02/10 Martini - Experience needed please

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SMM

Member Since 2017
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It's been a year now with my diabetic girl. I don't post for help often as I try to get on with it myself, but I am truly lost once more. I am so happy for all the others out there whose kitties give wonderful numbers, sad for those with bad numbers. I know she is due for an increase back to 2.5 units, I was trying to level her off the bouncing that she seems to be the queen of, but have no clue why is giving me these horrid numbers once again. Does anyone see what could possibly be going on with her? Any advice moving forward? Any bit of insight would be wonderful. Any pattern?
Thank you!!!!
 
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Hi, Sandy.

My immediate reaction to Martini's SS is that you're holding on to the dose too long. Martini's numbers aren't bad but I suspect you'd like to see more blue and green vs blue and yellow. I also don't think Martini is bouncing as much as you think. It looks more like "bouncelets" vs BIG swings in numbers.

I think I mentioned this in a previous condo: If you're concerned that the cut-off according to TR is too low for Martini, you don't need to stick with a drop below 40 (since she's past a year since diagnosis). Alternatively, a reduction when numbers drop below 90 may not stick -- if you're following SLGS. (It didn't look to me like you were reducing if numbers were less than 90.) Since you're the one who sees how Martini is behaving, pick a number that you think is "Martini's number" and would warrant a dose reduction. You can consider using that as the cut off for a reduction or allowing Martini to drop below that number on 3 separate occasions and then reduce. You are great at collecting data. Keep good notes on what you're doing in your comments on the SS so we can follow along (and maybe put a note in your signature) so we can figure out what's working for Martini.

An alternative way of approaching dose is to think in terms of maximizing the amount of insulin you're giving. What this means is you work to prevent a dose reduction while at the same time, getting Martini into mostly green numbers. You are on top of Martini's numbers so I would think she'd be safe. If you start to see drops into numbers that concern you, nudge the numbers up with food. If you look at Gabby's SS, this is what I was doing with her for for some time. Ideally, this allows her to spend as much time as possible in normal range numbers.

What % carb food are you using? Some cats do better on very low carb and some do better with a bit higher carb.
 
Thank you so very much Sienne for your thoughts. Yes, I want more blue and green!!! :) "Bouncelets" is a new term to me, but better than a big swing as you say. I was following SLGS after the TR, I was reducing ( I thought) after 3 times below 90 as she is a long term diabetic. BTW, your memory is great! I do try to feed the lower numbers all the time. I am using 1%-7% foods, mostly the 1-3%. I don't see a difference in higher carb foods to lower in her numbers. Also here in Canada we're pretty limited and if the food has any size chunks in it - it was always be thrown up. :(
I will try harder with the notes, what do you mean by putting a note in my signature?
ON SLGS I was following "If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose" as her nadirs were almost all between those numbers. Should I not have followed this as you think I've kept doses too long? (always have wanted to ask that :) I will be moving to 2.5 units tonight I think and I've decided my cut off point for her is 55 (3.1) or thereabouts, I hope you/anyone else would be in agreement. Again, thank you so much.
 
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Perhaps Sienne thought you were still doing TR because you aren’t holding the dose too long for SLGS.

I do want to point out that there is no “three times below 90” with SLGS for reductions. :)

I agree with Sienne that you are doing a lot of great testing and so you can do TR, and as Sienne said, use a little bit higher reduction point.

I wouldn’t bother with a fat or skinny dose at this point. I’d stick with increases and decreases of 0.25u and only fine tune the dose with smaller increment changes when she’s low blue/high green and you want the overall curve just a little lower.

Increasing to 2.5u is a good idea and I hope she’ll see some better numbers with it.:)

:bighug::bighug:
 
I saw in your notes that both kitties aren’t eating well. Do they eat the same thing? Bad batch of food perhaps? Has happened over here before. I hope you get to the bottom of it.

You test plenty for TR, I think you can get somewhere if you try it again and take advantage of the shorter times to increase. She’s a bit all over the place with nadir, isn’t she? It may even out when she’s in more blues and greens, or that’s the hope anyway. Some cats seem to pride themselves on being utterly unpredictable.

If you’re having trouble with lower numbers and getting her numbers up predictably, there’s a few things you can try. Asia also didn’t come up, much, with MC, HC or honey, very frustrating. Karo syrup (corn syrup) was a game changer. HC gravy or honey would bring her up 10-20 points, if anything on the cycles where she had momentum to go down, fast. With Karo, I can get her way up if need be. Might be worth experimenting with Karo or maple syrup instead of honey. Those sugars all have different makeups of fructose, sucrose and glucose and some cats respond to some better than others. And you can’t forget the power of real, sustaining food (fat and protein), when the sugar wears off, it will be a crash without something sustaining under it. You want to be confident you can get her numbers up if you need to. It’s hard to do much else without that component in place.

Once you figure that bit, I think you just need to increase as often as TR allows until you’re seeing more of the numbers you want to see, looks like Martini is a bit too comfy in high blues and yellows. If you know onset, you can keep an eye out for a big drop and intervene before it becomes a below 50 situation, it might be easier than bringing her up from a below 50, depending on the momentum of the cycle. And by all means, do set a higher number if 50 makes you wary, ECID. I saw that you did that and put it in your signature, that’s good so people won’t ask why if you reduce a number over 50.

What I have done with Asia is test a ton (obviously), it was not a conscience choice, much was out of necessity because I didn’t know what she would do, but it also let me see patterns very clearly because I didn’t have to guess too much what was in the blank spots. If you can fill in some blanks and test in spots you don’t usually, say on the weekends, try to get some +1’s and +2’s, find out where onset is, find out how much on average is a food bump. If you can try to figure out her nadir, which seems challenging at the moment, then you know the hours she will likely drop and try to figure out an average of how many points she drops per hour in a more typical cycle. That way, if you see something out of sorts, you can intervene long before you are in lime green territory. I know Asia drops about 20 points an hour, on average, and I also know she does most of her dropping in +2 through +4/+5 ish. So when I see a 50 point drop, my ears perk up. Depending on what number she is coming down from, I give her some more food or carbs to slow her down and I test again in an hour to see if she’s continuing to drop or has decided to surf.

Another note, I just read in a thread the other day, I will try to find to post it for you, but someone experienced when changing food to add a slightly higher carb, she couldn’t really tell until an adjustment period of a couple of weeks. Just something to ponder if perhaps you’ve dismissed it as not working without giving a little time for it to settle in the mix.

Last bit of advice, try to post every day if you can, I know it’s more work and some days are very uneventful and that’s fine, but just to give a quick report and ask any questions you may have, it allows everyone here to get to know Martini and her patterns better and that can only help. :)
 
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