2/18-19 Andy - 311 pmps: 193 +7; 313 amps

Andy is still bouncing a lot. Let's see where his nadir is if he does break another bounce tonight. I think there may be room to increase so we can try and flatten out those numbers. But are you able to feed the curve any more than you are right now?
 
Mandy & Rex said:
Andy is still bouncing a lot. Let's see where his nadir is if he does break another bounce tonight. I think there may be room to increase so we can try and flatten out those numbers. But are you able to feed the curve any more than you are right now?
Click to expand...

Yes, I can feed more often. Can you give me an example? Currently I have been dividing his meals: @ amps/pmps 2/3 and @+3 amps/pmps 1/3. Then if he went below 100, I fed as I thought needed to keep him above 40. So if he did not go below 100, he got no more food that day/cycle. I do think he needs more food though - he is always hungry compared to his siblings. (Other than the extra when under 100, he is getting 1 5.5oz can daily and he is a trim cat.)
Based on approx. 20 cal /lb, that is approx. what he gets with a 5.5oz can. (265-292 cal depending on flavor variety and 5 to 7% carbs)
 
Mandy & Rex said:
Let me tag @Wendy&Neko, @Jill & Alex (GA), and @Marje and Gracie as they know more about feeding the curve than I do. They may have more insight on how to help Andy.
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Thanks, Mandy!

Andy is bouncing a lot but he’s not taking a lot of steep dives which managing the curve with food can help with. But it is also helpful for bouncers and for kitties who are very carb sensitive. On thing I notice is that when you get a high PS, you often don’t test again until +3. This is part of the issue and I would suggest you always be in the habit of getting a +2 every single cycle that you can because if the +2 is the same or less than the PS, it’s going to be an active cycle.

The process is summarized as:

manage the curve with food ----> flatten the curve ------> adjust the dose (if necessary and it usually is).

This process or method is feeding so that we prevent the kitty from dropping too fast and/or too low. You can imagine if you aren’t careful with it, you can overfeed the kitty so it’s important to:
  • recognize this is a process that doesn’t change things overnight
  • requires that you, in general, feed the same amount of food kitty needs to maintain its current weight (assuming kitty is not under or overweight); obviously, if you’ve fed Andy his food for the cycle and then he fools you and drops more, you might have to feed a little more depending on where in the cycle he drops
  • requires consistency and some extra commitment at the beginning
  • requires that you know your kitty; what are his onset, nadir, duration......and does he ever get any overlap or carryover.
Typically, unless the kitty is taking a huge dive or drops below 50, we try to use LC to manage the curve with food. Obviously, if a kitty is coming down really fast early in the cycle and we know LC doesn’t slow that specific kitty down, the CG has to up the “ante” (i.e. the carbs). However, we do not typically feed a higher carb food at shot time unless you must have the insulin start its onset from a higher number, for example, in the case where you might not be able to monitor.

There are important things to consider when you are determining whether to feed lc, mc, hc:
  • where is he in the cycle? If it’s early in the cycle and he’s dropping fast (like 2/4 p.m. cycle), you probably want to use higher carb food; if it’s nadir or later in the cycle and nadir is above 40, you might want to try LC.
  • how carb sensitive is Andy? Some kitties never need more than LC food even when they take a steep dive or go lower. Others need the big guns if they drop fast early in the cycle. This is going to be up to you to figure out and experiment with. The goal is to be proactive instead of reactive to the greatest extent that you can.
It’s also important to know why we manage the curve with food. The goal is to get the curve to flatten, as shown in the diagram above. If we are consistent and do it right (and it’s ECID and trial and error as to what is “right”), then kitties will typically flatten out at a higher BG. Flattening prevents those dreaded dives and huge bounces but can also help with bouncing as Andy is doing. Flattening also will allow you to get more insulin in the kitty safely. This can, in turn, allow you to hold a specific dose longer. In addition, lantus and levemir are not insulins that can pull high numbers down as quickly as some of the other insulins can. However, for a bouncy cat, more insulin can help bring down the numbers. It also helps to offset the spikes that very carb sensitive kitties get in response to food.

For anyone reading this who then thinks, “well, if I just give my cat more insulin, the bouncing will stop”. No it won’t and it’s not safe to just increase the dose to stop bouncing. It’s the process of managing the curve with food specific to your cat that keeps it safe to increase the dose. That entails:
  • knowing your cat and having the time and commitment to experiment with feeding
  • feeding the correct amounts of food at specific times to bring the over all curve up
  • flattening the curve at a higher BG
How do we do this for a cat on lantus?
  • start by dividing the kitty’s normal food portion into four minimeals each cycle which are fed consistently at PS, +1, +2, +3, at first.. As you get more data, you might need to adjust those feeding times especially if your kitty onsets later and you might find you have to feed at different times to address the difference in cycles.
  • determine if kitty needs to be fed the same amount at each meal or if he/she needs to be fed different amounts at each meal. As an example, I studied Gracie’s SS when she was on lantus and figured out when she onset and when she took her steepest dive. I then determined I really needed to “frontload" her cycle with food. This had me fine tuning not just the times I fed her but feeding the majority of her food at PS and +1 and a little less at +2 and +3. Over time as I got more data on how she did with that, I changed the amounts of food and also changed the feeding times. When I switched her to levemir, I had to do the same thing all over again.
  • test more at first to catch the drops and figure out when to feed so the nadir doesn’t drop so low. And did I say test? When you are first starting manage the curve with food, I would suggest you test every cycle at PS, +1, +2, +3 because that is when onset will occur. You need to figure out exactly where he onsets so you know exactly when and how much to feed to prevent him from having a low nadir. Don’t get complacent if he’s higher at +1 than PS and think “I’ll test at +3”. This will not be forever. This is just to find out where he onsets so you can then manage the curve appropriately to flatten him out. Over time, as you start at a lower and lower PS, the nadir should be a little higher, curves flatter, and you can get back to regular testing.
  • realize that even after it works, things change. Gracie did occasionally. I would start testing more to find out where she was dropping and then I could get proactive to adjust feeding the curve to prevent the drop. (Keep in mind, once I started managing the curve with food, I always did but patterns change from time to time and you have to be flexible and realize what worked for one pattern, might need a bit of fine tuning for another).
In summary, learning to manage the curve with food involves learning how Andy responds to different carbs at different times during the cycle. You have to be a scientist and an investigator. Write everything down (note the % carbs you fed, the response you got to what you fed, how much you fed, and when you fed it). What kind of a bump does he get from LC, MC, HC early in the cycle and late in the cycle? Using this info, you can guide the cycles. Again, remember you might find that you have to steer the cycles differently. Gracie had a different a.m. cycle than p.m. and so her feeding schedules were a bit different. Any time you make a change, leave it for 3-4 days and give him time to adjust before you make another change.

That’s a lot of info at once but you can bookmark this and come back to it.

One other thing: when you make changes, make them one at a time. I never increased the dose and changed the pen the same cycle (not saying you do but I’ve seen people do it). You’ll never know what the cause/effect is if you are making more than one change at a time.

Pls let me know if you have questions.
 
Mandy & Rex said:
Let me tag @Wendy&Neko, @Jill & Alex (GA), and @Marje and Gracie as they know more about feeding the curve than I do. They may have more insight on how to help Andy.
Click to expand...
Sorry, just seeing the tag now.
I can't really add much at this point. Marje has already elaborated on the "manipulating the curve with food" post I wrote many years ago. In addition to Marje's post, it wouldn't hurt to read through that post as well as the few posts remaining in the thread.

I don't post much any more, but tag me if I can be of any help.
Good luck! :)
 
Marje and Gracie said:
Thanks, Mandy!

Andy is bouncing a lot but he’s not taking a lot of steep dives which managing the curve with food can help with. But it is also helpful for bouncers and for kitties who are very carb sensitive. On thing I notice is that when you get a high PS, you often don’t test again until +3. This is part of the issue and I would suggest you always be in the habit of getting a +2 every single cycle that you can because if the +2 is the same or less than the PS, it’s going to be an active cycle.
Click to expand...

Thank you so much Marje - a lot to digest here - can start the +2 high PS testing immediately. Feeding: I can definitely feed the extra meals but have to work around 20 other cats, 6 on special diets, so need to figure out the logistics on how to do it. I feed him in a condo now so I know "he" gets his food. If I feed for example 4 meals, he will be in the condo 8 times a day!:( I printed this out to study today. When I figure it out, I will post. (FYI - my current vets do not recommend Lantus for him so no support there!:() Thanks again:bighug:
 
Jill & Alex (GA) said:
Sorry, just seeing the tag now.
I can't really add much at this point. Marje has already elaborated on the "manipulating the curve with food" post I wrote many years ago. In addition to Marje's post, it wouldn't hurt to read through that post as well as the few posts remaining in the thread.

I don't post much any more, but tag me if I can be of any help.
Good luck! :)
Click to expand...

Lots to digest!
Thank you Jill! :bighug:
 
Yvonne & Big John & Andy said:
Thank you so much Marje - a lot to digest here - can start the +2 high PS testing immediately. Feeding: I can definitely feed the extra meals but have to work around 20 other cats, 6 on special diets, so need to figure out the logistics on how to do it. I feed him in a condo now so I know "he" gets his food. If I feed for example 4 meals, he will be in the condo 8 times a day!:( I printed this out to study today. When I figure it out, I will post. (FYI - my current vets do not recommend Lantus for him so no support there!:() Thanks again:bighug:
Click to expand...

What is the best way to add 1/2 hr BG's or other additional BG's in the SS? I have been using the REMARKS. Thx!
 
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Yvonne & Big John & Andy said:
Thank you so much Marje - a lot to digest here - can start the +2 high PS testing immediately. Feeding: I can definitely feed the extra meals but have to work around 20 other cats, 6 on special diets, so need to figure out the logistics on how to do it. I feed him in a condo now so I know "he" gets his food. If I feed for example 4 meals, he will be in the condo 8 times a day!:( I printed this out to study today. When I figure it out, I will post. (FYI - my current vets do not recommend Lantus for him so no support there!:() Thanks again:bighug:
Click to expand...
You’re welcome. No hurry...it takes time to absorb the info and figure out a plan.

Yvonne & Big John & Andy said:
What is the best way to add 1/2 hr BG's or other additional BG's in the SS? I have been using the REMARKS. Thx!
Click to expand...
I see Mandy responded. I did mine similarly. If I tested at +4, I entered the BG. If I then tested at +4.5, I added a semicolon in the same cell and then BG @ 4.5 with BG being the number I got.
 
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