Hi Georgette:
Sorry I missed you yesterday but you had the following question in response to a post I made on Clare's 11/2 condo:
I would really like to use the approach you're suggesting: manage with food -- flatten Clare's curve -- adjust the dose.
How do I do that? I mean, in practical terms? I tend to be kind of dense with these things :roll: , so if you would tell me sort of step-by-step, and also tell me how best to communicate with you during the process if it's okay to do that, I would very much like to.
For example, is there anything that I should be doing now while Clare is bouncing? Or does the food management happen only during her active cycles?
First, you have to have lots of patience but don't we all learn that with FD? You want to be as consistent as you can with the food management and it might take time to see the results. And remember that ECID.....so Clare might or might not decide to play along
Second, you will want to keep track of what you fed when. If you look at Gracie's SS, you'll see I have a column for the food fed where I record the %, how much she got, and what time. This will help you see how Clare responds to foods. When we started, we were feeding 0-1% carbs but after getting some great info about managing the curve with food, we bumped it up so we feed 4-6/8% carbs routinely and use a higher carb for low numbers or fast drops. For Clare, maybe you feed 8% all of the time; it's an experiment so you'll have to play with it some and also the %. You might find 8% is too much and she does better with 5%. Dr. Lisa says there's not a consistent difference between the two because the way the pet food manufacturers mix their foods can result in variations.
Third, it takes experimentation to see what works for Clare. I'm not sure what your work schedule is but it looks like someone is home at least until +4. Here's what I would suggest:
--determine how many calories per day Clare needs based on her weight. If her weight has been steady, then this will be easy because you just need to calculate the calories in the amounts you've been feeding. If she's been gaining, then you will want to cut back a tiny bit remembering you don't want her to lose more than 1% of her body weight per week. If she needs to gain, you could add a few calories. To adjust the number of calories if she is gaining or losing, weigh her, feed the new amount for a week, weigh her at the end of the week and see where she is. When she's stable, then you know how many calories/day will maintain her weight. If she's already stable, then it's easier.
--once you know the calories/day which Clare needs to hold her weight steady, plan to feed half the calories in the a.m. cycle and half in the p.m. cycle.
--start with a simple feeding schedule....divide the number of calories for one cycle into four mini meals. You can start with the mini meals being equal and then see how it helps. For Gracie, because she liked to dive early on lantus, I fed her a larger portion at PS and +1 and then smaller portions at +2 and +3. You might find Clare does better with two portions at PS and then smaller portions at +1, +2, +3 or even PS and +2, +3, +4. This is the hardest part....figuring out the feeding schedule which will slow the drop in the morning so she stays higher overall. You can also plan to feed a minimeal shortly before nadir to allow that number to come up a bit. So perhaps the mini meals are at PS, +1, +2, +5. Again, it has to be tailored to Clare.
--Once Clare is flatter, and most likely she will be a bit higher, then raise the dose. So the goal is to get her much flatter and she might flatten in high blue, low yellow. But once she does and her patterns are more consistent, then you can raise the dose.
Theoretically it should work. Can I guarantee it will? No. I have seen it work in many cats; but I've also seen cats where it didn't work or it worked to a degree. But it's worth a try.
Please let me know if you have questions. I'm not on at night during the week as much because I'm trying to get a little more family time in as it is the only time Mike is home. So send me a PM (I've got it set up for them to notify me and mine works great), and then I'll pop on your condo.
