3/23 Pumpkin AMPS 322 +2 319 +4 309 PMPS 355 +3 297

I don’t really see a bounce, to be honest, Pumpkin is staying higher and mostly flat within a meter variance range. Not all high numbers are from a bounce, sometimes they are just high because the cat just needs more juice.

With TR you evaluate the dose every 3 days/6 cycles, and if you aren’t seeing nadirs you want, you should consider increasing. This is the 7th cycle, and the best you’ve seen is just a wee bit under 300 twice. With TR I’d consider doing at least a 0.25u increase, arguably 0.5u with the majority of nadirs being over 300.
 
I agree with Christie. At this point (no blue nadirs) you should be increasing every 6 cycles. You could do a 0.25 unit increase this time, to put you back on the syringe line. ;)
 
I'll do a 0.25 increase. I can also use up at least 6 of the whole unit marker syringes I ordered by mistake ;).

One thing I'm wondering about is Pumpkin's dental issues. The vet noted there were issues on her last physical exam, which was the same exam where we got the diabetes diagnosis. He couldn't get a great look on account of her spiciness but he expects a least some root planing and possible extractions will be needed.

I asked him a couple of weeks ago about going ahead with the dental work and he said we should regulate her BG first. Everything I've read suggests fixing dental issues makes regulation easier.

Should I push harder on the dental work? And if so, is there any need to slow down on the increases until we see where she is after recovering from the dental issues?
 
I would push on the dental issues. We've seen a lot of cats (but not all) have a better time getting regulated after a dental. Sort of a catch22 situation. If your vet is not comfortable doing the dental on a diabetic, see if you can get a referral to a dental specialist. They are used to more "complicated" and older animals. Neko's numbers were much worse than Pumpkin's when she had her first dental. But it was her general practice vet who did it.
Jacques and Pumpkin said:
And if so, is there any need to slow down on the increases until we see where she is after recovering from the dental issues?
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No. Depending on what happens during the dental, if there are extractions for example, there may even be temporary higher numbers due to inflammation. If Pumpkin were dancing in greens close to reduction, you might be a bit more cautious, but not where she is now. Right now those higher numbers are setting her up for glucose toxicity.
 
Wendy&Neko said:
I would push on the dental issues.
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I emailed the vet about taking another look at the dental. And I went up to 4U this evening.

One other change I'm making is shifting more of her food away from her most active time. She's had lots of mini meals her whole life because she would vomit if she got a whole half day worth of food at once. Or act very dRaMaTiC if she went more than a couple hours without food.

This was the old schedule:
  • AMPS: 62 calories
  • +2: 31 calories
  • +4: 31 calories
  • +6 16 calories
  • +8 16 calories
  • PMPS: 62 calories
  • +2: 31 calories
  • +3: 31 calories
  • +4 16 calories
  • +8 16 calories

I've switched things up to do the smaller meals after her shots:
  • AMPS: 62 calories
  • +2: 16 calories
  • +4: 16 calories
  • +6 32 calories
  • +8 32 calories
  • PMPS: 62 calories
  • +2: 16 calories
  • +3: 16 calories
  • +4 32 calories
  • +8 32 calories
I'm hoping that'll stretch the active time out just a little more.
 
It's best to give most of the food before nadir. After nadir, the insulin effect is slowing down, and any carbs added then can make it slow down even more. It'll shorten duration and give you higher preshots. It's hard to say when Pumpkin's nadir tends to be, it'll become more clear when she gets into lower numbers, but I'd tried to avoid feeding after that if possible. In other words, the original feeding plan was better, but I'd ditch the +8 feed if you can, or make it 0 carbs if possible. It's the carbs, not the calories that you want to minimize in the latter part of the cycle.
 
Wendy&Neko said:
In other words, the original feeding plan was better, but I'd ditch the +8 feed if you can, or make it 0 carbs if possible. It's the carbs, not the calories that you want to minimize in the latter part of the cycle.
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It's just n=1, but she was still on a downward slope at PM+3 with this change when she's reasonably consistently been on her way back up at +3 on the old schedule. I'll see if I keep getting that result and keep an eye on the pre-shot numbers.

I don't think I can drop the +8 meal. The one in the middle of the night especially seemed to help reduce vomiting bile in the early morning, and gets her to give me to get an extra hour of sleep (which helps me avoid mistakes like forgetting to put her feeder on the ground before I head out the door; I'm already pretty sleep-deprived without getting woken up at 5:30 or 6 am for food). I can make it zero carbs without a problem though.
 
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