answer a couple questions particularly this one:
If she slides back into pinks or reds, increase the dose after roughly 6 cycles to 1u and hold for another 6 cycles unless she earns a decrease legitimately. We need to be more aggressive and more courageous in dosing low numbers, as long as someone can check on her during that cycle.
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In responding, I’m going to use an assumption that she didn’t earn a reduction today because it makes for a better example :)

Before the earned reduction today, she had been at 0.75u as a reduced dose and you skipped a shot. Remember that when we reduce a dose, we don’t need to hold the new dose six cycles as you would if you were increasing a dose. You only hold a reduced dose until any bounce clears or it becomes apparent that the new dose results in a failed reduction. What might be confusing to you is that you skipped a shot and you might be thinking about “counting consecutive cycles” in asking about holding the dose for six cycles after a reduction. In this case, you wouldn’t need to count consecutive cycles after a reduction and a skipped shot because we are still dealing with a reduction. The depot will likely fill fairly quickly after the skipped shot (and you can see, in fact, that it did).

We want to focus on whether the reduction is holding or not and we don’t want to leave Mala at high numbers waiting six cycles; it just won’t take that long to refill the depot because you are already operating from the standpoint of an overfull depot which resulted in the reduction being necessary (well, in most cases since Mala didn’t actually earn a reduction from 1u ;)).

It’s important for you all to look closely at her SS and see where her onset and nadir are this time around and what kind of duration she is getting. This will help you navigate lower numbers and how to handle them; any time you feel a little trepidation about shooting a number above 50, just stall long enough to get some input but remember that if your goal is to get her back into remission, you’ll need to be prepared to shoot as long as you have supplies to test and feed and are available to do so. Safety is always primary in every case, though.

Ok...have a great day. Post any questions and I’ll check back later tonight and also provide input on potential feeding schedules.
 
Marje - I can't tell you how grateful I am for your advice and intervention. I have felt rather adrift with long or even mid-term strategies, and in previous iterations of diabetes, she responded so quickly that we never got into much of a pattern. If I have a general set of principles around which I structure dosing and feeding, I have a better sense of how to move forward.

Davey had to return to work, and I have not been home since noon, but she seems to be out of the woods. Her non-bouncy nadirs tend to be between +4 and +8, and her current numbers are okay without additional feeding. We will drop to a .5 dose this evening, as little girl has absolutely and legitimately earned a reduction.

I still have a question about our next steps. Please pretend we're idiots who have never done this stuff, because in some ways we have not.

We shoot a .5. Mala may continue to surf comfortably in blues and greens for a cycle, perhaps two. By the end of that cycle, if she bounces again into the pinks, I would think that would be a failed reduction, and we'd be back to a .75. But would we increase again to .75 after one high cycle, or more than one? How long do we hold for a high series of numbers?

If Mala shows a low PS number, there are times when we can shoot as someone will be there to monitor. If work looms, it's hard to stay up until 1 or 2 AM until she's in the clear, but I will do that. I now know that she'll eat the medium carb stuff with honey if necessary, which helps. And teen boy can sometimes be dragooned into helping.

We're listening to everything people give us. We try to learn. You all are marvelous.
 
@Marje and Gracie
Sorry to hijack your thread Renee!
Thanks for clarifying that. I certainly didn't take it as criticism Marje.........peer review is what keeps this board such a great place.
What made me think Renee was not experienced with shooting low numbers, was that she was unaware that we don't feed any food when we are stalling and as she hadn't been giving insulin since 2011 (what a fabulous run at the falls!), I was very reluctant to suggest shooting 55.
Thanks again!
Bron
 
Her time at the falls is even better than that. First diagnosed in 2006, she went to the falls one month later; relapse 2011, back in remission in one month.

Although we should be, we are NOT experienced in shooting low numbers. Wednesday, we might have been able to handle it in the morning. Today was much harder when seeing under 40 numbers.
 
Hroswitha said:
Marje - I can't tell you how grateful I am for your advice and intervention. I have felt rather adrift with long or even mid-term strategies, and in previous iterations of diabetes, she responded so quickly that we never got into much of a pattern. If I have a general set of principles around which I structure dosing and feeding, I have a better sense of how to move forward.

Davey had to return to work, and I have not been home since noon, but she seems to be out of the woods. Her non-bouncy nadirs tend to be between +4 and +8, and her current numbers are okay without additional feeding. We will drop to a .5 dose this evening, as little girl has absolutely and legitimately earned a reduction.

I still have a question about our next steps. Please pretend we're idiots who have never done this stuff, because in some ways we have not.

We shoot a .5. Mala may continue to surf comfortably in blues and greens for a cycle, perhaps two. By the end of that cycle, if she bounces again into the pinks, I would think that would be a failed reduction, and we'd be back to a .75. But would we increase again to .75 after one high cycle, or more than one? How long do we hold for a high series of numbers?

If Mala shows a low PS number, there are times when we can shoot as someone will be there to monitor. If work looms, it's hard to stay up until 1 or 2 AM until she's in the clear, but I will do that. I now know that she'll eat the medium carb stuff with honey if necessary, which helps. And teen boy can sometimes be dragooned into helping.

We're listening to everything people give us. We try to learn. You all are marvelous.
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You’re welcome.

A failed reduction is if she doesn’t come back to green after any bounces clear. Remember that just because she bounces into pink doesn’t mean the dose isn’t working as long as she is coming back into green between the bounces and the bounces aren’t lasting a full six cycles. See below for further explanation but I want to put a “disclaimer” first.

Please note that what I’m about to say is for Mala only as she is returning from the Falls and we want to try to get her back there.

I would suggest that you see how long it takes her to clear bounces after being in green. If she can do it in a cycle or two, I’d hold the dose. However, and this is another part of being a bit more aggressive, if she’s taking 4-6 cycles to clear a bounce and then dipping her toes in green, I’d increase the dose. This might be something that you’ll want some additional eyes on when you are seeing it happen so just post and ask.

One of the other things Wendy mentioned in being a bit more aggressive was trying to hold her at a dose longer so she can get that healing time. Again, this is one of those situations where we are working the dose a bit to try and get her back to the Falls. One of the ways to do this is to feed the curve to anticipate the lower numbers and try to flatten the cycle out a bit more by feeding the LC food a little more strategically. If you can prevent the lower drops with feeding (and I don’t mean pumping her full of MC food with honey), then you can potentially keep the curve a little flatter. You’ll definitely want to anticipate this by looking at her patterns.
If you had tested at +2 today, I guarantee you would have already seen a big drop and you could have fed the curve to keep her from dropping and earning a reduction (hopefully....when they are truly ready for a reduction, feeding the curve won’t stop them from earning it).

If she’s in a bounce clearing cycle, you know she’s going to drop lower somewhere during the cycle so feeding strategically can slow that drop. You can also anticipate when the bounce might clear by watching for a string of flat yellow, looking for any high before the break, and also being sure you are getting those +2 tests (remember that a +2 that is similar to or less than the PS indicates a potentially active cycle).

Bron and Sheba said:
@Marje and Gracie
Sorry to hijack your thread Renee!
Thanks for clarifying that. I certainly didn't take it as criticism Marje.........peer review is what keeps this board such a great place.
What made me think Renee was not experienced with shooting low numbers, was that she was unaware that we don't feed any food when we are stalling and as she hadn't been giving insulin since 2011 (what a fabulous run at the falls!), I was very reluctant to suggest shooting 55.
Thanks again!
Bron
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You’re welcome, Bron. Your observation is logical and Mala has certainly recovered quickly from the skipped shot so absolutely no harm done and we can use this as a learning tool. Certainly, if Renee was not comfortable shooting it, then skipping was the best solution; I believe she will get back on the old bicycle before she knows it since Mala seems a bit intent on forcing them to right now. ;)
 
Hroswitha said:
Her time at the falls is even better than that. First diagnosed in 2006, she went to the falls one month later; relapse 2011, back in remission in one month.

Although we should be, we are NOT experienced in shooting low numbers. Wednesday, we might have been able to handle it in the morning. Today was much harder when seeing under 40 numbers.
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You are very lucky getting her back to the falls twice for so long. I had Sheba at the falls for 2 1/2 years which was great but she relapsed and I couldn’t get her back to the falls.
Mala is looking very keen to get back to the falls. ...... will watch with interest.
 
Just for the record, we never did get on the bike. We never even got on training wheels. The bike was presented to us, we thought about learning how to ride the bike, and then got a car. I have no bike.

Everything you've written makes absolute sense to me, until I start trying to apply this to Mala's chart. Like the below:

You can also anticipate when the bounce might clear by watching for a string of flat yellow, looking for any high before the break...

Between 10/2 and 10/4, I can sorta see this. Flat yellow numbers followed by a high, then an eventual break, followed by a week of even higher numbers. I see it on the 17th as well - yellow numbers followed by a high in the 400s, dropping into the blues the next cycle. But that cycle break was the precursor to the highest numbers she's thrown off so far.

In retrospect, I can see that we should have bumped the dose then to 1 u, which got us better numbers for several cycles. I have been told that we should have held that dose longer, but I don't yet see the patterns you do. If there are patterns, they feel more like theoretical patterns that may or may not apply to Mala. Just when I think I can predict where she's going to go - like a nice PS number in the blues followed by a 100 pt. jump.

BTW - with a +2 at 101, Mala is now eating lc food to help with the surf. That's right, yes? And this is on the reduced .5 dose.
 
Bron and Sheba said:
You are very lucky getting her back to the falls twice for so long. I had Sheba at the falls for 2 1/2 years which was great but she relapsed and I couldn’t get her back to the falls.
Mala is looking very keen to get back to the falls. ...... will watch with interest.
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Both relapses were, in part, the fault of a vet. In 2011, he prescribed steroids for an ear infection (despite being told she was in remission and having other options available for an infection). This time, he insisted she start eating prescription food for CKD and didn't help me research the carb load, so she was eating 30% carbs. I am frustrated beyond belief, and did change vets.
 
Hroswitha said:
Both relapses were, in part, the fault of a vet. In 2011, he prescribed steroids for an ear infection (despite being told she was in remission and having other options available for an infection). This time, he insisted she start eating prescription food for CKD and didn't help me research the carb load, so she was eating 30% carbs. I am frustrated beyond belief, and did change vets.
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I can understand your frustration. Changing vets was a good idea. CKD cats don't need prescription food, especially in the earlier stages of the disease.
 
Yeah, I mentioned phosphate binders and he looked at me as though I'd sprouted horns.

New vet has looked in to this board, though she'd never heard of it, and I hope will keep it in mind as I continue to consult with her.

Teen boy has been coached on what to do tomorrow. I have to leave around the time Mala hits her +4, and won't be home until around 6 PM (which is her PM shot time). Max will be testing and feeding per instructions through the morning. He will be posting here, and may ask for help. He adores Mala, and would do anything to keep her around.

She is, after all, older than he is. And she slept with him in his crib when both were babies.

As I type, Mala is sitting next to the laptop grunt-purring at me and booping me with stinky chicken food breath. I have chicken on the boil for her and the foster boys on the porch, and she wants it. Little black feet keep coming up to smack me in the nose when I don't pay attention.
 
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