Lantus and nadirs

So I think in all of this, the thing that is bugging me the most is not feeling like I am able to pinpoint Boots' nadir. Lots of days, it seems to fall in line with the "norm" for Lantus of somewhere between +4 to +6. But there have been a ton of days (including today) when the lowest reading we get is the PMPS. Or if that's not THE lowest of the day, it's really close to the lowest reading.

Is that pretty normal? I feel like somewhere I read that it's not uncommon for Lantus to almost have two bumps to a cycle - shot then drop then back up a little then drop again before the end of the cycle, or maybe even drop again then come back up a little again by +11.

Since so much Lantus dosing is based on the nadir, I guess it shouldn't matter if the lowest reading of the day was at +5 or PMPS... whichever is lowest, that's what I should base my dose on, right? Even though the PMPS is technically +0 of the next cycle? I guess it is also at the same time +12 of the prior cycle, though.

Also just curious in general why that happens, I guess. Anyone have any insight?

 

It doesn't matter when the nadir is, although if it's not somewhere between about +3 and +8, I'd be wondering if it was a cycle that was being ruled by a bounce, rather than a "normal" cycle.

Bounces overrule the normal cycle.

And yes, some cats have what is called a "double dip" with Lantus. They drop a little after +10 or so, but it's not lower than the nadir was earlier. If it's lower than the earlier nadir, then it's probably not a double dip, just a nadir.

Not sure if that all makes sense, but I wouldn't worry too much about it. I'd just look for the lows. I think part of the reason you're confused is that Boots is mostly flat at the moment without too much movement in his cycles. Which is great - so enjoy it!

 

When Neko was on Lantus, I spotted her nadir at anywhere from +3.5 to +13. Typically it would be later if it was a bounce breaking cycle. If she was looking for a reduction and starting lower, the nadir would be earlier. After a while I could guess roughly where her nadir would be, based on the preshot and +3 test. You do the best you can with spot checks. You don't need to be precise about picking the nadir, just know the range it's in. If the dose can get them in the normal number range, then it's a good dose. Fortunately, Boots seems to be fairly flat with his cycles.

 

You both mentioned that he's pretty flat (at least lately), which I definitely acknowledge is good, and I pray it stays that way. Is that common? I find it crazy, some of the SSs I've looked at have these kitties jumping around all day by hundreds of points in some cases - red to blue to green to black in one day! Is it known what causes some cats to be flat, and others to react wildly like that? Is it insulin-specific? Duration of illness? Or just luck of the draw?

The other thing you both mention is bouncing. I've seen that term all over but don't know that I quite understand all that it means. Could someone be so kind as to explain it to me? (and bear in mind, I'm not the brightest bulb )

 

I think the issue is more that you've got some very lovely, flat cycles. The difference between your +5 (166) and PMPS (146) is negligible. Remember, there's a 20 point variance due to the meter. I think you're trying to over interpret the numbers.

 

Me? Overthinking something? Has never happened...

 

The second post here is a good description of bouncing. Lots of newly diagnosed cats will bounce. Some certain black and white cats still like to bounce, though not as badly as she used to.

 

Wow! That is a great explanation of a bounce! Totally makes sense. Thanks, @Wendy&Neko , @julie & punkin (ga) , and most of all, you overreacting Mr. Liver!

 

glad you liked it. It really did take me forever to spot a bounce - i'd thought that when a cat was high, he was solid high - like 400-400-400. When I learned that the cat can bobble around while high - say from 250-400-300-275-440, then it became easier to spot them.

Boots isn't bouncing, but it's good to understand the concept.

 

I was just looking back over Boots' sheet. It'd be hard to spot anything in the PM cycle since readings are few, but I don't see any days jumping out as bouncing, now that I understand. No big jumps that can't be explained by food or the Dawn Phenomenon. I may be counting on you guys to help me spot one if he does get bouncy some day.

 

Bouncing is caused by either the cat getting into a range they aren't used to, or a cat's blood sugar dropping too fast. As a cat spends more time in normal numbers, their liver will stop reacting to it - ideally. Some cats just seem to be bouncier than others. The "cure" for bouncing is to get the cat's blood sugar into normal range as quickly as possible after diagnosis. If a cat gets used to bouncing it can take some effort to stop it, and some don't. Dyana's JD was diabetic for about 10 years and he bounced the entire time - from 40-500.

It's not insulin specific, although the longer the duration of the insulin in the cat's body, the better it's able to control the blood sugar. An insulin that only lasts 4 hours leaves a cat in high blood sugar for a lot of hours, which allows the cat's body to think that high numbers are normal. That's not a bouncing issue, but then when the cat gets into normal numbers it's likely to start bouncing.

It's not just duration of illness, although the sooner a cat gets back into normal numbers the better.

There are also many cats that have concurrent illnesses - in my experience it appears that those are often the kitties that are hardest to get controlled. Not always, but often. Look at how many kitties on here have something like Irritable Bowel Disease, Pancreatitis or Hyperthyroid in their signature lines. We also have a lot of cats with high dose conditions - acromegaly, insulin auto-antibodies or Cushings disease and those cats can very difficult to control. They are insulin-resistant, which means that they all need high doses of insulin to control their blood sugar. Punkin, Neko, Polly all got treated for their acromegaly, but not all of our high dose kitties have access to treatment.

In any case, cats are very individual and you can't really compare one to another. Just be glad you've got a flat cat in pretty good numbers!

Just saw your last post - just keep asking questions as you think you're spotting something and we'll help you figure things out.

 

Thanks so much for the explanations and help. I can't get over how helpful (and knowledgeable!) everyone here is