? Carb question / feeding the curve?

[Bandit's Mom]

I am again posting after quite a while! Have been lurking and trying to learn!

@Wendy&Neko 's recent reference to an old condo on Carb Sensitivity raised a lot of questions/doubts in my mind and I was hoping to get some clarity here.

In post #12 of the above condo, Jill (& Alex) says that feeding slightly higher carbs "allowed me to get more insulin into the cat. That slightly higher dose was just enough to flatten the curve... get rid of the higher numbers on both ends of the cycle... without kitty bottoming out. Another bonus was it made for fewer failed reductions."

I understand "feeding the curve" to some extent - feeding slightly higher carbs before onset to kitties who have a tendency to dive thereby reducing the drop and potentially reducing the bounce. Is that what Jill meant by flattening the curve and getting rid of higher numbers on both ends of the cycle?

- Will this work for newly diabetic/yet unregulated and really really bouncy cats like Bandit whose numbers are still all over the place?
- I presume one feeds higher carbs before onset but zero carbs after nadir?
- Does one feed higher carbs at the beginning of bounce cycles too? Bandit was 378 this morning and feeding her higher carbs would only take her higher - especially with the later onset of Levemir?

Bandit is on Young Again Zero Mature (< 1% carbs) and I had introduced some Dr. Elsey's Chicken (~5% carbs) but her numbers began to trend higher. I thought it was the higher carb food but taking it out also didn't bring her numbers back down. Worse, it seemed like the insulin was having no effect on her PS numbers! Anyway, we are now on Day 5 of our switch to Levemir and I think she needs an increase in her dose. I really hope she flattens out with Levemir in due course.

 

[Wendy&Neko]

Have you ever looked at @Sienne and Gabby (GA) Gabby's spreadsheet? Sienne was the master of this practice. It's not something I ever did. I will say that you want to feed higher carbs before they dive. The worse of the dives may or may not be at onset. You want to both reduce the dives and try to prevent unnecessary reductions. That includes those done by increasing on a bounce cycle. I'm also not certain who well you will be able to do this technique with feeding just dry food.

Bandit does need an increase. You started at too low a dose of Lev. The recommended switch is 70% of the Lantus dose, so 1.25 would have been a better start. I would increase now. It's possible the lower blues you saw first day were a strong reaction to the insulin switch.

 

[Bandit's Mom]

The problem is Bandit is really unpredictable or I haven't yet understood her patterns - despite poring over her and several dozen other spreadsheets for months now! I don't know when she is going to dive and how many cycles it is going to take her to clear a bounce. So it is really hard to feed the curve with her.

I started at 1 unit of Lev because she was doing really well at 1.75 of Lantus and I was going to decrease her to 1.5 when her numbers suddenly worsened - I couldn't tell if it was the introduction of the higher carb Dr. Elsey's or stress from the blood test or the Lantus going bad. To err on the side of caution I decided to start with 70% of 1.5.

Will take her up to 1.25. Was just waiting for the depot to build to see if she does anything with this dose.

And she still steadfastly refuses to eat anything except dry. I have managed to transition my civvie to locally available Whiskas wet food (which is probably junk quality, but Indians don't seem to think that pets deserve human grade food )

P.S. Got her labs done recently. Would appreciate eyes on her lab work too. Thank you!

 

[Sienne and Gabby (GA)]

First, Young Again is more than 1% carbs! It's by no means HC, but it's higher in carbs than they would like you to think. I believe it's around 5%.

I would also use syringes not the pen needle.

Part of my strategy with Gabby was to try to get her into mostly green mid-cycle numbers and blue pre-shot numbers. She tended to have an early onset and nadir and could dive very steeply early in the cycle so you may need to modify your thinking based on Bandit and how Bandit responds to Lev. I used Lantus with Gabby.

Because she had an early onset and nadir, I front loaded her cycle with her usual low carb food. Initially, I was spreading out her meals over the first half of the cycle. I walked this back to meals at pre-shot, +1, and +2. This helped to offset the early drop in numbers. If numbers looked like they were heading into dose reduction territory, I upped the carbs to try to prevent the reduction. I was not necessarily feeding HC prior to nadir. I used HC only if it looked like Gabby was heading toward a reduction.

 

[Bandit's Mom]

@Sienne and Gabby (GA) thank you for taking the time to explain that in such detail. Just to clarify, you did not feed Gabby after +2?
I don't think I can do that with Bandit though. She marches to her own beat and gets very anxious if she doesn't get food when she wants it. I cannot acclimatize her to eating at fixed times. I have tried! I can vary carb% during the cycle though.

YA claims to be <1% carb and trot out the nutritional information to substantiate that claim. So I don't know.

I usually use syringes but since this was the start of a new pen and whole units, I thought I would use pen needles to save syringes. I know pen needles are not as accurate. But I get cat food as well as syringes from the US and in the current covid scenario my supplies are dwindling!

@Wendy&Neko I took that increase to 1.25 today. Bandit seems to be bouncing to pinks even without diving (last night was only 270 to 180 - maybe a little lower). I guess I will have to wait for her body to get used to the new insulin. Can only hope she flattens out with time!

 

[Wendy&Neko]

A claims to be <1% carb and trot out the nutritional information to substantiate that claim. So I don't know.

We've heard that for ages. And heard many people find out it's not <1%. It's still low carb, just not what their marketing says.

 

[Bandit's Mom]

We've heard that for ages. And heard many people find out it's not <1%. It's still low carb, just not what their marketing says.

wow. didn't think you could get away with stuff like that in the US.

 

[Bandit's Mom]

Part of my strategy with Gabby was to try to get her into mostly green mid-cycle numbers and blue pre-shot numbers. She tended to have an early onset and nadir and could dive very steeply early in the cycle so you may need to modify your thinking based on Bandit and how Bandit responds to Lev. I used Lantus with Gabby.

Because she had an early onset and nadir, I front loaded her cycle with her usual low carb food. Initially, I was spreading out her meals over the first half of the cycle. I walked this back to meals at pre-shot, +1, and +2. This helped to offset the early drop in numbers. If numbers looked like they were heading into dose reduction territory, I upped the carbs to try to prevent the reduction. I was not necessarily feeding HC prior to nadir. I used HC only if it looked like Gabby was heading toward a reduction.

@Sienne and Gabby (GA) whenever you can, could you look at Bandit's SS and advice me on how I should feed the curve? I could really use the help of someone experienced in this.

Bandit seems to have fallen into a pattern of diving hard on a bounce clearing cycle and then bouncing high thereafter. I have Dr. Elsey's (chicken variant) which is ~5% carbs which I could feed at shot time, but I am not clear whether I should feed her that every day (even on bounce cycles) or only when she is headed lower. Looking at her PS numbers, I can never tell when she is going to dive/clear the bounce. Today she has fallen from 325 to 51!

Does feeding slightly higher carbs (5%) at shot time when kitty is bouncing make the bounce higher or take her longer to clear the bounce? If not, I could just feed blindly her 5% at shot time every day and see if that flattens her out a bit.

 

[Sienne and Gabby (GA)]

This is going to sound a bit weird but you don't have enough data. With having recently switched to Levemir, it's very likely that Bandit's pattern of onset and nadir will/have been changing. The pharmacology of Lev is different than Lantus and it typically results in a later onset and nadir. Looking at the pattern from a couple of months ago, it looked like Bandit had an early nadir. That's not as much the case at present. As hard as you're trying to figure out Bandit's pattern, I suspect you're going to need to wait a bit longer and keep gathering data so you have a better sense of what the typical pattern is.

Feeding 5% carb is not that much. A lot depends on how carb sensitive Bandit is. Some cats will get a 30 point bump in numbers from a piece of chicken that's zero carbs. Other cats need something substantially higher in carbs for a that kind of response. Manipulating the curve with food is more of an art than a science. It also depends on what your goals are. I do think that for right now, I'd encourage you to get more data on how Bandit is responding to Lev. If we need to work at trying to flatten the curve, once you know what the curve looks like (i.e., when onset and nadir fall), we'll be better able to think about how food fits in. FWIW, when I was trying to flatten out Gabby's numbers, I kept her food consistent. I would add HC when needed but the basics didn't change. But, that was my kitty and you know the saying -- ECID.

 

[Bandit's Mom]

Thanks a million @Sienne and Gabby (GA) . Will continue to gather more data and see where it takes us. You are right about it still being early days with Levemir.