8/10 TASHIE pmps=HIGH! +Questions***

[BorisV]

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=101911

Okay! I was all prepared to give a small dose increase this morning, we've gone longer than we should on this cycle but considering that I royally screwed up the best two she had, I gave it a little longer. Tashie has had really really good numbers (for her) on this dose and I was reluctant but filled the syringe with an increase.

Well, when I got 212 pre shot ((shocker for Tashie)) I had to expel the increase quickly down to the .5U dose - too much of a chicken to give an increase with that PS number.

Wish I knew where she went down to last night! Got a +2 and felt okay as she hadn't tumbled much........ Oh, if we only knew what goes on in the dark of the night!

Going to test @ +1.5 and see where she is headed ---- thought yesterday was going to be "the day" but she has her own agenda!

 

[BorisV]

Re: 8/10 TASHIE amps=212/+1.5=175/+2.5=97/+3.25=81/+4=66

Just have to say --- I am NOT syringe feeding at all this morning - she is actually EATING by herself after each test - just LC 4% - nothing else SO SO proud of her ....... now, let's go for that REDUCTION little girl! Have to add that the last two days are about the ONLY time we haven't seen RED or BLACK! Whoo Hoo!
And - I am NOT freaking out! ohmygod_smile ohmygod_smile ohmygod_smile

 

[ecurie]

Re: 8/10 TASHIE amps=212/+1.5=175/+2.5=97/+3.25=81/+4=66

:RAHCAT :thumbup :mrgreen: dancing_cat dancing_cat dancing_cat party_cat
Go Tashie!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Congrats Bern!!!!!!!!!!!!!!!!!!!!!

 

[BorisV]

Re: 8/10 TASHIE amps=212/+1.5=175/+2.5=97/+3.25=81/+4=66

Not yet - not yet - maybe this next test? Trying to not "over poke" and give it some time - especially as she has eaten in between. Gees, I can "taste" the reduction! And it tastes SO sweet!

We're tryin'! cat_pet_icon cat_pet_icon cat_pet_icon cat_pet_icon

 

[rhiannon and shadow (GA)]

Re: 8/10 TASHIE amps=212/+1.5=175/+2.5=97/+3.25=81/+4=66

Paws crossed....!
Work that juice Tashie! :mrgreen:

 

[Tigger's Friend]

Re: 8/10 TASHIE amps=212/+1.5=175/+2.5=97/+3.25=81/+4=66

This is looking like a nice change in your pattern, Tashi! Hope it sticks for you - keeping paws crossed. I can also see why you don't bother to check much at night with those +2 BGs - we have the same problem - but just when you make that assumption - !WHAM! - they surprise you! But Tashi's was a good surprise. Keep up the good work! :mrgreen: :mrgreen: :mrgreen:

 

[BorisV]

Re: 8/10 TASHIE amps=212/+5=56 got my patience pants on!!

Okay, I am CALM but have to grab those patience pants! I want this so badly for her ..... just a TINY little reduction, just a tiny one! TWO whole days with no blacks or reds ....... makes for a much prettier SS don't you think? And, just can't believe she is nibbling between these tests and I don't have to ram a syringe down her! .......no, I don't really ram it we actually have a nice little system down where she takes it like mother's milk now ......
The suspense is killing me! Come on Tash! Pleeaze!

 

[BorisV]

Well, Tashie had a GREAT day, recap:
amps=212
+1.5=175
+2.5=97
+3.25=81
+4=66
+5=56
+5.75=71
+6.50=69
+7.25=148

I "should" have given her a dose increase a few days ago - had one drawn this morning and quickly expelled some insulin as 212 is a REALLY low PS number for Tashie. I ROYALLY screwed up TWO potentially active cycles for her this week so I stayed a little longer at this dose thinking it was working for her.

***keep in mind, Tashie can drop over 100 points in an hour*** and when she goes low, it is a real struggle to keep her up. I usually have to start feeding her GRAVY whenever she goes below 100 because she dive bombs so fast. I did NOT do that today. I did NOT syringe feed her at all and she grazed on LC ONLY between tests - and she did actually eat. I WANTED a dose DECREASE for her! I played ALL by the protocol. Now, of course, it is always possible that she did drop to , say, 49 between +5 & +5.75 we will never know. Yesterday & today were the BEST numbers she has EVER had and now, she is HIGH! But, she seems (?) to be clearing bounces much faster?

QUESTION #1: Do I have to increase her? If I do, can I just "eeek" it up to say a f5U. Keep in mind that Tashie is JUST 5 pounds and we are struggling to keep her at that. She is teeny tiny. A .25U dose for Tashie is like a .5U dose for the average cat.

QUESTION #2: Let's talk BOUNCING! I never see any other cat registering HIGH !!! It's almost an embarrassment to post a "word"........why does she go from 148 +7.25 to HIGH @ =12? And, last night, she was 394 PS (low for her) so I did a +2 and she was 311 - so I thought she was "safe" .....then this morning to only be 212 amazed me - EYE OPENER! I know they bounce until they don't bounce ...... but isn't this DRASTIC bouncing? My silly vet thinks you base Lantus on the PS number - hello! If I did, Tashie would be on 10U!!! Just trying to get a better understanding of what her LITTLE body is going through.

.......I had an epiphany "ah ah" moment this week ........I am fortunate to have had many accomplishments in my life so far - believe it or not, I do have a brain and I can, and have worked hard. I came to the conclusion that getting Tashie at least "regulated" (better yet, OTJ?) would be the biggest accomplishment of my life. I am committed to take care of this little girl and make her life the best it can possibly be. This teeny, tiny little blue eyed girl has been an absolute trooper - she is extremely shy and has blossomed somewhat through this almost three month ordeal. She was never sick a day in her life and the "boys" always took the stage and this has really "bonded" us and I just want to do the best for her.

Just need some advice on where to go next .......

 

[Alexis & Nikki (GA)]

I can't offer much in the way of advice, but when she isn't bouncing her nadirs on this dose have been in the green, so if it were my cat I'd hold it. Tashie's complicated though,so I'll leave further advice to the experienced folks! Good luck, whichever way you go!

Nice cycle today Tashie! :mrgreen:

 

[BJM]

Never seen another cat HIGH, huh.

Pop over to Relaxed Lantus and take a look at Lucian's spreadsheet before being switched to Levemir a couple of weeks ago. That poor cat bounced like Tigger from Pooh Story. Now that he is on Levemir it is so, so much better.

Has anyone mentioned deliberately preventing a reduction by feeding the curve? That is when you intentionally feed some higher carb food to keep the glucose up a bit higher and hold off on taking a reduction in the hopes the body becomes more accustomed to lower numbers, but without so much of a drop that it triggers compensatory hormones and glucose release.

 

[Sienne and Gabby (GA)]

QUESTION #1: Do I have to increase her? If I do, can I just "eeek" it up to say a f5U. Keep in mind that Tashie is JUST 5 pounds and we are struggling to keep her at that. She is teeny tiny. A .25U dose for Tashie is like a .5U dose for the average cat.

You don't HAVE to do anything! You can fatten the dose or increase by 0.25u. You're the one holding the syringe and you know your cat. FWIW, though, dosing with insulin isn't necessarily correlated with weight. Gabby weighs a lot more than Tashie and is on the same dose.

QUESTION #2: Let's talk BOUNCING! I never see any other cat registering HIGH !!! It's almost an embarrassment to post a "word"........why does she go from 148 +7.25 to HIGH @ =12? And, last night, she was 394 PS (low for her) so I did a +2 and she was 311 - so I thought she was "safe" .....then this morning to only be 212 amazed me - EYE OPENER! I know they bounce until they don't bounce ...... but isn't this DRASTIC bouncing? My silly vet thinks you base Lantus on the PS number - hello! If I did, Tashie would be on 10U!!! Just trying to get a better understanding of what her LITTLE body is going through.

Some cats are bouncier than others. If you look at enough spreadsheets, you'll see there are any number of cats whose BG registers "HIGH." In all likelihood, Tashie was diabetic for a while prior to diagnosis. Her body acclimated to the higher numbers so when she drops into lower ranges, her liver and pancreas panic in a big way. Gabby has gone from an AMPS in the 400s to the 40s at nadir and back to the 400s by PMPS. Dyana's J.D. is also a bouncer.

BJ's suggestion has merit. However, I would give Tashie more time since she's just beginning to spend more time in lower numbers.

 

[Tigger's Friend]

I can't comment on dose, either, but I can say that Tigger is also a BOUNCER & it drives me crazy, too! He & tashi were dx'd on the same day, too!

I have looked at alot of other SS's & there are definitely other cats who read HIGH & black - scary, but true.

BJM said:
Has anyone mentioned deliberately preventing a reduction by feeding the curve? That is when you intentionally feed some higher carb food to keep the glucose up a bit higher and hold off on taking a reduction in the hopes the body becomes more accustomed to lower numbers, but without so much of a drop that it triggers compensatory hormones and glucose release.

I'd like to get more input from BJM on 'feeding the curve' to prevent a dose reduction & allow the cat to be accustomed to a higher dose & greener numbers longer. That might keep you stressed, though as well - confused_cat I'm assuming there would be even more testing to make sure there are no surprise drops. confused_cat

With Tigger, I had to do a reduction, but then fattened the dose twice - not back up to the full .25. Today he's had a great surf, I'm sweating a little with a 57 @ +9.75 + 59/+10.25. I didn't feed because that tends to shoot him back up & I wanted to let him surf if he could - I also wanted to see how his body would handle it on his own - but its definitely stressful!

Whatever you decide, good luck to you!!!

 

[BJM]

Sometimes a test at +2 gives you a clue if you're going to have an active cycle, where the drop is fast or big. When you see the glucose starting to dive like a bomber, instead of feeding low carb, you steer the numbers by feeding small amounts - 1-2 teaspoons of medium carb - 1 or more times to keep the drop from being too severe and triggering the 'bounce' response.

 

[Sienne and Gabby (GA)]

Feeding the curve the way BJ is suggesting is an advanced technique. You need a great deal of data and need to understand where onset and nadir are as well as know how your cat responds to HC/LC food. I've been doing this for quite some time with Gabby. I also implemented this strategy after having the date to know much more about her bouncing and I had the support of a very experienced Lantus user. By using food in this manner, you can end up in a situation where there are very low numbers because you have been preventing dose reductions. So in addition to knowing all of the above about your cat, you also need to have the skill and fortitude to know you can steer the curve, in some cases rather aggressively, if you need to. This is not a strategy I recommend for someone who is new at managing their cat's diabetes and/or is new to Lantus.

For many cats, given a sufficient amount of time on insulin, the bouncing self-corrects. Elian is a very good, current example of how a curve levels out.

 

[Jill & Alex (GA)]

hi bern. i've been using a method i dubbed "using food to manipulate the curve" to help control alex's curves for years. i've taught the method to sienne, marje, and scores of others. i don't necessarily consider it an advanced technique. however, a caregiver better pay close attention when using food to manipulate a curve or it can become risky business.

here are the basics:

what is meant by using food to manipulate the curve?
simply put, it's a method of feeding used to prevent kitty from dropping too fast and/or too low.
the amount of food usually fed to the cat is broken down into several mini-meals fed throughout the course of the day with the intention of flattening out the curve. lc is normally fed to all numbers except possibly in the case of a significant or fast drop or fed to a drop below 50.

the only time you might want to feed a little higher carb food at shot time is to bump the numbers up so the insulin is starting from a higher number when onset occurs if you're running out the door and will be unable to monitor.

if you're around to monitor, there's no reason to bump the numbers up at shot time. the beauty of lantus and levemir is being able to shoot low to stay low. shooting low is how you obtain the low flat curve with lantus and levemir.

whether you'd want to feed lc, mc, or hc to slow a drop depends on two things:
1. the carb sensitivity or lack of of your particular cat.
2. the point you're at in the cycle. a drop early in the cycle *may* require big guns. a drop at nadir (unless nadir is less than 40) or late in the cycle usually only requires lc to bump the numbers up. however, if you have a carb sensitive kitty, you may not have to use anything except lc to bump up the numbers. "KNOW THY CAT".

why would you want to manipulate the curve with food?
--- bouncers: kitties who drop low and then bounce to the moon benefit from food manipulation. using food to manipulate the curve will tend to flatten out the curve. flattening out the curve helps to prevent huge bounces.
--- carb sensitive kitties: kitties who experience large food spikes when consuming even lc benefit from manipulating the curve with food. strategically spacing out meal times will help flatten out the curve.

why do i want to use food to flatten out the curve ?
--- flattening out the curve allows you to get as much insulin into the cat as safely possible without having kitty bottom out on you.
--- flattening out the curve *usually* allows you to hang onto a dose longer
--- flattening out the curve allows you to shoot higher doses of insulin than you would have been able to otherwise.

why would i want to get as much insulin as possible into the cat?
lantus and levemir are known to have a harder time bringing down higher numbers. more insulin helps bring down the higher numbers in a bouncer's cycle. more insulin will help counteract the spikes in a food spiker. using food to manipulate the curve will flatten out the curve and help keep your kitty safe.


when using food to manipulate the curve, i generally recommend starting with dividing up the normal amount of food your kitty should be eating into 8 mini-meals to be fed at preshot, +1, +2, and +3 of each cycle. however, that recommendation is strictly a starting point. a plan customized for YOUR cat is YOUR goal. frequent testing and learning how YOUR cat responds not only to food, but to the insulin itself will help you tweak the plan.
Edited to add on 11/13/2015:
I was referring to manipulating the curve when using Lantus in the paragraph above.
Levemir typically has a later onset (usually around +4) and a later nadir. To accommodate the difference, when using Levemir one might start with dividing up the normal amount of food kitty should be eating into 8 mini-meals beginning at shot time, +3, +6, and +7 of each cycle. However, that recommendation is strictly a starting point. A plan customized for YOUR cat is YOUR goal. Frequent testing and learning how YOUR cat responds not only to food, but to the insulin itself will help you tweak the plan.

a quote that goes along with this subject from Libby/Lucy found in one of Mocha's Lantus condos:

"carb manipulation is more about learning what your cat's response is to varying amounts of carbs at different times during the cycle, and using that information to your advantage. Learn how many points bump she gets from LC, MC, and HC, both early in the cycle and later in the cycle. Use that information to guide her cycles the way you want them to go. Mocha's AM and PM cycles are very different, so the best feeding times for her might not be the same in each cycle. Take the amount you would feed her over the 12 hour period, divide it into 3-4 meals, and experiment with when to feed them. Whatever changes you make, write them in your spreadsheet and hold it for at least 3-4 days to see if it is changing anything. Mocha drops later at night than she does during the day, so your food schedule might need to be different at night.

Many cats benefit from front-loading the cycle with food. That means feeding at PS, +1, +2, +3 (when the insulin is kicking in) and then NOT feeding after +6 (because for a carb sensitive cat, you would be adding food at the same time the insulin is wearing off, driving the numbers higher). The +9 snack is helpful for some cats when they are trying to go OTJ, because it can stimulate their pancreas. That is more useful if the cat is generally flat, but spikes up just before PS. I wouldn't worry about that yet, until you get to a lower dose."

experimenting is how YOU learn how YOUR cat responds not only to food, but to the insulin itself. no one feeding plan will affect two different cats in the exact same ways. experimenting, testing, recording your observations... these are the things which will help YOU with YOUR kitty because like you'll often hear around here...ECID. :mrgreen:



just a few thoughts...

 

[Jill & Alex (GA)]

I would just reinforce what Sienne said and add that it's an aggressive approach also for a kitty that won't always eat on demand.

no doubt this method is best used with a kitty who is eating normally.
ETA: however, this method can be used safely as long as Tashie eats... whether it be on her own or from syringe feeding.

And, I also feel that newly dx cats should not be fed to prevent a reduction. After all, the point is to go down in dose, right? She will bounce until she doesn't.

hmmm, i've always thought the point in practicing tight regulation is to get kitty into normal numbers as much and as quickly as possible to give beta cells the opportunity to regenerate... the pancreas time to heal... the "healing time" we always talk about around here. after all, according to the roomp and rand study: "Significantly higher remission rates were observed if good glycaemic control was achieved soon after diagnosis..."

all too often we've seen failed reductions and then the need to take the dose right back up after a single drop under 50. personally, i'd rather see kitty "earn" a reduction from maintaining lower BGs with a flatter cycle for a week than to reduce the dose based on a single drop below 50 when the rest of the cycle's numbers remain high.

just my thoughts...



bern: i left these links to good discussions on bouncing/somogyi in bob's condo tonight:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=78047#p843366
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=55306
you might might be interested in reading them...



~ edited to clarify

 

[jayla-n-Drevon]

bump

 

[Mouse & Me]

If food is used to manipulate the curve, what about when you are asleep? I assume an auto feeder can be used, but if the cat is also asleep, she cannot get up & feed to play with the numbers.

 

[Marje and Gracie]

Managing the curve with food is usually done to keep cats from dropping too fast or too low. The presumption is that if numbers are dropping quickly and/or low, you'll be either up testing and feeding or setting an alarm to get up and test/feed at the appropriate times.

If my cat was dropping fast or was lower and coming down, I, personally, wouldn't go to bed without at least setting an alarm for the next test, until he/she was fairly flat and stable on LC food or headed up and I was at or past nadir.

 

[Jill & Alex (GA)]

If food is used to manipulate the curve, what about when you are asleep? I assume an auto feeder can be used, but if the cat is also asleep, she cannot get up & feed to play with the numbers.

In addition to Marje's comments in the previous post (#20)...

Generally speaking, we don't encourage feeding after nadir whether one is using food to manipulate the curve or not. Feeding after nadir tends to act like applying the brakes to whatever action is left in that cycle.

As I described in post #15:

"when using food to manipulate the curve, i generally recommend starting with dividing up the normal amount of food your kitty should be eating into 8 mini-meals to be fed at preshot, +1, +2, and +3 of each cycle. however, that recommendation is strictly a starting point. a plan customized for YOUR cat is YOUR goal. frequent testing and learning how YOUR cat responds not only to food, but to the insulin itself will help you tweak the plan."

If we use food to manipulate the curve for reasons other than dropping BG numbers...
Many caregivers plan the PM shot so they can get a +4 (sometimes +6) before bed time. Since we're dividing up the normal amount of food fed (not feeding extra) prior to nadir, kitty will usually be looking and waiting for their next "mini-meal"... even if the caregiver has gone to bed.