? 6/11 Ivy, Bouncing cycles AMPS 156, +5 251, +6 241, +8 255

[Staci & Ivy]

https://www.felinediabetes.com/FDMB...-134-contour-pmps-112-2-210-3-5-141-6.278445/
Current cycle is relatively flat 170s up to mid 200s now on Libre, at +5.75

Overnight Ivy was still dropping and breaking bounces ( I think)

Yesterday, 6/10 the 2 cycles of fast drops occurred in the hours leading to next shot. I fed LC & a little mc mixed in.
Snacks Didn’t stop the drop leading to PMPS yesterday. She was 64 on Contour Next meter & 134
On Libre at PMPS.
6/10/23 Pm cycle was given reduced dose of 2.75u Lantus (should be 3.5u) she began falling before pmps at +5.5 to 133 on Libre.
Never got too high on PM cycle overnight, only to mid 200s on Libre.
Overnight At +5.5 began to drop, Gave small snack LC & MC mix.
Gave more small snacks of LC & MC at +8 & +10, leading to AMPS this morning.

Today AMps, I gave full dose 3.5 U & fed LC food with a 1/2 tsp MC mixed in. Additional snacks so far +1,2,3 gave been just LC snacks, she’s not gone over 250 Libre yet since AMPS. Plan to give snacks @ +6, +8, +10, hoping she doesn’t dive before her PMPS tonight in about 6 hours from now.

*When she’s dropping in the late part of the cycle, (at +7,8,9,10,11) Do I keep feeding snacks hourly if continuous drops to keep her from going too low or let her just fall into very green numbers (which is the goal to be in greens, I know)??

@Bandit's Mom you mentioned yesterday you could see from her SS on 6/5 she would likely bounce. Can you explain how to interpret that data so I can understand it?
Also, @Angela & Cleo I know you are experienced with late nadir bounce breaking, too. Any thoughts to help here?
Thanks all!!

 

[Angela & Cleo]

Also, @Angela & Cleo I know you are experienced with late nadir bounce breaking, too. Any thoughts to help here?

Hi Stacy. For me, the answer to your question will have me asking some questions first.
With TR, the goal is Tight Regulation.
Is that your goal? If it is, and I don't mean to sound crass and there is no judgement from me , but you're just going to have to get over the fear of blues and greens. Its easier said than done, I know! But it's a necessity for your sanity and also achieving your FD goal.

What helped me in the beginning was index cards. It made the decision of what and when to feed easier for me. I'd ask myself...

Where are we in the cycle?
When was my last test?
How much IS the drop since last test? Is it within meter variance?​

If the 'trend' was a late nadir, say after +6, then I would look at how much of a drop? Was it within meter variance (say 20%) from the last test? I would then decide the tsp of Carb% to feed.
FYI, nadirs change around and for awhile I was battling bounce clearing cycles with an early nadir at +3 . In those scenarios, I would feed higher % carb LC (8-10%) at shot time and at +1 and +2 and any 'snacks', I would let the numbers be my guide. Specifically are we within meter variance? Then I'd remind myself that I WANT .

This worked for me but I have the luxury of being able to feed Cleo almost any food (except foods with wheat gluten or soy). With Ivy's IBD, it might help to find foods with the protein she can eat with different carb % or maybe experiment with how much Karo/honey bump up her numbers.

 

[Staci & Ivy]

Hi Stacy. For me, the answer to your question will have me asking some questions first.
With TR, the goal is Tight Regulation.
Is that your goal? If it is, and I don't mean to sound crass and there is no judgement from me , but you're just going to have to get over the fear of blues and greens. Its easier said than done, I know! But it's a necessity for your sanity and also achieving your FD goal.

What helped me in the beginning was index cards. It made the decision of what and when to feed easier for me. I'd ask myself...

Where are we in the cycle?
When was my last test?
How much IS the drop since last test? Is it within meter variance?​

If the 'trend' was a late nadir, say after +6, then I would look at how much of a drop? Was it within meter variance (say 20%) from the last test? I would then decide the tsp of Carb% to feed.
FYI, nadirs change around and for awhile I was battling bounce clearing cycles with an early nadir at +3 . In those scenarios, I would feed higher % carb LC (8-10%) at shot time and at +1 and +2 and any 'snacks', I would let the numbers be my guide. Specifically are we within meter variance? Then I'd remind myself that I WANT .

This worked for me but I have the luxury of being able to feed Cleo almost any food (except foods with wheat gluten or soy). With Ivy's IBD, it might help to find foods with the protein she can eat with different carb % or maybe experiment with how much Karo/honey bump up her numbers.

I see what you were saying. Part of the problem is I’m not sure Of the Difference of late nadir with Ivy, or is it bounce breaking?, which she seems to always be doing, from what everyone is saying is happening.

For example, yesterday afternoon, she went from approximately 240 down to 77 on the Libre within 3 hours, leading up to PMPS time.

Her fast, sharp drops over a few hour period (1-3 hours) time seem much more than meter variance.

That drop began at +9 and I confirmed when it was PMPS with a handheld meter to make sure where we were. Technically, she was high enough to shoot. Problem is I don’t know how low she’s going to go in those first three hours. A lot of times she just keeps going down, and not up, so I gave the reduced dose.

All of the guides say that you should know where she’s going to go in the first couple hours when onset occurs to decide whether to give a full or reduced dose or skip.
That’s my problem, a lot of times I don’t know where she’s going to go, but it’s usually down, and not up.
And then I’m struggling for several hours to intervene with carbs & Karo to pull her back up.

I understand that we don’t want to reduce doses all the time, so that’s a problem for me.

The only thing that I can think to try is adding some medium carbs into her food at meal time and then the late cycle snacks like +8 & +10 In the hopes that it will bring her a little bit higher going into the next cycle shot time.

I’m still trying to find better either medium carb or higher, low carb foods to use to bump her up and I’m waiting to hear back from my nutritionist to see if we can re-formulate something I can feed her which might be slightly higher carb instead of the 6% low carb food she eats now for her, IBD, and other issues.

It’s not that I’m really afraid of shooting blues and greens. It’s trying to follow the protocols which say “be cautious if your cat doesn’t get a bump after feeding” which generally, Ivy does not go higher after a sharp drop prior to shot time, so that’s what makes me hesitate giving full doses when she’s really diving.

Does that make any sense at all?

Thanks!!

 

[Angela & Cleo]

Just want to let you know that I see your message and you have Valid points and great questions, but I'm preparing food to bring to my sick inlaws ATM. I promise to give it a better read later. .

 

[Staci & Ivy]

Just want to let you know that I see your message and you have Valid points and great questions, but I'm preparing food to bring to my sick inlaws ATM. I promise to give it a better read later. .

Omg no problem. Thanks for letting me know. And I hope they are ok. You’re amazing!!

 

[Staci & Ivy]

Update on today, I added some medium carb into Ivy’s snacks today at +6, +8 and +10.
At +8 and +10 she shot up about 100 points on the Libre, I gave about 3/4 teaspoon mc with lc at +6 and 1/4 teaspoon at +8 with LC snack. Too much of a bump!
It put her very high. Probably too much as it was mixed in with about a tablespoon of diluted low carb food. so that experiment seems like a bit too much medium carb food.
We were trying to see that she wouldn’t dive too low for PMPS tonight and it certainly put her very high, into mid 300s.

For this evening‘s, PMPS meal and shot I will add a 1/2 tsp of medium carb into her main LC meal give a low-carb snacks +1, 2 +3.
At +6, +8 & 10 I will add 1/4 tsp mc to 1 tbsp (watered down) LC snack. Hopefully she will not do a deep dive overnight tonight (since we gave a reduced shot last night at the p.m. cycle).
I will try my new auto feeder overnight and see if she can figure out what to do with it when it opens up in front of her. Hopefully she will investigate and take a snack. ( I will come in and check on her to make sure she eats the snacks.)

 

[Angela & Cleo]

Technically, she was high enough to shoot. Problem is I don’t know how low she’s going to go in those first three hours. A lot of times she just keeps going down, and not up,

Unfortunately, we don't know for certain how much lower they will or will not go. This is where having an idea of the kitty's carb sensitivity comes in. How much % carbs gives how much of a boost? I wish I could be of more help here but I don't have much to offer with an IBD cat. I think its great you have a nutritionist that can assist you in finding the answers here.

All of the guides say that you should know where she’s going to go in the first couple hours when onset occurs to decide whether to give a full or reduced dose or skip.

Small correction to this is also that its recommended to shoot a full dose IF you can monitor AND IF you have the MC (medium carb) and HC (high carb) food to intervene if necessary. This will get easier once you know what works for Ivy.

I read and reread the following sticky a thousand times and still reread it several times a week. It is a great description of determining a bounce clear.
Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers ,

"You are not shooting the number your cat is at now – you are shooting the number your cat will be at when the insulin kicks in. "​

It continues with (and emphasis is mine):

Why the +10s and +11s? These spot checks will help keep you out of trouble. Again, let’s say that you have a lower than usual preshot.
If your preshot is higher than +10 or +11, you know the insulin from that cycle is waning, the cat is on his way up, and the number is probably shootable.
If you have a preshot that is much lower than your +10 or +11, knowing why will help you decide whether or not to shoot.
Some Lantus, Levemir, and Biosimilar users notice a dip at the end of the cycle, meaning that the preshot is always a bit lower than +10 or +11 (but usually still higher than the nadir – the cat dips to a nadir at mid-cycle, then rises, then dips again). If this is your cat’s pattern, then this type of dip is not a reason to delay a shot. On the other hand, if your cat has a bounce clearing and is still careening downhill at shot time (usually characterized by numbers that drop for the whole cycle, without a clear nadir), then you will want to take that into consideration as you make a decision about shooting. ​

Feeding the curve is difficult and takes a lot of trial and error. Just when you think you have a system that works, they will flip the script!
Here is the Using Food to Manipulate the Curve thread which you may have already read and apologize if I'm giving you duplicate links. I reread this one tons too!

 

[Staci & Ivy]

Unfortunately, we don't know for certain how much lower they will or will not go. This is where having an idea of the kitty's carb sensitivity comes in. How much % carbs gives how much of a boost? I wish I could be of more help here but I don't have much to offer with an IBD cat. I think its great you have a nutritionist that can assist you in finding the answers here.


Small correction to this is also that its recommended to shoot a full dose IF you can monitor AND IF you have the MC (medium carb) and HC (high carb) food to intervene if necessary. This will get easier once you know what works for Ivy.

I read and reread the following sticky a thousand times and still reread it several times a week. It is a great description of determining a bounce clear.
Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers ,

"You are not shooting the number your cat is at now – you are shooting the number your cat will be at when the insulin kicks in. "​

It continues with (and emphasis is mine):

Why the +10s and +11s? These spot checks will help keep you out of trouble. Again, let’s say that you have a lower than usual preshot.
If your preshot is higher than +10 or +11, you know the insulin from that cycle is waning, the cat is on his way up, and the number is probably shootable.
If you have a preshot that is much lower than your +10 or +11, knowing why will help you decide whether or not to shoot.
Some Lantus, Levemir, and Biosimilar users notice a dip at the end of the cycle, meaning that the preshot is always a bit lower than +10 or +11 (but usually still higher than the nadir – the cat dips to a nadir at mid-cycle, then rises, then dips again). If this is your cat’s pattern, then this type of dip is not a reason to delay a shot. On the other hand, if your cat has a bounce clearing and is still careening downhill at shot time (usually characterized by numbers that drop for the whole cycle, without a clear nadir), then you will want to take that into consideration as you make a decision about shooting. ​

Feeding the curve is difficult and takes a lot of trial and error. Just when you think you have a system that works, they will flip the script!
Here is the Using Food to Manipulate the Curve thread which you may have already read and apologize if I'm giving you duplicate links. I reread this one tons too!

Hi Angela, thank you for the above. Below seems to be Ivy.
* Her preshot is pretty much always lower than 10 or 11 and lower than mid cycle also.
it seems to me her nadir is at preshot!
So based on the below guidelines, I’m actually not sure what they’re telling you to do.
If you have a preshot that is much lower than your +10 or +11, knowing why will help you decide whether or not to shoot.
Some Lantus, Levemir, and Biosimilar users notice a dip at the end of the cycle, meaning that the preshot is always a bit lower than +10 or +11 (but usually still higher than the nadir – the cat dips to a nadir at mid-cycle, then rises, then dips again). If this is your cat’s pattern, then this type of dip is not a reason to delay a shot. On the other hand, ifyour cat has a bounceclearing and is stillcareening downhill atshot time (usually characterized bynumbers that drop forthe whole cycle, without a clear nadir), then youwill want to take that into consideration as youmake a decision aboutshooting.

What does this actually mean? That you will want to take into consideration about shooting (the last line here??) I actually don’t get it! There’s no clear direction that I can see. Can you?

I do know that low carbs don’t really bring her up & medium carbs definitely bring her up, so that much I do know.

And thank you!!

 

[Angela & Cleo]

What does this actually mean? That you will want to take into consideration about shooting (the last line here??) I actually don’t get it!

The answer to this goes back to my question to you in post #2 about the definition of regulation and what that goal is for you and Ivy.

IMHO, My Goal is Tightly Regulated which means to me, that the considerations are (1) as long as I have the MC and HC food and (2) can monitor, I shoot the full dose. The only time I don't is if I have a lime preshot in which case i feed a tsp of LC and wait an hour.

I want the GREENS. I crave them. Its practically a sickness/disease at this point . I generally feed LC always unless the BG is lime.
I'm rereading this and I'm not sure its helpful

 

[Staci & Ivy]

The answer to this goes back to my question to you in post #2 about the definition of regulation and what that goal is for you and Ivy.

IMHO, My Goal is Tightly Regulated which means to me, that the considerations are (1) as long as I have the MC and HC food and (2) can monitor, I shoot the full dose. The only time I don't is if I have a lime preshot in which case i feed a tsp of LC and wait an hour.

I want the GREENS. I crave them. Its practically a sickness/disease at this point . I generally feed LC always unless the BG is lime.
I'm rereading this and I'm not sure its helpful

Super helpful. Thank you. Boy you’re a brave lady!!