What is "too steep" of a drop?

My vet suspects that Chester is experiencing Somogyi rebound, and I tend to agree with her. Since we increased Chester's dose from 2.0 to 2.5, he's been bouncing around like a rubber ball. We've decided to back him down to 2.0 again to see if that levels him out.

How much of a drop is considered too much? Obviously, going from 500 to 60 is an enormous drop...But how can I tell how low he "should" be going for any given dose of insulin? I was just happy to see some greens and blues. But this bouncing has got to stop. What are the point spreads that you guys see?

I'm sorry for posting here. I'm not on TRP at all, but it was suggested that you guys could help me make sense of these numbers.
I got in another fight with my husband again about how often we need to be testing Chester. There's no way I could get enough tests to do TRP (but I really respect you guys for doing it!).

I'm just so frustrated. On the lower doses, we didn't see much movement at all. Now we hit a dose where he's all over the map. SO next we go back to a dose that didn't seem to be getting him anywhere. How do you stand it?

 

I have no dosing advice to give you. All I know is that the normal amount for an increase and decrease is by 0.25u. Unless the case warrants having a dose adjustment of 0.50u. The experts will have to advise you on that.

The healing range is 50-120, from what I understand. As long as your kitty can maintain being in that range for as long as possible, the better the chances of the pancreas healing.

Drops are dependent upon the individual kitty. Some cats can drop as quickly as yours did, others drop not so quickly.

With regards to new dose amounts, be it an increase or decrease, please note that it'll take time for the kitty's body to become adjusted to the new dose; typically up to 72 hours, depending on the kitty. Every cat is different (ECID).

With regards to testing, and especially if you're both new here, you do need to test at least 2-3 hours after your shot, and as frequently as possible in order to acquire data to place on the spread sheet so that the experts can take a quick peek at how your kitty is doing, and advise accordingly with dose amounts, etc. Not to test may result in not catching something that may have otherwise been avoided (ie. a too low # for instance).

I hope that an expert can swing by your condo quickly to advise you on dosing amounts, and so forth. Welcome to the board!

 

One other thing, there's a 2 hour onset after Lantus is administered for it to work. So, you may not see any changes for 2 hours after you've given the shot. Sometimes, and again depending on the kitty, after you feed Chester, you may get a spike in the first #. This is more often the result of the kitty being fed, hence a food spike. More often than not it'll come down after the insulin starts to work. Don't panic. This is normal.

 

Some cats are just "bouncy." Ultimately, the approach we take is that once the bounce has cleared, you can increase the dose depending on where the nadir falls. Bounces can take around 72 hours to clear.

Right now, I think you will be more successful if you are able to get some additional tests. Because Lantus dosing is based on the nadir, it's important to get spot checks during both the AM and PM cycles. The pre-shot values are important so you know that it's safe to shoot but beyond that, you need data from each cycle. It's possible that you've missed some dose reductions since you aren't getting tests during the PM cycle.

If you're finding that you need to skip shots due to low numbers, one strategy is to reduce the dose so you can shoot twice a day. Your cat will benefit from consistent dosing. Every time you skip a shot, it has an effect on the insulin depot.

FWIW, Michael Somogyi's original 1938 paper (based on urine glucose testing of humans) has never been replicated. The subsequent research suggests that chronic Somogyi rebound is, at best, a controversial concept. It has never been documented in cats on long-acting insulin such as Lantus.

 

And an expert came by. Thank you, Sienne!

 

Thank you both.
I know. I need more tests.

 

If you can get some random tests and, in particular, if you can get a before bed test every night, that will give you a much better idea of what's going on. Consider getting tests whenever you leave the house or come home. You don't need to do a full curve -- just try to get a few more spot checks in and some of the big swings in numbers may begin to make more sense.

 

Many people seem to think that you need to test ten times a day in order to follow TRP. But you don't. You can get by with four providing you test at the appropriate times. Once before each shot, and again somewhere in between shots. Spot tests, like before bed. A test in the middle of a cycle to try to catch the nadir. Test at a different "in between" time each day or night and eventually you fill in the blanks of your SS. Following TR doesn't need to lead to fights between you and your DH.

Carl

 

Like Carl said, you just need 4 tests per day. And it really helps to be consistent with the dose. The hardest thing about Lantus is keep the same dose for at least 3 days before adjusting by 0.25 units. Look at this starred sticky for pictures of how to measure a 0.25u dose. The pictures are at the bottom. Chester was sure lucky to find your house.
Liz