11/21 Blue AMPS 406 126 +7

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AMPS 406 to 465 (+1) = Food bump from breakfast.

465 (+1) - 371 (+2) = 94 point drop in an hour. A test at +1.5 per my suggestions yesterday might have helped you catch it sooner.

371 (+2) - 282 (+3) = 89 point drop in an hour. Again, a test at +2.5 would have put you in a position to intervene with food sooner.

Potential bounce territory again.

Patty and Blue said:
He's at 371 + 2 and I know he's still high but do I need to still slow him down from dropping so much?
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Again, think of the pendulum: the higher it starts the more momentum it gains as it drops and the greater the likelihood it will end up high again at the end of the swing.

I'm a little confused on what level I need to give him a snack or is it anytime he drops?
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Reposting this from yesterday:

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Original post: https://www.felinediabetes.com/FDMB/threads/11-20-blue-amps-352-60-3-5.238851/#post-2683590

Here's my take and best suggestions:

1. When Blue drops, he drops early, and he drops fast and far, typically starting from +1, usually through to +4. He is very consistent in this respect. [Blue appears to metabolise insulin really quickly.]

2. It takes a lot of carbs to slow Blue down when he drops - and also to raise his numbers when he is running low.

3. FOR EVERY CYCLE (regardless of whether PS is low or high):

(a) Start testing at +1. If roughly the same or any way lower than PS (even if only, say, 10 or 20 points lower than PS), start feeding HC snacks (20%) straight away. The bigger the drop, the bigger and more gravyish the snack, with honey if indicated.

(b) Test every 30 minutes until at least +4 and be generous enough with the carby snacks to stay ahead of the drop (unless it's howlingly obvious he's having a significant bounce and is going to stay high enough for the rest of the cycle).

[ETA 21 Nov: Don't automatically assume that because Blue is high at the beginning of the cycle - even if there's a food bump at +1 - that the bounce won't break during the upcoming cycle. Watch how numbers have been trending through the course of the bounce - rising to peak, levelling off, starting to descend. This may be over a couple of cycles, but take into consideration that Blue now tends to break bounces quite quickly, another factor driving the need for frequent testing in the early hours of a cycle.]​

(c) Only give HC 20% during these hours. (The extra carbs to balance the insulin action early in the cycle are better than Blue spending more time in much higher numbers from a long/big bounce.)

(d) If Blue needs steering after +4 then if he's close to 50 keep with the HC 20% (with honey if indicated). If he's over 90, try the MC 12-15% gravy food instead. If numbers drop back down towards the 50 mark go straight back to the HC.

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Mogs
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This is what I meant about testing every half hour last night. It wasn’t needed last night but might have helped today. Testing often early will let us know if it’s the big drops triggering the bounces. I think that is what Mogs is saying.
 
Patty and Blue said:
Oh no, don't scare me. I have been waiting all day and have to go to the grocery.
I guess I'll have Tara feed him a little while I'm gone to play it safe. Yikes. BBL
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Awww I didnt mean to scare you. I'm just curious where Blues true bottom is. I didnt mean in this particular instance . I'm sorry :(
 
As a follow on from my earlier post, Blue's tendency is to drop hard and fast early in the cycle, and the higher he starts the more scope he has to experience really steep drops. As soon as he gets to a dose that moves his nadir into a better range, when the depot starts to establish it usually becomes a firefight to keep him in safe numbers and then he heads for the stars again. This means that his curves are V-shaped and he doesn't get long enough time in better ranges for his body to become familiar with them. This then reinforces his tendency to bounce.

I've just gone through two of Blue's recent cycles, added the feeding and an interpretation of how the cycle progressed. I hope it helps you get a better feel for how the rate of drop in the early part of the cycle influences the rate of rise in the latter part.

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19 Nov AM - Bowl-shaped cycle (desirable at this stage in treatment)

- Bounce broke in previous PM cycle, plus dose was increased to 0.5IU.
- Lowish start to the cycle, less far to fall.

AMPS - 191 - _________________ FED LC BREAKFAST <--- Bounce broken, plus some benefit from dose increase, but still working from the 0.25IU depot.

+1.00 - 154 - 37 point drop (-37/hr). <no food> <--- Possible tail end of clearing bounce. Dose onset likely. Not clear if AMPS feed BG up or may possibly have helped it dip - see +7.00.

+1.50 - 162 - 8 point rise (-16/hr). FED LC SNACK.

+2.00 - 128 - 34 point drop (-68/hr). FED LC SNACK. <--- Dose in full swing. Prev LC snack not enough to stop acceleration of drop.

+2.50 - 110 - 18 point drop (-36/hr). FED 15% CARB SNACK (NB - For future reference, 15% is MEDIUM carb). <--- Prev LC slowed drop but was not enough to level it out.

+3.00 - 96 - 14 point drop (-28/hr). FED SNACK (assuming here that the 'HC' in the SS notes is still 15%, i.e. actual MC). <--- MC (15%) slightly slowed drop rate, not enough to hold numbers above 100.

+3.50 - 90 - 6 point drop (flat). FED LC SNACK. <--- Effects of insulin dose starting to reduce, medium carb (15%) sufficient to hold numbers, not raise them.

+4.00 - 80 - 10 point drop (-20/hr). FED SNACK (assuming still the 15% carb 'HC'). <--- Previous LC snack not enough to hold numbers, levels drop again - to value likely to trigger bounce.

+4.50 - 98 - 18 point rise (+36/hr). <no food> <--- Bump from previous MC carb snack plus weakening of dose helped raise numbers.

+5.00 - 111 - 13 point rise (+26/hr). <no food> <--- Dose weakening and possibly some carryover from snack 1 hour earlier.

+7.00 - 98 - 18 point drop. (???/hr) <--- May indicate that bounces, not carby snacks, have greater influence on numbers later in cycle. Also possible that dip might be in response to +6ish LC feed.

+8.00 - 103 - 5 point rise (+5/hr). <--- Essentially level.

+9.00 - 119 - 16 point rise (16/hr). <--- Dose wearing off.

+10.00 - 153 - 34 point rise (34/hr). <--- Dose spent. Potential mild bounce in progress.

PMPS - 217 - 64 point rise (32/hr). <--- Mild bounce looking more likely.

PM+6 - 261 <--- Mild bounce confirmed.

Note that PMPS was only 26 points higher than AMPS, followed by mild bounce through yellow mid=250s to pink 352 at following AMPS. Bounce cleared immediately the next dose was administered, assisted by the still-filling depot.

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20 Nov AM Cycle - V-shaped cycle (undesirable)

- AMPS influenced by mild bounce.
- Depot still filling (3 x 0.5IU cycles completed).

AMPS - 352 - ____________ FED LC BREAKFAST. <--- Bounce-influenced.

+1.00 - 288 - 64 point drop (-64/hr). FED LC WITH A LITTLE 12% MC ON TOP. <--- Drop magnitude/rate a potential bounce trigger. Bounce clearing, stronger depot effect. Dose onset likely.

+2.00 - 180 - 108 point drop (-108/hr). FED 12% MC WITH GRAVY. ALSO FED FF GL BEEF 20% HC. <--- Drop magnitude/rate a definite bounce trigger.

+2.50 - 129 - 51 point drop (-102/hr). FED ALL GRAVY HC 20%. <--- Prev MC 12% snack not enough to reduce rate of drop.

+2.75 - ??? - ____________________ FED HC 20% MEAT AND GRAVY.

+3.00 - 72 - 57 point drop (-114/hr). FED A LITTLE MORE HC 20% + GRAVY + (generous?) DROP OF HONEY. <--- Prev HC snack not big enough to reduce rate of drop / too much momentum.

[Note: Based on Blue's historical response, significant bounce pretty much a certainty by now: fast, deep drop and well into greens - either will do it.]

+3.50 - 60 - 12 point drop (-24/hr). FED HC 20% + GRAVY + HONEY + HONEY ON GUMS. <--- Drop rate much reduced after prev HC/honey snack, also dose starting to weaken.

+3.75 - 61 - ______________ (flat). FED HC 20% + DROP HONEY. <--- Drop halted: big carb hit plus dose effect likely to have peaked by this time.

+4.25 - 87 - 26 point rise (+52/hr). <no food> <--- Carbs from prev snack now exceeding effect of weakening insulin dose. Bounce starting.

+4.75 - 142 - 55 point rise (+110/hr). <no food> <--- Bounce in full swing. Rise rate as fast as drop rate earlier in cycle.

+5.25 - 195 - 53 point rise (+106/hr). <no food> <--- Bounce continues. Rise rate as fast as early drop rate. Ninety minutes after food, reasonable to assume bounce influence > carb influence.

+6.25 - ??? - ___________________ REGULAR LC FEED.

+9.00 - 417 - 222 point rise over 3.75 hrs (c. +59/hr). <--- Bouncing. Rise rate slowing up, possibly due to BG levels getting into 'comfortable' zone.

PMPS - High - Minimum 167 point rise* (+56/hr). <--- Nowhere else for bounce to go.

(* Based on 584 as highest fully registered meter reading on Blue's SS.)


Mogs
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Patty and Blue said:
Down 146 +5.75 and he's eating his regular meal. Hopefully he's okay now and won't fall much more.
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Patty and Blue said:
he's at +7 126.
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Dropped after a substantial LC feed. Again.

I think it's possible that at times your boy could be producing little pulses of insulin after larger feeds. There are hints in the data. (See +7 dip on 19 November for an example.)


Mogs
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It is incredible. I was actually wondering the same, if his body was generating some insulin.
He's 233 +9 and Tara fed him some MC while I was at the grocery and it was +8.5 when he got it.

I'll study this more later. I'm preparing dinner. Thank you for all the great information. :bighug:
I wish I was getting a better handle on him like you seem too. Maybe I'll send him over for a visit.
You can send him home once he's all good. :)
 
Mogs has mentioned that before but I was hesitant because my Bella is like an alarm and wants to eat on time at 3:30-4:00.
So it's +7. Their meals would be close together. I feed at 8:30 and 3:30 daily.
I do give a token spoonful to the others when I feed Blue at 8:30 to give him his insulin. I might
be able to give the token in the afternoon and then a meal at 8:30. All I can do it try. We will see.
 
tiffmaxee said:
. I think having a large meal at +7 might be the problem.
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I don't think the data supports the afternoon meal driving numbers so high. Per my earlier post, Blue has seen dips on a couple of occasions after he's had a his bigger feed around the +6ish mark (assuming the data I've garnered from the threads is accurate). Most of the time any such effect would be completely eclipsed by a bounce that commenced a couple of hours earlier. If you look at the rise rates in the detailed breakdown of the two cycles above, it's clear that the fast rises start long before the afternoon feed. Also, if the afternoon feed was a very big factor in the high numbers later in the cycle, one might expect the preshot feeds to create really big food bumps at the beginning of each cycle but that is not happening: a fair amount of the time the +1 is level or lower than the PS BG reading (occasionally with a higher +2). If anything, I have a suspicion that there may be times when the PS meal might be a contributing factor in the lower +1 readings Blue gets.

For now, I don't think Patty should change the size of the morning feed and timing/size of the afternoon feed. It just introduces another variable and could throw everything up in the air again. I think she should try to concentrate on slowing/reducing the early fast/steep drops - known major bounce triggers. I think she should aim for target nadirs no lower than the blue - preferably lower mid-blue - range and then help Blue to surf at that level because at the moment greens also trigger bounces. Spending more time in the blues should hopefully help his body become more comfortable with lower numbers, the idea being to set up a positive feedback loop that promotes bowl-shaped cycles, not V-shaped ones.

If that doesn't work then try something else.


Mogs
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