? 2/14 - Gen, AMPS >400, PMPS >400 - dosing advice needed

[Allie & Gen]

Yesterday

I could really use some input. We are now starting the 12th cycle on this dose, and while it has definitely brought him lower nadirs and longer stretches of blue and yellow, for the last couple of days he's had several AMPS and PMPS >400. I can't figure out why he won't stay down! He's also touched green only very briefly, twice (although in each case he hit some pretty low numbers when he did).

I think we're due an increase, but I'm a little worried about how far those dips have gone and about how steep his cycles keep wanting to be, at least at the very start and end. I would really appreciate thoughts on how to flatten him out more - ditch those reds and pinks at least. I know his various other medical issues are likely contributing to how stubborn his BG is being about regulation (and hopefully Tuesday will bring insights and recommendations from the abdominal ultrasound etc that will give us a path forward for managing his GI issues and finally getting him that dental), but I want to do the very best I can for his FD in the meantime.

Anyway. I've been working on some projects and not feeling terribly sociable today, but I hope everyone's having a pleasant weekend and that your kitties surf safe.

 

[Wendy&Neko]

I hope your day has included some snuggling with your Valentine Gen.

You are right that he could probably use an increase. It could be all his medical issues are contributing to his inability to stick with the nicer lower numbers, or it could just be he hasn't hit the fitting dose yet. As far as increase timing, one thing to consider is how long he's going between green numbers lately. From the 10th AM to the 12th PM cycle I count green the 5th cycle after the first green. Tonight is cycle 4. Ideally you'd try to avoid an increase on the cycle they are breaking a bounce.

What is your feeding schedule in the first half of his cycles?

 

[Allie & Gen]

I hope your day has included some snuggling with your Valentine Gen.

Plenty of snuggles, thank you.

You are right that he could probably use an increase. It could be all his medical issues are contributing to his inability to stick with the nicer lower numbers, or it could just be he hasn't hit the fitting dose yet. As far as increase timing, one thing to consider is how long he's going between green numbers lately. From the 10th AM to the 12th PM cycle I count green the 5th cycle after the first green. Tonight is cycle 4. Ideally you'd try to avoid an increase on the cycle they are breaking a bounce.

What is your feeding schedule in the first half of his cycles?

How can I be sure what is and isn't bouncing at this point, apart from just counting cycles after the latest low green? He doesn't really have a baseline to reference for what a non-bounce cycle looks like, if that makes sense. It's one thing if he's in all high numbers, but a cycle like today's AM cycle, with a fairly low blue nadir, doesn't look like my understanding of either a bounce or a bounce-break cycle. Sorry for still being confused about this!

Gen is a lifelong grazer/free-feeder (from set amounts of food). He gets his food right at the start of his cycle (unfortunately I have little wiggle room there), and generally eats a bit then, but he goes back and eats periodically throughout his cycle without any imposed schedule. He's been a bit less predictable since the episodes of inappetence and the start of mirataz/anti-nausea meds, but generally he stretches it out through the whole cycle.

 

[Wendy&Neko]

Grazers are a bit trickier when trying to manipulate the cycle to slow down fast drops. The question is whether you can get his preshots lower so his drops aren't as extreme. How would he feel about you lifting food in the last part of the cycle so he has to eat earlier? Or even switching it out to something like zero carb snacks? I'm wondering if the carbs later in the cycle are causing the Lantus to lose duration in Gen which can lead to higher preshots.