Opie, B.O.S, and the Smile Curve

Discussion in 'Prozinc / PZI' started by LovingOpie, Jun 24, 2023.

  1. LovingOpie

    LovingOpie Member

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    Here we go again with a new Thread, old link here. . . https://www.felinediabetes.com/FDMB/threads/opie-working-through-wonky.278668/
    I shot my first green, was awarded a B.O.S.award and we continue. . . there was the worry that shooting a low number BG would make Opie go low but he never even hit a nadir, just has continued to rise very slowly all night. The numbers are almost identical on each side of the AM nadir making a smile curve but instead of the smile going over the 12 hour cycle he has a long smile going over the 24 hours. I wonder if this is normal.
     
  2. LovingOpie

    LovingOpie Member

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    today he did a weird thing, I guess it would be a bounce but he went from pink to yellow, up and back all day. Pink, yellow, pink, yellow, . .
     
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  3. Shelley & Jess

    Shelley & Jess Member

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    Even though he crossed colours several times it's basically been a flat cycle taking meter variance in to account.

    Here's a quote I copied about meter variance from a Marje & Gracie post:

    "The 20% variance only applies to tests taken with a single meter. That means if you use Meter A and you take a test and then later take another with Meter A, there is an allowable 20% meter variation. That helps us tell whether the cat is actually flat or going up or down. If the numbers are within 20% of each other, they are, for all intents and purposes, the same number. The 20% meter variation does not apply to human meters of a different type."

    A lot of times, it’s not anything to really think about but when you are wondering if the BG is really flat or not, it’s something to consider."
     
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  4. Chrispooky12

    Chrispooky12 Well-Known Member

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    Panzer is bouncing to just into the yellows though...cats:banghead:
     
  5. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Yes. This is a flat bounce cycle today when we consider meter variance. It’s better than bouncing into red though.
     
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  6. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    He probably will come down soon.
     
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  7. LovingOpie

    LovingOpie Member

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    thanks for that info! I was calling it a wobble. . .
     
  8. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I’m hoping that since he hasn’t bounced as hard (as high) as he sometimes has, that he will be back to work in better numbers soon.
     
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  9. LovingOpie

    LovingOpie Member

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    So when the numbers stay flat like he did today it is a bounce? Does it happen for the same reason then?
     
  10. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Yay! I see he’s back in blue tonight. I thought so.

    To answer your question: It still is a bounce because, for the duration of the bounce, he has the stored form of glucose and counterregulatory hormones working against the insulin — and that makes him temporarily insulin resistant. So his numbers don’t go down like we would expect them to during the cycle. Happily, tonight he’s already back in blue.
     
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  11. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Opie really went for it last night. I don’t see anything in the notes about what fed him and when. How did you manage it?
     
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  12. LovingOpie

    LovingOpie Member

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    I did not feed as I wanted to know if he would go below 50 which he might have done before the +4 time. When the numbers came up a bit and at the +6, I fed him 1/2 can of LC FF. I did wonder if we should decrease but opted to see what will happen yet. I could not post or add to the SS overnight as there was a storm and I had no internet. Then my computer froze up until this morning when I got it to go again. This is why I am glad we can text but I am feeling more confident that I know what to do now.
     
  13. LovingOpie

    LovingOpie Member

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    Thanks. This is exactly the kind of information I like, it helps me to understand what he is doing and why. :)
     
  14. LovingOpie

    LovingOpie Member

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    After last night I was certain that we would see a long bounce, so I wasn't surprised when we started out in pink. I can't believe it, but he went down to blue at +3. When the numbers go down it is a great thing but a lot of work, when the numbers are high we get to rest. . . the life of a CG.
     
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  15. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    You got it!! Congrats on earning that coveted BOS. You are doing great with him, Julie!!!
     
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  16. LovingOpie

    LovingOpie Member

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    Well Opie earned a decrease. . . just went down to 30 at +3, fed teaspoon MC Friskies extra gravy 15% and gave Karo. Half hour later he went to 51.
     
  17. Shelley & Jess

    Shelley & Jess Member

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    Just popped in for a sec, so quick response - Keep a close eye on him please & keep testing every 30 minutes, the quick bump was probably from the Karo, but it'll wear off quick & don't know if MC will be enough to keep him up - you're still really early in the cycle & insulin still working and he could drop again.
     
  18. LovingOpie

    LovingOpie Member

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    Yes, I am worried about him going down again, there is a long time til nadir at +6. I also think about the 20% meter fluctuation and wonder if that means he could be that much lower?
    Thanks for popping in. . . :bighug:
     
  19. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Yep, you know the drill. Keep testing every 30 minutes. A full two hours after HC wears off is the safe way.
     
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  20. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    So 1.5 units tonight is the new dose. He will surely bounce from this as well.
     
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  21. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    If he were much lower than 30 you would be seeing symptoms -- how is he acting?
     
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  22. LovingOpie

    LovingOpie Member

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    he seems normal and going up very slowly
     
  23. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Congrats on the dose reduction!!!

    One thing you don’t have is any +2 data. While PZ is not the depot insulins, onset is still about the same and you should be able to get some good info about how the cycle might stack up. On the days he’s not bouncing, he’s well into onset by +3 which tells me he is onsetting around +2. What does that do for you, you ask? If you see him onsetting quickly, you can potentially ward off those steep drops which then result in a bounce. The bigger the drop, the more likely he is to bounce. The goal is to get that BG to come down more steadily and you can do it by checking a little earlier and feeding a little appropriate food to try and flatten the curve a little more. There is a real science to this but also an art since it varies from cat to cat.

    If you can change that first test time to +2, then we can see what he’s doing and I can make some other suggestions as to how to help that curve get a little flatter at the beginning.
     
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  24. LovingOpie

    LovingOpie Member

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    I will try to get some data for you. I am aware of feeding at that time to slow down the insulin and avoid a steep drop which makes a bounce so I do try to feed him a lot at that time especially. What is a depot insulin and what is depot exactly?
     
  25. LovingOpie

    LovingOpie Member

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    What a crazy day. Opie went down to 30 and bounced up to 371 at PMPS. That must be very hard for him. I did lower the dose but I know that it will take a long time for the bounce to clear after today, unless I get very lucky. He does eat well when he is high. Those Pure Bites were a great thing but now he won't eat without topping it and he licks that off and expects more on top. He doesn't actually get down into the real food underneath. I am trying to get him to eat without it now. Yesterday we sat and stared at each other, a bowl of food in front of him. Of course, after a long while who do you think caved in? yep, me
     
  26. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    You did say he can be very stubborn about food. First thing I did was ask you today about snacks before the 30, after you said he went to 30, and you said he had eaten a whole can of Fancy Feast. So I assume that was at the +2 (or +1)? We have talked a lot about those snacks. But yeah, the +2, if we knew where he was at that time then perhaps you could have given the MC before at +2 to prevent the 30 from happening.
     
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  27. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I would suggest if you don’t know what the drop is, you can’t feed the correct food in the correct amount. If you look at a bounce clearing cycle, for example, with AMPS of 320 and +2 of 116, that’s a huge drop. Feeding more of a 6% carb food “might” work but it might take more like a 10% carb food. If you don’t know what the +2 is, you might feed a large amount of fairly LC food but it won’t be enough, likely, to slow that train down. If my Gracie was going to clear a bounce, I’d test even at +1 and start slowing her down from there and it might take as much as 13% carbs to get her to flatten out and then come down more slowly.

    As an oversimplification. A depot insulin like Lantus or Levemir or their biosimilars (and while they are both depot insulins, the manner in which the depot is formed is different) are slow release and one shot builds upon the previous so you get a cumulative effect over time. PZ is pretty much an “in and out” insulin. If you would like a more detailed explanation, you can read it here.

    While PZ is a good insulin, the depot insulins (which are human insulins but work great in cats) are the gold standard. They are not nearly as harsh as insulins like Caninsulin, Vetsulin, Humulin/Normalin. You can get a really nice overlap from one cycle to the next in a really well regulated cat.
     
    Last edited: Jun 26, 2023
  28. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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  29. LovingOpie

    LovingOpie Member

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    The bounce did not last too long and he went down all day to 131, 138 at PMPS so it is sure to be a watchful night.
     
  30. LovingOpie

    LovingOpie Member

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    After a nice cycle of mostly blue, Opie bounced even higher into red, went only into yellow briefly and is now pink and on his way to red again for PMPS. Ugh . . . at first I thought it was due to feeding him that HC food last night but I see that it is a bounce and a good one. . .
     
  31. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I am thinking he may make a move tonight. I think maybe the MC when he was in the 80s last night might have been too much, but you know, it was night time, and I understand. And he did pretty well until the bounce began and you could not stop it. But yes, he could make a move to go lower tonight.
     
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  32. LovingOpie

    LovingOpie Member

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    You might be right but I doubt real low, though he just hit blue. You will have to explain why it was too much and not right to give MC when I wanted to slow him down from goin under 50. What makes the difference when I am supposed to use MC in the AM to slow down the drop if dropping too fast? I guess I don't understand the fine points of using food.
     
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  33. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Wow Opie. When will you come down?
     
  34. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    About the food question the other day — the MC question. I don’t think it “wasn’t right” but I was just saying that I don’t think I would have used MC when he was in the 80s because it is overkill. I would have tried spoonsful of LC to see if it would help him surf in green. Of course, if the LC didn’t help him surf then I would have switched to MC as he approached 50. He got a really big spike into blue from the MC so it is easy for me to look back and now say it was overkill, right? It’s my Monday Morning Quarterbacking! At the time you had to make the call and went with MC (it was also night time and your ability to stay up needed to be taken into consideration.) So now we know that Opie gets a really good spike out of MC we can use that information in the future if you really need to bring him up. OBTW, I have named one of the adorable orange kittens that were dumped in Opie’s honor!
     
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  35. LovingOpie

    LovingOpie Member

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    Opie will be very honored and an orange one besides! As to food, I think he is super sensitive to carbs so I keep him mostly 5% or less. To me, HC is 14-15% at least that is what I see so far. As for today, he just hit yellow so I am keeping my fingers crossed that he will go down from here and call it an end to the bounce.
     
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  36. LovingOpie

    LovingOpie Member

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    After 2 cycles of blue yesterday we are again back to pink with a bit of yellow thrown in. Tonight is the 11th cycle with the 1.5 dose. We seem in a holding pattern. It gets rather repetitive doesn't it?
     
  37. Chrispooky12

    Chrispooky12 Well-Known Member

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    I feel your pain right when I get ready to increase Panzer he throws me some greens :arghh: cats!
     
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  38. LovingOpie

    LovingOpie Member

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    :) yes, sometimes I think it is a form of play. . .
     
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  39. LovingOpie

    LovingOpie Member

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    Opie is in a holding pattern, right now third cycle of bouncing. He comes out of a bounce, goes to blue and then bounces again. It just doesn't seem to change. I guess I won't know if this dose is good until he comes out of the bounce long enough to see a real nadir?
     
  40. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Hi Julie

    What Opie is doing is not uncommon. Many diabetic cats will go up and down around a dose until they finally settle into it and earn a reduction.

    He looks to me like he needs a dose increase back to 1.75u but I’d wait and see what he does tonight and if he doesn’t see a nice bit of green (more than just dipping his toes in), I’d suggest raising the dose in the morning.

    The other thing you can do when you get him to 1.75u is to not reduce him until you see him go below 40 one time or if you see him go between 40-50 on a few consecutive days. This might indicate he’s about ready for a decrease. Lastly, if you have a cycle where he hasn’t dropped below 40 but you are working hard to keep him from doing so, you will want to decrease the dose back to 1.5u. As we discussed, those +2 tests are important since that is when onset occurs and you can, hopefully, catch the drop before it goes too low. I would even go one step further and if he starts to clear a bounce in a previous cycle and then you get a low bluish number at PS, I’d even test at +1 that cycle.
     
  41. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I agree with this. On his current dose he has seen blue nadirs for the most part and I would increase back up to 1.75 and definitely get the really early tests in at +2 (and possibly also the +1 as Marje suggests) in order to head off the lows like the 30 he had at +3 before on 1.75 units. Hopefully increasing the dose back up to 1.75 will allow him to spend more time in lower numbers and get used to them. You can experiment with carbs to see about keeping him from dropping below 50 in order to allow him to spend more time at the 1.75 dose.
     
  42. LovingOpie

    LovingOpie Member

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    This is wonderful information. I will definitely do as you suggest.
     
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  43. LovingOpie

    LovingOpie Member

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    Thank you. I understand now that the idea is to keep him at as high a dose as works to keep him in the lower numbers for longer periods of time so that his body gets used to it. When the body gets accustomed it is possible to decrease, at least, hopefully.
     
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  44. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Safely :):)
     
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  45. LovingOpie

    LovingOpie Member

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    So I increased the dose and tested after the +1 where he was pink, at +3 he went to yellow. I fed him a lot throughout but LC as usual because he was still high. When I tested him at +6 he dropped to 77. This is the time of day when I am not supposed to feed him until PMPS. My question is do I wait until he drops to 50 to give a MC food or do I feed him now since he tends to keep dropping all the way to PMPS? I am guessing that I wait with food and just keep testing. . .
     
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  46. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I would not feed him yet. Look at June 30. He didn’t keep dropping. And June 21 and June 26. He seems to start going up after +6 on many days (trying to pick out days where we can see a real nadir because he’s not in a bounce.)
     
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  47. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    So I would wait and see if he continues to drop and get a +7
     
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  48. LovingOpie

    LovingOpie Member

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    Well I did wonder if he would start to go up but he doesn't always do that so it was a difficult decision to make.
     
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  49. LovingOpie

    LovingOpie Member

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    exactly what I was thinking. . . just wanted back up. Thanks
     
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  50. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    And I wouldn’t stress too much about the +6 feeding. If you find that is about when he nadirs (and I think he usually does) go ahead with an LC snack at +6. Really it’s still not too late to do an LC snack since, unless I am miscalculating, his +6 was only 25 minutes ago. So you aren’t going to ruin anything. A little LC when they’re in green can help them surf. And the suggestion is not to feed much after nadir so that’s approximately after +6. So it’s a guideline/suggestion and not a hard and fast rule where if you give him a little LC at a little past +6 the whole cycle would be spoiled. You would not spoil anything.
     
  51. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Sometimes he has drifted down toward PMPS. But as I said above, you can use your best judgment.
     
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  52. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    A good example of what you were talking about would be June 23 where he appears to have been breaking a bounce and he did drift (safely) down after +6 (actually was pretty flat-ish when considering meter variance) on that day. And today he also seems to have broken a bounce so he may do the same thing. With you monitoring him, though, I am not worried for his safety.
     
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  53. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    That day (June 23) his recorded nadir was at +10.
     
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  54. LovingOpie

    LovingOpie Member

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    So let me get this straight. . . it is still ok to give him a little LC food right at the nadir +6 after testing?
     
  55. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Yes. The goal is to just give him a little LC food so you can try and keep him level in those greens. This is a good test because if he shoots up, we will know that might not be the best strategy but we won’t know without trying. Even if it is well past that point now, I’d test and if he’s not flat or headed back up a bit, give him a small amount of LC.

    edited to add: just looking at his SS, I see he’s up to 124. Did you feed him after the 70? The Remarks. Column is a great place to list his feeding which helps us immensely. If you look at Gracie’s SS, you’ll see how how kept track of her feeding which is really important for managing the curve with food.

    Great job getting that +1.5 test.

    Also…..for those reading and following along, when I suggested Julie only reduce him if he drops below 40 once or between 40-50 on a few consecutive days. This was recommended because Opie is a long-term diabetic and it’s in accordance with suggestions in the MPM which Julie is following.
     
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  56. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I would say so, yes. Don’t we say not to feed AFTER nadir? Not at nadir? I would of course keep it to a teaspoon or two of LC. Unless you have a cat who jumps up really high from LC. Some cats do — so every cat is different. We soon would be able to tell if a tsp. Of LC at +6 caused Opie to jump up. Today, where you didn’t feed anything at +6 and then he went to blue at +7 we know it wasn’t the food. You didn’t cause the rise to blue with food. I guess I am just saying that if you feel he needs an LC spoon at +6 then it’s fine to give it. If you feel he doesn’t need it, that’s fine too. Of course if he’s low enough that there’s a need to feed him to bring his BG up, then it doesn’t matter what hour it is - just do it (I am writing that more for anyone reading and not for you because you already know this.)
     
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  57. LovingOpie

    LovingOpie Member

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    So I fed up to the +6 test and right at the test time but not after. Decided to wait for one hour and retested at the +7 to find that he already went up quite a bit. It appears that he is again bouncing because he is pink at +9 and probably still going. . . .
     
  58. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    So that is loss of duration primarily, in a huge way. He might also bounce but to go up that fast is definitely loss of duration. It’s possible (likely) the food clipped his duration which means he “might” be carb sensitive. Please be sure you record this so you can see exactly what you fed at what time and the results.
     
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  59. LovingOpie

    LovingOpie Member

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    I always feel that he is very sensitive to carbs, that is why I only feed him 3% or less. I do keep record of feeding but on paper and not on the SS. I also don't record what type meaning shrimp or chicken etc. and it is loosely done meaning approximate per half hour etc. He eats a lot of times in those hours I have allotted and it is difficult to keep exact track of it all because I don't always have the time to go and write it down. I guess I will have to try harder and do better. Should I try zero carb? and is zero carb something I can give him even after nadir?

    another thing. . . could it be the amount of food per time? would that matter? 1/2 can, whole can?
     
  60. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    It doesn’t matter what type, really. Just the % carbs, how much, & at what + time. I wouldn’t suggest trying 0% carbs but I would try to frontload the cycle so if you need anything at all at nadir or after to bring him up, it’s just a tsp.
     
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  61. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Boing! Just looked to see what’s going on with Opie.
     
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  62. LovingOpie

    LovingOpie Member

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