Darrah....first, some homework for you. I know you’ve been studying Girlie’s SS so the things you need to know are her onset, nadir, and duration. Does she ever get carryover and/or overlap and under what circumstances?
I want to give you some information about duration that will help you look at her SS with a different eye.
Take a look at her a.m. cycle of 10/23. See how she went from 184 to 243 and then continued to skyrocket? That initial fast bump up isn’t a bounce; that’s loss of duration. Things that can cause loss of duration include too much HC food (or even LC if the cat is really carb sensitive), lack of absorption of the shot, or not enough insulin. On that particular date, she had a lot of HC with gravy at about her nadir and that will put the screeching brakes on duration faster than anything I know of. I’m not saying she didn’t go on to bounce....that’s probably why you saw 700s. First, she lost duration, and then she took a hard bounce because she dropped so fast and so low. So now you can look at her SS and see how often she is actually losing duration. Looks to me like she also lost it the day before in the a.m. cycle.
That brings me to ask the question....how is your shooting technique? Again, I’m brainstorming but I’ve seen a couple cats that were very clearly losing duration but they weren’t always getting a lot of HC food and there wasn’t something that caused a steep drop or low numbers. When we checked the shooting technique, it turned out the insulin was just getting right under the skin and not going into the subq tissues. Obviously, you also have to be careful in how you shoot so you don’t hit muscle. I don’t know if you’ve seen the post I did on
Testing and Shooting Tips but you could review your shooting technique in comparison with what I discussed. What I’ve found when technique is the issue is the CG was shooting parallel to the spine but also shooting really “flat" instead of at a 45 degree angle so the insulin was just going right under the skin which meant less absorption and less duration.
Ok....let’s talk about managing the curve with food.
A cautionary note to readers first: this advice is specific to Girlie and where Darrah is using lantus insulin. If your cat is bouncy and you want to learn to manage the curve with food, please tag a long-time member who has a lot of experience using this technique. ECID.
Girlie’s SS reminds me a bit of
Tashie’s SS although I have seen other cats that looked like this as well. You might also see some similarities.
When we see a cat with such deep dives and hard bounces (and I do believe that kitties that dive fast have harder bounces than those that just go lower....and Girlie’s SS also shows this), we try to get the curve to flatten out with food. We call this “using food to manipulate the curve”. The process is like this:
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 Girlie her food for the cycle and then she fools you and takes another dive, you might have to feed a little more depending on where in the cycle she drops again.
- requires consistency and some extra commitment at the beginning
- requires that you know your kitty; what are her onset, nadir, duration......and does she ever get any overlap or carryover.
Typically, unless the kitty is taking a huge dive (which Girlie does) or drops below 50, we try to use LC to manage the curve with food. Obviously, if she is coming down really fast early in the cycle as she is wont to do, and we know LC doesn’t slow her down, you have 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 are is she in the cycle? If it’s early in the cycle and she’s dropping fast, 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 Girlie? 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. I have noticed that you’ve given her MC and/or HC food and it’s sort of done the job but it’s been reactionary which is what we all do at first. Many kitties, like Girlie and like my baby girl, need us to be proactive with the feeding so that’s what we need to change.
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. 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 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 most likely when the dives will occur. You need to figure out exactly where she drops so you know exactly when and how much to feed to prevent the drop. Don’t get complacent if she’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 she drops so you can then manage the curve appropriately to flatten her out. Over time, as you start at a lower and lower PS, the dives should stop and you can get back to regular testing. Now is a good time for you to try it since you have to go back to work full time the end of November.
- realize that even after it works, she might, at some time, revert back to her diving. 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 Girlie responds to different carbs at different times during the cycle. You have to be a scientist and an investigator. Write
everything down (you’ve actually been doing a really good job but I’d go a little further and note the response you got to what you fed, how much you fed, and when you fed it). What kind of a bump does she 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 her 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. If you suspect a med might be impacting her BG and the vet agrees with you stopping it, then only do that. Don’t stop the med and change the dose at the same 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.
Please let me know your questions. And, I realize that there is a little
when you read what this details. The first time it was introduced to me, I thought “why can’t they just tell me exactly what to feed when?”. As I learned, it’s because no one size fits every cat. Gracie was my kitty and I was the one that was going to have to do the work to figure it out. But I had been given very valuable tools on how to do it. And.....everyone should know their cat this well.
