treating a bounce

Well, Ben aka Tigger aka Mr Bouncy Bounce continues his rollercoaster journey. So here I am again looking for dosing advice. Should I not be increasing the dose for numbers that are obviously a bounce. Maybe the sliding scale isn't such a good idea. This morning's number and dose are in the books but what should I be trying now?

Just when I get excited for a yellow he throws up a black to keep it interesting. I'm off tomorrow through Tues night so can do curves or at a minimum some more frequent testing if needed.

Thanks,
Lisa

Hi Lisa,

Yes, he definitely does bounce. Sometimes lowering the dose a little helps that; sometimes guiding it with food can help. If you can, I'd get a curve. It'd be nice to know when he starts down (is it right away and could food at +2 slow a fast drop?), when is he lowest ( is his nadir early and could we slow that with a little snack?), how low is he going (if he is dropping from 600 to 100, then it's too big of a drop and he can't help but bounce. Maybe then we can figure out to adjust the dose)

The good news is that the insulins works - he has some nice blues scattered around. We just have to figure how to work with it!

So what dose should I use when I do the next curve? Should I stick with my current sliding scale or drop the dose a little?

You might try feeding the curve. This means to feed a little bit more food around +3 as the most impact of the insulin begins. It helps slow the drop, which helps reduce bouncing. So you might feed 1/3 at shot time and 2/3 at +3.

I'd think stick with dosing the same for the curve. That will help tell why he gets those numbers at that dose and may help determine if a different dose is needed or if food control like Sue suggested is the way to go.

Almost done with a curve where I fed at +4 (napped through the +3 time). It seemed to flatten out to the point that he hardly dropped at all. Is that a good thing or should I increase the dose? I'm a little confused right now.

If he doesn't bounce for pmps, I'd keep the lower dose and see what the amps looks like. The pinks aren't great, but they are a lot better than blacks. The hope is that he will surf along without bouncing and eventually drop into lower ranges. I like that feeding may have slowed the drop and we should be able to use that, going forward.

If you can, I'd give him a snack and test before bed. It would be great to also get a nadir around +5-7 to see what happens at night (he seems to drop lower that cycle) but understand you both may be tired of poking and testing and tired, literally.

Today was a lazy day for all of us. I spent most of the day napping on the couch so I can certainly be up at midnight to check a +7. And Ben doesn't mind the testing at all. All I have to do is say "Come on, Ben" and he is racing me to our testing spot. Thank the good Lord for Pure bites.

I think I might be starting to understand this. The goal is to get him used to the 300's then the insulin will eventually cause him to drop to the 200's. Then he gets used to the 200's then he starts to be regulated. I've been trying to force the issue and making him bounce. Which only makes it harder for him to get used to a number.

So now the question is steady dose or sliding scale?

Lisa is now wiggling into patience pants that might be starting to fit. :lol:

The only other thing to remember is that some cats bounce; some don't. And the ones that do bounce until they stop....

I tend to like the flexibility of sliding scales, especially with cats who tend to bounce. But some cats definitely do well with sliding scales; some don't. Not sure about Ben.

Yep, those patience pants are almost always a tight fit.....

As you can see last night's +7 was a scary (in Ben's opinion) yellow so this mornings AMPS was black. Boo! Feeding him a snack didn't seem to change things. Any other ideas? Maybe a lower dose at night?

Its an ongoing experiment.
Try what you think might work. Collect data. Evaluate the result. Adjust for the next time. Cross your fingers!

Yep. Wonder if it might have continued to drop lower than that. Well, grasping at straws, he is 100 points lower than that 600.....

I am not sure, Lisa. Bouncing is so hard to figure out. I wonder. He does seem to be a kitty who has an immediate reaction to a bounce (the next preshot) and then maybe a later reaction - a higher cycle overall. That may be why his patterns make so little sense. Like on 10/10 he had a good pmps. The next 2 cycles were higher and Then he had a better amps again.

The good news is that the insulin does bring down those ugly blacks. And it does last long enough. He isn't jumping up at +8. It's a gradual climb.

The question is: up or down? You have increased gradually which is good and your sliding scale accounts for the lower preshots when you get them. I'm with BJ. It's up to you. Either way will give you information. We used to advise not to shoot the bounce. In other words, don't raise the dose when the preshot is clearly a bounce. It didn't work for every cat. But maybe it is something to try with Ben. You could lower the scale for those blacks and see if it is better or worse.

Regardless of what you do, keep testing for those ketones.

Sue and Oliver (GA) said:

Yep. Wonder if it might have continued to drop lower than that. Well, grasping at straws, he is 100 points lower than that 600.....

Regardless of what you do, keep testing for those ketones.

Click to expand...

There is that, Sue. ;-) And so far, he has never had any ketones. So kudos to him for that.

I'm free today (except for a Dr appoint in Am) so I'll check him several times today and see how he drops with 2 U. And I'll drop the PM dose to see if I can flatten him out at night. Silly kitty. Some consistency would be nice, Ben!

2U is obviously too much for a bounce. Made him drop like a rock. So I cut back the PM dose and I'll see what happens. And I'll give him half a can and check him once more before we go to bed.

Back in black this morning. Who would guess that Ben is an AC/DC fan. Not sure what happened since he didn't drop that low last night. I'm trying the slightly lower dose for the blacks today to see what happens.

I'm not sure Lisa. Ben does like to throw curves at you! I feel like this matches what Sue mentioned a few days ago about a couple higher cycles in reaction to a bounce. His cycle last night was higher than one would expect, but he seems to do that. The bounce she mentioned after 10/10 had him in pinks for the next few days. Then he was in pinks last night. He might be so sensitive to a bounce that he runs high for at least 2 days after, then it clears and we go from there? It's a thought anyway. Lowering might work. Data gathering will help at least. Could tell us if he needs to keep going down and maybe see if that helps smooth out those bounces.

You're doing a great job Lisa! I know it's frustrating but keep those patience pants on and we'll do what we can to figure it all out!

Well, five out of the six AMPS have been in the black recently. So I'm going to try a lower steady dose for several days and see what happens. Of course if he drops into the blues on a PS, I may have to modify that. But somehow I don't think that'll be an issue. :roll:

Hi Lisa

Since I use Lev I can't really help you at the moment with dosing but I can explain a bounce maybe a little better, so what is happening might make a little more sense.

It isn't that Ben is dropping dangerously low that is triggering the bounce its how fast he is dropping when he starts to come down. It kind of goes back to that very basic physics principle "For every action in nature there is an equal and opposite reaction" So when he comes screaming down from black to blue his body reacts and throws him back up equally as fast.

A good way to think about a bounce is it is like you going for a drive on the freeway, when you first get up to speed 75 mph feels really fast, but as you get a couple hours of driving under your belt that same 75 mph starts to feel comfortable and like you really aren't going that fast anymore. Now you suddenly hit road construction and you are immediately forced to now drive 45 mph, now your brain says that is still a very quick pace and if you tried to jump out of the car while going that speed you will get badly hurt, but to your body that is now use to going 75 mph, 45 mph feels like you are just barely crawling along. You have to watch your speed like a hawk so you don't creep up again to the 75mph because that is where your body feels comfortable.

Same thing happens with a bounce, their bodies get use to crusing along at 300-500 and suddenly here comes the insulin you just shot, it slams on the brakes and asks them to reduce the speed quickly to a level that while we know is safe feels to them like they are crawling along (going too low) so just like you having to keep your foot off the accelerator to keep from speeding in that construction zone, their body reacts goes into self protect mode and releases stored sugars and counter-regulatory hormones to drive the numbers back up. The faster the drop down, the faster the rise back up.

Now I don't know how to correct this with PZI so hopefully Sue, Rachael or Lu-Ann will chime in, but how I've handled it with kitties that I have used NPH with is setting a fairly high shoot number and chasing numbers, so that regardless of if I'm shooting 12/12 or 8/8/8 or some variation there of.

And example with N which only last about 8 hours in a cat. I have a cat who's preshot is 485 and I know .5 will drop them into the mid 200s so I would shoot .5 watch the drop then watch for the rise to start, once they hit my "Shoot number of 350" I shoot another .5 and watch for the drop and rise to start again. With the game plan of only letting them drop in small steps down the different levels and giving them their bodies time to adjust to the ever lower and lower levels. So basically I walk them down where the reds slowly change over to pinks, then those pinks go yellow, then yellows blues etc. Now again I know this works with NPH and it is also how I walk mine on Lev down, just don't know if it works yet with the P insulin.

Mel and The Fur Gang

I love the analogy of the speed of the car, Mel. Yes, Prozinc can be given every 8 hours, as long as it is rising and over your target. I am struggling with Ben because I see so few patterns. Sometimes I think his bounces hit a cycle or two later than the actual low. And then sometimes I think he isn't bouncing but the insulin isn't lasting long enough. Some cycles support a bounce; some suggest the insulin isn't lasting long enough.

We fooled around with the food, right? And no big revelations…..

Lisa, could you shoot every 8 hours, say on a weekend and see what happens? If you do, you need to be able to monitor carefully. First, we divide whatever dose you think worked best into 3rds. So say, your target is 250-300. When he hits that number, as long as it is after +8, you shoot 1/3 of the cycle's dose. Then you test carefully and when he hits +8 and he is near your target, shoot again. So you are basically doing 8/8/8 instead of 12/12.

You might look at BookW0rm's Spreadsheet. Lisa went on TID for awhile and he improved and he dropped back down to BID. Cassie was one of our bounciest kitties. He has been on PZI for 2 years and finally, is on minute doses in tiny ranges. But he did bounce for a long time.

https://docs.google.com/spreadsheet...FJTWnViWEtEQkdFNnRBYlV2UGhiRnc&hl=en_US&gid=6

I'm not sure about this url. It may give you her most recent ss. If it does, go up to the top and pick the farthest one to the right, 8/11-1/12. It shows you when he was bouncing up to the 600s and then she went TID for awhile.

The trouble with TID dosing is that it will be impossible when I'm working. I work 12 hour night shifts at the hospital and can't guarantee that I can get away to give him a dose in the middle of the night. I'm reluctant to try something that might help him but I can't realistically do. I already feel bad enough that I can't get him regulated but that might just shatter me. In this case, ignorance is might just be bliss. I'm going to just have to figure something else out.

I like the car anology, Mel. I'm going to try to lightly touch Ben's brakes with smaller doses. Today's dose of 1.4 brought his black to a pink around his usual nadair time. Which seems like a nice drop. We'll see what Ben thinks at his PMPS.

I can certainly understand that! If we are looking for positives (and we are :mrgreen: ) 1.4 has gotten you about the same numbers that 1.8 did yesterday and 2 units did on 10/10. So maybe less is better.

Don't beat yourself up. Like Sue said maybe the answer is less insulin. Who knows? You can only do what you can do. We'll keep working to see what works and what doesn't. :smile: