Question on feeding low numbers...

[Pumbaa]

With Levemir, the nadirs are frequently much later than with Lantus.

Tonight, Pumbaa had dropped down to 99 at his AM +10. Normally we remove food at +10 so that a food spike doesn't cause a higher PS number. I fed him at +10.

But, if a nadir on Levemir is at +10, and you want to feed a low, how can you do that and still not have a PS number higher than it should be, if it wasn't influenced by food?

This is why I am testing Pumbaa again, very soon.

 

[Blue]

How come you want to feed when low? The number 99 is quite nice so you don't need to bring that number up at all.

If you feed at +10, the food should be out of the system by two hours later.
You should be able to feed just like normal times, at shot times and any others that are not between +10 and +12.

Just think Feed the 40s.

 

[Pumbaa]

Blue, 99 is beautiful! But Pumbaa was dropping and I was going to be gone from +10 until right before the PMPS, and didn't want to take the food away at +10 in case Pumbaa started dropping too low and went to eat like he instinctively does.

Also, Pumbaa is such a bouncer, someone had brought up trying to steer the lows up via food in order to prevent the bounces. I've been testing this today.

Suze

 

[Angela & Blackie & 3 Others]

It would make sense to feed if you're concerned that he'll drop, especially if you're not going to be home to test. I think I've done that a time or 2.

 

[Sienne and Gabby (GA)]

Suze:

I think it's fine to see if your hypothesis about feeding works. However, just a few questions for you to consider. When do you start feeding to offset a drop? How low do the numbers need to be? How do you account for different times in the cycle when the drop is occurring? How fast does the drop need to be?

My point here is that there are any number of variables that you need to consider which makes this a rather complicated process. I tend to think that cats will do what they are going to do. They are living, breathing organisms and you are attempting to manipulate or control that creature's physiology. It's a challenge. Frankly, I think it's important to always remember that it's our cats that have the lead in this sugar dance. We're just along for the ride.

 

[Carl & Polly & Bob (GA)]

Hi Suze,
I think I am interpreting the past 48 hours or so differently?
To me, it looks like the bounce cleared on the PM cycle on the 9th, and yesterday's AM cycle was pretty.
The 99... he may have been dropping, but it was only 11 points in two hours. I'd call that surfing. You fed it, but didn't carb him up (good job) and he kept surfing. Then he dropped to 49, came up slow to a safer "let Mom sleep" range, and gave you a nice AMPS today.
Now he looks like he's bouncing from the 49? But not too high....
The first cycle on this dose, you saw 40s (whether from the increase or not, it was still in the 40s). So this makes two 40s on this dose. You can wait for a third time in the 40s, and follow that alternate route to a reduction like some people do. But if you do, I think he will have earned a full reduction, not just a drop or two.
I guess I just don't want to see you miss a well-earned reduction...
Carl

 

[Pumbaa]

Sienne, I'm not seeing it as being complicated as you are, if the 2% difference in carbs is even making any difference. I'm thinking it is, but very slightly.

Yesterday morning, for example, when I first tested this slightly higher carbed food, Pumbaa had dropped to 83, when normally at a +2 he goes up. I wanted him flatter/not dropping so early in the day, so I gave him a little 9% carb Friskies in addition to the 7% carb food he already had for the morning.

Yesterday AM at +10, knowing I was leaving for over an hour, and I had to take his food away so he wouldn't have a food-influenced PMPS, I didn't give him 9% carb food, I just put a couple of Stella & Chewy's freeze dried raw nuggets on his 7% food, to get him to eat enough to tide him over, in case he was still dropping.

Last night when he hit 49 at PM +6, I did give him more of the 9% food, because I didn't want him to drop any lower and potentially cause a high bounce. Then at PM +8, I needed to get a couple of hours of sleep, so I gave him a little more of the 9% food to keep his numbers up since he may not have hit nadir yet (I didn't know if the 67 and 66 after the 49 were food influenced or if 49 would have been his nadir without any food intervention).

So I guess it's just going to be instinctive and based on whether I am going to be able to test in the near future when I see him dropping low. As well as trying to keep him around 50 to try and prevent bounces.

My fingers are really crossed about this!

Suze

 

[Pumbaa]

Carl, sometimes with Pumbaa I think a bounce has cleared, then he dives and bounces on the bounce. I'm very happy that that didn't happen this time!

I don't want Pumbaa to miss a well-earned reduction, either, but right now getting him to flatten out and not bounce/dive is my goal. I don't want to reduce his dose, have the reduction fail, and have him start bouncing again, if at all possible.

While 110 to 99 in 2 hours isn't a big drop, I just wanted to make sure Pumbaa ate his normal food before I pulled it. Hence, why I put some Stella & Chewy's on top to entice him to eat. (My cats are free-fed, so they always have food available.) And you know Pumbaa with his dives...you just never know when he's going to drop. :roll:

So what do you think about the times I gave him the 9% carbed food to steer him a bit? I think it worked, but who knows? Pumbaa might have gone up anyway just by eating his regular food.

So why do you recommend taking the full reduction when the time for a reduction is eminent, instead of reducing at a slower pace? What I'm thinking is that, if I reduce him gently, less chance of his failing, or going back to bouncing, etc.

Suze

 

[Pumbaa]

Thank you, Angela. Blackie is gorgeous, btw!

Suze

 

[Carl & Polly & Bob (GA)]

So why do you recommend taking the full reduction when the time for a reduction is eminent, instead of reducing at a slower pace? What I'm thinking is that, if I reduce him gently, less chance of his failing, or going back to bouncing, etc.

Two reasons -
1 - because this is the 2nd time he drops below 50 on this dose. Like he's trying to get your attention...
2 - because I don't believe drops more or less of insulin, when you are on a dose of 3u, make any difference at all. The .25u reduction would only be an 8% change in his dose. That really isn't that much difference. There's a host of other things that will make his numbers fluctuate on a cycle by cycle basis. I don't believe a drop or two of insulin does any more towards changing the numbers than a teaspoon more or less of food does. Syringes are far from perfect. I'd be willing to bet there's a drop or two difference in every shot you give him. None of the treatment (insulin, food, carbs, etc) that we do has anywhere close to that degree of precision. Not to mention the +/- 20% built into the meters.

Carl

 

[Pumbaa]

Carl: Valid reasons. I was curious on your take because there are others who do recommend going down in less than full .25U increments. I like to hear the reasoning from all sides.

Suze

 

[Dale 'n' Chip]

2 - because I don't believe drops more or less of insulin, when you are on a dose of 3u, make any difference at all. The .25u reduction would only be an 8% change in his dose. That really isn't that much difference. There's a host of other things that will make his numbers fluctuate on a cycle by cycle basis. I don't believe a drop or two of insulin does any more towards changing the numbers than a teaspoon more or less of food does. Syringes are far from perfect. I'd be willing to bet there's a drop or two difference in every shot you give him. None of the treatment (insulin, food, carbs, etc) that we do has anywhere close to that degree of precision. Not to mention the +/- 20% built into the meters.

Carl

I agree with most of those variables, but you better believe mere drops of Levemir make a difference in this range. In fact nudging up before breakthrough (with Levemir) may be a sure recipe for stagnation. So increases should be in decisive increments and in a timely manner.

But on the way down, once regulated, it may take sneaking down by drops to make the reductions hold.

So consistency of dose and accuracy of syringe and digital caliper become critical.

 

[Sienne and Gabby (GA)]

It can make sense to "skinny" or "fatten" a dose when you are close to a good dose or if you have a cat that isn't holding reductions of 0.25u. I adjust Gabby's doses in drop amounts. This is another one of those, "Know your cat." situations.

 

[Pumbaa]

Thank you, Chippendale's and Sienne, for the other side of the story.

Since I just want what is best for my Pumbaa, I need to keep an open mind and try to figure out what would be the best thing for him. Because of this conflicting information.

I'm not complaining that the advice/information is conflicting, because everyone giving the advice has their own hitory/take on these things. For valid reasons. What I need to be able to do is then assimilate this information, and merge it with how Pumbaa reacts to insulin, and make my own decisions, since I fill/hold the syringe. And I can only pray that I make the right decisions for my little guy. Right?

Suze

 

[Carl & Polly & Bob (GA)]

Right
And I will always defer to wisdom and first hand knowledge on Lantus or Lev. I may not agree 100%, but if we all agree on everything, then there's no reason for this site to exist. We could all just buy the book.

Carl

 

[Pumbaa]

We could all just buy the book.

This one? ;-)

 

[Blue]

Blue, 99 is beautiful! But Pumbaa was dropping and I was going to be gone from +10 until right before the PMPS, and didn't want to take the food away at +10 in case Pumbaa started dropping too low and went to eat like he instinctively does.

Also, Pumbaa is such a bouncer, someone had brought up trying to steer the lows up via food in order to prevent the bounces. I've been testing this today.

Suze

OK, 99 at +10 and you say the number is dropping? Did you test at +9 and have a much higher number? How do you know how much he is dropping? If you are going to be back at ps, then feeding at +10 will ensure that you get a food influenced number at ps, so it won't be of use for shooting.

If he has a late nadir, then the 99 is fine for +10, unless you are seeing large drops in this same cycle, and the % in the drops is not decreasing. Then you may want to feed but also know you may have disrupted the next ps.

ETA:
He was not dropping at +10; his +8 was lower, 83, so Pumbaa was leveled out, surfing and in a very decent zone, so he sure did not need food to be left during your absence till ps.
Hitting one 49 around nadir is not an indication to reduce his dose; if you want to see how firm ath 49 was, you could have done a retest and see what you got.
Reducing by a drop really DOES make a difference for some cats, but others are not sensitive at all to drops.... just go by your data on YOUR cat to know.

This dose of 3u is looking quite nice for Pumba; I have no idea what happened on the 9th though.
I'd say if it ain't broke, don't mess with it. Pumbaa is liking this dose with mostly blues and some few greens.

 

[Pumbaa]

OK, 99 at +10 and you say the number is dropping? Did you test at +9 and have a much higher number? How do you know how much he is dropping?

At +8 he was at 110. At +9 he was at 99, and, he has had PS nadirs in the past, which is why I tried to steer. The date in question is 12/10, not 12/11.

If you are going to be back at ps, then feeding at +10 will ensure that you get a food influenced number at ps, so it won't be of use for shooting.

Thank you, that is what I wanted to know.

If he has a late nadir, then the 99 is fine for +10, unless you are seeing large drops in this same cycle, and the % in the drops is not decreasing. Then you may want to feed but also know you may have disrupted the next ps.

Thank you, again, this was what my initial question was about.

ETA:
He was not dropping at +10; his +8 was lower, 83, so Pumbaa was leveled out, surfing and in a very decent zone, so he sure did not need food to be left during your absence till ps.

Wrong day...the data I was questioning was on 12/10. See above.

Hitting one 49 around nadir is not an indication to reduce his dose; if you want to see how firm ath 49 was, you could have done a retest and see what you got.
Reducing by a drop really DOES make a difference for some cats, but others are not sensitive at all to drops.... just go by your data on YOUR cat to know.

I totally agree about one 49 not being the indication to decrease the dose, when there are so many other things going on as well. I also agree about knowing our own cats and determining how they respond to the insulin and if they have failed at .25U dose decreases in the past, as Pumbaa has.

This dose of 3u is looking quite nice for Pumba; I have no idea what happened on the 9th though.

This is a nice dose for Pumbaa! What happened on the 9th is what Pumbaa is famous for, bouncing and diving. *sigh* That's why I'm trying to use food to prevent him from going to a low number that would cause a bounce, so that we can stop this bouncing/diving madness and get him flatter/more evened out.

I'd say if it ain't broke, don't mess with it. Pumbaa is liking this dose with mostly blues and some few greens.

To me, as long as he's still bouncing and diving, he's broken. If I can catch and steer his lows, via food, maybe I can prevent these highs, like his 342 today (12/12). I don't know what I missed before his 80 reading last night that would have caused this bounce today, but he didn't bounce like this from the 49 on 12/10, and I am hoping that that was because I fed him higher carbed food (9%) at the 49 to prevent him from going lower. I'm still testing this steering by feeding slightly higher carbed food.

Blue, I hope you're staying warm up there! I hear via friends and clients that the weather is quite frigid in your neck of the woods.

Suze