? 11/22 Snickers PMPS + 2

[Snickers and Chrissy]

Snickers PMPS was 176. I gave her .25 unit. Almost two hours later (like 1.5) I checked and it said 64. (Alpha Trak 2). I double checked and it said 84. I checked a third time and it said 89. I'm assuming the 64 was wrong then? How did it go from 64 to 88 and 89 in like a minute? Did I do something wrong? Can different parts of her ear give different readings?

Am I updating this thread correctly? Am I supposed to delete the first post then? I'm feeling a bit frustrated. Grrr. FYI, Snickers seems totally fine. She was getting slightly irritated I poked her ear a bunch of times in a row though.


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*Just an update in case anyone wonders. Snickers PMPS was 176, I gave her a dose of .25. I think her numbers today were pretty good. She did not dip into the light green danger zone at any point. I'll monitor her tonight and see how it continues to go

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Original Post

Hi, Snickers and I are still only on week 2 of this whole diabetes thing and trying to figure it out.

I read a lot of posts where people talk about bounce back and I searched the term on here and read more posts about it, and want to make sure I'm understanding correctly for Snickers' sake.

So if your BG numbers drop too low, then the next day they can bounce back and be too high? Is that the right idea or am I misunderstanding?

Last night Snickers dropped to 54 about 2 hours after her dose of .5 units. I gave her some more food (she only ate half at dinner time) and a few Temptations treats (I don't give them to her anymore but kept them in case she goes low, I thought they'd help).

This morning Snickers was at 210, which is high for her morning numbers. Actually, 210 is high for her at all it seems like. She doesn't usually get that high in the day, though granted I've only been checking her morning numbers consistently for a short while. I didn't realize I should check so often till I came here.

So is 54 to 210 a "bounce back?" Or is that because I gave her extra food last night? Or both? When a cat is bouncing, then it's best to keep them at the same dose or a lower dose, is that right?

I gave her .5 units last night and eyeballed .25 this morning. Just checked and her numbers are now 116. Wondering if I should have given her the .5. Thanks so much for any help!

 

[Figaro's Liz]

Bouncing is a hugely frustrating reality of working towards regulation for many cats including my Figaro who seems to constantly be bouncing.

If a cat's BG goes low--for them--they are often going to bounce as a result. A "low" in this case doesn't have to be 50, it may be that a cat who has been--for example--in the 300-400s but drops to 150 will bounce, because that 150 is low for them and their body is not used to such a low BG level. Their body/liver reacts by releasing stored glucose, apparently as a defense mechanism.

Bounces can last for as many as 6 cycles (3 days) but they can also be of shorter duration. ECID (Every cat is different!). In Figaro's case, a bounce usually is in the very high 200s, 300s, and maybe 400s, and identifiable by flat numbers (meaning, not much or any drop at nadir).

I am NOT a very experienced member but based on my limited knowledge, Snickers' current cycle does not look like bounce to me. 201 or even 210 is very close to 193, which was her PMPS last night. Taking into account that BG meters have a 20% variance in accuracy, those are virtually the same. And now she is surfing in greens, so you are not getting flatness to the cycle at all.

More experienced members will hopefully chime in too.

I just love that Snickers actually looks like a Snickers bar!

 

[Snickers and Chrissy]

Bouncing is a hugely frustrating reality of working towards regulation for many cats including my Figaro who seems to constantly be bouncing.

If a cat's BG goes low--for them--they are often going to bounce as a result. A "low" in this case doesn't have to be 50, it may be that a cat who has been--for example--in the 300-400s but drops to 150 will bounce, because that 150 is low for them and their body is not used to such a low BG level. Their body/liver reacts by releasing stored glucose, apparently as a defense mechanism.

Bounces can last for as many as 6 cycles (3 days) but they can also be of shorter duration. ECID (Every cat is different!). In Figaro's case, a bounce usually is in the very high 200s, 300s, and maybe 400s, and identifiable by flat numbers (meaning, not much or any drop at nadir).

I am NOT a very experienced member but based on my limited knowledge, Snickers' current cycle does not look like bounce to me. 201 or even 210 is very close to 193, which was her PMPS last night. Taking into account that BG meters have a 20% variance in accuracy, those are virtually the same. And now she is surfing in greens, so you are not getting flatness to the cycle at all.

More experienced members will hopefully chime in too.

I just love that Snickers actually looks like a Snickers bar!

Thanks so much for your post. And your Figaro is freaking adorable!

I think I'm getting it. So for it to be a bounce, the numbers have to be drastically different. Like a 200 point variance or something like that.

I'm a little confused about the flatness to a cycle though. So if the numbers don't drop at all during a cycle, that's bad? If they do drop, then that's good?

I understand there's supposed to be a curve (I'm still learning about that) but I guess I thought the less variance between numbers the better. Like if all the BG numbers were in green for the whole day, wouldn't that be good?

 

[Figaro's Liz]

Thanks so much for your post. And your Figaro is freaking adorable!

I think I'm getting it. So for it to be a bounce, the numbers have to be drastically different. Like a 200 point variance or something like that.

I'm a little confused about the flatness to a cycle though. So if the numbers don't drop at all during a cycle, that's bad? If they do drop, then that's good?

I understand there's supposed to be a curve (I'm still learning about that) but I guess I thought the less variance between numbers the better. Like if all the BG numbers were in green for the whole day, wouldn't that be good?

The numbers do not need to be drastically different to cause a bounce, necessarily, but drastic drops are one way a bounce can trigger. The 300/400 to 150 example I mentioned is just one example of many types of "low for a certain cat" numbers that could cause a bounce. Sorry if that was confusing. My point with that example was to say that a cat doesn't necessarily have to go below 50 (or 68 in the case of the alphatrak) to trigger a bounce.

To broadly say flatness is either good or bad is not really possible. You are right that all BGs in the greens for a whole day IS good--in fact that is what we are generally trying to get to with the TR protocol used on this forum.

However, numbers that are high and flat are not as desirable. They can be caused by bouncing, but I should say, they can also be caused by the insulin dose being too low. It doesn't look like you are having this problem (of high/flat numbers) with Snickers right now!

It's important to remember that we base dosing of Lantus on the nadir, the lowest point in a kitty's cycle, and not on preshot numbers which are generally going to be higher than nadir (and it can take a while to reach those flat green curves).

Once again--I am not super experienced so maybe another member will be able to elaborate better.

 

[Snickers and Chrissy]

The numbers do not need to be drastically different to cause a bounce, necessarily, but drastic drops are one way a bounce can trigger. The 300/400 to 150 example I mentioned is just one example of many types of "low for a certain cat" numbers that could cause a bounce. Sorry if that was confusing. My point with that example was to say that a cat doesn't necessarily have to go below 50 (or 68 in the case of the alphatrak) to trigger a bounce.

To broadly say flatness is either good or bad is not really possible. You are right that all BGs in the greens for a whole day IS good--in fact that is what we are generally trying to get to with the TR protocol used on this forum.

However, numbers that are high and flat are not as desirable. They can be caused by bouncing, but I should say, they can also be caused by the insulin dose being too low. It doesn't look like you are having this problem (of high/flat numbers) with Snickers right now!

It's important to remember that we base dosing of Lantus on the nadir, the lowest point in a kitty's cycle, and not on preshot numbers which are generally going to be higher than nadir (and it can take a while to reach those flat green curves).

Once again--I am not super experienced so maybe another member will be able to elaborate better.

Thanks so much, that all really helps. Even if you're not super experienced, you're still more experienced than me.

This probably sounds silly, but I wasn't actually thinking about it like I should be basing Snickers insulin on the nadir. I mean, I know it's bad if it goes too low and so I've been keeping an eye on that, but then when the numbers climb again I get worried if they go higher. Thank you so much for pointing this out about the nadir so that I can start thinking about it in those terms.

So it sounds like if the nadir is good and the numbers don't climb too, too high, things are good. Like if her nadir is 70 and the highest she gets is 200, I shouldn't go messing with her insulin dosage. There's so much info here. My vet is great but I know she doesn't know everything, so I'm trying to learn. Thanks for helping

 

[Figaro's Liz]

Thanks so much, that all really helps. Even if you're not super experienced, you're still more experienced than me.

This probably sounds silly, but I wasn't actually thinking about it like I should be basing Snickers insulin on the nadir. I mean, I know it's bad if it goes too low and so I've been keeping an eye on that, but then when the numbers climb again I get worried if they go higher. Thank you so much for pointing this out about the nadir so that I can start thinking about it in those terms.

So it sounds like if the nadir is good and the numbers don't climb too, too high, things are good. Like if her nadir is 70 and the highest she gets is 200, I shouldn't go messing with her insulin dosage. There's so much info here. My vet is great but I know she doesn't know everything, so I'm trying to learn. Thanks for helping

This forum saved my life when Figaro was diagnosed... it's so incredibly confusing and there is so much to learn! So I'm glad to be of some help, just want to be sure to express that I'm also still learning and I haven't gotten Figaro to remission, or even regulation yet.

Oh and it doesn't sound silly AT ALL!! Believe me... I know how much info there is to absorb, and a lot of it is counter-intuitive. You're doing the most important thing already with testing Snickers BG, to keep her safe (meaning, to keep her from going too low), and that's fantastic. Good job!

Have you had a chance to read the sticky on this forum about dosing methods, SLGS (Start-low-go-slow) and TR (Tight regulation)? I really strongly encourage you to pick a method because forum members will be able to help you much more once you have chosen one of those. It looks like you are able to test plenty for TR, and because Snickers' numbers look pretty good already, I would encourage you to try TR if you feel up for it. The TR protocol includes clear guidelines for how to decide when to decrease or increase the dose, and people here on the forum can help when questions come up.

Here is the link: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Snickers and Chrissy]

This forum saved my life when Figaro was diagnosed... it's so incredibly confusing and there is so much to learn! So I'm glad to be of some help, just want to be sure to express that I'm also still learning and I haven't gotten Figaro to remission, or even regulation yet.

Oh and it doesn't sound silly AT ALL!! Believe me... I know how much info there is to absorb, and a lot of it is counter-intuitive. You're doing the most important thing already with testing Snickers BG, to keep her safe (meaning, to keep her from going too low), and that's fantastic. Good job!

Have you had a chance to read the sticky on this forum about dosing methods, SLGS (Start-low-go-slow) and TR (Tight regulation)? I really strongly encourage you to pick a method because forum members will be able to help you much more once you have chosen one of those. It looks like you are able to test plenty for TR, and because Snickers' numbers look pretty good already, I would encourage you to try TR if you feel up for it. The TR protocol includes clear guidelines for how to decide when to decrease or increase the dose, and people here on the forum can help when questions come up.

Here is the link: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

Thanks so much. I did read through that sticky but found it a little confusing. However, that's probably because I'm still trying to process all this. I'll definitely read through it again and try to make more sense out of it and pick a plan. Thanks

 

[Figaro's Liz]

Thanks so much. I did read through that sticky but found it a little confusing. However, that's probably because I'm still trying to process all this. I'll definitely read through it again and try to make more sense out of it and pick a plan. Thanks

FWIW (for what it's worth!) I had to read those stickies probably 10 times! It's okay to be confused, we have all been there and understand. It will start to make sense--definitely post and ask questions!

 

[Snickers and Chrissy]

FWIW (for what it's worth!) I had to read those stickies probably 10 times! It's okay to be confused, we have all been there and understand. It will start to make sense--definitely post and ask questions!

Thanks so much!

 

[Gill & George]

Firstly here's a link to the last thread on the Lantus forum (we try to remember to include these on a new post so that it's easy to look back through history, both for you and anyone trying to help)
http://www.felinediabetes.com/FDMB/...with-low-i-think-numbers.221965/#post-2481247

and the other link yesterday on health

http://www.felinediabetes.com/FDMB/...hanksgiving-im-terrified.221974/#post-2480905

Wondering if I should have given her the .5. Thanks so much for any help!

Given that 54 with the AT, last night when you shot 0.5u.
You made a good choice trying the 0.25 this morning. (a drop below 68 on an AT is a reduction even on TR which is the more aggressive of our two dosing methods)
This is what Liz was getting at when she touched on

It's important to remember that we base dosing of Lantus on the nadir, the lowest point in a kitty's cycle, and not on preshot numbers which are generally going to be higher than nadir (and it can take a while to reach those flat green curves).

I agree with Liz, it doesn't look like Snickers bounced, but my reasoning is slightly different, because when we see a cat bounce they usually shoot up, and stay up for at least one cycle, and usually a maximum of 6.
So Had snickers stayed in the 200 region with all his numbers today then that would have looked like a bounce.
Snickers, however, came down as soon as the 0.25u, Lantus usually onsets around +2 . The 201 this morning was most likely due to the extra carbs pushing his BG up at the end of the cycle. The dry treats, can stay in their system for a little longer, and it is likely they kept his BG up right until the amps, once you shot and the insulin got working the BG dropped. With Soft food the carbs last for about 2hrs, but with dry it's longer (we haven't got a time for that.

As an example of a bounce have a look at Figaro's SS
Look at September 9, he dropped to green at PMPS, hung about there for a few hours, then shot up into yellows and pinks, no clear curve, stayed up there four 4 cycles, numbers bobbled, not clear curve, and on the 5th cycle, the bounce started to clear with the AMPS of 137 on september 12, the bounce went on to clear that morning dropping back into green early in the cycle. By PMPS on 9/12 he had started a new bounce.

I think I'm getting it. So for it to be a bounce, the numbers have to be drastically different. Like a 200 point variance or something like that.

Not necessarily, it's about the cycle not showing a distinct curve, and the cycle looking flat. The numbers may bobble about, but you don't see a gradual dip towards midcycle with a rise by PS.

Snickers, is very recently diagnosed, and with the food changes, history of steroids, and with the way she has/is responding to insulin, it may be prudent to be cautious with the dosing. Even if he happens to be high at pmps tonight I would not take the dose up. Hopefully he will be high enough to shoot, and I think it also prudent that you monitor very closely in the coming days, as you have been doing these last three days, we still don't know if the 0.25u will prove to be too much.

If you can get a few consecutive cycles on this 0.25u, it will give you a better idea of how she is doing with this dose.

I know you haven't picked a protocol yet, but regardless a drop below 68 on the AT is Snickers telling you that the dose is too high.


I will be in bed by the time it's your PMPS but do post for advice, you can change your thread title to get reflect the situation, perhaps get a +11 and ask for opinions then. That way you stand a better chance of keeping on schedule while you wait for responses.

 

[Snickers and Chrissy]

Than you so much for the info and advice! I really appreciate it.

I'll stay at the .25 for the next few days for see then and so what happens.

So I should link previous posts I create to new ones? Sorry, i will remember that for the future. I'll be checking Snickers soon and give an update later

 

[Figaro's Liz]

Than you so much for the info and advice! I really appreciate it.

I'll stay at the .25 for the next few days for see then and so what happens.

So I should link previous posts I create to new ones? Sorry, i will remember that for the future. I'll be checking Snickers soon and give an update later

Many people just drop the link to their previous post at the top of each new thread. We each try to only start one new thread in the Lantus group sub forum each day because there are lots of kitties to follow! It is helpful to title your daily post like this:
Date, cat name, BG#s or question.
For example...
11/22 Snickers AMPS 201 question about bouncing

And then throughout the day you can edit with new questions or BGs! This way people can follow Snickers daily progress.

 

[Snickers and Chrissy]

Many people just drop the link to their previous post at the top of each new thread. We each try to only start one new thread in the Lantus group sub forum each day because there are lots of kitties to follow! It is helpful to title your daily post like this:
Date, cat name, BG#s or question.
For example...
11/22 Snickers AMPS 201 question about bouncing

And then throughout the day you can edit with new questions or BGs! This way people can follow Snickers daily progress.

Ohhhhh. Okay. Got it. Thanks.