MPM, Opie and Lower Numbers

LovingOpie

LovingOpie

Active Member
The last couple of days has been a real learning experience for me. Opie has had lower and lower numbers and I have been up l long hours of the night monitoring him but he is beginning to show improvement, (fingers crossed). Here is the link to previous threads explaining the foods and how to shoot low . . . https://www.felinediabetes.com/FDMB/threads/opie-and-mpm.278371/ Today he started in the blue, we shot with low BG and he is in the green.
 
Suzanne & Darcy said:
Yes. I hate wobbling. I think Opie is going to have a good cycle today. Paws crossed.
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Yes, he did very good. Today he went up just a bit after AMPS and I am assuming it is a food bump. About how much can you expect in rise from food? I guess it would matter on how much food he ate? Also, I can tell he is feeling better because he is eating more like himself when he is lower longer.
 
Only 35 points. Not much of a food bump really - and also within meter variance. It just looks like maybe his insulin hasn’t kicked in yet (well, we don’t know what his number was a little earlier- he could have had a little food bump and be going down at +2.5.). Looks okay so far. A few more hours will tell. It’s good that you got that +2.5 test though so you could head off any surprises (with food) but he isn’t heading down quickly. Hopefully, he will have a nice steady drop.

Oh, and every cat is different in response to food. Food bump can be different for each cat and will depend more on the amount of carbs than anything. A lot has to do with how well their pancreas is working.
 
Opie is doing a lot the same as yesterday. Is there a way to avoid the bounce? I know food in small amounts over the time will lessen the severity of the drop and hopefully stop the liver from getting 'scared' into dumping glucose into the blood but is there anything else?
 
well the rise has started, probably will go high for PMPS. I am always sad to see it. . . but not complaining because he is doing a lot better thanks to everyone here. I don't miss those days of solid pink, day after day after day. Thank you!
 
That was kind of short-lived, wasn’t it? It is a shame. Other than the feeding that we’ve already talked about a lot, there really isn’t much else you can do to help minimize bouncing. The more time he spends in normal numbers the better. That gives his body a chance to get used to them. Hang in there. So he seems to feel better these days? When he’s in the blues and greens?
 
LovingOpie said:
well the rise has started, probably will go high for PMPS. I am always sad to see it. . . but not complaining because he is doing a lot better
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You could think of it as "Liver Training School". The liver hasn't quite gotten the hang of it yet that the lower numbers are safe and ok. The lessons (normal numbers) are still being learned and it can take a while for it to sink in.
 
Shelley & Jess said:
You could think of it as "Liver Training School". The liver hasn't quite gotten the hang of it yet that the lower numbers are safe and ok. The lessons (normal numbers) are still being learned and it can take a while for it to sink in.
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Well the liver has another big lesson today with yet another even bigger bounce at PMPS. Hope it learns fast. On top of it all, my meter didn't work good, thought the battery but not sure. A lesson for me to have a second on hand.
 
Suzanne & Darcy said:
That was kind of short-lived, wasn’t it? It is a shame. Other than the feeding that we’ve already talked about a lot, there really isn’t much else you can do to help minimize bouncing. The more time he spends in normal numbers the better. That gives his body a chance to get used to them. Hang in there. So he seems to feel better these days? When he’s in the blues and greens?
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It seems the more time he is in the blues and greens the better he is eating which is a wonderful thing to see. He just looks better in his face but it is just something I see, not a real physical change or anything like that.
 
PMPS was 360 and in 2 1/2 hrs he went up to 428. He did eat more but that seems like a big food bump or isn't it? I guess time will tell. He has been at 1.5 for quite some time, do you think it needs adjusting again or does he just need to stop bouncing?
 
He does appear to be sneaking up at nadir just a wee bit. I'd like to see you hold the dose for a couple more cycles to see what he does, see if he's really creeping up on you - the last good nadir (101) over the last several days was so close to the recommended hold the dose & could've been green on either side of that 101 you caught.

From MPM dosing protocol:
Once you know your kitty's nadir over the last several days/nights....
If nadirs are 50-100, hold the dose for additional cycles.
If the nadirs start to rise, then increase the dose by 0.25u.
If nadirs stay in green numbers (50-99), continue to hold the dose.

Remember, nadirs determine if the dose needs changing. Those green nadirs are how well the dose really works when he's not bouncing. You can't stop the bouncing - if kitty is determined to bounce he's gonna bounce, you just need patience while his body figures it out.
 
Shelley & Jess said:
He does appear to be sneaking up at nadir just a wee bit. I'd like to see you hold the dose for a couple more cycles to see what he does, see if he's really creeping up on you - the last good nadir (101) over the last several days was so close to the recommended hold the dose & could've been green on either side of that 101 you caught.

From MPM dosing protocol:
Once you know your kitty's nadir over the last several days/nights....
If nadirs are 50-100, hold the dose for additional cycles.
If the nadirs start to rise, then increase the dose by 0.25u.
If nadirs stay in green numbers (50-99), continue to hold the dose.

Remember, nadirs determine if the dose needs changing. Those green nadirs are how well the dose really works when he's not bouncing. You can't stop the bouncing - if kitty is determined to bounce he's gonna bounce, you just need patience while his body figures it out.
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Thanks. Today we are starting out lower so we shall see.
 
Suzanne & Darcy said:
I guess we have our answer :D nadir of 90 today. Hold the dose. Excellent cycle so far. This afternoon.
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I can not tell you enough how wonderful it is to have you there. When I get the numbers, even as tired as I may be, I can't wait to get them onto the SS because I know that you will be just as anxious to see them as i am. It was a good day today wasn't it? A big thank you to you, Suzanne & Darcy, and Shelley & Jess :bighug:
 
He doesn’t like those yellows I guess? The refusing to eat and growling, I mean? Or does he always growl when you test him? Are you using a lancing device or doing it freehand. What do you use for treats?
 
LovingOpie said:
Well that is good then. . . progress. He is yellow, very crabby and not eating. He growls for testing now.
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Jess used to get 'cranky' when she was yellow - I used to call it her 'Drama Queen Yellow Self'!

ETA: She'd moan and groan for no reason. And same thing, making a fuss while I tested, but sat there patiently while I did it! :confused:. Cats!!
 
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Suzanne & Darcy said:
He doesn’t like those yellows I guess? The refusing to eat and growling, I mean? Or does he always growl when you test him? Are you using a lancing device or doing it freehand. What do you use for treats?
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He used to come right away for testing and not complain, sometimes growl a little but sits patiently. I do freehand pricking but we test three times more per day than we did previously so that is a very big change. No treats because he would never ever go back to eating his food, he is very stubborn that way, always has been. Would you believe that even the 'magic dust' doesn't entice him when he is this mood? I do notice a change when he is in certain numbers but I haven't figured exactly what numbers yet. Possibly it is a Jess says and he doesn't like yellow.
 
I thought he might dip into the blue waters today. I am now wondering what his preshot will be tonight. I hope he was a little happier mid day today? (In blue)
 
LovingOpie said:
today it is a bigger bounce and back to the pink. Ugh. . .
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I’d give this dose another cycle or two and if you don’t see any nadirs below 90, I’d suggest a dose increase to 1.75u.

Are you feeding after nadir? I’m asking because some cycles, he’s not getting good duration and so he bounces higher (as into red). If you look at his am cycles on 6/12 and 6/13, he’s losing duration pretty quickly from +8 to PMPS. If you are feeding after nadir, are you able to try and get his food into him in mini meals before then and then if he’s still hungry, give him a very small freeze dried chicken, as an example, snack later?
 
Marje and Gracie said:
I’d give this dose another cycle or two and if you don’t see any nadirs below 90, I’d suggest a dose increase to 1.75u.

Are you feeding after nadir? I’m asking because some cycles, he’s not getting good duration and so he bounces higher (as into red). If you look at his am cycles on 6/12 and 6/13, he’s losing duration pretty quickly from +8 to PMPS. If you are feeding after nadir, are you able to try and get his food into him in mini meals before then and then if he’s still hungry, give him a very small freeze dried chicken, as an example, snack later?
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What do you mean by duration? He gets no food from +10 to PMPS as I was told. Otherwise, I feed him as often as possible throughout the whole day. Do I not feed after nadir? I know that I am supposed to ffed in the morning to keep the numbers from dropping too quickly and causing a bounce but I do not know the strategy otherwise.
 
LovingOpie said:
What do you mean by duration? He gets no food from +10 to PMPS as I was told. Otherwise, I feed him as often as possible throughout the whole day. Do I not feed after nadir? I know that I am supposed to ffed in the morning to keep the numbers from dropping too quickly and causing a bounce but I do not know the strategy otherwise.
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Duration is the length of time the insulin lasts and it can vary from cat to cat.

Correct that we don’t feed the two hours before PS as we don’t want to influence the PS BG with food.

Think of food & duration after nadir (in regard to insulin) like the brakes of a car. When we feed food, especially HC food after nadir, it slams on the brakes of the duration. But even LC food after nadir can affect the duration and shorten it and it can vary by cat.

I’ve seen some diabetic cats eat LC all cycle with no effect to duration but when I see duration be affected by the BGs on the SS, the first thing I think of is a food influence as it is the simplest to correct. I see this on Opie’s SS.

For many diabetic cats, dividing the portion of food they normally get in a cycle and then feeding it in 3-4 mini meals before nadir works best with the insulin. But, because it can be individual, you will have to see what works best for Opie.
 
Marje and Gracie said:
Duration is the length of time the insulin lasts and it can vary from cat to cat.

Correct that we don’t feed the two hours before PS as we don’t want to influence the PS BG with food.

Think of food & duration after nadir (in regard to insulin) like the brakes of a car. When we feed food, especially HC food after nadir, it slams on the brakes of the duration. But even LC food after nadir can affect the duration and shorten it and it can vary by cat.

I’ve seen some diabetic cats eat LC all cycle with no effect to duration but when I see duration be affected by the BGs on the SS, the first thing I think of is a food influence as it is the simplest to correct. I see this on Opie’s SS.

For many diabetic cats, dividing the portion of food they normally get in a cycle and then feeding it in 3-4 mini meals before nadir works best with the insulin. But, because it can be individual, you will have to see what works best for Opie.
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So I feed him what I can in small amounts before the nadir and basically nothing after til PS? It is a possibility that is happening with Opie. He has a habit of not eating when I want him to and lately eats better after nadir.
 
I have a question about when the nadir is because I am assuming it is at +6 for Opie but what happens when the low is at +12 like today? This afternoon I did not feed him after the +6 and he went down lower by PMPS. I did as Marje and Gracie suggested and he did not go way up. It was difficult to not feed him all afternoon though I gave him a few freeze dried treats to ease the change for him.
 
LovingOpie said:
So I feed him what I can in small amounts before the nadir and basically nothing after til PS? It is a possibility that is happening with Opie. He has a habit of not eating when I want him to and lately eats better after nadir.
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Yes that is ideal although you can give some super LC treat after nadir if need be. I kept boiled chicken breast to give Gracie because she didn’t care for the freeze dried treats.

LovingOpie said:
I have a question about when the nadir is because I am assuming it is at +6 for Opie but what happens when the low is at +12 like today? This afternoon I did not feed him after the +6 and he went down lower by PMPS. I did as Marje and Gracie suggested and he did not go way up. It was difficult to not feed him all afternoon though I gave him a few freeze dried treats to ease the change for him.
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Nadir can vary by cat and also insulin. For example, Lantus and PZ generally nadir around +6 but Levemir nadirs +8 - +12 and typically closer to +12. It also onsets later. Some cats have an early nadir and some a later one and you have to look at the trends and determine what it is for Opie.

However, bounce clearing cycles like Opie is having today, are not good for determining the true nadir. By true nadir, I mean a “ typical” cycle where the BG comes down to roughly midcycle and then gradually increases to the next PS. The lowest BG during that kind of cycle is the nadir.

It might take a few days of feeding before nadirs to really see a difference but be sure Opie is eating all the calories he needs to. It is very important he eats his regular number of calories so he doesn’t get fatty liver disease (this occurs when caloric intake is greatly reduced or the cat quits eating). Some cats take to a new feeding schedule just fine but others do not so be careful.

I tried every way I knew to get my 13 year old cat on a feeding schedule for months and months and months and he’s an absolute “no”. He’s a grazer and he does not want to eat just four meals a day like my other cat. Note: my two cats are healthy. Gracie, on the other hand, took right to a mini meal feeding schedule. I’ve observed that “food motivated” (i.e. “live to eat”) cats, like Gracie and my Livia, are easier to get on a schedule than cats like my Tobey who just “eats to live”. :cat::cool::p
 
LovingOpie said:
What do you mean by duration? He gets no food from +10 to PMPS as I was told. Otherwise, I feed him as often as possible throughout the whole day. Do I not feed after nadir? I know that I am supposed to ffed in the morning to keep the numbers from dropping too quickly and causing a bounce but I do not know the strategy otherwise.
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As we have talked about, we don’t recommend feeding after the typical nadir hour because it can shorten the duration of the insulin (the food at this particular time in the cycle- after nadir- can help to push numbers higher when the action of the insulin is starting to slowly wane. You did have some specific problems getting him to eat also, so I haven’t inquired lately about the feeding schedule. Also, when you first joined there was a lot of new information to take in, so it is not surprising that this slipped through the cracks.
 
I fed him as suggested and he is going up before the nadir, probably a food bump but it seems like I am preventing him from dropping down to the healing numbers or is that because he is still clearing a bounce and is still wonky?

My next question is can I feed him AT the nadir when I test as l long as I don't AFTER?

You will probably ask what I fed so it was Fancy Feast classic pate LC.
 
LovingOpie said:
I fed him as suggested and he is going up before the nadir, probably a food bump but it seems like I am preventing him from dropping down to the healing numbers or is that because he is still clearing a bounce and is still wonky?

My next question is can I feed him AT the nadir when I test as l long as I don't AFTER?

You will probably ask what I fed so it was Fancy Feast classic pate LC.
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Remember that every meter can have a 20% variance between tests so he’s pretty flat between PMPS and +3. It’s hard to know if he’s still got some bouncing wonkiness but it’s possible. I’ve seen it look like the bounce was clearing and then the BG rise again before truly clearing.

Yes you can feed him midcycle but try to feed the biggest portions earlier and a lesser portion then.
 
ok, he went way up by +6 tonight and is back in pink. . . increase dose? is it possibly the insulin which was started on May 22? or is he just bouncing like crazy? (would have to purchase another insulin as don't have a back up this time. . . usually am more prepared)
 
Having had no response by AMPS, I made the decision to increase dose. All I can do is hope that I made the right choice.
 
LovingOpie said:
ok, he went way up by +6 tonight and is back in pink. . . increase dose? is it possibly the insulin which was started on May 22? or is he just bouncing like crazy? (would have to purchase another insulin as don't have a back up this time. . . usually am more prepared)
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The insulin is only a month old - or will be soon - it would not be that.
 
LovingOpie said:
Having had no response by AMPS, I made the decision to increase dose. All I can do is hope that I made the right choice.
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Well, he had a nadir of 90 during the morning cycle just three days ago and things seem to have been creeping up a bit from there. He seems to have been bouncing around all over the place. As long as you are testing, I'm not worried about Opie -- and you do great at that. He's been having some good nadirs on this dose (1.5 units) but, things have been a little different lately. I believe the pink rise last night and this morning is him bouncing, but Opie doesn't stay high too long. I think you may see some yellow today in the early part of the cycle and then perhaps see Opie going lower into blue and perhaps even lower with the dose increase. I'll be checking back to see :)
 
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