Re: 1/31 Mookie AMPS 284
Hi Randa:
I'm going to try and post this again before I go to work so you have the day to think about it and others can chime in if they like.
The goal in food management is to flatten the curve:
manage the curve with food ----> flatten the curve----> adjust the dose
One of the best ways to do this is to use a feeding schedule but since ECID, you will have to experiment a bit with it. Many feed on a schedule of PS, +1, +2, +3. Gracie was a diver then bouncer and I started this schedule with her and it helped her but I was taking her allotment of food and spreading it evenly between those feedings. But she liked to onset fast between +2 and +3 so I really started frontloading her. She is a tiny cat and gets 1.3 oz per cycle so I fed her .5 oz at PS and +1 and then .15 oz at +2 and +3....that way she had a good foundation of food on board for when the insulin onset. You want to figure out how many calories Mookie should have and then give 1/2 of those in the am cycle and half in the pm cycle. It's trial and error but see if you can give him a good part of the portions at PS and +1 and then the remainder at +2 and +3. Some beans find they have to move to a PS, +2, +3, +4 feeding...again, trial and error. You can give a small, boiled chicken breast snack at +5 so Mookie won't be hungry later in the cycle. And, finally, you don't want to feed at or after the nadir if you can avoid it as it slows the peak action of the insulin down. Before FD, Gracie was fed small amounts all day but she acclimated quickly to her new schedule so Mookie can
Sienne started this kind of food mgmt with Gabby in April, 2010; it took several months for her to start showing the progress and Sienne has continued to tweak it so take a look at Gabby's SS. Gracie actually didn't take so long to start responding so just remember...ECID. I was not able to get Gracie's curve as flat as I wanted with lantus so I changed her to lev and she's done much better.
The other very important thing to do is make it your goal to get a +2 for as many cycles as you can. The +2 should be about the same as the PS. If it's not, then you should be prepared for an active cycle. In this situation, you might actually want to feed a little higher %carbs to flatten the cycle. Let's look at Mookie's pm cycle on 1/16. His PS is 319 and his +2 is 254....that would have thrown a red flag up to me and I would have done one of two things at the +2: (1) retested in 30 mintues to see how fast he was dropping and then fed a higher %carb if he was coming down faster OR (2) just fed a higher % carb. He took another big drop by +4 and another one at +6. I see in your notes that you gave him .75 oz of 4% at +4 but it didn't slow him.
I also use WN 4% varieties for Gracie's regular meals unless she is coming down fast. Then I switch to WN chicken/herring (6%) or turkey/salmon (6%), WN salmon/trout (8%), or I also have some 10% (Pet Guard Savory Seafood or Halo's Spot Stew's Wholesome Turkey). If she's coming down really fast from clearing a bounce, I give her the 10%. You'll have to experiment with Mookie to see which food slows him down and flattens the curve. Gabby has a problem with the glutens in gravy and so Sienne gives her a drop of honey early on in the cycle....she has it marked in her remarks as "HC" and when she gave it to her. We've also been working with Barb to control Checker's early drops so look at his SS, too.
The result of controlling the curve with food is usually that the mid-cycle number comes up as the curve flattens. It's at this point that you have to decide whether to raise the dose while trying to still keep the curve flat. Food management becomes an art and a science
And even though you think you might have it figured out, sometimes they throw you a curve ball. But the basic premise is that it lets you get more insulin into the kitty as the kitty flattens out.
If you look at Gracie's cycle last night, Mike did a nice job of keeping her relatively flat. She's on levemir and tends to nadir at about +14-+15 as she has great carryover most of the time. So we know her big drop time is going to be after PS. Then she usually goes up a bit after +3 and then onsets about +6 or +7 which is another time she drops low. Last night she decided to bounce a bit from the 40 yesterday.
One last thing is that sometimes you end up feeding a little more to control the curve. If I know Gracie is going to have an active cycle, I try to lower her portions where I can (she now gets fed at PS, +2, +4, +5 with a snack at +3) to balance where I know I'll have to add food later in the cycle. Sometimes she takes a little more than I had anticipated....again, it's a balancing act you have to figure out for Mookie as we don't want them to gain too much weight. But you want to try and just feed his same amount of food but do it at times that controls the curve. He may need higher or lower carbs to control his curve than Gracie does....you'll have to see how carb sensitive he is.
I hope this helps...please feel free to ask questions. I am going to work but will check back in later tonight. Have a great day!!!
