? 7/22 Leonard AMPS 206, PMPS 370, +3 283

Leonard’s trying to make me crazy- he’s just been bouncy for days. We did a curve yesterday with a nadir at +8 of 192. So, why does he keep bouncing? Is his pancreas trying to work and the liver is responding ? Is there anything we can do? LOL - Sorry for all the questions !

 

Hi Marie - Leo was bouncy most of his diabetic life - mostly due to Acro. But I've seen other bouncy cats, who also seem to bounce around without much pattern. There can be lots of reasons. Are you sure he is pretty stable with the amount of food he eats, and the feeding schedule?

 

Yes, we are very consistent with the amount and type of food. He gets fancy feast pate- no dry food. And Purebite treats at test time only. We have only been feeding him before insulin (as this is how our vet had instructed us to do at dx), but recently have tried to spread it out a little with a snack at bedtime (always 2 hours away from testing.) Could this small change be causing this? I have been considering a timed feeder to try and get him smaller, more frequent meals.

 

There really are no fixed rules for regular feeding except one. There should be no food for 2 hours prior to AMPS and PMPS - which you are doing. Kudos to you for testing and maintaining Leonard's chart.

Small changes could affect BG values during the day. Leonard's insulin dose is slowly creeping up. 3.0 units is a lot. Please make sure to continue weekend nadir tests, and PMPS+ tests. Those additional tests can be useful to measure dose effectiveness.

We had a big boy too - once. He was "Little Buddy" - 18 - 19 pounds. He went to the Rainbow Bridge in 2005. His purr was huge.

 

Leonard has been up to 4 units @ 2 different times in his diabetic journey. First time he went quickly into remission (for about a year) and the second time (back in January) he was flying down toward remission, but it didn’t stick this time. We learned to home test when we got a 51 @ the vet (on an Alphatrak). I knew we had to change our ways - no more fructosamine tests to “check “ his numbers. Any other ideas on why the bouncing? It started after this last dose increase...

 

I don't know why he is bouncing. It could be his body detecting some higher insulin and trying to adapt to it. Really, there can be many hypothese - which I've seen on the forum. Since you are doing consistent feeding and dosing, that is probably the best you can do.

Other conditions can push up BG - typically infections like tooth infections or UTI.

 

Thanks so much for your input !! If he keeps doing this we may need to see the vet just to make sure nothing else is going on. He had a dental and 5 extractions in (I think) April so I sure hope it’s not that !

 

Getting a 2nd (or 3rd) remission gets harder and harder each time

Is there any way you can get some mid-cycle tests during the day or do you work and it's impossible?

 

We work - and it takes 2 of us to test - which means Sunday is our mid cycle day !

 

Okay Marie, Leonard, I finally got to read the sheet, I'm not seeing anything like a 'bounce' here. A bounce would be numbers going low enough for the body to think "hypo" (below 60) followed by a glucagon release and a sudden appearance of a red or black number. Not seeing it.

What I'm seeing is this:
* 3.0 is a pretty good dose of Lantus, with preshot numbers in the yellow range. Could be better, but Leonard is obviously responding to the insulin and relatively consistently.
* You finally saw the numbers you wanted on June 21 and got all panicky and lowered your dose suddenly. Not a good idea in this case, and it threw Leonard off for over a week. If you see numbers mid-day like 78 which then come back up to normal pre-shots, that is precisely what you're aiming for. Hold your nerve and repeat hoping for the same again.
* Quarter-unit adjustments at most. That day you dropped from 3.0 to 2.5 was disastrous.
* Don't panic when you see a number in the dark greens. They're dark green because that's a good number.
* If you see a light green, and he's not acting weird, feed him some of his normal food and lower dose by at most a quarter unit and stay there.
* Consistency is key. Don't panic like June 21, just keep up the quarter unit rises till he shows greens again, and try to keep him there.
* Try to get to know his patterns to the point that you're confident shooting at lower and lower in the blues. Ideally you want him under 180 most of the day.

You'll probably end up moving slowly up to 3.5 over the next couple of weeks, and one day you'll see a reaction like you did June 21. If you see dark green, don't change the dose at all. If you see light green, lower by a quarter unit, but stay there, not changing dose for a while. Try to get to the point where you're seeing preshots between 150-199 and shooting normally.

 

So the current numbers we are seeing over the past week to 10 days (going from blues to bright pinks) aren’t considered a bounce ?

 

Nope. A bounce looks like a checkmark on the graph. Low, then suddenly high (over 450) over the course of an hour or two. And it happens once, not every day for a week.

I think you're seeing a bit more insulin resistance than you did on the 21st, when he was finally beginning to settle into a groove before you changed dose. Now he is more resistant and you'll need to gradually add quarter-units until he settles down again. Then stay there as I said, when he does.

You'll also need to watch his low-point as you did before, so when he starts to settle in again, you know when to lower dose gradually. (Quarter-units only please. No sudden changes.)