? Time for another dose increase?

Bouncy Alfie seems to have had a good couple of days

He had his first yellow last night, and given his AMPS and relatively low PMPS reading yesterday I'm sure he must have got near the blues again yesterday morning. Unfortunately I'm back at work so can't check daytime readings until the weekend.

Is it time to increase his dose again? Should I eventually hope to see better AM and PM PS numbers and gentler falls as the dose increases or will the nadir just get pushed lower? As he's had the odd nice blue lately I don't want to push too far too soon!

 

Why don't we see where he is tonight? The blue you got the other day wasn't unsafe by any means, and while it may be lower than he's used to, it's still not as low as we want them to go. I would see where he is, but I think you could probably safely do a small increase.

 

I'm happy to keep him at 2.75 for now if that will help him get more used to the low numbers before increasing. Perhaps it's best to see how he does the next few days and increase on Saturday when I'll be home to monitor him closely?

I spoke to my vet this morning. He's keen to do a test for acromegaly since it's 'taking a long time' to get him regulated. I did my best to explain the concept of bouncing, which he wasn't familiar with, and he's happy to keep creeping up the dose to see if it reduces the high cycles. I'd rather not put Alfie through the stress of a hospital visit unless it's absolutely necessary.

 

The recent yellows and that blue are good signs. I understand your reluctance to increase when you're back at work. His numbers tell me that you could very likely give him 3.0 u quite safely but it's your call.

Re the acromegaly test: I think it's far too early to think about doing it. You're at a low dose level right now and might well see a lot more action as you get near 4 units. When kitties get near 6 u and don't show much response, then the issue of acromegaly is more relevant. Many/most vets don't understand the bouncing phenomenon very well or at all. We also know here from the combined experienced of very many people that getting regulated can take a l-o-n-g time. My kitty was diagnosed 18 months ago and I'm barely beginning to see signs of it over the horizon.

 

He's only been on Prozinc for ten days. I think your vet needs a pair of our patience pants!

I agree that you could move to 3.0u. If monitoring is a concern, you could raise it on a PM cycle since you are able to monitor pretty late into his evening cycle. Or were you just staying up late because you weren't at work? Most people try to do increases during the AM cycle because cats tend to run lower at night and they can monitor more easily during the day. However, Alfie doesn't look like he's running lower at night, so that isn't really an issue at this point.

 

Thanks both. I agree it's too early for any acromegaly test. My vet seems a bit acromegaly obsessed, he's mentioned it since the start. Apparently because Alfie is a big cat. But I think he's just a big boy! He's pro home testing but has always suggested just running a 12h curve once a week. I don't think he's ever seen so much data on one cat and is starting to appreciate how variable just one weekly curve could be. In the last week for Alfie that curve could have either looked terrible or great, depending on the day!

Yes, oddly he seems to be running lower in the morning on Prozinc. It was the opposite on Caninsulin. That may just be because his nadir on Caninsulin was earlier so we caught it. Re: the testing, I cut a deal with hubby, I haul myself out of bed every morning at 6am (even on holiday!) to do his morning jab and he stays up late to do the evening tests if we need them. If I'm not in bed by 10pm on a work night I'm wiped out! Fortunately, he's a night owl and I'm an early bird, it would never work the other way around!

 

This a revelation for most vets. I spent many, many months doing a weekly curve for my vet and got nowhere. Once I switched to the "FDMB Way" I learned why that was the case. Any progress I've made with my very tricky FD kitty is down to testing and logging data in the SS.

 

Well, we are having an interesting week here with Alfie's numbers! He had another low pre shot test this morning. I stalled for half an hour without feeding and the test was the same, so as I had to go to work, I gave him just 0.5U so he had a tiny bit of insulin in his system. He was super wriggly though so this might have ended up being a fur shot anyway!

My question is, as he has had a couple of really good cycles, should I keep him at 2.75U and see what happens over the next few days, or should I be looking to increase his dose?

Can't wait for out vet to check his spreadsheet next, it's going to blow his mind!

 

Your AMPS was right on the margin of the "no shot" boundary of 11 mmol/L. You don't have data in these BG ranges yet so reducing to a token dose was a good decision. See - this is what happens when the insulin resistance from glucose toxicity is overcome. It's exciting and scary!

As for the 2.75 u dose, let's see where he is tonight.

 

I know, it's really scary! I re-read the stickies afterwards and realised the no shoot number is even higher on an Alphatrak2 meter so I'm very glad I didn't give him more, especially as I'm not at home to monitor. Will be very interested to see where he is tonight! It's great to see his numbers improving though and it's very encouraging that he's not shot off into another black cycle after his great blue night a couple of nights ago

 

Some of them get less bouncy when the BG is in lower numbers. The SS is SUCH a valuable tool, isn't it?!

 

It's amazing! When he had his super high cycle last week I shared it with the emergency vet. Her response was 'Oh wow, this is great! I wish all my diabetic pet owners were this organised!'. Obviously I pointed her at this forum

 

I really do think many vets take the "lowest common denominator" approach when instructing clients on how to treat their FD kitty. They assume from the get go that the client will want to do the least amount possible and just hope for the best - get dose from vet/maybe a curve once in a while/done!

 

I agree! I understand the idea of home testing is scary at first for owners (it was for me!), but if vets understood how valuable that data is and how it can inform their treatment options, I'm sure they'd be encouraging everyone to do it. Though it does depend on the commitment of the owner, I've had a few people tell me they wouldn't be bothering with what we're doing for Alfie if it was their pet, which is shocking!

 

Some of those people would euthanize a kitty for soiling outside the litter box. I say don't have a pet if you can't tolerate any inconvenience.

 

Boing! Off he goes again. Poor little guy, no wonder he was starving when I got home!

Let's hope he comes down later now he's been dosed.

 

Partly bounce and partly low doses. He'll come back.

 

A lot of people say they wouldn't do this for their cat, but I think they would...not all of them, but I think some would because they would learn how important it was. Right now, they really don't know so they don;t know why we go to such lengths!

 

We've had an interesting week. Alfie's preshot numbers seem to have generally been improving and we've had a few blues!

I was merrily thinking about whether I should increase his dose and then last night he threw in a 7.1 at +6, not unheard of but his preshot was 27.3!

I'd have checked it wasn't a freak result but I was out and hubby did it. He also said Alfie was really hungry all night and ate a lot.

Should I stick with this dose a few more days to see what happens? I wasn't able to get a +6 this morning unfortunately, I will get one tonight and tomorrow morning.

Thanks in advance!

 

I say stick with this dose for today if your nerves can handle it. You haven't seen any green yet so he's safe. He's very bouncy so there'll be a cycle or two of reaction.

Maybe try 3 u on a day off?

 

Ok, thanks. I'll stick with it today and increase tomorrow when I can monitor. Providing he doesn't throw me any curve balls!

 

I increase Alfie to 3U last night. It was supposed to happen yesterday morning but hubby, being helpful, got up before me to do it and didn't know about the dose increase. Anyway, last night was a great cycle, even if he did probably come down a bit too far from that red starting point. He's high and flat this morning, I've just popped home at lunchtime to sneak in a +6, which I'm assuming is a bounce from last night's blue?

I know it's hard to say with so little data at this dose, but should I hold my nerve and stick with 3U or is it possibly too high? I'm always a bit paranoid he'll drop too far mid cycle when he has a lower pre shot number. That said, he's always dropped less steeply with lower preshot numbers previously so I guess need to trust the previous data!

 

Last night's numbers were lovely! The blacks today are bounces - and Alfie is a very dramatic bouncer! If you have the nerve for it, try staying with 3 u. If you can get a lunchtime +6 fairly often, that's a good time for a test. If he had dropped into dark green on your SS I'd say go back to 2.75 u if you can't monitor. There's a lot of guesswork with this but the blues that are starting to show up with more regularity are good news.

 

Yes to all of that. High and flat today is most likely because of the lower number last night. Yes to sticking with the 3 units. He still had lots of room to drop from his blue last night. Remember you're aiming for the dark greens eventually. And yes, many cats will actually drop more on a higher pre-shot and less on a lower pre-shot. If you do get a lower pre-shot than normal, you can stall for 20 minutes without feeding and retest. Usually at that point you'll have a more normal pre-shot number and can give the dose without fear. Cats can rise pretty quickly in that last hour from +11 to +12, so even just 20 minutes can make the difference sometimes.

 

Awesome, thank you both, that's all very reassuring! I normally walk to work but if I drive in I've got time to whizz home and back again in my lunch hour if I'm quick. I'll try and do that a couple more times this week so I've got more data.

I'll stick with it and see how it goes

 

Blues are ALWAYS nerve wracking when they first show up! But the fact that they are showing up is very good news.

 

OK, trying not to panic here but his numbers are dropping rapidly tonight after his high flat cycle this morning.

I guess I'll be having a late night!!

 

Hi Jen,

No need to panic - no green yet and you have a+4 test on your SS. Give him a little snack of his regular low carb wet food and test again at +5.

 

Thanks Kris, just a bit nerve wracking seeing him drop quite so fast!

Have given a little snack and will retest at +5

 

I've been there many times, Jen. Slow, deep breaths ...

 

Still dropping but at least it's slowed down a bit.

He's super energetic and just the best play session he's had in a long time.

Will test again at +6

Deep breaths... deep breaths...

 

It's nerve wracking I know! But remember it's a good thing. And you're with him and can steer, so he will be fine.

 

We have our first green number! Way to go Alfie!

Hopefully that's his nadir and his next test will show he's on the way back up. He's not bothered, he's fast asleep!

Fingers crossed he gives me a nice normal AMPS so he doesn't test my nerves any further!

 

You got a green!!! That is a big drop though - I can understand having a bit of nerves with that drop!

 

That's amazing! Mr. Bouncy Alfie will likely be more insulin sensitive after these low numbers so monitor carefully. It's likely you'll see black numbers too - all part of the process.

 

Thank you for all you reassurance and support last night everyone! It was a long night but really fantastic to see our first green

I arranged to work from home this morning just incase he had another cycle like that, but of course Mr Bouncy is doing what he does best, so I got a +5 and left him to it! Fingers crossed we see a repeat of last night again later. I promise to be much calmer about it this time!

 

Another milestone along the FD road has been reached! And look - no black this AM! You saw some lovely numbers yesterday.

 

Yes, he's bouncing but not as high as he has sometimes before. It's great to see such good progress, fingers crossed he keeps it up!

 

We got another green! Exciting times again with Alfie last night. And he seems to be having a responsive cycle this morning, so I've no idea what his PMPS will be!

I guess we just keep steady at this dose for a few days and see what happens right?

 

Nice! Yes, I would say to hold steady at that dose for a bit longer. Those PM cycles are looking great, and it's so good that he's clearing the high/flat cycles so quickly!

 

Very nice! Yes, stay with this dose for now. Does your vet still think he might have acromegaly?

 

Ha, well our vet was supposed to call me last week to catch up but I've not heard a peep, so I guess he's had a look at his spreadsheet and thinks we're doing just fine on our own!

 

We've not had quite such nice numbers since the lovely blues and greens of earlier this week. He's not high and flat, he is responding, he just seems stuck in a higher gear! Is this still just him bouncing from the good numbers?

He seems more lively in himself. He's going out more and even slept on our bed with us for a little bit last night, which he's not done since he was first diagnosed.

I just need to keep his dose steady and be patient right?

 

Typically it's said 3-6 cycles to clear a bounce, so if you don't see any better numbers tonight, I think you could do an increase tomorrow, if tomorrow is a cycle you can monitor.

 

This mornings cycle is cycle 5 since his last green and blue, so he probably is still bouncing. Like they say, most kitties will bounce up to 6 cycles but don't be disheartened if Alfie decides to bounce a couple extra. There's a kitty on Lantus who bounces for at least 8 cycles .

Have you been able to get a ketone test? Just to be safe, not guaranteeing he will get any . Good to hear he's more lively and slept in bed with you! I remember how happy I was when Maury first did that, months after diagnosis

I would hold the dose until his bounce clears since we've seen what 3.0U can do when he's not bouncing. Need an extra pair or patience pants?

 

Djamila and I are at it again!

 

LOL...yes, but this time with different advice! We usually just end up repeating each other!

 

Thank you both! I'll hang on at 3U to see what happens once this bounce clears.

I might need to take you up on that extra pair of patience pants Yong!

And yes, him sleeping on the bed was great, even if it was only for a short time. Not sure hubby was to impressed at being woken up at 2am so I could point it out though!

 

Sorry, forgot to say, haven't managed to test for ketones this week but will definitely try and get at least one test over the weekend.

 

Trying very hard to find my patience pants here! We've had a solid black cycle this morning and he's been super hungry all day as well as drinking and peeing a lot.

I'm crossing everything that it's the last his bounciness coming out and tonight will be better. I've done a +2 test and he at least looks like he's in an active cycle so that's good.

I know I sound like a stuck record, but I'm torn between letting him hang out at this dose for a bit longer or increasing to try and get his numbers down. He's had such high numbers for so many weeks, I know every high flat cycle is doing him more damage.

On top of that I can only really monitor properly at weekends, so it feels like that's the only time I can do increases which means it will take longer to get him to safe numbers.

Sorry, rant over, just having one of those days and needing to vent!

 

I'd go to 3.25 u. The longer he sits in these high numbers the harder it'll be to shift him. Teasel used to do this on ProZinc - bounce high and get stuck.. The only thing that would move him was a dose increase.

 

Thank you Kris, I'll try increasing tomorrow morning. It does feel at the minute like I increase dose, he responds really well, then seems to get used to it and hangs out at high numbers again until there's another increase

Hopefully we'll eventually hit a dose where he responds well then stays good!

 

Sometimes that can happen...but usually steady increases help that as eventually you break through!

 

And of course, because he heard me threatening to increase his dose, he's now popped out a nice blue number!

Do you all still think I should push on to 3.25 tomorrow morning?

 

Very nice! Yes, I think you can try 3.25 u tomorrow AM.

 

And they say cats can't understand us....

 

Even if they can't understand us most of the time, they seem to understand threats very well! lol.