07/13 Mister AMPS 237

[Elizabeth & Mister]

7/12 Mister AMPS 136, +1.5 110, +3 85, +4 98, +7 72, +9.5 117, PMPS 256, +4.5 167

It’s crazy how one cycle can feel like a week. Mister saw a nadir of 72 yesterday, but this bounce and these last 2 PMPS/AMPS has me questioning a dose increase. Can I get some eyes, please?

The only thing that concerns me is the amount of HC he was eating and his numbers weren’t moving on the dose above this one. I’ve been fighting very hard using carbs to slow him down, and yesterday felt so much easier not having to do that, seeing a food bump with LC, realizing I can let him go a little lower naturally and not need HC or syrup to put on the brakes.

He also seems to do his best in numbers above 70. Any lower and he gets extra spicy, even hissing at me. So how low do I let him drop before I step in? What if 50 is too much for him? Also, and last question for now, why does he seem to bounce some days with lower nadirs than usual and not other days with the same low numbers? I’d like to be patient and see what he does when he breaks this bounce but that patience is wearing thin.

I have to take little Calliope to the vet today. She had an ear infection and now what seems to be an abscess by her ear. She had this same issue a few years ago, same location too. If anyone could send her some vines or prayers, I’ll update when we get back. My poor girl. She’s prone to dirty ears, and it’s strange that this fluid filled bump is in the same spot it was years ago. This will probably drain my savings, which is a very scary thought. Lots of stress. Lots of animals I love more than anything and lots of feeling like I’m not doing enough for them.

 

[Adriana and Lola]

I hope your Calliope feels better Elizabeth!

 

[Briana + Binx]

I hope you know you are absolutely doing everything (and more than enough) for your babies!! I’m sorry if it’s not feeling that way, it can be so much to many one let alone more than one.

I’m sure someone will be by for a dosing review! In the meantime, sending many healing vines for Calliope

 

[Connie & Parker & Moonie]

You’re such a wonderful caregiver Elizabeth - and someone I look up to for inspiration for when I feel like I’m falling short! I hope you know that.

Sending you and precious Calliope lots and lots of healing vines and prayers. I hope she gets well soon.

One question I have on the bounce is - do you think it’s related to the pace of the the drop? Meaning 100 to 80 (20 percent drop) in an hour doesn’t produce the same bounce that 200 to 80 does (60 percent drop)?

 

[Elizabeth & Mister]

Poor baby Calliope, she hasn’t stopped crying since we got in the car. She’s a shy girl, skittish and doesn’t like change. She hides whenever company comes over so the vet is especially unpleasant for her. My girl, I hope they treat her appropriately so she feels better. I know she must be in pain.

I worry about leaving Mister, but the food I gave him at +3 slowed his drops. I fed him again at +4, more than I would have had I not been leaving and I left food in his timed feeder just in case this appointment goes longer than expected. You never know with vet appointments. I get so anxious leaving him, especially when I don’t know how he’s going to do breaking his bounce

 

[Elizabeth & Mister]

I hope your Calliope feels better Elizabeth!

Thank you so much me too, they shaved her head so now she looks silly like her brother.

 

[Sara & Khloe]

Hey Elizabeth, sending all the healing vibes to Calliope! I hope she feels better soon! Extra pat pats from me to her today!

Big big big hugs I hope the rest of your day is much easier when you return from the vet!

 

[Elizabeth & Mister]

I hope you know you are absolutely doing everything (and more than enough) for your babies!! I’m sorry if it’s not feeling that way, it can be so much to many one let alone more than one.

I’m sure someone will be by for a dosing review! In the meantime, sending many healing vines for Calliope

Thank you so much I know I make dosing suggestions a little more difficult by asking and then doing things like carbing him up a little extra like I did today, but not knowing how long I’ll be gone I veered on the safe side.

 

[Elizabeth & Mister]

You’re such a wonderful caregiver Elizabeth - and someone I look up to for inspiration for when I feel like I’m falling short! I hope you know that.

Sending you and precious Calliope lots and lots of healing vines and prayers. I hope she gets well soon.

One question I have on the bounce is - do you think it’s related to the pace of the the drop? Meaning 100 to 80 (20 percent drop) in an hour doesn’t produce the same bounce that 200 to 80 does (60 percent drop)?

That is so kind of you to say, thank you. I feel the exact same way about you & Moonie, I really look to you often. We all must feel this way at times, but I see so many loving CGs going the extra mile here so it’s easy to be harder/more critical on ourselves I suppose.

That’s a very good point. I wish I could ask his pancreas what the heck is going on sometimes because I think (at least as far as I can see from his data) there are multiple factors at play for when he bounces or not. I wish I could figure it out better to prevent them but that may be wishful thinking.

 

[Connie & Parker & Moonie]

That is so kind of you to say, thank you. I feel the exact same way about you & Moonie, I really look to you often. We all must feel this way at times, but I see so many loving CGs going the extra mile here so it’s easy to be harder/more critical on ourselves I suppose.

That’s a very good point. I wish I could ask his pancreas what the heck is going on sometimes because I think (at least as far as I can see from his data) there are multiple factors at play for when he bounces or not. I wish I could figure it out better to prevent them but that may be wishful thinking.

I think kitties just like to be unpredictable sometimes and keep you on your toes! But I hope (and think) the mysteries of Mister’s pancreas will reveal themselves to you in time.

I hope Calliope’s vet visit went smoothly! They’re always so stressful on the kitty and caregiver both.

 

[Elizabeth & Mister]

Hey Elizabeth, sending all the healing vibes to Calliope! I hope she feels better soon! Extra pat pats from me to her today!

Big big big hugs I hope the rest of your day is much easier when you return from the vet!

Thank you so much sweet friend, I’m posting an update about Calliope now. She’s much calmer now, it’s almost like she knows she’s going home now. I can’t wait to get back to Mister. Ahhh, how am I going to start working again when leaving him for just 2 hours is so hard

 

[Elizabeth & Mister]

Calliope got a haircut, so they could see the abscess. There’s a scar there from where she had it lanced the first time this happened (about 2 years ago) and a tiny little cut in the middle where they think it started, either from herself scratching or any other way. They did drain some of it with a needle. She has a pretty nasty double ear infection, bacteria and yeast. They gave her an antibiotic injection (Convenia) and prescription for antibiotic/antifungal/steroid (Posatex Otic Suspension) to give her once a day for 2 weeks, and a Dexamethasone sodium phosphate injection which I questioned them about since learning more about the dangers of steroids, but this being her only time on them I decided to go ahead and let them give it. They also gave me a ketoconazole/TRIS ear cleaner to use daily before the drops. Sheesh. Seems like a lot. But she gets these infections often, and I’ll be bringing her back this time in 2 weeks to make sure it’s cleared up. They were much more thorough this time. The last 2 ear infection visits they only prescribed Animax, which seemed to clear things up but then right back it all came.

 

[Connie & Parker & Moonie]

Hey! I spent a little time going through Mister's SS during a late lunch. This should have huge caveats since I'm a total feline diabetes beginner. So this is more from the lens of a third party who spends a lot of time going through messy data to draw reasonable(ish) conclusions for a living.

Mister's nadir is actually a very poor indicator of whether he will bounce, in large part because many of his nadirs are heavily food influenced. He seems to be bouncing in response to the whole glucose event: how high he started, how quickly he dropped, how much food was required to slow the drop, and how accustomed his body was to normal numbers at that point (he's bouncing so much less now than he was before and can sustain hours in greens before he bounces).

On the first point, the food adjusted drops seem more predictive of future drops than his actual stated nadir. I think the amount of feeding he's required has made the data very messy to interpret in terms of what nadirs are producing bounces. Clearest example is July 5 PM cycle. PMPS 167, he got to 82 by +1.5. This 50%+ drop happened despite despite 5% food mixed with 20%. Then he stayed low for ~3 more hours despite being given 28%, honey, Lil Gravies, and later 20% food. Next AMPS was 268.

Compare this with June 27 PM cycle - PMPS 104, gradual fall to 86 at +3.75 and 72 at +5.75 with much less intervention (LC/MC only). Next AMPS was 114.

The measured nadir on July 5 was only in the low 80s, but an 82 obtained despite that much carbs represents much stronger downward pressure than an unassisted (or less assisted) 72. I think it's hard to say "he bounced from an 82" because in reality, he needed so much carbs to produce that endpoint. Heavy intervention suggests that the underlying insulin action was much stronger than the visible curve shows. My uninformed hypothesis - HC food may prevent a dangerous number without necessarily preventing the physiological response (bounce) to the rapid fall.

Fast early drops are his most consistent trigger - his clearest bounce-producing cycles involve a large % fall by +1.5 to +3:

• 5/23 AM: AMPS 101 to 65–78 around +1.5 despite MC; PMPS 279.
• 5/26 AM: 152 to 68 around +1.5; PMPS 270 and next AMPS 333.
• 5/30 AM: 218 to the 78–94 range around +2; PMPS 348.
• 7/5 PM: 167 to the low 80s by +1.5 despite aggressive feeding; next AMPS 268.
• 7/9 AM: AMPS 65, initially green, then climbed to 233–259 late and PMPS 338. This was likely a delayed response from 7/8 PM which had PMPS 163, down to 74 by +4.

Based on this, if he were my cat (take all of this with a huge grain of salt),

I would think about a standardized front-loaded feeding schedule. His most problematic drops usually begin early, so I would give most of his cycle’s food before +4. Obviously that's for an ideal hypothetical and maybe not possible given that Mister often drops late during bounce breaks.

I would also start responding to the % of declines rather than the absolute number (unless that absolute number is super super low of course). Sara's columns on Khloe's SS would be very useful for this. 80 from PMPS 100 might not actually require intervention, but 80 from PMPS 200 might deserve something more aggressive.

Basically the goal would be to do small measured interventions early on to slow his drops and minimize urgent HC feeding later. Hopefully this will be much easier on this dose! But I really wonder if he was on a higher dose than ideal and that created the bounces.

Just my 2 cents - take it more as some stuff that jumped out to someone who works with data, rather than someone who knows a lot about feline diabetes.

 

[Elizabeth & Mister]

Hey! I spent a little time going through Mister's SS during a late lunch. This should have huge caveats since I'm a total feline diabetes beginner. So this is more from the lens of a third party who spends a lot of time going through messy data to draw reasonable(ish) conclusions for a living.

Mister's nadir is actually a very poor indicator of whether he will bounce, in large part because many of his nadirs are heavily food influenced. He seems to be bouncing in response to the whole glucose event: how high he started, how quickly he dropped, how much food was required to slow the drop, and how accustomed his body was to normal numbers at that point (he's bouncing so much less now than he was before and can sustain hours in greens before he bounces).

On the first point, the food adjusted drops seem more predictive of future drops than his actual stated nadir. I think the amount of feeding he's required has made the data very messy to interpret in terms of what nadirs are producing bounces. Clearest example is July 5 PM cycle. PMPS 167, he got to 82 by +1.5. This 50%+ drop happened despite despite 5% food mixed with 20%. Then he stayed low for ~3 more hours despite being given 28%, honey, Lil Gravies, and later 20% food. Next AMPS was 268.

Compare this with June 27 PM cycle - PMPS 104, gradual fall to 86 at +3.75 and 72 at +5.75 with much less intervention (LC/MC only). Next AMPS was 114.

The measured nadir on July 5 was only in the low 80s, but an 82 obtained despite that much carbs represents much stronger downward pressure than an unassisted (or less assisted) 72. I think it's hard to say "he bounced from an 82" because in reality, he needed so much carbs to produce that endpoint. Heavy intervention suggests that the underlying insulin action was much stronger than the visible curve shows. My uninformed hypothesis - HC food may prevent a dangerous number without necessarily preventing the physiological response (bounce) to the rapid fall.

Fast early drops are his most consistent trigger - his clearest bounce-producing cycles involve a large % fall by +1.5 to +3:

• 5/23 AM: AMPS 101 to 65–78 around +1.5 despite MC; PMPS 279.
• 5/26 AM: 152 to 68 around +1.5; PMPS 270 and next AMPS 333.
• 5/30 AM: 218 to the 78–94 range around +2; PMPS 348.
• 7/5 PM: 167 to the low 80s by +1.5 despite aggressive feeding; next AMPS 268.
• 7/9 AM: AMPS 65, initially green, then climbed to 233–259 late and PMPS 338. This was likely a delayed response from 7/8 PM which had PMPS 163, down to 74 by +4.

Based on this, if he were my cat (take all of this with a huge grain of salt),

I would think about a standardized front-loaded feeding schedule. His most problematic drops usually begin early, so I would give most of his cycle’s food before +4. Obviously that's for an ideal hypothetical and maybe not possible given that Mister often drops late during bounce breaks.

I would also start responding to the % of declines rather than the absolute number (unless that absolute number is super super low of course). Sara's columns on Khloe's SS would be very useful for this. 80 from PMPS 100 might not actually require intervention, but 80 from PMPS 200 might deserve something more aggressive.

Basically the goal would be to do small measured interventions early on to slow his drops and minimize urgent HC feeding later. Hopefully this will be much easier on this dose! But I really wonder if he was on a higher dose than ideal and that created the bounces.

Just my 2 cents - take it more as some stuff that jumped out to someone who works with data, rather than someone who knows a lot about feline diabetes.

Firstly, thank you so much for taking the time to go over his SS in such detail, thank you for caring enough about a cat you've never met, to go over his numbers and patterns and my novice notes so carefully enough to share your thoughts. I don't know if I'm just overly tired, overly emotional, or overly sensitive when it comes to the care of my boy who relies so heavily on the choices I make, but I had to take breaks reading your comment because it made me teary eyed. I'm constantly amazed and positively emotional over the level of care strangers on the internet put into helping others on this forum. You also pointed out several specific instances that show a pattern that I have known exists, but haven't been able to pinpoint as clearly, which is that he sometimes drops very fast and hard early in the cycle, which not only makes it difficult for me to know how to feed him, but also makes it incredibly difficult for me to then later interpret his data. I'm constantly wondering, is he bouncing? is he losing duration because I did feed him so much and it doesn't catch up until later? (an example of this would be 7/9, I never considered that his numbers began rising due to a delayed response from the PM cycle of 7/8, but I was beating myself up for adding MC to his breakfast and thought I basically aborted his cycle. But I added that MC because he so often does drop fast and early, and a number as low as 65 gave him no room that day for those kind of drops.)

It's also very confusing to know what's going on when I see things like the AM cycle of 7/5 (after his reduction) where his drops were gradual and no MC was necessary at all, then we got to the PM cycle where he dropped from 167 to 82 in under 2 hours and it took an extreme amount of HC to keep him flat for a few hours, and then he went up into the 130s for several hours. Again, made extremely hard to interpret because 1. why did he drop so hard that night when he surfed so beautifully that morning? 2. I fed so much HC because his numbers weren't moving even after the large amounts I was giving him, but then he shot up to 130. and 3. I know I could have stopped the HC at +2 but how was I to know if he would keep dropping or not since that is such a large amount of carbs just to keep him flat and I eventually needed to go to sleep because I could barely stay awake. It felt too risky. So basically it's been so sporadic that I have an extremely hard time figuring out a feeding schedule that will make his cycles go more smoothly, without all of the extreme ups and downs. I agree part of the problem was the dose being too high, "too much insulin can look like not enough insulin" possibly, because if I hadn't been feeding so much MC/HC, I know he would have earned a reduction much sooner, but my feedings kept him propped up enough to make it seem like an increase was necessary. I wasn't intentionally feeding him to prevent reductions, but that started to become what was happening. At the same time I'm thankful for those numbers because they prevented him from going into DKA, even if I had to feed him more than necessary to keep him there.

It also makes it nearly impossible for me to recognize any patterns of nadirs. This is why I so desperately want to get him to a dose where it's possible to steer him using LC, and only MC when like you said if his numbers get to a dangerous low.

I think responding to the % of the drop rather than the number itself is a very important detail and I may take Sara's idea and add that column to my SS to make it easier for me to keep track of. Other than that, my head feels like it's spinning 24/7 and I'm just trying to keep it above water. I feel so scared and nervous because this sweet boy doesn't know he has anything wrong, he just eats what I feed him when I feed him, and I could (and do) just cry thinking about feeling so lost when his life feels like it is very much in my hands. And he doesn't know, he just trusts me...he's just being a cat.

So again I genuinely appreciate you sharing your thoughts. Your opinions and ideas are extremely valid and helpful even if you are only basing them from the stand point of viewing patterns and data. I would love to hear from someone with the added learned experience of treating FD on all of this too. Because I feel like I am winging it most days and that doesn't feel very good.
ETA @Marje and Gracie @Wendy&Neko @Christie & Maverick (I know I am a handful, but if any of you have the time to read this and let me know your thoughts I would be so appreciative, I think it holds a lot of value and presents several concerns I've been having and not knowing how to voice)

 

[Christie & Maverick]

Hi Elizabeth! I just happened to be checking in on you and Mister, didn’t actually get the tag, but can take a look at your questions and his SS. I need to get up to speed a little first, since I’ve been off a little from the forum. Although perhaps by then, Wendy or Marje have some thoughts to share. But I’ll be back anyway.

 

[Elizabeth & Mister]

Hi Elizabeth! I just happened to be checking in on you and Mister, didn’t actually get the tag, but can take a look at your questions and his SS. I need to get up to speed a little first, since I’ve been off a little from the forum. Although perhaps by then, Wendy or Marje have some thoughts to share. But I’ll be back anyway.

Please, no hurry! thank you!

 

[Connie & Parker & Moonie]

Firstly, thank you so much for taking the time to go over his SS in such detail, thank you for caring enough about a cat you've never met, to go over his numbers and patterns and my novice notes so carefully enough to share your thoughts. I don't know if I'm just overly tired, overly emotional, or overly sensitive when it comes to the care of my boy who relies so heavily on the choices I make, but I had to take breaks reading your comment because it made me teary eyed. I'm constantly amazed and positively emotional over the level of care strangers on the internet put into helping others on this forum. You also pointed out several specific instances that show a pattern that I have known exists, but haven't been able to pinpoint as clearly, which is that he sometimes drops very fast and hard early in the cycle, which not only makes it difficult for me to know how to feed him, but also makes it incredibly difficult for me to then later interpret his data. I'm constantly wondering, is he bouncing? is he losing duration because I did feed him so much and it doesn't catch up until later? (an example of this would be 7/9, I never considered that his numbers began rising due to a delayed response from the PM cycle of 7/8, but I was beating myself up for adding MC to his breakfast and thought I basically aborted his cycle. But I added that MC because he so often does drop fast and early, and a number as low as 65 gave him no room that day for those kind of drops.)

It's also very confusing to know what's going on when I see things like the AM cycle of 7/5 (after his reduction) where his drops were gradual and no MC was necessary at all, then we got to the PM cycle where he dropped from 167 to 82 in under 2 hours and it took an extreme amount of HC to keep him flat for a few hours, and then he went up into the 130s for several hours. Again, made extremely hard to interpret because 1. why did he drop so hard that night when he surfed so beautifully that morning? 2. I fed so much HC because his numbers weren't moving even after the large amounts I was giving him, but then he shot up to 130. and 3. I know I could have stopped the HC at +2 but how was I to know if he would keep dropping or not since that is such a large amount of carbs just to keep him flat and I eventually needed to go to sleep because I could barely stay awake. It felt too risky. So basically it's been so sporadic that I have an extremely hard time figuring out a feeding schedule that will make his cycles go more smoothly, without all of the extreme ups and downs. I agree part of the problem was the dose being too high, "too much insulin can look like not enough insulin" possibly, because if I hadn't been feeding so much MC/HC, I know he would have earned a reduction much sooner, but my feedings kept him propped up enough to make it seem like an increase was necessary. I wasn't intentionally feeding him to prevent reductions, but that started to become what was happening. At the same time I'm thankful for those numbers because they prevented him from going into DKA, even if I had to feed him more than necessary to keep him there.

It also makes it nearly impossible for me to recognize any patterns of nadirs. This is why I so desperately want to get him to a dose where it's possible to steer him using LC, and only MC when like you said if his numbers get to a dangerous low.

I think responding to the % of the drop rather than the number itself is a very important detail and I may take Sara's idea and add that column to my SS to make it easier for me to keep track of. Other than that, my head feels like it's spinning 24/7 and I'm just trying to keep it above water. I feel so scared and nervous because this sweet boy doesn't know he has anything wrong, he just eats what I feed him when I feed him, and I could (and do) just cry thinking about feeling so lost when his life feels like it is very much in my hands. And he doesn't know, he just trusts me...he's just being a cat.

So again I genuinely appreciate you sharing your thoughts. Your opinions and ideas are extremely valid and helpful even if you are only basing them from the stand point of viewing patterns and data. I would love to hear from someone with the added learned experience of treating FD on all of this too. Because I feel like I am winging it most days and that doesn't feel very good.
ETA @Marje and Gracie @Wendy&Neko @Christie & Maverick (I know I am a handful, but if any of you have the time to read this and let me know your thoughts I would be so appreciative, I think it holds a lot of value and presents several concerns I've been having and not knowing how to voice)

Aww Elizabeth of course I care so much about you and Mister! It’s always so much easier to spot patterns when it’s not your own SS, and I figured whatever I’d dig up (even if it shouldn’t be relied upon) might serve as a basis for questions or thoughts if nothing else.

I’m curious to hear what someone more experienced would see in Mister’s SS. You ask such great questions Elizabeth. We all get to learn a lot from your condos because you think so carefully about how to help Mister and then ask such great questions.

 

[Marje and Gracie]

Firstly, thank you so much for taking the time to go over his SS in such detail, thank you for caring enough about a cat you've never met, to go over his numbers and patterns and my novice notes so carefully enough to share your thoughts. I don't know if I'm just overly tired, overly emotional, or overly sensitive when it comes to the care of my boy who relies so heavily on the choices I make, but I had to take breaks reading your comment because it made me teary eyed. I'm constantly amazed and positively emotional over the level of care strangers on the internet put into helping others on this forum. You also pointed out several specific instances that show a pattern that I have known exists, but haven't been able to pinpoint as clearly, which is that he sometimes drops very fast and hard early in the cycle, which not only makes it difficult for me to know how to feed him, but also makes it incredibly difficult for me to then later interpret his data. I'm constantly wondering, is he bouncing? is he losing duration because I did feed him so much and it doesn't catch up until later? (an example of this would be 7/9, I never considered that his numbers began rising due to a delayed response from the PM cycle of 7/8, but I was beating myself up for adding MC to his breakfast and thought I basically aborted his cycle. But I added that MC because he so often does drop fast and early, and a number as low as 65 gave him no room that day for those kind of drops.)

It's also very confusing to know what's going on when I see things like the AM cycle of 7/5 (after his reduction) where his drops were gradual and no MC was necessary at all, then we got to the PM cycle where he dropped from 167 to 82 in under 2 hours and it took an extreme amount of HC to keep him flat for a few hours, and then he went up into the 130s for several hours. Again, made extremely hard to interpret because 1. why did he drop so hard that night when he surfed so beautifully that morning? 2. I fed so much HC because his numbers weren't moving even after the large amounts I was giving him, but then he shot up to 130. and 3. I know I could have stopped the HC at +2 but how was I to know if he would keep dropping or not since that is such a large amount of carbs just to keep him flat and I eventually needed to go to sleep because I could barely stay awake. It felt too risky. So basically it's been so sporadic that I have an extremely hard time figuring out a feeding schedule that will make his cycles go more smoothly, without all of the extreme ups and downs. I agree part of the problem was the dose being too high, "too much insulin can look like not enough insulin" possibly, because if I hadn't been feeding so much MC/HC, I know he would have earned a reduction much sooner, but my feedings kept him propped up enough to make it seem like an increase was necessary. I wasn't intentionally feeding him to prevent reductions, but that started to become what was happening. At the same time I'm thankful for those numbers because they prevented him from going into DKA, even if I had to feed him more than necessary to keep him there.

It also makes it nearly impossible for me to recognize any patterns of nadirs. This is why I so desperately want to get him to a dose where it's possible to steer him using LC, and only MC when like you said if his numbers get to a dangerous low.

I think responding to the % of the drop rather than the number itself is a very important detail and I may take Sara's idea and add that column to my SS to make it easier for me to keep track of. Other than that, my head feels like it's spinning 24/7 and I'm just trying to keep it above water. I feel so scared and nervous because this sweet boy doesn't know he has anything wrong, he just eats what I feed him when I feed him, and I could (and do) just cry thinking about feeling so lost when his life feels like it is very much in my hands. And he doesn't know, he just trusts me...he's just being a cat.

So again I genuinely appreciate you sharing your thoughts. Your opinions and ideas are extremely valid and helpful even if you are only basing them from the stand point of viewing patterns and data. I would love to hear from someone with the added learned experience of treating FD on all of this too. Because I feel like I am winging it most days and that doesn't feel very good.
ETA @Marje and Gracie @Wendy&Neko @Christie & Maverick (I know I am a handful, but if any of you have the time to read this and let me know your thoughts I would be so appreciative, I think it holds a lot of value and presents several concerns I've been having and not knowing how to voice)

Connie did a great synopsis and front-loading is a very important part of addressing these kitties who drop so fast so early. I would definitely try to beef up what he gets at AMPS, +1, and +2 in terms of amount, not carbs. You want to try and catch it with LC, if possible.

The other thing that is important is consistency. In other words, whether Gracie started out the day high or low, I fed her the same amount every time to front load her cycles. I think the best thing for you to do is to figure out how to feed him more LC food from PS to +2 and stick with it consistently. I agree it’s the big drops that get him bouncing.

 

[Elizabeth & Mister]

Connie did a great synopsis and front-loading is a very important part of addressing these kitties who drop so fast so early. I would definitely try to beef up what he gets at AMPS, +1, and +2 in terms of amount, not carbs. You want to try and catch it with LC, if possible.

The other thing that is important is consistency. In other words, whether Gracie started out the day high or low, I fed her the same amount every time to front load her cycles. I think the best thing for you to do is to figure out how to feed him more LC food from PS to +2 and stick with it consistently. I agree it’s the big drops that get him bouncing.

Thank you so much Marje. I was just about to come on here and ask for advice for his +1, since he's completely flat. I'll feed him some now, LC, and test at +2. Some trial and error may be in the future but I'm hopeful we will figure this out.

I totally agree that consistent feedings is important because I've been thinking about that recently... I kind of feed him around his BGs right now (high BGs, either don't feed or feed 0%, lower BGs, feed higher % or more food, different feeding patterns pretty much every day) instead of feeding him on a consistent schedule and letting his body do what it's going to do naturally and then adjusting things as needed (hope that makes sense). That will also make things much easier when I need to be away from him and have to meal prep so my mom knows what to give him and when. I don't want to put too much on her, but she is willing to feed him for me while I'm not home and make sure he's behaving normally.

 

[Christie & Maverick]

A few other thoughts in addition to what was mentioned wrt feeding and front loading consistently. I do see the Lantus double dip going on a few times now, as recently as July 10th and July 11th. That’s where they hit nadir in the cycle, then they go back up, then come back down a little into +11 or preshot, but not as low as nadir. I tend to see something similar as Connie noted which is to consider the % drop as significant, anything more than meter variance. The idea of continuing with consistent front end loading is worth doing. If it were me, I’d also prefer to use LC or higher LC in that exercise. That would mean a snack every time at +1 regardless of the BG and /or if you test it.
.

 

[Elizabeth & Mister]

A few other thoughts in addition to what was mentioned wrt feeding and front loading consistently. I do see the Lantus double dip going on a few times now, as recently as July 10th and July 11th. That’s where they hit nadir in the cycle, then they go back up, then come back down a little into +11 or preshot, but not as low as nadir. I tend to see something similar as Connie noted which is to consider the % drop as significant, anything more than meter variance. The idea of continuing with consistent front end loading is worth doing. If it were me, I’d also prefer to use LC or higher LC in that exercise. That would mean a snack every time at +1 regardless of the BG and /or if you test it.
.

Thank you for this, it's reassuring to have a clear image of a game plan rather than anticipating every test and then feeding. Connie generously sent me a food scale too so I will be able to start weighing his meals soon for even more consistency which I'm super excited about. I plan on doing the same for the civvie's, the consistent meals.

As far as feeding after nadir, because he's very used to that and already gets spicy if it's been more than 4 hours without food (spicy and inconsolable, he will meow and be up in my face until I give him something), should I be sticking to things like animal protein (boiled chicken), low/no carb snacks, and avoiding wet food unless he's dropping close to 50?

I think I put too much thought into it, but I'm also concerned that I will keep feeding him to avoid a reduction, especially because I do test so often. How do you know when it's time for a reduction unless it's luck of the draw that you test and they are below 50 (like when I overslept my alarm) vs you test and they're at 51 with time to drop so you feed them to prop them up? I reduced this last time based on how much HC I was feeding him and not seeing his numbers move but that tells me I missed a reduction somewhere along the line to get to that point.

 

[Sara & Khloe]

I may take Sara's idea and add that column to my SS to make it easier for me to keep track of.

Hey sorry I’ve been alittle swamped today and haven’t had time to read everything in depth but I am currently working on some SS additions for you but testing them to make sure they don’t accidentally break before I send it over to you.

 

[Marje and Gracie]

Thank you for this, it's reassuring to have a clear image of a game plan rather than anticipating every test and then feeding. Connie generously sent me a food scale too so I will be able to start weighing his meals soon for even more consistency which I'm super excited about. I plan on doing the same for the civvie's, the consistent meals.

As far as feeding after nadir, because he's very used to that and already gets spicy if it's been more than 4 hours without food (spicy and inconsolable, he will meow and be up in my face until I give him something), should I be sticking to things like animal protein (boiled chicken), low/no carb snacks, and avoiding wet food unless he's dropping close to 50?

I think I put too much thought into it, but I'm also concerned that I will keep feeding him to avoid a reduction, especially because I do test so often. How do you know when it's time for a reduction unless it's luck of the draw that you test and they are below 50 (like when I overslept my alarm) vs you test and they're at 51 with time to drop so you feed them to prop them up? I reduced this last time based on how much HC I was feeding him and not seeing his numbers move but that tells me I missed a reduction somewhere along the line to get to that point.

Yes use boiled chicken or FD chicken for snacks after nadir if he is not below 50.

I think I remember you had the same question the other day about whether you wake up to a 51 and wonder whether to reduce. If you don’t get a reading below 50, you don’t reduce, generally. The caveat is if you are feeding constantly to keep him above 50 and I don’t mean a couple meals. I mean all cycle. Then you can try and reduce.

You should also take a reduction if he’s been mostly green for one week but he hasn’t done that yet.

 

[Elizabeth & Mister]

Hey sorry I’ve been alittle swamped today and haven’t had time to read everything in depth but I am currently working on some SS additions for you but testing them to make sure they don’t accidentally break before I send it over to you.

You are so kind for this, thank you so much Sara. Thinking about the time/stress that will save me means so much to me.

 

[Elizabeth & Mister]

Yes use boiled chicken or FD chicken for snacks after nadir if he is not below 50.

I think I remember you had the same question the other day about whether you wake up to a 51 and wonder whether to reduce. If you don’t get a reading below 50, you don’t reduce, generally. The caveat is if you are feeding constantly to keep him above 50 and I don’t mean a couple meals. I mean all cycle. Then you can try and reduce.

You should also take a reduction if he’s been mostly green for one week but he hasn’t done that yet.

Okay that better answers my question. Basically I was thinking if I saw a 51 at say +5, I would feed that. If I didn't feed it, chances are he'd drop below 50. I was thinking in terms of would this be considered feeding to prevent reductions, which we don't want to do. But even if I feed a 51 and prevent him from going below 50, unless I have to continue to feed him, no reduction, no harm no foul. I think I'm catching on... like I said, thinking too much into it... I just don't want him to get to a point where he's missing reductions and I'm messing up by feeding him too many carbs to keep him straight again.