I'm stuck here. I shot low 12/25 but he didn't stay low. How would I have kept that run going?
You couldn't. His PMPS number was actually his nadir from the previous cycle.
I have an auto feeder. He gets fed 5-6 times a day. He was getting 2 oz at shot time but not eating it all so I reduced the amount. He gets 1.5 oz @ +3 but was leaving some of it. So reduced to 1 oz. Lately he hungry at +7 or 8. But I only give him 1 oz so he will eat for the PS.
If you're interested in learning to how to manipulate the curve with food you'll want to start as stated in the link I posted (for Lantus), "
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."
It's work and chances are you won't see immediate results. It's a process both on the learning end as well as for getting results.
You'll also want to learn/know Smokey's response to insulin:
- Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
- Peak/Nadir - the lowest point in the cycle
- Duration - the length of time insulin continues to lower blood glucose
We've also found that feeding after nadir will often slow down or even stop the action of the insulin. If Smokey has to eat after nadir, try to limit it to low carb snacks if it doesn't stress him out too much.
Long explanation short: The goal is to prop up the cycle by strategically timed mini-meals. Initially the cycles will run a bit higher, but that's what enables you to give a higher dose of insulin without the fear of kitty bottoming out.
Make sense?
ETA: Experienced & seasoned members offering advice in the Lantus and Levemir ISG should be very familiar with using food to manipulate the curve.
How would I maintain the run? Should I have given him a fat dose on 12/26?
Generally speaking, you'll want to dose consistently, so no, you wouldn't have wanted to offer a "fat" dose on the 26th.
Honestly, if I were in your shoes I would bite the bullet and follow the TR Protocol to the letter. Smokey is not as "different" as I've heard you say. With as much as you test I think he would definitely benefit from an aggressive approach. Just my opinion.
Starting Nov 20th, when he bounced high I gave him a bit of Novolin R to bring him down, while I continued to dose him with Lantus as uaual. That kind of short-circuited the bounces. A few weeks of that was enough to get his liver used to the lower numbers and to allow him to begin to heal. Check out his spreadsheet, the times I gave him R is in the comments. He went quite low a few times (remember I use the Relion when you see those numbers), but not from the R, those lows happened when the R was out of his system. They happened because he was getting better and needing less of the Lantus.
Using R at the beginning of a bounce is a good option for some cats. However, in this case, the increased risk may not even be necessary if Paula follows a more aggressive treatment plan. The verdict is still out on that one.
