? How to catch a bounce & what does one do?

I increased Mookie's insulin again, this time by 0.25U am and pm to see if maybe my more conservative increases were ineffective. It hasn't done anything. In fact, his numbers are looking worse. I'm pretty sure now that there is bouncing but I can't seem to catch when it happens & I don't know what to do about it.

I had a feeling that Mookie has dental infection/gingivitis. He has some redness of his gums and one tooth has a lot of plaque and look like there is a grey spot on it. I took him to the vet yesterday who confirmed a possibility of mild gingivitis and gave him a 10 day prescription of amoxacillin.

The vet also took his frucstosamine level, which was 741 (range 191 - 349) and suggested that I should increase his insulin to 2.5 units am and pm. He agreed to wait and see what happens with the antibiotics before increasing the dose. I know that fructosamine can't distinguish between high glucose due to diabetes and high glucose due to infection and other factors, so I am very hesitant to increase his dose so dramatically, especially since increasing his dosing over the past month hasn't done anything and he is in great shape.

If the antibiotics work and Mookie is in fact on too much insulin, I assume that the bouncing is going to continue and get more intense. What is the best way to track him over the next few days so that I can catch the bouncing? Is it possible for a cat to have a dramatic glucose drop within the first 1/2 hour to one hour of shooting? Or, it is more likely to happen later because Lantus doesn't kick in right away?

Considering his high BGs over the past month, Mookie isn't showing any normal diabetic signs. He is not excessively thirsty or hungry, his appetite is good and steady, his coat is nice and shiny, his weight is stable at 6.2kg, his energy is good and he only urinates x2 per day. He is also negative for keytones.

Any insight is appreciated!

Thanks

 

There is such a thing as New Dose Wonkiness. wait for the depot to build, six cycles, then decide what to do,with the dose.

I think you just need to do the next increase.

You've been on this dose for 6 consecutive cycles, you can do another increase by 0.25u next cycle.


It is possible in the first 1/2 hour as you ask, due to carryover from the last dose.
Lantus has a cumulative effect because of the depot.

 

Hi @cataphraz ,
may I ask what is the feeding schedule like ad if it consistent - the same every day, and do you feed the same day and night?
What does he eat - carbs wise?

 

His feeding schedule is very consistent - 9am and 9pm he eats 2oz (56g) of raw bison + 1/8 can of DM (for taste - I'm weaning him off of years of commercial food) + some dehydrated chicken treats (1% fiber). He doesn't eat anything in between his am and pm feedings.

The bison contains only 0.46% fiber and as far as I understand the DM contains 3% fiber.

 

Thank you for that info! Many cats do better if fed smaller meals throughout the day v. 2 large meals.
Oddly enough but some cats handle their curves better if fed a bit higher LC food v. raw/no or 0% carbs.
The raw bison you are currently feeding is (IMHO) one of the best nutrition wise choices. Commercial food is full of filler cats don't need. But, again, some do better eating crappy canned food around 5-10% carbs than they did when on raw or zero carbs. My girl Ducia is probably one of them.

But with the AB in the picture I think best approach is to let it a few days to start working - once the infection/ inflammation is out of th e picture - the numbers might go down - you'll see with routine testing and then will decide what to do with the dose. Once she is clear of infection and the overall numbers are going down - let her earn her reduction per method and take it from there.

If it were my cat I'd increase the dose by 0.25 like @rhiannon and shadow (GA) posted above however I am not sure if it ok to increase while starting the AB course. I'd do but ask around.

I'd rather think that if he has too much insulin his numbers will tell you when to reduce per your dosing method. Bounces can be triggered by many things - from first time spent in lower than usual numbers to dropping too many points in a short period of time and yes, etc. There are techniques to counteract bounces but I think letting time to clear the infection and to continue testing to catch that pesky bounce time is a way to proceed for now. I hope amoxi does the job but from what I have heard clyndomicin (spell?) works better on the tooth infection for some cats, at least. Amoxy (I think) is a wide spectrum AB, hopefully it works well for Mookie.

If I am wrong here please correct me, somebody!.

With my bouncy girl I found it extremely helpful to take the +2 test every cycle - often good predictor of the cycle to come. Preventing the fast drops by offering fresh food just prior to usual go low numbers time is one way to control bounces. There are other ways, too. But get rid of that infection 1st.

I hope it was helpful.
I hate bounces, everyone on here does..
On the positive: many ppl here deal with bounces so you are in the good company with extensive practical experience. We'll beat the beast sooner or later!

 

Here is a link to your previous post. We include those so people can easily follow back any history.

Your signatures says you are using SLGS, which would mean holding the dose for 7 days. However, you have done enough testing of late that you are getting a good picture of what this dose can do, and Mookie will likely need that increase. It would have been nice to get that before bed test in the PM cycle last night. He's bouncing today, and we can only guess why with no tests after PMPS yesterday. Bounces can be caused by steep drops, or numbers lower than they are used to. Some cats drop fast at onset, and giving a second meal with a few carbs before onset can help slow down steep drops (and reduce bounces, not eliminate them). I don't know if it's possible for you to spread out Mookie's food some. I fed Neko raw food, and I split it between her main meal and a couple smaller meals earlier in the cycle (+2 and +3). An autofeeder is a great tool if you aren't home to do that.

I actually fed Neko raw food with 3-5% carbs, depending on the protein. Many cats do better with some carbs vs. no carbs, some even better with slightly higher % low carb food. Here's a post on Feeding Zero/Low Carb vs. Lower Carb. Also ECID (each cat is different) in how carb sensitive they are. That's something you have to experiment and learn about Mookie.

Your subject line asks how to catch a bounce, and what to do. I've already talked about trying to slow fast drops. The second kind of bounce is when they see numbers that are lower than they are used to. The way to solve that is to eventually find a dose where they see enough normal numbers that they get used to them. Right now Mookie's body has forgotten how good those greens and blues feel. In the mean time, you will have to just endure the bounces. Some cats are just bouncy and there isn't much you can do about it other than increasing to that good dose.

I would get a dental as soon as you can afford it. Make sure you see a vet that does dental x-rays first. Cats with underlying infections like the teeth, will be much harder to regulate. The antibiotic may help. As Tanya mentioned above, clindamycin (Antirobe in Canada) is more specific to oral issues. If you do give an antibiotic, it's also a good idea to give a probiotic (at least two hours apart), as the AB can be hard on the tummy flora, resulting in diarrhea or some nausea.

 

I decided to do a 12 hour curve overnight last night because he was super high pre-bedtime at +2. Unfortunately, I set my alarm wrong and missed an hour at the end shifting the times of the readings but I think the information I managed to get was very interesting. He was in the red almost all night. At +4 he was 403 (heading downwards on the curve) - he was very lethargic, eyes were heavy - then he perked up 45 min later as I was falling asleep, with bright eyes running around - then at +6 he was at 410 (heading upwards on the curve). Could he have had a big drop between +4 and +6? Was this a possible symogi/bounce? I noticed he also had quite a significant drop Mar 10th +11 to Mar 11th AMPS - could his liver have reacted to that drop as well? Unfortunately, I didn't catch it and don't have the +1 for that day.

His numbers have gotten significantly worse as he is building insulin stores on 1.5 units x2 per day. Before I found this forum and the SLGS & TR protocols a month ago, it would take him a week to normalize on an increase dose, so I feel better following the SLGS than the TR protocol. He was better off on 1.25 x 2 per day - which had in fact brought him down to the blue zone (113) on Feb 28th when I panicked and didn't give him any insulin that evening, throwing everything off again. He's on the way down again at +11. I'll have the AMPS in about a 1/2 hour. I feel that I need to hold the dose at least another day. Also, I was reading elsewhere that the only way to control a symogi is to cut the dose by 50% or return to 1U x2 per day, which ever is lower. I'm very tempted to try this as giving more and more insulin does not seem to be making him any better.

Thoughts?

 

Good morning,
sorry about the Reds last night..but it seems that Mookie was going down by the +11 last night. Hopefully he'll keep that downward movement going.

somogyi was never proven in cats, not really even in people. Many vets mistakenly refer to bounces as Somogui effect but it is wrong. What I see in Mookie's SS is the cat who has something else going on, and that something is the infected tooth, most likely.

When one increases doses and sees no response a question about insulin resistance comes to mind. But think it is a bit early for Mookie to go that way. Some times too large of a dose acts as too small and in such instances a dose reduction is often recommended but I doubt that taking half of a dose at once is good idea.. But it is impossible to assess properly while he having tooth infection - it has to be addressed first.

IMHO, you need to give Amoxi a chance to do its job - a few days to make sure whether or not it helps the infection. If not, then I would, probably, ask for another, oral specific antibiotic instead and try it for another several days. (I'd probably would add probiotics, too).

Hopefully someone with greater experience will chime in later on.

Common Mookie, work that dose and give your mama bean a break!

 

Thanks His AMPS was 385 (same as +11) he usually increases by 54 after eating a meal so likely before he ate he decreased to approx 341 and is now on the way back up again.

 

I am no good at reading SS without blue numbers (or green) but I have a feeling that Mookie might be one of the cats who lowers later in the cycle - I have nothing to support the thought, it's just a feeling.

If I am right then I'd test him like that: preshot, then +2. If the +2 is much greater that the preshot was - put down the lancet until later in cycle - maybe take +6 or +7 and then +9 or +11. Good example from last night - I'd cancel the curve after the +2 and test much later again.
If the +2 is lower (I have not seen it in his SS though) do take the +4 and take from there. Lower than preshot +2 often means active cycle ahead.

I hope Amoxi helps and you'll see better numbers over the weekend.

It might be good idea to start a new thread for each day addressing current concern. The way the title reads now only people experienced with bouncing stop by but you can get many tips from others if you title it something dose and tooth infection related - great many CGs dealt with teeth and stubborn high numbers with various degree of success - you certainly will hear something useful.

 

Thank you! I'll try the test times you suggested