? 7/7 Ivy amps 206, +5 82, +8 54 (Libre), +10 88 Contour, +11 “Lo” Pmps Dose Advice Needed!

[Staci & Ivy]

https://felinediabetes.com/FDMB/thr...400-4-254-bounce-dose-ok.278915/#post-3083473
Hi everyone, it’s been a minute since we’ve posted. We changed Ivy‘s diet to a medium carb 12.5% carb home cooked lamb diet.

On 7/2 &7/3 She was dropping lower on the Libre (for her) overnight. I didn’t let her drop down to the 40’s (Libre) by using carbs to boost her bg for hours on end every 20 minutes or so.
(Therefore I’m not really able to see where the dose will drop her if I’m constantly boosting her up)
We ended up lowering her dose to 3.0 units Lantus on 7/4 after the overnights where I had to feed her snacks all night to keep her boosted until about 3 am (+9) until she was stable enough for me to leave her alone. (Exhausted)

Per our nutritionist, we are trying method to feed her larger meal at amps/pmps, +2 small snack & +6 larger snack, to try to spread out calories & carbs to even her out more.

We are also trying feeding a little more food in overnight cycle than daytime cycle to see if that helps decrease overnight deep, extended drops and hope for more flats.
*Yesterday and today, she’s had lower stretches in blues and greens for 6-7 hours. (I know that’s a good thing).

After a long low stretch, She then tends to bounce high later In the cycle.

**My question is this: if she doesn’t get out of this lower range (50s-80s on Libre) at pmps tonight, do I give her a full dose?
Concern is that she surfed low, (for her), for a long stretch again today. Or, is a reduced dose or a skip advised?
(Her AMPS was a bit lower than usual.)

Also, Is she just getting used to lower numbers and surfing these numbers more??

So far I have not cross checked her on Contour handheld meter since she’s not gone under 40s on Libre, which is when she should be 60-80s on the Contour meter .

If she goes very low on Libre, I will definitely cross check with ear pricks.
Thank you.

still dropping at +9…

 

[Staci & Ivy]

45 on Libre now. Will check contour. **

Still dropping at +9. Is this just a Lantus surf? Or is dose too high?
(She’s not yet dropped below 90 per SLGS method) and it’s only day 4 on this current dose.

@Wendy&Neko @Bandit's Mom @tiffmaxee @Sienne and Gabby (GA)

 

[Staci & Ivy]

Photo for reference different meters/variances. contour is 123 bg when Libre is 48 ( she went higher by time I tested her).

 

[Staci & Ivy]

**AMPS in 3 hours. Is anyone available for dosing advice?
she’s been low, for her, all day long (very unusual )

 

[Staci & Ivy]

contour 96 Just now.

 

[Wendy&Neko]

As you said, she has not gone below 90 on a human meter. With SLGS, that means you stay the course on the dose. It's too early in the cycle to play what-if scenarios for PMPS. Maybe post again around +11 so we have time to think about what to do.

Also, Is she just getting used to lower numbers and surfing these numbers more??

Time will tell. You can't predict trends from one or two cycles activity. I sure hope so though.

 

[Staci & Ivy]

As you said, she has not gone below 90 on a human meter. With SLGS, that means you stay the course on the dose. It's too early in the cycle to play what-if scenarios for PMPS. Maybe post again around +11 so we have time to think about what to do.

Time will tell. You can't predict trends from one or two cycles activity. I sure hope so though.

Normally, she would have already bounced up high from this stretch of lower (for her) numbers.
Given this stretch at these lower numbers, would I shoot a full dose in 2.5 hours?
(I’m not sure I will be comfortable giving a full dose if she’s in this range at pmps.)
I need to be talked off the ledge here

 

[Wendy&Neko]

I have a little home work for you. Take a look at Ivy's spreadsheet, and tell me what her cycle looks like the one after she shows a stretch of Libre greens.

 

[Staci & Ivy]

I have a little home work for you. Take a look at Ivy's spreadsheet, and tell me what her cycle looks like the one after she shows a stretch of Libre greens.

I will. But she just dropped to 88 on the Contour meter

 

[Staci & Ivy]

I have a little home work for you. Take a look at Ivy's spreadsheet, and tell me what her cycle looks like the one after she shows a stretch of Libre greens.

She bounces up high after a stretch of greens. That’s her norm. Is that what you are asking me?

 

[Staci & Ivy]

*Do I reduce her dose going forward based on dropping under 90 on human meter?
*And what dose do I give in 2 hours if she’s still low, given how low this dose kept her all day today?
Or, do I skip or give reduced dose?
(Not normal for Ivy to stay this low all day).

 

[Wendy&Neko]

*Do I reduce her dose going forward based on dropping under 90 on human meter?
*And what dose do I give in 2 hours if she’s still low, given how low this dose kept her all day today?
Or, do I skip or give reduced dose?

Yes, you reduce any time she goes under 90 on a human meter (or the AT) since you are following SLGS. Her current dose is 3.0 units, so her next dose would be 2.75 units. If she's still below 90 at shot time, you have a couple options. The first is to delay - without feeding - for a while, say 20-30 minutes, and see if she comes up above 90. The second option is a skip, but if she's likely to bounce later on, that will make the numbers worse. Let's see what she goes before going into finer details based on guesses. Also, I wouldn't say this dose has kept her low all day, it's kept her almost in normal blood sugar numbers. That maybe low compared to what she's used to, but it a really nice stretch of healing numbers. We also don't dose based on how she's done all day on a dose, but rather how low the dose has taken her.

She bounces up high after a stretch of greens. That’s her norm. Is that what you are asking me?

Yes - looking at what she typically does can give you an idea what she might do next.

 

[Staci & Ivy]

Yes, you reduce any time she goes under 90 on a human meter (or the AT) since you are following SLGS. Her current dose is 3.0 units, so her next dose would be 2.75 units. If she's still below 90 at shot time, you have a couple options. The first is to delay - without feeding - for a while, say 20-30 minutes, and see if she comes up above 90. The second option is a skip, but if she's likely to bounce later on, that will make the numbers worse. Let's see what she goes before going into finer details based on guesses. Also, I wouldn't say this dose has kept her low all day, it's kept her almost in normal blood sugar numbers. That maybe low compared to what she's used to, but it a really nice stretch of healing numbers. We also don't dose based on how she's done all day on a dose, but rather how low the dose has taken her.


Yes - looking at what she typically does can give you an idea what she might do next.

Ivy tends to keep dropping when I delay. So that option concerns me since she’s so low, for her, already.

I think I have to be prepared to either skip or give a reduced dose.
*What is a recommended reduced dose if she’s above 90 if that’s a safe option (based on her low green stretch today)??

Which option is safest given what we see at this point (skip or reduced dose)?
She’s still “Lo” on Libre now at +10.5.

She most likely will bounce high later as a results of this long stretch of very green numbers. If I give a reduced dose or a skip, that will certainly elevate her numbers.

 

[Staci & Ivy]

We are at +11 and still “Lo” on Libre (most likely under 90 on human meter).
Do we skip this dose or reduce dose in 1 hour?
(I still can’t believe she surfed this long in such low numbers, for her, today).

 

[Staci & Ivy]

Looks like we are skipping a dose unless anyone else has another idea
10 minutes till feeding and shot time.

 

[Wendy&Neko]

I got back to you a little late on the +10, otherwise I would have suggested a small snack then to help prop her up until PMPS.

Please get a meter test with that PMPS.

 

[Staci & Ivy]

I got back to you a little late on the +10, otherwise I would have suggested a small snack then to help prop her up until PMPS.

Please get a meter test with that PMPS.

She’s at the same “Lo” Libre level as she was earlier when I tested her.
So it seems pretty certain she’s at same level ( under 90.
She’s had it with me poking her. (I was bitten and scratched earlier).

I figured if she went over 50 on Libre then I was safe to shoot as she’d be over 100, but she’s not over 50.
So I’m inclined to just call it a skip unless you think I reduce is in order in the next few minutes.

 

[Wendy&Neko]

How about stalling 20-30 minutes and see what she does.

 

[Staci & Ivy]

How about stalling 20-30 minutes and see what she does.

My concern is that even if she comes up a little bit, she usually goes lower at onset anyway, so I’m a little afraid that in the next hour to two hours I would really be pushing her down even further.
Sounds dicey given her Lo readings for the past several hours. Do you agree?
Well, I hate the thought of skipping a shot. I also don’t wanna push her into a hypo. I want to be safe here.

 

[Staci & Ivy]

Dose has been skipped for tonight. Very bummed since I know it will shoot her very high and will take days to reset

Let’s hope her new, reduced dose will serve her well.
This marathon is not for the weak.
Thank you for your guidance, Wendy!

 

[Wendy&Neko]

There was a good chance that between feeding her, and time to onset, she would come up. I'd still check her numbers after food, to make sure she is coming up and how much. Good data for next time.

If you see her dropping towards the end of the cycle, next time (and there will be a next time), try feeding her a small meal around +9.5 to +10. That'll still give you 2 clear hours towards preshot to not be food influenced and might stop the drop and get her to flatten out. In general, it's a good idea when they get into green numbers (on the Contour), to feed a couple tsps LC to try to get them to flatten out or surf - regardless where in the cycle.

 

[Staci & Ivy]

There was a good chance that between feeding her, and time to onset, she would come up. I'd still check her numbers after food, to make sure she is coming up and how much. Good data for next time.

If you see her dropping towards the end of the cycle, next time (and there will be a next time), try feeding her a small meal around +9.5 to +10. That'll still give you 2 clear hours towards preshot to not be food influenced and might stop the drop and get her to flatten out. In general, it's a good idea when they get into green numbers (on the Contour), to feed a couple tsps LC to try to get them to flatten out or surf - regardless where in the cycle.

She is already coming up from food. I’m sure by onset time she’ll be higher. I’m watching in the Libre.
The strange thing was that she wasn’t dropping at end of cycle, she was in that Lo zone for hours before pmps. The amps was low for her, so I had an inkling she might drop, she did.
From +1 she began to drop, and at +5 she really began to go much lower for her and remained there for the rest of the cycle.

Does it seem odd that since she’s now eating a medium carb 12.5% diet that she would go lower on a dose of Lantus? (I would have thought it would make her go higher)

My question is that if I keep feeding her, do we ever know if the dose is too high since we are propping her up with carbs?
(I would have had to feed her constantly for at least 3/4 hours at that low range today).

 

[Wendy&Neko]

Feeding her regular food is not "propping her up with carbs". Some cats do better with a bit higher carbs, she may be one of them. And since you were only testing with the Libre and getting Lo, you don't know if she was continuing to drop, flat, or rising a bit at the end of the cycle.

Today was a bounce breaking cycle - nadirs tend to be later when that happens.

 

[Staci & Ivy]

Feeding her regular food is not "propping her up with carbs". Some cats do better with a bit higher carbs, she may be one of them. And since you were only testing with the Libre and getting Lo, you don't know if she was continuing to drop, flat, or rising a bit at the end of the cycle.

Today was a bounce breaking cycle - nadirs tend to be later when that happens.

Ok got it. Thank you so much!