12/29/15 Smokey--AMPS 247; +3=190; +5=173;+6=141; +10=184; PMPS 223

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It's nice to see Smokey heading down. Some people try to feed to keep a cat from dropping fast and then bouncing, but I never had any luck with that.
 
Below is a link from other condo.

http://www.felinediabetes.com/FDMB/threads/question-on-smokey-dose.150009/#post-1568975

I'm trying to keep Smokey in normal numbers and using food to help. Today he is heading for normals and want to keep and prevent bounce tomorrow.

So far today he has had his normal meals . Last one was +3 and he had 1 oz DM. But he's hungry and begging now.

Jill suggested I post here for advice on doing this. Basically I want to get him to keep normal on this dose since it seems he can be in normal numbers. But he always bounces next day.
 
Hi Paula

I’ve read through the posts from today and yesterday. One thing I have observed about Smokey and definitely agree with Jill (although I agree with all she has recommended to you for Smokey) is that Smokey isn’t really any different than any of the other cats here regarding his BG. I don’t see any unusual patterns or issues on his SS.

I’d like to reinforce some of the things Jill was suggesting but also add some other thoughts. Jill taught me how to manage the curve with food with Gracie and one diagram she put on our condo which really helped me visualize the process was:

manage the curve with food ----> flatten the curve ----> adjust the dose

I would suggest switching your thought process from stopping a bounce and keeping him in normal numbers at this dose to making sure you understand how Lantus works and what Smokey’s patterns look like. Study his SS; every single CG should know (after a bit of time) what their cat’s onset, nadir, and duration are. When you manage the curve with food (and we are talking about their regular diet), you are feeding at times to anticipate the low numbers and support them so they don’t go lower with the result that the curve stays flatter. This might seem counterintuitive but getting them flat (even if it is flat yellow) then allows you to safely raise the dose. And if they are flat (even yellow), guess what they aren’t doing? They aren’t bouncing.

As Jill said, you will need to experiment (and it takes time and patience) but you determine where he onsets and where he takes his biggest drops. Gracie was on levemir but she liked to drop at onset so I gave her food early (AMPS, +2, +3, +4) to control the onset and then she liked to drop later in the cycle so I also fed later (+6, +7) and before nadir to try and keep her from dropping so low. I know that is a lot of feeding and Smokey may not need anywhere near that (because he’s on lantus) but it’s just an example. Also...Gracie liked small portions, not large ones, and feeding her more often allowed me to feed her the portion sizes she liked. When she was on lantus, she liked to drop at onset (+2) so I usually gave her a double portion of food at AMPS, and then also fed her at +1, +2, and +3 to try and keep her flatter.

Edited to add: I also have found that some cats do better on a higher low carb food. Gracie did very well with foods that were 6% and 10% calories from carbs. Both are still LC. You might find with Smokey, that it also works for him.

This is not an overnight fix...it takes some time and effort. And also, as Jill said, it will likely result in his numbers being higher across the cycle initially. But once they are flat, you can then raise the dose the appropriate amount according to whether you are following TR or SLGS.

The other thing I want to suggest is that you have to leave the worries about bouncing behind. Believe me (and anyone like Jill or Libby or Sienne....that has been here longer will tell you that I was the worst worry wart about how to stop bouncing), it is what it is. Accept it, quit worrying about it, and put your energies toward trying the above. Try not to focus so much on keeping “Smokey in normal numbers”. Focus right now on managing the curve with food and getting it flatter.

I hope this helps. I’ll check back around later if you have questions.
 
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Like Marje, I read through the last couple of your condos. I agree with what Marje and Jill posted. One of the hardest things to appreciate with Lantus is that any change you make is unlikely to make an immediate difference.

When Jill was coaching me to use food to intervene with Gabby's numbers so I could get as much insulin as was safely possible into her, it took weeks to see a difference. My read is that you make a change and would like to see Smokey maintain any change from that point forward. Insulin doesn't work that way. Insulin is a hormone that your cat's body may or may not be producing in addition to the Lantus you're giving. Thus, numbers will vary. It's not like an antibiotic that once you give it, the bacteria is treated. Rather, sometimes insulin needs increase or decrease depending on any number of factors -- your cat's health, stress, food, the phase of the moon (I'm not kidding) and sometimes, because they're cats and don't like to be predictable.

The one thing that treating Smokey's diabetes will (hopefully) teach you is patience. Try one thing at a time and see how well it works. And give the change enough time to see if it's working.
 
Marje and Gracie said:
Hi Paula

I’ve read through the posts from today and yesterday. One thing I have observed about Smokey and definitely agree with Jill (although I agree with all she has recommended to you for Smokey) is that Smokey isn’t really any different than any of the other cats here regarding his BG. I don’t see any unusual patterns or issues on his SS.

I’d like to reinforce some of the things Jill was suggesting but also add some other thoughts. Jill taught me how to manage the curve with food with Gracie and one diagram she put on our condo which really helped me visualize the process was:

manage the curve with food ----> flatten the curve ----> adjust the dose

I would suggest switching your thought process from stopping a bounce and keeping him in normal numbers at this dose to making sure you understand how Lantus works and what Smokey’s patterns look like. Study his SS; every single CG should know (after a bit of time) what their cat’s onset, nadir, and duration are. When you manage the curve with food (and we are talking about their regular diet), you are feeding at times to anticipate the low numbers and support them so they don’t go lower with the result that the curve stays flatter. This might seem counterintuitive but getting them flat (even if it is flat yellow) then allows you to safely raise the dose. And if they are flat (even yellow), guess what they aren’t doing? They aren’t bouncing.

As Jill said, you will need to experiment (and it takes time and patience) but you determine where he onsets and where he takes his biggest drops. Gracie was on levemir but she liked to drop at onset so I gave her food early (AMPS, +2, +3, +4) to control the onset and then she liked to drop later in the cycle so I also fed later (+6, +7) and before nadir to try and keep her from dropping so low. I know that is a lot of feeding and Smokey may not need anywhere near that (because he’s on lantus) but it’s just an example. Also...Gracie liked small portions, not large ones, and feeding her more often allowed me to feed her the portion sizes she liked. When she was on lantus, she liked to drop at onset (+2) so I usually gave her a double portion of food at AMPS, and then also fed her at +1, +2, and +3 to try and keep her flatter.

Edited to add: I also have found that some cats do better on a higher low carb food. Gracie did very well with foods that were 6% and 10% calories from carbs. Both are still LC. You might find with Smokey, that it also works for him.

This is not an overnight fix...it takes some time and effort. And also, as Jill said, it will likely result in his numbers being higher across the cycle initially. But once they are flat, you can then raise the dose the appropriate amount according to whether you are following TR or SLGS.

The other thing I want to suggest is that you have to leave the worries about bouncing behind. Believe me (and anyone like Jill or Libby or Sienne....that has been here longer will tell you that I was the worst worry wart about how to stop bouncing), it is what it is. Accept it, quit worrying about it, and put your energies toward trying the above. Try not to focus so much on keeping “Smokey in normal numbers”. Focus right now on managing the curve with food and getting it flatter.

I hope this helps. I’ll check back around later if you have questions.
Click to expand...

Thank you Marje. I will have to get some higher carb food. The highest I have right now is 3% except for the kind in gravy. I guess that's what I'm trying to do get him flat so I can work from there. I feed him 5-6 times a day because he demands it. He has been leaving some in his bowl and sometimes he doesn't even come to eat, so I thought reducing amount of food was right. Maybe I should leave it down so he can nibble if he wants.
 
L
Sienne and Gabby (GA) said:
Like Marje, I read through the last couple of your condos. I agree with what Marje and Jill posted. One of the hardest things to appreciate with Lantus is that any change you make is unlikely to make an immediate difference.

When Jill was coaching me to use food to intervene with Gabby's numbers so I could get as much insulin as was safely possible into her, it took weeks to see a difference. My read is that you make a change and would like to see Smokey maintain any change from that point forward. Insulin doesn't work that way. Insulin is a hormone that your cat's body may or may not be producing in addition to the Lantus you're giving. Thus, numbers will vary. It's not like an antibiotic that once you give it, the bacteria is treated. Rather, sometimes insulin needs increase or decrease depending on any number of factors -- your cat's health, stress, food, the phase of the moon (I'm not kidding) and sometimes, because they're cats and don't like to be predictable.

The one thing that treating Smokey's diabetes will (hopefully) teach you is patience. Try one thing at a time and see how well it works. And give the change enough time to see if it's working.
Click to expand...

Thank you, Sienne, yes in a way I want Smokey to maintain a change. When he has a good day I thought it would continue. On this dose he had a couple of good days. One was a 24 hr run. So I thought it would "catch on". I am hoping today's run will continue and last longer until it is his 'normal'. Obviously I'm wrong.
 
You've gotten a ton of good advice already, so i'll just be a cheerleader.

This isn't difficult to do - just takes a little analyzing to see what's going on already. Hang in there, keep asking questions and you'll get Smokey into better control.
 
Woodsywife said:
Thank you Marje. I will have to get some higher carb food. The highest I have right now is 3% except for the kind in gravy. I guess that's what I'm trying to do get him flat so I can work from there. I feed him 5-6 times a day because he demands it. He has been leaving some in his bowl and sometimes he doesn't even come to eat, so I thought reducing amount of food was right. Maybe I should leave it down so he can nibble if he wants.
Click to expand...
You're welcome, Paula. Unfortunately, I think you are missing the lesson. It's not a question of feeding him at random times when he demands it or free feeding him. When you manage the curve with food, it means just that ... You manage it. You feed specific amounts at specific times. We aren't saying its not time consuming....it is. But I was working full-time when we started Gracie on it and Sienne worked full time the entire time that she was managing Gabby's curve wit food.
 
Marje and Gracie said:
You're welcome, Paula. Unfortunately, I think you are missing the lesson. It's not a question of feeding him at random times when he demands it or free feeding him. When you manage the curve with food, it means just that ... You manage it. You feed specific amounts at specific times. We aren't saying its not time consuming....it is. But I was working full-time when we started Gracie on it and Sienne worked full time the entire time that she was managing Gabby's curve wit food.
Click to expand...

I understand. I was feeding at certain times and when he demands it. So I will stop. There are 4 feeding times that never change. I just have to get the others set now. I have a feeling my autofeeder won't be sufficient now. It only delivers 2 meals.
 
Let me see if I can explain what I did with Gabby.

First, Gabby got her regular meals -- sort of. My normal feeding schedule was different for Gabby than the typical cat here because Gabby's onset and nadir were early. This is why we stressed that you have to know when your cat's onset and nadir fall and what kind of duration Checker's is getting from her insulin. Gabby's nadir typically fell at +3 or +4. Under normal circumstances, I broke her meals into four portions that were fed at pre-shot, and then +1, +2, and +3. This helped to offset her tendency to dive early in the cycle.

If you look at a day like the PM cycle on 5/30/2014 (the tabs for different years are at the bottom of my SS), you'll see I started giving her HC at +2.5. This was to prevent her from getting a dose reduction and to flatten out the curve. This is what we mean by feeding the curve. It doesn't mean that you don't feed your kitty her regular meals. I may have split a portion up and added HC to that portion but I tried to keep Gabby's overall food intake constant.

 
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