2/17 - LILY AMPS 555, lows 109, 79, 105 in the night, point reduction?

[Calicos are Best (GA)]

Hi everyone,

I haven't been on in a little bit, but I have been monitoring Lily the best I can. This morning Lily was 555, however she did hit some low points at 109, 79, 105. I did give her snacks to keep her sugar up.

Do you think that I should reduce Lily's insulin from 1 unit to a smaller dose?

Here is what her BG has been like yesterday:

2/16/19 - 309 at 7:33 AM, gave 1 unit insulin at 7:40 AM
2/16/19 - 222 at 7:00 PM, gave 1 unit of insulin at 7:10 PM

2/16/19 - 109 at 10:32 PM, @ 10:32 PM, gave Lily 2 tsp Gravy Lovers
2/16/19 - 79 at 11:50 AM, @ 12:00 AM 1.5 tsp gravy & 2 drops Karo syrup
2/17/19 - 105 at 12:50 AM, @ 1:00 AM 1.5 tsp gravy & 2 drops Karo syrup

2/17/19 - 555 at 7:30 AM this morning

More information on Lily's SS.

 

[Calicos are Best (GA)]

Not sure how much to reduce, will try doing a .75 unit dose instead of 1 unit.

Don't want Lily to get too much off schedule. Going to feed and give her the .75 dose.

 

[Gill & George]

Sorry no one was around to help earlier.
On SLGS she did earn a reduction, so yes, down to 0.75u.
?
How is Lily? Is she eating well? feeling good? Is she acting normal?anything off with her?

Although she did earn a reduction, the recent DKA history does mean that you need to keep in mind that she is getting enough insulin. I can see that you have been feeding some higher carbs to keep her numbers from dropping below 90 so you can continue to give insulin, but that yesterday that didn' prevent her from earning the reduction.

you're doing a great job monitoring the ketones keep that up especially in light of the reduced dose.

Just a tip so you can catch peoples eye more quickly, Use the ? prefix from the drop down list, it highlights you have a specific question you need help with.

Hope you and your family are keeping OK

 

[Calicos are Best (GA)]

Thanks for keeping an eye out Gill! I appreciate it. My family and I have been getting through this time.

Lily has been acting normal. She sleeps and gets around like herself I would say. She eats her meals like normal. No problem eating, Thank goodness!

She does do a few things still that I don't understand. She will dry heave and nothing comes out. Her body makes those stomach or gurgle noises sometimes too. Similar to hungry noises from a person's stomach. These things started after her last hospitalization. I never heard Lily do these things before. She is doing them less and less though. Hoping they go away soon.

 

[Gill & George]

gurgle noises sometimes too. Similar to hungry noises from a person's stomach. These things started after her last hospitalization. I never heard Lily do these things before. She is doing them less and less though. Hoping they go away soon.

Perhaps she is getting stomach acid. Some kitties get this if they go too long between meals, another reason why many of us feed multiple meals. For the latter part of the cycle when you don't want to be feeding carbs, because it can stall the cycle, Folk have found that just a few small pieces of poached chicken breast given as a little treat, can prevent the stomach acid and doesn't affect the BG.

 

[Calicos are Best (GA)]

Great suggestion. I have been seeing Lily doing these things less and less. It would not hurt to have chicken breast on hand as a snack. She would really like that also.

I am not a fan of small meals all day...I think I would have to get one of those timed feeders we were talking about before if I did go that route...I'll keep observing for now.

 

[Gill & George]

I have been seeing Lily doing these things less and less.

Do you mean she seems lethargic less active? With her DKA history this would worry me.

I am not a fan of small meals all day...I think I would have to get one of those timed feeders we were talking about before if I did go that route...I'll keep observing for now.

How are you feeding her at the moment? Just the two meals unless she needs some HC food? They really do much better on multiple feeds, but it's not an all day thing, much as I think my kitties would enjoy an all day buffet service, that's not what they get. Even in remission I fed multiple meals as it's easier on their pancreas.

I don't feed small meals all day George gets his main meal at PS (75g), then a +2 (50g)then another meal at +5-+6(50g). This stops him getting stomach acid problems but the timings of the food are there so that he has some food in his system when insulin onsets and when it's at its peak, this helps keep him from diving fast, which in turn helps with the bouncing. I'm still fine tuning this as his cycles this time round are different to what we experienced at first.
First time round he was dropping faster and earlier in the cycle so he would get PS +1 / +3-+4 . To mirror when he was likely to experience fast drops. I found this very effective.
In fact, I was initially feeding amps +6 and Pmps and +6, finding that he would drop fast early in the cycle and I would be chasing numbers and then he would be bouncing up by next PS the bounce being triggered by the fast drop. When I changed to feeding at PS +1 +3, his curves flattened out which lessened the bounce response and allowed him to spend extended periods of time in the lower ranges, which saw him turn the corner, he gained weight, had more energy, fur was in better condition and he even got playful (for an older boy)

 

[Calicos are Best (GA)]

I never heard Lily do these things before. She is doing them less and less though.

I'm sorry I didn't mean to confuse you, in reply #4 I meant she was doing the stomach noises and dry heaving less and less. And in comment # 6 I was referring to the same thing vaguely.

How are you feeding her at the moment? Just the two meals unless she needs some HC food?

Yes, this is exactly how i feed Lily now. Doesn't seem to be the best outcome as she is always bouncing!!!!

I don't feed small meals all day George gets his main meal at PS (75g), then a +2 (50g)then another meal at +5-+6(50g).

How do you decide the how much to feed at each meal? Or how much is too much or too little? 3 times a day seems fair. I only feed Lily 3 cans of Kitten Fancy Feast a day. 1 1/2 in the morning and 1 1/2 at night. I could split it up into 3 cans 3 times a day? If that is not too much? hmm?

In fact, I was initially feeding amps +6 and Pmps and +6, finding that he would drop fast early in the cycle and I would be chasing numbers and then he would be bouncing up by next PS the bounce being triggered by the fast drop.

Sounds a little tricky to pick the best times of day to feed...

I know I am having a hard time, so I do need to change something. I feel like I have to stay up all night or check Lily's numbers all day just to make sure Lily doesn't get too low. And I know I can't possibly do that. Even feeding her the teaspoons of snacks to not get too low doesn't seem stable to do all the time.

 

[Gill & George]

I only feed Lily 3 cans of Kitten Fancy Feast a day. 1 1/2 in the morning and 1 1/2 at night. I could split it up into 3 cans 3 times a day? If that is not too much? hmm?

If you feed 3 cans a day total, and if that is a good amount for her, she's either holding her weight if she's a healthy weight or putting some on if she lost weight from dka/diabetes.
I would perhaps give
amps 1 can
+2 1/4 can
+5 1/4can
pmps 1 can
+2 1/4 can
+5 1/4 can

Looking at the SS she does start to drop early in the cycle, at +1-+2, feeding at +2 might slow her down, my best guess is that she is nadiring around +5/+6, though there's not enough data to say that with certainty, so again a little meal around +5 may just keep her flatter and safer for you. You won't know without trying, but I do think with the way she drops feeding the curve may help you get her more steady. Give any new feeding regime time to settle down so you can see more clearly what is going on. You may have to fine tune the feed schedule depending on what you find.

When/if you start a new feeding schedule, be sure to note it on the SS, if you look at Georges ss, you'll see that I make notes on everything I feed George when, how much, carb%, it helps me get a better feel for what to do to keep him safe.

Today I had to go out, and he through me a 63@ +7 just as I was heading out the door for a couple of hours, now, if I had been staying home I would not have fed, and I would have waited an hour to see what his BG did. But as I wasn't going to be home I gave him a little extra food LC which I've found in previous days has been enough to bump his numbers up and continue to surf safely in the greens. You can see that today although he dipped into 63, the drop was fairly gentle. His pattern at the moment is that he spikes at +2 but then he drops somewhere between +3 to +4.5 (this is his onset), he then continues to drop, reaching nadir at somewhere around +7-+8. (the low point in his cycle), I have seen that if I feed late in the cycle at +7+8 with LC it will be enough to bump his numbers up, so I felt reasonably confident that he would be safe for a couple of hours. A lot to consider though he was dropping gently, flattening out, and it was late in the cycle, so I could avoid using higher carbs.

However, if that 63 had been at +3, dropping from the 126 at +2 then that's a fast drop(almost 60pts in an hour), early in the cycle, I would be very nervous about leaving him, and would probably rearrange plans.
But if I couldn't stay with him, then I would have given him some higher carb at +3, and probably time some more food at +4 and +5 erring on the side of caution when picking carbs. I would add that if at home I would use a lighter approach trying a higher LC first and seeing what that did for him. Again using these drops on days that you can monitor to gather data, will help you better understand Lily's patterns, and give you a better indication of whether you need to add more food or carbs when you are not able to monitor.

 

[Calicos are Best (GA)]

Wow George has an Amazing SS! I feel lazy compared to the work you put in keeping up with the BG numbers all day. I can tell that the information pays off and you really know what your are talking about. You must go through so many strips on your meter.

I would perhaps give
amps 1 can
+2 1/4 can
+5 1/4can
pmps 1 can
+2 1/4 can
+5 1/4 can

Maybe tomorrow morning I will try to do this feeding schedule and see what happens.

 

[Gill & George]

I feel lazy compared to the work you put in keeping up with the BG numbers all day. I can tell that the information pays off and you really know what your are talking about. You must go through so many strips on your meter.

I'm a bit of an obsessive I just don't like dealing with unknowns.
When I'm home I figure I might as well check. I've been trying to figure him out since his relapse with the steroids, as I get more comfortable with his patterns I'll probably ease up.

Maybe tomorrow morning I will try to do this feeding schedule and see what happens.

You may need to give it a few days before you see any difference, it's important to look at trends rather than individual cycles.

I'm sorry I didn't mean to confuse you, in reply #4 I meant she was doing the stomach noises and dry heaving less and less. And in comment # 6 I was referring to the same thing vaguely.

That's good, you had me worried for a moment there.

 

[Calicos are Best (GA)]

I'm a bit of an obsessive I just don't like dealing with unknowns.

Don't frown, you're an awesome Cat Mom to George!!! I don't blame you for wanting to know.