? What's up with these highs and lows?

So I complained yesterday http://www.felinediabetes.com/FDMB/...ect-dropping-off-sharply.178262/#post-1967773
that the insulin dose was not keeping Fearless in consistent numbers. I always look at his SS to try to determine how to proceed (i.e., how has he reacted to a certain BG level at the same hour on the same amt of food before) and today the SS let me down. Since he's been on 1U he's never dropped from 200s to below 100 @+3, so I didn't expect that today. Still, 67 wasn't bad so I fed to slow him down. Didn't work. Now he's sure to bounce again. I'm losing my mind here! What should I have done differently?

 

Well, he's earned a reduction back to .75u tonight. Kitties are hard to regulate and he hasn't been on insulin that long. You're doing great with him. Just keep following his lead. He will likely bounce but the 48 on AT is way too low so break out the HC food and or honey/karo. keep testing for the next few hours to make sure he stays above 68. Remember bounces can take upto 6 cycles to clear so hold the new dose of .75u for at least that long.

 

OK so as @Doodles & Karen taught me - CIC - the cat is in charge. So if you feel out of control and going out of your mind - that is because you are trying to control a cat. And just to top it off ECID - so Fearless is special on how he will do this dance - and oh - yeah - just to reconfirm he is leading - CIC.


I see Fearless likes to bounce! He saw green on the 18th AM with a string of blue then bounced for 5 cycles, then saw some blue and green on the 20th PM cycle. A small bounce that began to clear the 21st PM cycle. Small bounce again on the 22nd then green today! It looks like his bounce cycles are getting shorter perhaps?

 

We test on a human meter. We fed the 48 and 30 minutes later he's back to 66. Feed? Don't feed? Doesn't matter since he'll bounce anyway?

 

test and you'll you know if another small snack LC is needed.

 

If he is still dropping and you don't let him go too low by offering small snacks you allow his body to stay longer in greens, sort of like rehearsing for the future when you will get him to stay green all the time.
If he stays at the same level all the better. Keep testing to know how he does.

 

He's at 66 on the 1/4 can I fed 30 minutes prior to the 66 test. Since we're about 30 minutes away from his typical nadir (+6), my instinct is to not feed the 66. Is that sound reasoning or not?

 

The +2 test would have given you more time to feed up front a little snack to slow down the bounce.
I read your post and wonder if you are talking about my cat - she does just the same including bouncing and unexpected drops.
I also am trying to find out a way to guard against bounce/going below 50 and to flatten the cycle - no solution yet, working process .

 

Sorry, I missed where you switched to the human meter. He still earned he reduction to .75u with the 48. I might with hold food and keep testing. Like Tanya mentioned you'll know if he needs more food to keep him surfing.

 

It does to me but make sure to test in 30.

 

Your cat is trying to tell you to wear patience pants and not to take them off. Have you seen @Kris & Teasel's condos? Teasel loves to bounce and your SS reminds me of her SS.

 

A couple others have made the same mistake, so I just amended the SS so it's obvious I use a human meter, even if you scroll past the row that reads "ReliOn."

 

I don't mind being patient. I'd just like to see some kind, ANY kind of pattern in his numbers.

 

Here's a pattern to think about ... Fearless sees a lower number and bounces back into high numbers. Then he eventually comes into a lower number and bounces again.

 

Yep - CIC - mind blowing experience.

ETA - especially for us people that look for patterns for a living and cat find one.

 

In hindsight, sure, a +2 might have skipped right over the 100s and been the red flag I needed to feed earlier. But looking at the SS, I didn't see the point today. He gets tested so much anyway, I was trying to spare him more pokes. Plus the 1/4 can I fed at +3 should have been enough (based on his history) to stop him from dipping below 50, but it wasn't. That's what I mean about being to predict (at least within reason) a certain outcome based on what the SS tells me.

 

How's fearless holding?

 

Well sure, I know that. It's trying to keep him lower than 200 without going below 50 that's the hardest thing ever.

 

Tanya and Ducia said: ↑
The +2 test would have given you more time to feed up front a little snack to slow down the bounce.
I meant to say "the drop" not bounce.

 

Next test is in 15 minutes.

 

Teasel could win an award for bouncing. I've given up trying to control it with food. I save the food interventions for when he's going too low. The rest of the time I just take it as it comes and try not to get fussed. Periodically I increase his dose when there's been no blue or green for many cycles. I have a closet full of many pairs of patience pants. My goals are simply to: 1. keep him safe; 2. get blues and greens more often and 3. stay sane myself. That last one is really important in order to handle this in the long term.

 

His bounce was due to break and it did... on the 5th cycle. Same pattern as last time. In a case like that if at all possible, you'll want to test him earlier... at his onset.

When is his onset? Looks to me like his onset is early. Some tests at the +1s combined with +2s will pin it down for you. When a bounce is due to break and he's dropping prior to or at onset, it'll put you on a heightened alert and you'll know to feed immediately in the cycle to slow him down and/or give him more surfing time in greens.

Make sense?

Karen's correct, but considering the greens have been few and far between as well as surrounded by such high numbers AND given as much as you test and the fact that his numbers were brought up very easily, I'd hold the dose while using food to manipulate the curve. However, the decision is yours.

Has anyone given you this thread to read: Using Food to Manipulate the Curve? It's a technique which should help with Fearless... especially in circumstances like today.

Seems to me you're equating bouncing as something bad. It's not. His body is doing exactly what it's supposed to do to protect itself from perceived lows! If he didn't bounce, I'd worry. Here's another thread you might want to read: Cat on a Pogo Stick Discussion: Increase, maintain or lower the dose to stop bouncing?


Just my thoughts...

 

He's 134 @+6, his usual nadir. So he dropped 150 pts from amps (on 1/2 can food) to +3, got fed 1/4 can and dropped to just below 50, got another 1/4 can and rebounded within 30 minutes so I stopped feeding. Now @+6, he's back in the blues. Not a typical day. It doesn't even look like the LC food had any effect on the numbers. And did his nadir come @+4.5 instead of his usual +6? Or are these numbers so wonky that nothing is as it appears?

 

All that's supposedly different about today is the bounce broke and it happened to break hard. When a bounce breaks there's added momentum to the downward motion created by the exogenous insulin given at shot time. That's what you're seeing. Added momentum which caused him to drop further than usual earlier in the cycle.

No biggie. It happens.

 

That makes sense. I guess I wasn't thinking this last one was a "typical" bounce because the numbers weren't all really high.

So whenever I think a bounce is breaking I should get a +2 to check for that big drop. Got it. What about other times? Is testing @+3, +6, and +9 enough? When things like this happen I feel like I should test every hour until nadir, but I just can't do that to his poor little ears. What kind of testing schedule would you recommend. And yes, I can steer with food, but it doesn't always work.

 

That's why I love the +_2 test and as Jill said, especially when a bounce is expected to break. The +2 could have warned you start feeding the curve to slow him down some.

It's all a learning curve for us beans. Take today's experience and use it for about 5 cycles from now.

 

Until you can say with certainty when the insulin onsets, I'd get a +1 and +2 if I were you. As far as testing on a regular basis, that all depends on how Fearless reacts to insulin. Do you know when the insulin *usually* onsets, peaks, and what kind of duration he's getting on whatever the current dose happens to be?

It's every caregiver's job to learn how their cat responds to any given dose:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose

I also like to include the following when we're talking about learning the basics...
A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose when using Lantus or Levemir:

• Carryover - insulin effects lasting past the insulin's official duration
• Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
• Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
• LANTUS & LEVEMIR: WHAT IS THE INSULIN DEPOT?
• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Once you know these responses and understand the concepts above, you'll automatically know when to test and patterns will pop right off the spreadsheet.

One more thing, always focus on how low the dose is taking Fearless. Don't pay attention to the high numbers seen when bouncing other than to figure out when/if the bounce will break.

His ears will be fine if you use your fingers/a tissue to apply slight pressure to staunch the blood flow after testing. Some use Neosporin. Personally, I prefer Herbal Healing Salve because my cats groom each other and I don't want them licking/ingesting Neopsporin with pain relief. If you look at Alex's spreadsheets from 2006 through 2014 you'll see she was tested more than most cats. After all that testing, she didn't have a mark on her. Her ears were intact, unmarked, and as beautiful as they were prior to diabetes.

Perhaps more experimenting is needed. There's a lot of trial and error involved in knowing when and what to feed. There's also a learning curve when you consider needing to know his response to insulin, the concepts mentioned above, and how he responds to food. It takes time. Learning all the variables can be a slow process. Cut yourself some slack...

 

I forgot to mention the "BECOMING DATA READY" section included in the TIGHT REGULATION: SHOOTING & HANDLING LOW NUMBERS sticky. Ha! More reasons to get those "forgotten" spot checks... the +1s, +2s, +10s, and +11s.

 

Same thing happened today as yesterday and the day before ... only now it's bouncing higher and earlier.

 

Yes, it is. The bounce has just begun. Hopefully it'll clear faster this time. Now it's time to save some strips, take a nap, go out, take time to digest all the info you were given, or find something fun to do.

 

I have five +2 results on the current dose (two higher and three lower). Not enough to be conclusive and I will have to get some +1s to know the exact timing. His am cycle nadir has been all over the place: +3.5 (1x), +4.5 (2x), +5 (2x), +6 (1x), +9 (2x). Though I don't have as much data, the pm cycle seems to be more consistent, +5 (3x) being the most prevalent.

The best way to amass the data you're speaking of (and please correct me if I'm wrong) is to test nearly every hour (+1, +2 and +3 for onset, +5, +6 and +7 and maybe +9 for nadir, +10 and +11 for duration) for at least a few days. Of course if he's bouncing all bets are off.

BTW, earlier you characterized the 5 cycles from the 94 on 5/21 pm to this morning as a bounce. The thing is, I was looking at the blues on 5/21 and 5/22 and thinking he wasn't bouncing because in the past when he bounced he stayed in the 300s and 400s. I ask, because this evening he has dropped back to yellow. Is he still bouncing?

 

Just try to get some random tests to accumulate the data you need.

I think you meant the 94 on 5/20. Yes, I do believe he cleared the bounce in 5 cycles this morning... just like the last time he bounced.

A cat can bounce to the 100s and still be considered a bounce. There's nothing magical about higher numbers. Occasionally when I had Alex tightly controlled she would bounce from a very low green into 100s. By the same token, cats can and do bounce into the 200s. Tonight, the last entry I see is a 202 @ +5... at this time I feel comfortable saying he's still bouncing.

Will he clear his bounce in less than 5 cycles this time? Let's hope so, but that remains to be seen...

 

So even if Fearless has a "normal" looking curve with dips into the 200s or even 100s he's still bouncing? How, then, do you ever really know what's a normal cycle versus what's a bounce? I've been thinking 5/15 am was "normal" (for Fearless) until the big jump between +6 and +9, after which I thought he was bouncing until 5/16 pm when he was in blue again. And even though he started 5/17 in the 300s, he dropped into the 100s both cycles, and again on 5/18 until he bounced off the 78. That was a definite bounce (to me) because he never got out of the 200s and 300s until 5/20 pm. The definition of bouncing given here is vague (I assume on purpose, because ECID). Is a drop of 80 points in 2 hours (5/20 pm) enough to trigger a bounce? Or is it because he began the next day in the 400s? What are the markers I should look for to determine what is a bounce and what is normal higher numbers for a newbie?

BTW, he's at 172 now, very similar to the 5/21 pm cycle.

 

Bounces are triggered by a fast drop or a drop into numbers kitty's body is not used to seeing. Not sure what you mean by a normal cycle at this point in the regulation process. Right now, you're pretty much going to see bounces in-between the cycles that drop him into greens. Once he sees more greens, he should clear his bounces faster. At least that's the plan. Some cats have other ideas.

5/15 was the first cycle on the increased dose to 1u bid. IMHO, the cycle was still showing "not enough insulin". The insulin peaked at only 130. You'll notice 6 cycles later on 5/18, the depot was filled and he dropped to 78 on that same 1u dose. Then he cleared the bounce in 5 cycles on 5/20 PM.

Fearless is not clearing his bounces quickly like you seem to think. At this point in time (this will change, but for right now), his bounce hasn't cleared until he has returned to green or a number which is close to the number that sent him bouncing in the first place.

In other words if kitty is bouncing from a green, he's not clearing the bounce when he drops to a blue number. He hasn't cleared the bounce until he goes back to green. With Fearless, this is currently taking 5 cycles.

Make sense?

It's very late here and I have to get some sleep. I'll have to check back for questions sometime tomorrow.
Goodnight!

 

That's the best explanation I've heard to date. Thanks!

 

One more question: Others here have told me that the more time spent in the healing greens, the better. However, if every time Fearless hits the greens he bounces, and he can't clear that bounce until he lands back in the greens (which then triggers another bounce!) isn't it counterproductive for a newbie like Fearless who is used to pinks and reds to shoot for greens early on? Do caregivers ever try to keep their furbabies out of the greens (steering with food, etc) so they spend the majority of their time instead in yellow for a while, then later in the blues for a while, and finally in the greens, where by that time their bodies have slowly become accustomed to the lower numbers? I know this sounds like pie-in-the-sky thinking and probably unattainable, but just wondering.

 

That's a good question and in the post # 22 where Jill said the below in response to the earned reduction is a bit like what you are talking about, and it would be to hold earning the reduction and using food to get him to stay flatter longer to help him with the bouncing. I am sure Jill will weigh in and explain it to better than I can.



Karen's correct, but considering the greens have been few and far between as well as surrounded by such high numbers AND given as much as you test and the fact that his numbers were brought up very easily, I'd hold the dose while using food to manipulate the curve. However, the decision is yours.

Has anyone given you this thread to read: Using Food to Manipulate the Curve? It's a technique which should help with Fearless... especially in circumstances like today.

 

I've used food before, but only to keep him out of the low greens, NOT to keep him in the yellows, and then later, after he's become accustomed to the yellows w/out bouncing, to keep him in the blues, and only after a good stretch of blues w/out bouncing, allowing him to go into the greens.

 

You're welcome.
Using a bounce from greens was only an example. The same can be said for a bounce from blues or yellows. If he bounces from a given color, the bounce hasn't cleared until he returns to that color.

To expand on that a little bit...
If a reduction was taken because the drop which triggered the bounce was too low and BG numbers trend upwards OR never return to the greens... you're looking at a failed reduction.

No, it's not counterproductive. The quicker you can get kitty into greens the faster his body will get used to them and he'll end up spending more time in what we call "healing numbers" (numbers in the 50 - 120 range). The whole idea behind practicing tight regulation is to bring kitty's BG numbers down as quickly as safely possible. Even if the OTJ status is never achieved, kitty is residing in normal numbers... less chance of damage to other organs and generally, just a healthier place to be.

Check out Alex's 2009 spreadsheet. Don't be put off by all the testing. In addition to treating Alex I wanted to create a teaching tool to show what happens when "shooting low to stay low". She had been in remission for almost 3 years when a simple case of gingivitis put her back on the juice. Because I was experienced, wasn't afraid of low numbers, could monitor as much as necessary, and understood the TR Protocol I was able to pull her numbers down quickly. Within two weeks I had her down to normal numbers. Granted, my ability to monitor her combined with the fact that this wasn't my first rodeo helped a lot, but you can see how the aggressiveness of the TR Protocol works when followed!

Oh yes, we've seen some caregivers try, but in the almost 11 years I've been here I've never seen it work to their advantage. All I've seen is a waste of time, money, and effort.

Feeding to prop up a drop to low numbers should not be confused with Using Food to Manipulate the Curve OR carb manipulation. The first part in the "Using Food to Manipulate the Curve" post describes manipulating the curve with food for bouncers or kitties that experience huge food spikes. Basically, it means feeding at strategic times based on the individual cat's response to insulin. This is done to prop up the entire curve so you can keep as much insulin in the cat as safely as possible. Hint: more insulin is usually required to combat food spikes and/or flatten bouncy kitties out. Feeding the normal amount of food divided into mini-meals at predetermined intervals during every cycle will help to keep kitty from bottoming out... that way you can keep a higher dose... not have to take a reduction... in turn, the food spike and/or bounce becomes flatter.

BTW, the idea is not "to keep him in yellows, and then later, after he's become accustomed to the yellows w/out bouncing, to keep him in the blues, and only after a good stretch of blues w/out bouncing, allowing him to go into the greens"... rather as explained above.

Make sense?

Not sure when I'll be able to get back here to answer questions. My schedule is rather full today. It might not be until later tonight. However, there are others around who can help.

 

I think I have enough to chew on for now (no pun intended). I have been front-loading with food, for the most part, but starting tonight I'm going to try dividing it more evenly among the first 4 hrs of each cycle (instead of feeding the biggest meal at PS times). Thanks again.