3/28 Squeaks; AMPS 99--need dosing advice

Good morning!

Squeaks has been on his reduced .1 dose for about 10 cycles now. As you can see, there are a lot more blues than greens. Nadirs are generally below 150. Given this information, should I increase back to .25 or should I hold the .1 a bit longer? I guess he isn't handling the reduction as well as I'd hoped.

Previous post for continuity:
https://www.felinediabetes.com/FDMB...s-112-8-47-dose-decrease.244876/#post-2762665

 

Hi!
I would sell my left kidney for an SS such as squeaks! But I hear what you are saying.... I don't have a lot of experience with such lovely SS, so I will tag
@tiffmaxee
@Sue and Luci

See if they can advise you.

 

Lol, totally get it @Hercule's mum! Compared to how this looks when we first started a little over a year ago, it's a huge improvement!! I still have some hope for remission, so just trying to get there (fingers crossed!) Thanks for tagging!

 

Fingers crossed you will!

 

It does look like you need to go back to 0.25U. You may need to "feed the curve" to prevent drops below 50 so that he can stay on the higher dose a little longer.
What % carbs do you feed?

 

I would increase too.

 

Thanks @tiffmaxee! @Bandit's Mom, interesting, I haven't heard that term before! His food ranges from 0%-5% on the norm. I do have some medium carb 8% food I use when he gives me a lower post PM shot number before bed. What you're saying is that I can use those 5% and 8% carb foods to help keep Squeaks on the .25 a little longer so the next reduction sticks?

 

if you need more info about "feeding the curve", here is a copy of a posy by jill& Alex:

what is meant by using food to manipulate the curve?
simply put, it's a method of feeding used to prevent kitty from dropping too fast and/or too low.
the amount of food usually fed to the cat is broken down into several mini-meals fed throughout the course of the day with the intention of flattening out the curve. lc is normally fed to all numbers except possibly in the case of a significant or fast drop or fed to a drop below 50.

the only time you might want to feed a little higher carb food at shot time is to bump the numbers up so the insulin is starting from a higher number when onset occurs if you're running out the door and will be unable to monitor.

if you're around to monitor, there's no reason to bump the numbers up at shot time. the beauty of lantus and levemir is being able to shoot low to stay low. shooting low is how you obtain the low flat curve with lantus and levemir.

whether you'd want to feed lc, mc, or hc to slow a drop depends on two things:
1. the carb sensitivity or lack of of your particular cat.
2. the point you're at in the cycle. a drop early in the cycle *may* require big guns. a drop at nadir (unless nadir is less than 40) or late in the cycle usually only requires lc to bump the numbers up. however, if you have a carb sensitive kitty, you may not have to use anything except lc to bump up the numbers. "KNOW THY CAT".

why would you want to manipulate the curve with food?
--- bouncers: kitties who drop low and then bounce to the moon benefit from food manipulation. using food to manipulate the curve will tend to flatten out the curve. flattening out the curve helps to prevent huge bounces.
--- carb sensitive kitties: kitties who experience large food spikes when consuming even lc benefit from manipulating the curve with food. strategically spacing out meal times will help flatten out the curve.

why do i want to use food to flatten out the curve ?
--- flattening out the curve allows you to get as much insulin into the cat as safely possible without having kitty bottom out on you.
--- flattening out the curve *usually* allows you to hang onto a dose longer
--- flattening out the curve allows you to shoot higher doses of insulin than you would have been able to otherwise.

why would i want to get as much insulin as possible into the cat?
lantus and levemir are known to have a harder time bringing down higher numbers. more insulin helps bring down the higher numbers in a bouncer's cycle. more insulin will help counteract the spikes in a food spiker. using food to manipulate the curve will flatten out the curve and help keep your kitty safe.


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.
Edited to add on 11/13/2015:
I was referring to manipulating the curve when using Lantus in the paragraph above.
Levemir typically has a later onset (usually around +4) and a later nadir. To accommodate the difference, when using Levemir one might start with dividing up the normal amount of food kitty should be eating into 8 mini-meals beginning at shot time, +3, +6, and +7 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.

a quote that goes along with this subject from Libby/Lucy found in one of Mocha's Lantus condos:

"carb manipulation is more about learning what your cat's response is to varying amounts of carbs at different times during the cycle, and using that information to your advantage. Learn how many points bump she gets from LC, MC, and HC, both early in the cycle and later in the cycle. Use that information to guide her cycles the way you want them to go. Mocha's AM and PM cycles are very different, so the best feeding times for her might not be the same in each cycle. Take the amount you would feed her over the 12 hour period, divide it into 3-4 meals, and experiment with when to feed them. Whatever changes you make, write them in your spreadsheet and hold it for at least 3-4 days to see if it is changing anything. Mocha drops later at night than she does during the day, so your food schedule might need to be different at night.

Many cats benefit from front-loading the cycle with food. That means feeding at PS, +1, +2, +3 (when the insulin is kicking in) and then NOT feeding after +6 (because for a carb sensitive cat, you would be adding food at the same time the insulin is wearing off, driving the numbers higher). The +9 snack is helpful for some cats when they are trying to go OTJ, because it can stimulate their pancreas. That is more useful if the cat is generally flat, but spikes up just before PS. I wouldn't worry about that yet, until you get to a lower dose."

experimenting is how YOU learn how YOUR cat responds not only to food, but to the insulin itself. no one feeding plan will affect two different cats in the exact same ways. experimenting, testing, recording your observations... these are the things which will help YOU with YOUR kitty because like you'll often hear around here...ECID. :mrgreen:



just a few thoughts...

 

Medium carb food depends on how carb sensitive a cat is. For some that’s 15%.

 

Thank you @Hercule's mum and @tiffmaxee--good info! I'll start to play around with his food and see what happens!