12/29 Quintus: PMPS=85 +1=68

[Steph & Quintus & L & O]

+3 135 -- more honey& gravy? more of yesterday's mix? more of today's normal food? (I don't think he's very hungry anymore...)

 

[Stacy & Asia]

I don’t think he needs any more food or carbs for now. See what he does and test again in 30

 

[saltycat]

Looks like you've gotten some great advice today. I would add a link on your SS in the remarks to this thread for future reference. Anytime I get a condo with good info in it, I link it on the SS so I know where to find it easy. It can be a lot of information to absorb in the beginning. Take things in as you can and slowly it all starts to click. I was in a fog at the beginning, but reading other condos and posts from members more experienced then me helped guide me along the way. Tests and tracking what you feed are very helpful in learning your cats patterns and what it takes to bring numbers up. Every cat is a bit different, and their patterns can shift over time.

P.S. you weren't kidding about Quintus being a cuddler! Nice pics of your boy.

 

[PussCatPrince - GA]

I would add a link on your SS in the remarks to this thread for future reference. Anytime I get a condo with good info in it, I link it on the SS so I know where to find it easy.

This sounds like a great idea but I am not sure what you mean.

I was in a fog at the beginning, but reading other condos and posts from members more experienced then me helped guide me along the way.

That's me , that is . lol

 

[Tracey&Jones (GA)]

Free feeders make it really hard! I knew his eating pattern way before trying this. Meant some late nights too. It helped with his feeder as I heard it opening so it made me look.

 

[Steph & Quintus & L & O]

+3.5 = 238

 

[PussCatPrince - GA]

As I said earlier, stalling, shooting reduced doses, and skipping unless the number is too low to shoot, or the CG cannot monitor or doesn’t have supplies, is more for the caregiver than for the cat. We do expect new members to do all of those things until they feel more comfortable shooting lower blue and then green numbers

That's actually very leveling. I'll be taking that on board even though it is not on Tyler's condo.

 

[saltycat]

This sounds like a great idea but I am not sure what you mean.

sent you a pm to not clutter up Stephanie's condo.

Looks like either has a bounce coming on or a nice rise from the foods. I know it is tough, especially when being sick too, but another test in a few hours would be good data if you can get it. If the numbers are food influenced, once the gravy and syrup wears off they can start dropping again. It is tough until you learn how your cat responds to carbs and where the numbers typically go. Good to see him heading up and not down.

 

[Marje and Gracie]

I’m sorry I suggested you shoot and then I had to leave without letting you know that I asked Stacy if she would stay with you. When we suggest someone shoot their first green number, we either stay with them or ask someone else whose been through it if they can help and Stacy very graciously said she would be happy to. You all have done a great job.

Thanks for all the info. Some comments, because there are a number of points which, although they make sense, do not seem to be things I can realistically do. I'm sure what you present works, but I need to fit the way I manage Quintus's diabetes within the constraints we have, both him and me.

I understand. Everyone has different constraints and limitations. The information any of us provide you is to be considered by you and you are the one that makes the choice on what you can and can’t do. There is no judgement here.

I mentioned above, for the time being at least I am stuck with a mix of LC and HC (or is it MC?) food that I can't really separate. When I give him a helping, he eats a bit more LC (paste) at the beginning, and there is more kibble in the end of the helping. But if I give him paste on its own, I'll never get enough kibble in him to keep him from having diarrhea.

Yes, you did mention that but there are plenty of foods out there that could also potentially work for him in combination with his kibble that might be a little higher carb. I was suggesting it just so you might consider it. Again.....no judgement.

hope you're not implying I'm not willing to learn about my cat or experiment. I have been doing that like crazy, even before he was diagnosed. The reason we diagnosed his pancreatitis and then his diabetes is because I knew my cat well enough to know something was off.

Time and work? well, maybe. I need to earn a living. I live alone. I work nearly an hour away from home. My whole life these last weeks has been revolving around Quintus's ears and spreadsheet numbers and sticking food in his face. I wrote about this in a thread the other day -- I am not willing to lose my relationship with my cat and end up with only an illness to manage.

That said: yes, I'm sure it's doable. But I don't think at this stage I have the data or means to do it well, both in terms of experience of how his BG reacts to food or insulin, and of food options I can play with.

Goodness.....I don’t know you so why would I imply that? I tell everyone the same thing just so they know what it entails. If they feel they can do it, great. If they feel they can’t, great. I’m not here to judge you; I’m only here to help. Obviously, if people are here, they have much more care and concern for their catthan people who just say “put the cat to sleep” or “I’m not going to test”.

Again....I just offer the information. For new members, I can’t possibly know who lives alone, who works, when they work, how far away they live from work, etc. The information is provided and you are able to decide what you can and can’t do. It’s really just that simple. We all have to make our decisions and the rest of us support the decisions you make. As experienced members, if we see something dangerous, we need to let the caregiver know. You asked for help; I’m telling you what I see and what I might suggest you try. Nothing commits you to any of it

you seeing that many dives and bounces since the 25th? I'm seeing a small one on the 27th, following the NS (one of the reasons I want to stay away from NS). He hasn't touched red since 24th evening -- excepting of course yesterday when I overdosed him with honey.

Yes and well before. He went low on the 25th and bounced on the 26th. He cleared the bounce that night, you didn’t shoot, he lost duration and likely also bounced from the low numbers on the 27th. He went low again that night and the next morning; you shot an 18 hour cycle. The night of 12/28 was partially the depot being drained from the 18 hour shot but also some bounce which he cleared today.

have no doubt the diabetic ups and downs are unpleasant. And I can see the swings or dips are tiring. But observing how Quintus is doing compared to a few weeks ago, it's clearly way better than swimming in black and red levels of glucose all day. He's going outside and being more active than I've seen him in months. He's playing. He's alert. He's using his scratching post. He's grooming. He's climbing all over me to purr on my lap and my arms.

Excellent.....we must always consider how kitty is doing because they aren’t just a number.

this is pretty much what I did after yesterday's shot, and we ended up in honey-level lime greens. Which brings me to say I really think the dose was still too high, and that what we're dealing with here is not just my lack of technique and bad management, but also a cat who struggled to stay out of the reds and blacks and barely touched green on 3ui 2 weeks ago, and now can't keep out of lime green on 1ui. I understand the depot comes into play, but all in all, I struggle to interpret this differently than his pancreas is improving. I'm aware I can be mistaken on this, and if that's the case, would really like to understand what I'm missing.

I am not able to tell from the Remarks in his SS that you fed the curve but I could be mistaken. A cat has to spend a considerable amount of time in green numbers for the pancreas to heal. He isn’t. He’s just diving and bouncing. Is it possible he needs less insulin? The way to tell is to drop the dose and start over. That’s what we call a rebound check. Usually they don’t work and they leave the cat in higher numbers but I don’t think you are talking about dropping him too much.

Until you shoot consistently, you won’t know for certain so I would suggest you decide what dose you think you are comfortable with shooting twice a day and see what he does. If you pick 0.5u and it doesn’t work, you can go back up. Without having more info on exactly how you are feeding him, it’s difficult to tell, with all the dose changes and 18 hour shots, what dose is the best for him. The kind of detail that helps us help you is what % carbs he ate, when he ate, how much he ate, if you gave him any honey or syrup and how much.

 

[Marje and Gracie]

The reason I wanted to find the post Marje wrote is because the one I linked to suggests manipulating the curve with food is an advanced technique and it’s best not to attempt it, and I know if it were me, and I were pretty new at the time, my mind would have shut off reading after I saw that. “Me advanced? I don’t think so, I hardly know what I’m doing! Feeding the curve isn’t for me.”

So I don’t think it’s an “advanced” technique, per se, it’s just one that is hard to get your head around and employ, like Marje said, it requires more investment of time, work and experiementing. I don’t think she was implying you weren’t willing to do that, I think she was just clarifying what makes it “advanced” and how it still can apply to you even if you don’t put yourself in that category. I wouldn’t use that word at all, I would just say feeding the curve is very useful once you’ve had a little bit of time, a little bit of data, and you are frustrated that the dose gets the nadir where it should be, but everything else is a mess. FWIW, I didn’t choose to start manipulating with food, Asia made me do it and I just listened to her when I saw it working and began to feed more than just neon green numbers.

Thank you, Stacy. You are correct.

It is a bit overwhelming and I normally do like to wait until members have more experience and know their cat better. However, I knew Stephanie was off work right now and Quintus is really erratic. I thought we could perhaps help him get a little flatter and at a better dose before she has to go back to work. And thank you, Stacy, for stepping in and helping Stephanie today. It was a great learning experience for all.

It’s important, Stephanie, to keep really great records so you can look back and see when he was at 61, you gave a specific percentage of carbs, and he did such and such. The thing that complicates it is where in the cycle is the lower number. Here is the post (see post #13) I did that Stacy was looking for and it discusses some of this. I don’t expect you to read it now or today but you can bookmark it and read it when you are ready.

 

[Steph & Quintus & L & O]

@Marje and Gracie thanks for your responses, too tired to respond right now, but thanks.

 

[Steph & Quintus & L & O]

+5=308, so the rise is flattening, I'm guessing I need to check in an hour to make sure he's not plunging down?

 

[saltycat]

I'm not as familiar with Quintus and his up and down numbers. They don't generally come crashing down as the carbs wear off, more of a slide down so don't stress about him crashing like when he clears a big bounce.

The Lantus typically gives the lowest number around the +6 mark, every cat is different. 300's are a safe number. if you need some sleep I would leave some normal food out for him.

 

[Stacy & Asia]

Looks like you've gotten some great advice today. I would add a link on your SS in the remarks to this thread for future reference. Anytime I get a condo with good info in it, I link it on the SS so I know where to find it easy. It can be a lot of information to absorb in the beginning. Take things in as you can and slowly it all starts to click. I was in a fog at the beginning, but reading other condos and posts from members more experienced then me helped guide me along the way. Tests and tracking what you feed are very helpful in learning your cats patterns and what it takes to bring numbers up. Every cat is a bit different, and their patterns can shift over time.

P.S. you weren't kidding about Quintus being a cuddler! Nice pics of your boy.

That is a great idea!

 

[Stacy & Asia]

I agree, I think you could get something in the middle a +8 or +9 if you’re up to it and just peep what he’s doing in the middle there, you have some good information to work with for the next time and when you get a better handle on what amount of what foods gives him what kind of a boost, you can auto pilot things a bit more.

I would think the HC would wear off by now, and he may be bouncing or you put him at a higher number with the honey but enough time has passed in this cycle that he’s probably not going to try to zoom down. Maybe he will double dip and go down a little more.

 

[Steph & Quintus & L & O]

@Marje and Gracie: so, thanks for your explanations, and sorry if I have been defensive. I also understand, as you had told me previously, that you have not been able to follow the previous episodes in Quintus's story closely, and that the advice you are giving cannot obviously take into account all our constraints and history.

He went low on the 25th and bounced on the 26th. He cleared the bounce that night, you didn’t shoot, he lost duration and likely also bounced from the low numbers on the 27th. He went low again that night and the next morning; you shot an 18 hour cycle. The night of 12/28 was partially the depot being drained from the 18 hour shot but also some bounce which he cleared today.

I'm trying to follow, but I can't quite.

Indeed, he went low early 25th and therefore I didn't shoot. After discussion with @Chris & China I decided to give the 18h cycle a try, because the previous morning (24th) he had come up with similar PS numbers, and I hadn't shot, and he had ended up in the black. Do we agree that the rise we see between +12 and +18 (shot time) on the 25th is the insulin given 12+ hours before wearing off?

By 26th morning, he has gone through a dose reduction (2.25 on 23rd down to 2.00), skipped one shot, and replaced two shots with one through the two 18-hour cycle. If we look at what might be acting in the depot (as I understand it), there would be 1 2ui shot 18 hours before, another 36 hours before, and two 2.25 shots from the 23rd. It would seem normal to me (but again, this is where I'm maybe missing something?) that his numbers on the morning of the 26th be higher. I'm assuming the yellow and pink is what you interpret as the bounce? What makes us say it's a bounce and not simply due to "not enough insulin" following the reasoning I just outlined?

On the 26th he ate normally, and ended up lime green at the end of the PM cycle, the second one with 2.00 ui after resuming "normal" 12-hour cycles. Again, the way I'd interpret that is that we are building up the depot and that 2.00 ui is already showing us it is too high a dose for him.

We then have the same situation on 27th morning, with the skipped shot, as the 25th or the 24th: what makes us affirm the higher numbers (blue to pink) are a reaction to the AMPS-time low numbers and not simply his BG going back up because he doesn't have enough insulin to deal with it correctly, as the last shot was 24h before?

See what I'm having trouble with here?

A cat has to spend a considerable amount of time in green numbers for the pancreas to heal. He isn’t. He’s just diving and bouncing. Is it possible he needs less insulin?

Seems to me the pancreas can also be healing because the pancreatitis that caused the diabetes is being dealt with and more normal function is resuming, also probably because overall lower numbers (even if not all green by far) means less glucose toxicity.

Can a cat diving and bouncing explain that he's still headed for the lime greens on 0.5 when a week ago he was on 2.25?

Regarding the diving and bouncing: I understand the mechanism behind bouncing, but don't yet see why a bounce should result in an "artificially low" dive. What happens in the body to cause it?

The way to tell is to drop the dose and start over. That’s what we call a rebound check.

That is where I've been headed in my thinking since around the 27th. I thought 1ui would be an ok dose to do that with yesterday, clearly not. I'm giving 0.5 a shot today, but I think I might end up with 0.25.

what % carbs he ate

This looks straightforward, but try as I might, I cannot find the % carbs in the NF kibble that goes in his mix. DM seems to be 6%. NF wet (but is it the cans or the pouches? can't tell) is 27%. I mix them. It's a heterogeneous mixture. He eats more of the paste at first. Often some kibble is leftover.