How do you know if it is lack of duration or a bounce?
Sorry to just get back to you. If the BG shoots up quickly like yesterday (44 to 151 in two hours), it’s lack of duration. It starts there and by PMPS, the lack of duration makes the starting bounce even higher. Frequently when he’s been in green, he loses duration and then bounces.
There have been several days he’s dropped quit a bit from AMPS to +3. I’m going to give you info but it’s a lot to take in so you might need to read it a few times. Ask questions.
When we see a cat with such fast dives and hard bounces (and I do believe that kitties that dive fast have harder bounces than those that just go lower), we try to get the curve to flatten out with food. We call this “using food to manipulate the curve”. The process is like this:
manage the curve with food ----> flatten the curve ------> adjust the dose (if necessary and it usually is).
This process or method is feeding so that we prevent the kitty from dropping too fast and/or too low. You can imagine if you aren’t careful with it, you can overfeed the kitty so it’s important to:
- recognize this is a process that doesn’t change things overnight
- requires that you, in general, feed the same amount of food kitty needs to maintain its current weight (assuming kitty is not under or overweight); obviously, if you’ve fed Opie his food for the cycle and then he fools you and takes another dive, you might have to feed a little more depending on where in the cycle he drops again.
- requires consistency and some extra commitment at the beginning
- requires that you know your kitty; what are his onset, nadir, duration
Typically, unless the kitty is taking a huge dive or drops below 50, we try to use LC to manage the curve with food. Obviously, if he is coming down really fast early in the cycle and if we know LC doesn’t slow him down, you might have to up the “ante” (i.e. the carbs). However, we do not typically feed a higher carb food
at shot time unless you must have the insulin start its onset from a higher number, for example, in the case where you might not be able to monitor. Opie drops quite a bit but he doesn’t usually do a nose dive.
There are important things to consider when you are determining whether to feed lc, mc, hc:
- where are is he in the cycle? If it’s early in the cycle and he’s dropping fast, you probably want to use higher carb food; if it’s nadir or later in the cycle and nadir is above 40, you might want to try LC.
- how carb sensitive is he at different parts of the cycle? Some kitties never need more than LC food even when they take a steep dive or go lower. Others need the big guns if they drop fast early in the cycle. This is going to be up to you to figure out and experiment with. You do know he’s very carb sensitive later in the cycle.
It’s also important to know why we manage the curve with food. The goal is to get the curve to flatten, as shown in the diagram above. If we are consistent and do it right (and it’s ECID and trial and error as to what is “right”), then kitties will typically flatten out at a higher BG. Flattening prevents those dreaded dives and huge bounces. Flattening also will allow you to get more insulin in the kitty
safely.This can, in turn, allow you to hold a specific dose longer. However, for a bouncy cat, more insulin can help bring down the numbers. It also helps to offset the loss of duration and food spikes very carb sensitive kitties get in response to food.
For anyone reading this who then thinks, “well, if I just give my cat more insulin, the bouncing will stop”.
No it won’t and it’s not safe to just increase the dose to stop bouncing. It’s the process of managing the curve with food
specific to your cat that keeps it safe to increase the dose. That entails:
- knowing your cat and having the time and commitment to experiment with feeding
- feeding the correct amounts of food at specific times to bring the over all curve up
- flattening the curve at a higher BG
How do we do this?
- start by dividing the kitty’s normal food portion into four minimeals each cycle which are fed consistently at PS, +1, +2, +3, at first.. As you get more data, you might need to adjust those feeding times especially if your kitty onsets later and you might find you have to feed at different times to address the difference in cycles.
- determine if kitty needs to be fed the same amount at each meal or if he/she needs to be fed different amounts at each meal. As an example, I studied Gracie’s SS when she was on lantus and figured out when she onset and when she took her steepest dive. I then determined I really needed to “frontload" her cycle with food. This had me fine tuning not just the times I fed her but feeding the majority of her food at PS and +1 and a little less at +2 and +3. Over time as I got more data on how she did with that, I changed the amounts of food and also changed the feeding times. When I switched her to levemir, I had to do the same thing all over again.
- test more at first to catch the drops. And did I say test? When you are first starting manage the curve with food, I would suggest you test every cycle at PS, +1, +2, +3 because that is most likely when the dives will occur. You need to figure out exactly where he drops so you know exactly when and how much to feed to prevent the drop. Don’t get complacent if he’s higher at +1 than PS and think “I’ll test at +3”. This will not be forever. This is just to find out where he drops so you can then manage the curve appropriately to flatten him out. Over time, as you start at a lower and lower PS, the dives should stop and you can get back to regular testing.
- realize that even after it works, he might, at some time, revert. Gracie did occasionally. I would start testing more to find out where she was dropping and then I could get proactive to adjust feeding the curve to prevent the drop. (Keep in mind, once I started managing the curve with food, I always did but patterns change from time to time and you have to be flexible and realize what worked for one pattern, might need a bit of fine tuning for another).
In summary, learning to manage the curve with food involves learning how Opie responds to different carbs at different times during the cycle. You have to be a scientist and an investigator. Write
everything down. What kind of a bump does he get from LC, MC, HC early in the cycle and late in the cycle? Using this info, you can guide the cycles. Again, remember you might find that you have to steer the cycles differently. Any time you make a change, leave it for 3-4 days and give him time to adjust before you make another change.
That’s a lot of info at once but you can bookmark this and come back to it.
and he went down to green again today!