Question about bounces

Can a cat just keep bouncing?
We increased his dose 3 days ago and he went in the yellow then immediately a lot higher for 6 cycles. Then he started coming down - 310 at +5.5 last night (I didn't have an ounce of energy left to make it to +6).

I was expecting his AMPS just now to be lower but it was back at 507! He did have a midnight snack when I checked his BG, but not enough to be this high 6 hours later. Ugh, I was so ready to see a magical 350 this am, or likewise some encouragement we are going in the right direction.

So, is he bouncing again? If he just keeps bouncing do we stay at 0.5 units until we get more consistent data?

Previous thread here: http://www.felinediabetes.com/FDMB/threads/help-tiggers-bg-all-over-the-place.198966/

 

Unfortunately the answer is yes for some cats. I have one of them. The best way to cope is accept that your kitty is a bouncer (for now - some change their pattern) and follow the dosing guidelines as well as you can. The bounce inflated numbers can make interpreting the patterns harder but you have a lot of people here to help you.

 

I'm right there with you today. These bounces are crazy! One minute celebrating and the next in black.

 

It's scary, confusing, and disappointing. Tigger had an amazing day yesterday! He ate great, pooped well (a big deal with chronic constipation), played with a feather toy, napped in the window, cuddled, showed off his new trick (getting on the scale all by himself for a treat), and his BG finally started a slow trend downward. I was so sure we had lower numbers coming our way today. Sigh. Ok, vent over - back to being hopeful.

 

While a cat can bounce off any lower number, I’m not seeing a bounce from that yellow. It’s possible he went lower the night of 8/11 and that’s why you saw a black AMPS on 8/12 but, in reality, he looks fairly high and flat to me like he needs more insulin.

This is why I don’t like to see a cat that has had DKA following SLGS. Holding doses that long when he’s high like this is a concern if he still has any infection and he’s vomited a few times as well. It’s best to get them to a good dose as quickly as safely as possible. You are checking ketones daily? I don’t see a reading since 8/4.

If it’s possible for you, I would try to do TR just until you get him to a better dose and then you could switch to SLGS. You don’t want to be going back and forth between the two but, if you are available to test, it might be a good idea to get him into better numbers a little faster considering the DKA. Tag me and I’ll be happy to explain further in this condo, if you are interested.

If you’ve switched permanently to a human meter, if you send me a private message, I’ll tell you how I can modify his SS for you so it records the numbers in the correct colors for human vs AT meters.

And to answer your original question, cats can “typically” bounce up to six cycles in response to a low/lower number but I’ve seen a few cats bounce a little longer. However, if you miss a cycle of getting any tests, he could go lower and you wouldn’t realize it so what might look like one long bounce to you might be two separate ones.

 

It was suggested to me by another member that he was bouncing that day as I still have a lot to learn, both from this site and from Tigger. I am available to test a little more often this week as I am supposed to be on vacation but my girlfriend is leaving for a long weekend at her parents and we have plans tomorrow and Thursday so I am not comfortable giving him at least 1.25 units (he is 5kg) with little supervision the next two days. Plus once I go back to work on Monday it is basically just PS numbers we can get, besides a random mid-cycle on weekends, and/or if i set an alarm to wake up in middle of night. Considering the vet did not want to restart the insulin at all (I insisted) and after carefully reading all the important stickies on this forum, I feel more comfortable with the course we're on now . . . . though I do hate seeing those black numbers. He is due for another dose increase on Friday and that gives me about 6 cycles where I can monitor closely as I'll be stuck home alone anyway! Especially if I jump the last 0.5 dose cycle. Would that be terrible? Instead of 14, changing after 13 (its only one cycle not one full day.) Also, I have added some ketone numbers to his SS, but I am not testing daily.

I know its not the same as hard evidence like BG and ketone numbers, but he really seems to be doing good this week. Of course, he loves it when all attention is on him and mommy stays home all day. Honestly, he's been so cuddly, more playful, and I know his vomiting cycle well. Aside from the constipation which is helped a lot by the miralax, he also pulls his fur out in batches and swallows some of it. He has done this for years and we've tried almost everything. He does not have feline hyperesthesia either. It really started after he had the last of his teeth pulled, and yes I mean all the fangs too. The vets all conclude its stress but no spray or medicine helped and really if I get him his miralax and comb him regularly he only has a hairball once a week. Unfortunately it sometimes coincides with just having eaten or being a little constipated and he vomits undigested food as well.

 

Even if you were home 24/7, I would not raise his dose from 0.5u bid to 1.25u bid. I’m not sure where you got that number. Once you start Lantus, Basalgar, or Levemir, you don’t adjust the dose based on their weight...you adjust it on how low the dose is taking them (the nadir).

Right now, because you have two nighttime cycles of no tests at all, we don’t know if this dose took him lower or not. My guess is it might have but probably not so low that it would preempt a 0.25u bid dose increase which would be in line with SLGS (see my comments below though in consideration of nadir and DKA history).

We can offer advice but you hold the syringe and he’s your cat. If you feel more comfortable waiting until Friday to increase the dose, then that’s what you should do. Safety first and you do need some data (even one test besides PS) at night. It doesn’t matter if you increase after 13 cycles instead of 14. If you can continue to get a PS and midcyle test during the day and a PS and a +2 and before bed or even a +3 or other test at night, that will help you know how low he’s going.

Under SLGS, the increases are 0.25u for nadirs over 150. However, if you are finding that his lowest numbers are higher than 300, you might want some input about increasing by 0.5u due to his DKA in July.

If the blood ketone strips are too pricey to test every day (and they are pricey), why not buy urine ketone strips? They are inexpensive and, if he were mine, I’d be testing ketones every single day.

 

Oh well I went and read the TR protocol and it had stuff about his weight and starting dose. I will definitely consider increasing the dose sooner though. When would be safe?
So far the ketostix have been unsuccessful - he's sneaky about bathroom time. The ketone test strips are expensive and only came with 10. I have 30 arriving tomorrow along with some BG strips for the precision xtra meter as backup. I will get another test tonight soon - closer to +6? or anytime now?

(I feel ok going up to 0.75 for tomorrows am dose - depending on PS of course)

 

I’m glad you increased the dose to 0.75u.

 

you can always put plastic wrap in the litter box, making a pocket in the middle for the pee to run into, then you have the pee for testing?? try it.

 

If you don't mind the cost, the Nova Max Plus Glucose and Ketone Meter Kit is pretty easy to test with... We only blood-tested for ketones when numbers were in reds and high pinks. Here's a good deal on strips + the meter: https://www.adwdiabetes.com/product/20784/free-nova-max-glucose-ketone-meter . Yes, the strips are very expensive, but worth it to avoid a DKA.