1/18 Webster - Update

Hi everyone. Sorry it's been a few days but I just wanted to check in and let you know how everything is going.

I had to shoot low for the second time this morning. I fed him a little of his LC, waited for him to rise and shot 30 mins late. So far so good!

I've had Webster on 1U for 8 days now and hes been peaking in the greens here lately and seems to bounce back up into the pinks.

The way that I'm interpreting his numbers is that the 1U seems to be just about perfect and the higher pinks that we are seeing are occurring only because he's bouncing. If I raise his dose, he might drop really low and then bounce really high. Perhaps leaving him at the 1u and waiting for his liver to simmer down might be the best course of action. What are your thoughts?

 

I think you've got a good grasp of things, mike. I'd hold the dose and let him work it. If some of the higher numbers don't start coming down in another week or so, I'd consider increasing the dose slightly while carbing him to keep him over 50 for a few cycles to see if that doesn't bring down the higher numbers. But with him currently having nadirs in the 50's/60's in between the bounces, that's pretty ideal.

When he hits green numbers, you might try giving him a couple of teaspoons of regular low carb to help him surf along. Perhaps you're already doing that.

The only thing i'd add is that it's probably not a good idea to fill in cells with color where there are no tests. That could give some false information - blood sugar doesn't stay constant for hours like this. Just having the test cells colored in is sufficient.

Great to see you & Webster!! and Kudos on shooting low this morning!

 

Good to hear from you Mike. I'm glad that Webster is doing so well.

 

Just a quick observation

It's tricky to feed and then assume that just because he comes up, it's OK to shoot....just feeding is going to bring his BG up, so you're not going to be sure if it was the food that caused him to rise or was the insulin actually wearing off

If you don't feed when you stall, and in 20-30 minutes his BG goes up, then you'll know that the insulin is starting to wear off and it's ok to go ahead and feed/shoot. This is what we suggest doing when you're concerned about a low Pre-shot number. Don't feed, retest in a little while to see if he's on his way up and then feed/shoot.

Of course any time you shoot a lower number, it's a good idea to plan on getting at least a +1 and +2 to see what they're going to do.

Nice to see some of those pretty green numbers Webster!! Keep it up!!

 

Hi Mike,
I agree with Julie. Keep the dose. Let's see what Webster does with it.

Enjoy the evening.

Ella & Rusty

 

Thanks Julie. I'm going to start putting out an additional 1/2 to 3/4 oz of food whenever he's hitting in the greens around nadirs to keep him surfing as you mentioned.

As for coloring in the blocks where no data was collected, I started doing this after seeing a few others who were also doing this. It seems to help me better visualize exactly whats going on when looking back at his SS. I do however see what you are talking about as far as giving false info. You do make a good point and I will most likely go back to not shading in other assumed boxes. Thanks for the input!

Let's let this dose ride a while and see what happens with a little bump in food when the time is appropriate.

 

Hi Mary. Good to hear from you too! Thank you!

 

Thank!

I wasn't 100% confident when it came to shooting that lower number this morning. I remember last time I fed him a little and then watched his number rise for over an hour before shooting.

I understand what you are saying as far as not feeding but what do you do if his number is still the same 30 mins later w/o food or even 1+ hours after food? What if his number is dropping? At what point would you feed?

 

Excellent. Will do. Thanks!

 

Hi Mike!

Just wanted to elaborate a bit on what Julie mentioned about upping the dose just a smidge and then holding the lowest numbers up to try to bring down some of those higher numbers. While Eddie has very recently flattened out, he was a rollercoaster kitty for almost a year before he settled down. For him, one thing that seemed to help with the bouncing was to get just a little bit more insulin in to pull the higher numbers down and flatten him out. That meant also propping up his lowest numbers. At one point, when I had a long weekend and could monitor closely, I slightly increased his dose, even though he was getting good nadirs in the 50's/60's. I did have to hold up his numbers, but being able to flatten him out in lower numbers for a couple consecutive cycles really seemed to make a big difference. I was only able to hold that increased dose for a few days, but it did seem to kickstart him a bit after that.

 

There's not really a cut and dried answer to this....A lot of it is knowing your cat and how they respond to food

USUALLY, they're going to head up sometime during that 30 min to an hour, but you're right that occasionally we'll see that if we don't go ahead and feed, they continue coming down.

The best thing I can say at this point is that if you get a low PS number that you're not comfortable shooting, stall, don't feed and while you're waiting for the retest, post and ask for help. There are lots of people here who can help you evaluate Websters spreadsheet for the recent few days and help advise you what best to do on that day

As you get more and more tests in, you'll learn better what Webster does...after awhile, most of us will shoot anything over 50, but only after we've had lots of time to learn how our cats respond

Make sure your subject line says something like "Stalling, need help" so the people monitoring the board know you're looking for eyes

@Marje and Gracie might be able to explain it better, so I've tagged her

 

Thanks for stopping by!

Could you further elaborate on how you propped up his low numbers? How long did you wait before feeding him extra and how much were you feeding him at a time? Were you using his usual carb food?

 

Being one that was not good at holding doses when we were new because Gracie was young and I wanted her in lower numbers and I didn't fully understand how the insulin works, I think if the nadirs are where you want them but he's bouncing, it's worthwhile to give him more time on a dose and see if the cumulative nature of lantus starts to trend the overall curve down a bit. Some cats are very slow responders. But if you see the nadirs trending up, it's time to increase the dose.

I've also done the method Jen is discussing. It really takes some commitment because you are basically overdosing the cat a bit and then keeping the numbers from dropping lower by feeding a higher low carb food....that's the goal, at least. You don't want to increase the dose so much that you have to prop up with HC all the time. Generally, you want to anticipate where they go lowest in the cycle and feed a higher low carb food before they get there; also feeding him extra of the higher low carb at that time can help. Occasionally, we have to throw in the higher carbs but you don't want to be propping up the numbers every single cycle with HC. So try a 10% food and a little extra of it.

On Chris's comment: the only time we would suggest a new member feed at shot time is if you test and get a 40 something number. The guidelines say if you get a 40 something at PS to not feed at the first 40s number but wait 15 mins, retest and if he's not coming up, give him a small amount of LC and retest a little later. The theory being that the LC is going to raise the BG enough to shoot but not so much that you would be shooting a food spike. One thing I do recommend to members is if the kitty is breaking a bounce and headed downhill so that by +10, you've got a lower number (e.g. 60s or so) and you know your cat's patterns well enough to know he's going to keep dropping, it's ok to feed some LC right before that +10.

Once you really know him and you feel comfortable with knowing what kind of food spikes he gets when, etc, then I don't think it's a big deal to feed a little LC between +10 and when you shoot if he is really coming down as long as the amount you feed is a very little LC. You want to know his patterns well enough to know he doesn't get much, if any food spike from a small amount of LC so you are shooting a realistic number. But if you don't understand that about your cat, it's best to not do it. "Why not" you ask? Well, if you don't know how much he spikes, consistently, and he comes up quite a bit from a little LC, you shoot, he onsets, and then he drops like a rocket and you are up all night.

The other thing that is very important is what he's doing coming into the +10 through PS timeframe. If he's flat as a board, I would not feed unless he's below 50 and then I'd follow the "Dealing with Low Preshots" post. If he's a flat 60, for instance, I'd shoot it, no food. Don't get in the habit of feeding a perfectly good, flat, surfing number because, with lantus, he's probably going to come up after you shoot and feed.

 

Hi Mike,

The amount and timing of the carbs really depends on the cat, and you have to just experiment to figure out what works. For Eddie, at that time, it would usually take medium carb (12-15%) to slow him down if he was dropping fast in the cycle. At that time, I relied heavily on the +2 tests, and sometimes the +1 test to try to anticipate a drop, and to give me a heads up when I needed to carb up. For example, for Eddie, if his previous cycle was flat, or if he was dropping all cycle long the previous cycle, that was a big heads up that he might drop fast and hard the following cycle. If his +1 had little or no food spike, that was a big red flag for me to add some carbs. If his +2 was lower than his pre-shot, that was another warning. If he was dropping really early in the cycle - like +2 or +3, I'd use higher carb. If it was later in the cycle, like around +5 or +6 and he was slowing down, I'd feed just a bit of his regular low carb food. The key seemed to be being able to anticipate the drop, and learning which patterns meant a drop was coming, and getting food in before the drop happened. I misjudged as often as I guessed right, but when I got it right, it did seem to help. To get an idea what I did with Eddie, I used this technique starting on 8/30 through 9/1, if you want to have a look at his SS. Feeding notes are all the way over on the right if you scroll over. I should add that I'd switched to the three-times-between 40 and 50 method of reductions at that point in time.

Edited to add: I cross-posted with Marje. She does a really good job of explaining this method.

 

Lots of great information. Thanks Marje!

 

Thank you all for the advice.

After listing to everyone, I'm going to leave Webster at the 1U dose for another week and start offering a little bit of LC food 1/2 hour to hour or so prior to his nadir to attempt to level him off and prevent these bounces.

If this method doesn't lessen the bounces and bring down preshot numbers, I'll up his dose slightly (0.125U) and feed him a little extra to prop him up.

 

I made a typo which I corrected in my post but is not corrected in the quote.

should read

Also, just to clarify, when I say:

The reference to not feeding applies to the two hours before the shot. Obviously, once you shoot, you want to feed.

 

I'll have to do some experimenting over the next few weeks to see how Webster responds. Very detailed SS by the way.

 

I noticed these typos last night but quickly figured out what you were trying to say. Thanks for coming back and clarifying anyway.

 

Sorry....my fingers got behind my brain