Pete 6/23/24 (PMPS 79 / +3 80) Confusing BG trends

[CrazyKaitLady]

https://felinediabetes.com/FDMB/threads/6-11-pete-pmps-87-1-103.291044/

Been a while since I posted about Petey...he's still spending a lot of time in the right range but his blood sugar trends are still a mystery to me. It seems like we're at the right dose, or at least very close to it, but he's not regulated. We go through some good days, some low days, then bounces, then bounce clearing cycles.

I don't know if he just needs more time at this dose to settle in or if there's something I should change? He's been at this dose for over a month and it's been several weeks since I had a fur shot. I was wondering if I should change his feeding schedule or quantities? He currently gets 1 can at shot time and half cans in a timed feeder at +3 and +6. I did try feeding him at +2 and +4 instead for a while but I'm not sure that it made a difference and he seemed pretty hungry. Though I'm open to trying it again.

He seems to be consistently lower at night. Daytime BGs are a lot of blues and the nighttime BGs are a lot of greens so I end up losing a lot of sleep staying up to check him when I shoot low or he goes low at his +3 reading. A friend with a diabetic cat suggested adding some medium-carb food to his snack at +3 since that's the point where he usually goes low? I've also contemplated going down a quarter of a unit on his dose to see if he runs a little higher but is at least more regular that way. I know that's not what I'm supposed to do per TR but I'd rather have him a little higher but consistent than lower but constantly bouncing or dropping low unexpectedly.

Today's numbers are especially confusing to me. He dropped from 165 to 65 between AM shot and AM +6, then has stayed at around 80 ever since then. He was only at 79 when I gave him his PM shot so I added a quarter can of a medium carb food to his dinner to try to pad him up a bit overnight, but it didn't seem to affect him at all because he's still at 85 at +4.

I'd appreciate any thoughts or advice! He's not consistent enough that I feel like I can just go to bed and trust that he won't go below 50 when he's low at the +3 (midnight for me) but these late night checks are killing me.

 

[Heather & Shooter]

Hi Kait! Sorry, but I am definitely not qualified to give you ANY advice in this regard. You are further ahead of this insulin game than me. I'm going to tag a few people though in hopes you can get some help in what your best course of action would be.

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

 

[Staci & Ivy]

He's not consistent enough that I feel like I can just go to bed and trust that he won't go below 50 when he's low at the +3 (midnight for me) but these late night checks are killing me.

Hi Kait, like Heather just says, by no means am I qualified to give advice either.
I am having a similar issue with Ivy and I just gave a .25 reduction because I was up all night giving hourly (and more often as well) snacks and getting absolutely no sleep either.
We are also having daytime cycles where I’m doing same feeding hourly snacks to keep her coasting but it seemed like too much propping up with medium carbs constantly and it became unsustainable for me.
Not sure how it will work out but I had to tweak something for my endurance to care for her.

I am hoping some more expert advice will help guide you here with Pete.

 

[Angela & Cleo]

When I look at your SS, it seems that Pete's nadir is +4, at least in the PM cycles 6/15 and 6/20. The PM cycle 6/23 is such a beautiful flat surf with great duration. I may have stopped testing after +4 or +5 and called it a night .

 

[CrazyKaitLady]

When I look at your SS, it seems that Pete's nadir is +4, at least in the PM cycles 6/15 and 6/20. The PM cycle 6/23 is such a beautiful flat surf with great duration. I may have stopped testing after +4 or +5 and called it a night .

I did finally get to bed at +6 (I just had to be up really early for a TNR clinic drop off so I also got a +9). He does seem to hit is lowest at +3 or +4 sometimes but not with enough consistency that I feel comfortable trusting it since the pattern never seems to hold across consecutive cycles? We do have some really good cycles but it kinda feels like luck more than routine/regulation because what kind of pattern I'm going to get that day seems so variable haha. And I'm surprised he didn't go higher than he did at +3 after I gave him extra medium carb food in addition to his regular dinner last night, though I guess those carbs could have basically negated his nadir dip and he would have dropped at that point otherwise?

Is it typical for cats to be lower on alternate or nighttime cycles? I get so much daytime blue and so much overnight green. My mathematical brain wants to be able to predict that when we input this food and this insulin we get this result in his blood sugar and that result is repeatable. But his pancreas has other ideas haha

 

[JoM]

I just wanted to say I can relate. In our 6th month and Ive never dealt with anything more unpredictable than feline diabetes. I never stay up unless I see limes and as soon as it starts trending up, Im off to bed. Sometimes i wonder what goes on at night, but I just cant stay up or I cant function the next day. Hang in there.

 

[Wendy&Neko]

He does seem to hit is lowest at +3 or +4 sometimes but not with enough consistency that I feel comfortable trusting it since the pattern never seems to hold across consecutive cycles?

When he starts with a lower preshot, the nadirs seem to be at +4. When he starts higher (possibly from a bounce), the nadirs are later. Bounce breaking cycles have later nadirs.

With nadirs at +4, that's ideally the last time for a meal. Carbs given after nadir, when the insulin starts wearing off, can shorten duration and give you higher preshots for the following cycle. It's OK to give some no carb snacks later if you need to.

As Angela pointed out, when you see him flat or rising for a couple hours, without higher carbs on board, you are good to call it a night.

I've also contemplated going down a quarter of a unit on his dose to see if he runs a little higher but is at least more regular that way.

I'd actually be considering going the other way. Ideally you'd like his nadirs to be in the 50-80 range and get rid anything not blue. This might not be a long term thing, but at a time when you can monitor closely, an increase might help even him out.

 

[CrazyKaitLady]

When he starts with a lower preshot, the nadirs seem to be at +4. When he starts higher (possibly from a bounce), the nadirs are later. Bounce breaking cycles have later nadirs.

With nadirs at +4, that's ideally the last time for a meal. Carbs given after nadir, when the insulin starts wearing off, can shorten duration and give you higher preshots for the following cycle. It's OK to give some no carb snacks later if you need to.

As Angela pointed out, when you see him flat or rising for a couple hours, without higher carbs on board, you are good to call it a night.
I'd actually be considering going the other way. Ideally you'd like his nadirs to be in the 50-80 range and get rid anything not blue. This might not be a long term thing, but at a time when you can monitor closely, an increase might help even him out.

Thank you! I will try putting his meals back to +2 and +4 for a couple weeks and see if he normalizes on that. He was pretty hungry last time I did that but I can give him some of the freeze dried chicken treats and he'll probably get used to it after a few weeks. And maybe if that doesn't level him out I can consider a slight increase for a few days to see how he does, though I will be biting my nails through that haha. Thanks for the input and support!