8/5 Charlie +12AM 54 SKIPPED PMPS 450 +2 329 +3 315 +9 344

Yesterday

Hi guys,

Seems like the bounce is over at least temporarily, but now Charlie's numbers are low. Since we found a large pool of clear liquid this morning (vomit? urine?) we really wonder if Charlie had a hypo last night while we were sleeping. Again, we also found diarrhea.

BG at 7am was at 3 (54 US). After eating, BG at 7:30 was 3.9 (70 US). BG at 8:00am was 79. BG at 9:00am was 90. Decided, after much discussion, to skip and only give her antibiotic this morning.

I know it seems strange to ask this with all the high numbers we've seen during the bounces, but is there a slight possibility that .5 units is too much?

Really don't know what's going on with Charlie but I'm not surprised to find vomit this morning, as yesterday my gut told me she didn't feel well. :cry:

8/5 Charlie-Vomit/Diarrhea BG 7am (54) BG 7:30 (70) Help.

Also, could it be possible that all these bounce days are a continued somogyi reaction due to a very low number (that possibly came on Aug 2nd at +1 or +2)?

I know it doesn't look like the traditional case of Somogyi, but do you think Charlie could possibly be experiencing this -- that she needs less insulin, not more? Typical Somogyi would show as very low numbers (like hypo) followed by high numbers. But an article a friend found says with Somogyi, the BGs do not always normalize within a few days - sometimes an episode can affect BGs up to 3 days.

Could this be a sort of "nontraditional" somogyi (since other than this morning, we're not sure that Charlie is dipping down into the low, low numbers that typically trigger this rebound). Still, is it possible for an individual cat, say Charlie, to be so sensitive to rapid drops into the green (going from red to green within one 24 hour period), even if it is NOT a hypo green, that it sets off this Somogyi wave effect? And if so, would it be worthwhile taking Charlie to .25 for a couple of days to test it out?

I guess the question has to do with "absolutes." That is, does the cat have to go to hypo levels before Somagyi can be triggered.... or could it be based on a particular cat's sensitivity (a threshold that may be somewhat higher than hypo range)?

This idea was triggered because a friend on the board had the idea. She looked back to when Charlie first started the Lantus and saw the "colors of the rainbow" effect with Charlie -- with her BG range fluctuating pretty wildly -- routinely going from blue & green to red within a 24 hour period. She was trying to think of reasons why Charlie's BGs fluctuate so much.

Of course if Charlie has an infection, BGs would be high too.

Any thoughts on this ?

Re: 8/5 Charlie-Vomit/Diarrhea BG 7am (54) BG 7:30 (70) Help

I'm sorry Charlie is not well today. Clear and/or foamy liquid vomit is usually a sign of an acid tummy. I wonder if she is having a pancreatitis episode? I'd call my vet if that persists.

Somogyi has not been documented as occurring in cats following a tight regulation protocol. In fact, many of us question whether it actually exists or not. In theory, it results from a chronic overdose. I'm not seeing that on Charlie's spreadsheet. She looks like many, many of our bouncy kitties. Her liver is not used to the green and blue numbers and so you get a release of counterregulatory hormones and glucagon which drives the BG up. You don't want to increase or decrease the dose unless the cat earns a reduction per the protocol when the bounce clears or, if numbers remain high when the bounce clears. There are several "rainbow" kitties in LL and some of them are long-term diabetics.

A bounce occurs either due to a fast drop or numbers lowr than the kitty's liver is used to. Numbers don't have to be low...and you can see this with Charlie...when she gets into blue, even, she will bounce. It can take up to six cycles for a bounce to clear and it has been my observation ...not documented scientifically...that cats clearing bounces often come down fast and sometimes low like Charlie did last night.

I really don't think Charlie looks any different from other bouncy cats and, no, I do not think this is any type of Somogyi....traditional or not. and we have found that doing a rebound check...that is taking the dose lower..doesn't work and it causes you to then waste time dealing with hyperglycemia. I think Charlie's dose is fine...her liver just needs some training

One thing I want to add about bounces is they are a natural response. It's nothing to be worried about....what we would worry about is an unregulated cat like Charlie that does not bounce. Are they tough for caregivers to take? Yes and every single new member with a bouncy cat asks the same questions.....as did I you just have to wait them out and hope that she will flatten out a bit soon.

ITs hard to say how low Charlie went last night. I would keep a close eye on her. Did you skip her shot or are you stalling and will shoot as she comes up? While ECID, several cats in this forum, including mine, have gone into the 30s with no symptoms.....but as I said...ECID. Charlie has been low on caninsulin...how did she act? I'm not making light of low numbers...they should be taken very seriously.

Hang in there....FD is a marathon not a sprint and cats bounce until they don't. She looks the same to me as so many other kitties.... :smile: ;-)

Re: 8/5Charlie-Vomit/Diarrhea BG 7am(54) BG7:30(70) BG 8(79)

We have been retesting every 30 minutes and waiting for some input from the board to decide if we should skip or shoot. It's now almost 2 hours after her morning AMPS time (7am). 8:45am now. Should we shoot at 9 or skip?

2 things in case it's a pancreatitis episode:
- We still have to give Charlie her antibiotic this morning (no matter what, we will do that shortly)
- We do have some anti-pain medicine from our holistic vet (meloxidyl) so we can give that too but haven't yet. Our new holistic vet gave it to us as it's lighter than the buprenorphine.

Charlie's behavior:
- was restless this morning when she came in the room
- ate immediately
- now lying outside and bit me the last time I checked on her. Now she has been calm with my partner for the last 3 morning blood tests.
- found multiple pools of different things in the morning (small amount of vomit with food on her chair / large pool of clear liquid without foam sort of near her litter box / more clear liquid under the table where she usually rests).

When cats have seizures, do they drool and leave liquid next to them like humans? Is there any chance Charlie could have had a seizure last night while we were sleeping and that led to the clear fluid?

Re: 8/5Charlie-Vomit/Diarrhea BG 7am(54) BG7:30(70) BG 8(79)

Vomiting and aggression can be signs of a hypo but there is no way to know if she had a seizure....those things are also symptoms of other things...the vomiting could certainly be due to pancreatitis and the aggression due to pain. I would watch her very, very closely today and if you see anything else unusual, call your vet or the emergency vet.

Normally two hours is the maximum amount any of us stall just because it's difficult to get back to our normal shot times . If you shoot two hours late, you make it up in increments (shoot early) 15 minutes per cycle or 30 minutes once a day until you are back on schedule.

Here's the issue.....if you don't shoot ( and she is at a safe number now for a cat that is feeling good and having no health issues like possibly not wanting to eat later or vomiting), her numbers are going to go up..maybe a lot. Normally the no shoot umber for a new member is 150. You've shot a 133 before but you haven't shot this low. You do have a good amount of data for the short time she has been on lantus. But if we tell you it's ok to shoot your first low number, we ae supposed to stay with you and I am not able to do that tonight....I was up two nights ago all night with Gracie and last night with another member...and it looks like another test/sleep night with Grace tonight so I'm running in fumes. I would ask Jane to help you but she's not on the board right now.

So I don't want to tell you it's ok to shoot with no one here for a few more hours to help you. You could shoot a reduced dose, like .25u just to get some insulin in her but because of the depot, she might look the same as if you'd shot a full dose....and in both events, I think she is going to come up and bounce.

Re: 8/5Charlie-VomitDiarrhea BG 7am(54). SKIPPED.

One other thing I want to add....you hold the syringe. There is a link to "handling low numbers" in my signature block.
I would be sure that if you skip, you check her religiously for ketones as infection and not enough insulin, food, water can be a precursor to diabetic ketoacidosis. You've handled low numbers before. I feel certain that if you shoot she will come up and bounce as long as you can get her to eat.

Re: 8/5Charlie-VomitDiarrhea BG 7am(54). SKIPPED.

Thanks for the quick feedback Marjorie. We decided to skip the shot this morning in the end. We will watch Charlie closely, give the antibiotic and POSSIBLY give the pain solution (meloxidyl). If I knew Charlie was in pain for sure, I'd give it. It's likely with the vomiting, but who knows as now she is on her chair on the balcony and not hiding. Not sure as I don't know if we should mix in more variables.

For now, we skipped her morning shot and will test throughout the day as we try to figure out what to do next at 7pm (give her .5 units? reduce to .25?)

Re: 8/5Charlie-VomitDiarrhea BG 7am(54). SKIPPED.

Ok...I hope she feels better. I'd hate to see you reduce her dose. I'm just not seeing the need....we've had this discussion with several new members lately.

I will leave a pm for Sienne or Jill to look at your condo tomorrow so you can get their opinions as well.

Have a good day and I hope she feels better.

Re: 8/5 Charlie - Vomit & Diarrhea BG 7am (54). SKIPPED.

Jill! Ugh, drat my luck, I'm so sorry I'm coming late to this as I'd have been happy to watch the cycle with you, had you shot. I *just* got your email, too. Got up five minutes ago, put coffee on, splashed cold water on my face, switched on my laptop, and found this... I'm sorry!

For what it's worth, I'm with Marje about that dose. What I'm seeing when I look at Charlie's SS is this:
- Charlie is a cat that's still quite new to insulin treatment.
- Charlie's liver need what we call "liver training" - it "panics" at healthy numbers and floods Charlie's system with sugars/hormones, making her BOUNCE.
- The bounces take a couple of days to clear.
- For Charlie on Caninsulin, there is little data, and ecepting the last few days, testing was not at consistent times, which explains the "colourful" look.
- During the first couple of Lantus-days, the shed had not yet built up enough to have a "strong" effect, and even though you saw blue, the bounces were both lower and shorter.
- As the she began to build, you stared seeing green, and the bounces became higher and more prolonged, but what looks to me still pretty much like "standard bouncing".
- This morning's beautiful green AMBG (not AMPS due to skipped shot, this once) was the FIRST green one, but look at the trend: except when she was still in bounce-mode, she came nicely down, albeit "only" into the blues for her morning pre-shots. This was was just her first "extra-low" one.
- Because of the cumulative nature of Lantus, this cycle would have pretty much played out similarly or the same even, whether you'd shot or not - the sipped shot of this morning wont' have most of its effect on *this* cycle, but on the next one(s).
- I don't see that her dose is too high. Instead, I see a cat responding fairly well, actually, to the insulin (and the dose), that simply needs a bit more time to show which direction she wants to go.

That's IMHO of course. I can understand how frustrated you are at seeing those high numbers, and at seeing Charlie feeling yucky. Like Marje said, it's likely that you're going to see more of that still, so you'll need those BOS to try and grin and bear it, ok? Love her and cuddle her and watch her carefully today - you can always re-assess whether to have the vet look at her again on Monday/Tuesday.

About the pain meds: If you suspect pancreatitis *IN THE LEAST*, you need to know that that's often an extremely uncomfortable and painful condition, and cats' masterful ability to mask pain doesn't exactly make treatment easier! Karre came back onto Lantus due to a case of pancreatitis, and he was in considerable pain. The pain meds helped a lot. Are there *any* signs Charlie is in pain? Will she allow you to pick her up? Will she allow you to massage her abdomen? If you palpate it, are there signa of flinching, or pulling away, or vocalizing? If you *do* suspect pain, I'd give the meds. I know it's another factor to take into consideration - but a cat in pain can have just as affected numbers as one who needs a dosing adjustment... Pain and stress, you know. Same for us beans!

For the sake of avoiding terms that are considered to be, let's say, on the margins - let's refer to bounces/bouncing. No, a cat does not at att need to have a hypo episode to bounce. They bounce off any number that feels low to their system or a drop that feels too fast, it need not be a green or even a blue number! And yes, an infection would very likely affect Charlie's numbers - how many more days of ABs again? (Coffee not kicked in yet.) Are you able to take Charlie's temperature?

How is Charlie behaving right now?

I'm so sorry you're so concerned and have all these stress factors to contend with! Hang in there, k?
Jane

Re: 8/5 Charlie - Vomit & Diarrhea BG 7am (54). SKIPPED.

Of all the 4 vets that we took Charlie to so far (our original vet, 2 ER vets, and our new holistic vet), all of them felt Charlie's stomach and said she doesn't have the normal reactions of a cat who has pancreatitis. Charlie was not screaming, not very vocal, and just a bit squirmy (because she's not really one to let anyone pick her up aside from us).

This morning, she's not cuddly. She has been out on the balcony on the far other side of our place all morning. She allows us to do the blood tests, but didn't like it when I held her to take the antibiotic (sort of normal as it's something we have to "force feed" with a water syringe and she doesn't like being restricted in any way). We'll try to take her temperature. Still haven't given any pain meds.

Does it make sense to keep testing hourly before her PMPS? Or should we just let her be and test at the PMPS since she didn't get her shot anyway?

Re: 8/5 Charlie - Vomit & Diarrhea BG 7am (54). SKIPPED.

Sorry about the delay, Jill, I was in PM-land.

Given that (+3) of 104, I think you're ok to space the tests out a bit. I wouldn't take my eyes totally off it, since as we know the previous cycle's shot is more important to this one than the (lack of) shot that directly preceded it. I'd get a (+5) and see from there. How does that sound to you?

Jane

Re: 8/5 Charlie - Vomit & Diarrhea BG 7am (54). SKIPPED.

Sounds like a plan, Stan.

7.2 (130 US) at +5.

I think we can wait and test at the PMPS. Thoughts?

Re: 8/5 Charlie - Vomit & Diarrhea BG 7am (54). SKIPPED.

You could wait until PMPS, yes. I'd probably still use this chance to get data on what sort of reaction Charlie has, if any in the same cycle, to a skipped shot, and also given the fact that you've not got (+10)/(+11) data yet. Becoming data ready to shoot low numbers (and this morning pretty greeeen BG suggests you may well come up against this again soon) can be a tricky process, and since most likely this cycle wil play out the same way it would have done *with* a shot (due to Lantus's nature and the workings of its shed), it could be interesting to see what Charlie does in the two hours before pre-shot.

Remember, from the Sticky:

BECOMING DATA READY

Let's talk specifically for Lantus and Levemir. This is about fine tuning your curves. Are you data ready to handle a lower preshot number? This is where the very early cycle spot checks (those +1's, +2's) and those very late cycle spot checks (the +10's, +11's) come into play. Call them the "neglected" spot checks. Everyone gets those +6 spot checks, but there is a reason to collect data in the very early and very late part of the cycle.

Say you get a preshot of 150. Well if you've collected the data on the average time it takes the insulin to start having any effect for your cat and what happens after +12, then you might see that shooting a 150 is actually very safe in your cat. Kitty will be in the 200's before the insulin starts working. You are then using the lag time (aka overlap and carryover) between shooting and effect time to your advantage.

So why the +10's and +11's? Well say you are on day 5 of a dose increase change and your storage shed is now not only full, it is overflowing... and your +10 or +11 was way higher than your preshot. Good way to stay out of trouble cause now you know you would have shot a still dropping number, not a good idea. so what is the plan then?.... keep testing, and not 2 hours later, every 20-30 minutes would be better, so you can catch the minute it turns and do not loose all your overlap. If you miss the rise and cat is way up there BG wise before you shoot, remember the number is just going to continue to rise in those hours before the insulin has a chance to kick in, and you have a roller coaster curve going rather than the flat curve that is ideal.

Also some Lantus and Levemir users notice a dip at the end of the cycle, meaning that their preshot is always a bit lower than their +10 or +11. It is important to know if your cat is one of those because if you are not raising your dose because your PS doesn't seem to call for it, yet your nadir is not so hot... this could be the reason why.

This might be a good opportunity to review this thread itself, but also this Sticky on Handling/Shooting Low Numbers. The better you understand Lantus, and Lantus dosing, the more confidently and safely you will be able to go ahead with treatment decision, and the better a chance your sweety has to feel better and better soon! Also, PLEASE bear in mind that ketones continue to be a danger factor, as Marje reminded you. Try to get a urine test in.

How does that sound to you? Any queries?
Jane

Re: 8/5 Charlie - Vomit & Diarrhea BG 7am (54). SKIPPED.

Hi Jane,

I have read and reread all of that, but I must admit that I STILL do not get it fully. Maybe my head isn't compeltely clear? Or it's just information overload from all that I have been reading?

I do get the overall message that more data (also at the neglected times) is important to round out the full picture, so we'll try to test around 5pm, 6pm and 7pm tonight if we can get those in.

Also, the ketone test will happen tomorrow at noon at the vet during the urine test.

Re: 8/5 Charlie - Vomit & Diarrhea BG 7am (54). SKIPPED.

charliesmom said:

Hi Jane,
I have read and reread all of that, but I must admit that I STILL do not get it fully. Maybe my head isn't compeltely clear? Or it's just information overload from all that I have been reading?
I do get the overall message that more data (also at the neglected times) is important to round out the full picture, so we'll try to test around 5pm, 6pm and 7pm tonight if we can get those in.
Also, the ketone test will happen tomorrow at noon at the vet during the urine test.

Click to expand...

Good plan, about the ketone test, Jill! If you do happen to catch Charlie as she's peeing today, you can of course also get a ketostick in there.

And regarding the sticky: I'd love to try and help explain anything that's unclear (and boy do I know what it's like to get information overload and feel like a lot of thing don't seem to make sense!) - would you be able to pinpoint the aspects you're finding confusing? If you like, just pick out and quote whatever passages they are, and I'll see if I can elucidate (as I'm sure others will when they get in).

Jane

Re: 8/5 Charlie - Vomit & Diarrhea BG 7am (54). SKIPPED.

I think Jane summarized the variables you're looking at quite well. The only think I would add to the list is that Charlie's been dealing with what is likely a GI issue. What can happen when a cat has an infection of some sort is that the infection drives BG numbers up. Once an antibiotic kicks in, numbers can drop. You may be seeing the result of the antibiotic along with the bounce clearing.

I agree with Marje and Jane -- Charlie is bouncing. Bounces are a common occurrence and are certainly one way to know that your cat's liver is working properly! When you're not used to seeing them, at the very least it's disconcerting. I would not encourage you to reduce Charlie's dose as a result of a bounce. The people that have done "rebound checks" only end up wasting time and allowing their cat to sit in high numbers unnecessarily long. You did not start on too high of a dose and you haven't raised Charlie's dose in an excessive amount.

Just as an aside, some time ago, Gabby was dealing with a GI bug. She would vomit and have diarrhea. She responded to antibiotics (metronidazole) and an over the counter medication to help with her upset stomach (famotidine). The vet would put her on the meds for a week or two. We'd stop the meds and Gabby would be OK for maybe a couple of weeks and we'd go through the same thing again. I ended up running every test in the book. We done everything short of an intestinal biopsy. The final trial before a biopsy was to put Gabby on the meds for a month. Since the longer course of meds, the problem hasn't recurred.

BUMP 8/5 Charlie Shoot .5? Stall first?

About to give the evening shot and need input. I think the advice was to go for .5?

Numbers today, as a reminder:
7am (normal AMPS time) = BG was 54
7:30am = BG was 70
SKIPPED SHOT
BG +1 = 79
BG +2 = 90
BG +3 = 104
BG +5 = 130
BG +6 = 176
BG +10 = 481
BG at +11 = 479
BG at +12 = 450

Jane/Sienne/others:

This is the part of the text that I don't get and it relates to our decision right now I think (as it seems like charlie has gone DOWN since her +10 rather than up):

In short, does it mean we should now stall and test every 30 mins until it starts to rise again???????

"So why the +10's and +11's? Well say you are on day 5 of a dose increase change and your storage shed is now not only full, it is overflowing... and your +10 or +11 was way higher than your preshot. Good way to stay out of trouble cause now you know you would have shot a still dropping number, not a good idea. so what is the plan then?.... keep testing, and not 2 hours later, every 20-30 minutes would be better, so you can catch the minute it turns and do not loose all your overlap. If you miss the rise and cat is way up there BG wise before you shoot, remember the number is just going to continue to rise in those hours before the insulin has a chance to kick in, and you have a roller coaster curve going rather than the flat curve that is ideal.

Also some Lantus and Levemir users notice a dip at the end of the cycle, meaning that their preshot is always a bit lower than their +10 or +11. It is important to know if your cat is one of those because if you are not raising your dose because your PS doesn't seem to call for it, yet your nadir is not so hot... this could be the reason why."

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

Go ahead and shoot. The 481, 479 and 450 are all within the 20% meter variance.

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

Jill

Yes...shoot the .5u dose. She is surfing. With meter variance, there is no difference in her last few tests. Don't stall.

I want to get this to you so you can shoot...I'll bbl to explain the rest.

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

shooting now. no blood test.

steak with truffles and mashed potatoes are on the stove!!

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

In the quote, notice it says that the +10 or +11 is way higher. That would have to be over the 20% meter variance so to be way higher than your PS, that +10 would have had to be well over 540 as 540 would just be the upper limit of the meter variance from 450.

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

Just got your PM (was at the stove myself). I'm glad you shot. Good move. Does the quoted passage make sense to you now, with Marje's notes?

Jane

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

That part makes sense.

What about this part:

Also some Lantus and Levemir users notice a dip at the end of the cycle, meaning that their preshot is always a bit lower than their +10 or +11. "It is important to know if your cat is one of those because if you are not raising your dose because your PS doesn't seem to call for it, yet your nadir is not so hot... this could be the reason why."

- what do they mean by "your PS doesn't seem to call for it, yet your nadir is not so hot"

Not so hot??? I find that confusing. What exactly makes a nadir hot? Being within the appropriately acceptable range for normal cats (3-5?) US 54-90 BG level?

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

This *can* seem confusing, especially taken out of context - remember the whole document was written to make sense as a whole, and even make sense out of its connection with info from other stickies. That's the crux of keeping on reading - seeing the whole picture takes a while! Took me a long time :mrgreen:

The passage you are quoting, I would explain like this: One holds off on increasing a dose, or shooting the current (previously increased) dose, (note the context at that point references a dose increase change) because the pre-shot is a dropping number, and that becomes a pattern (because the cat is one who dips after +10/+11 and so habitually shows lowering/dropping pre-shots that do NOT seem to say "Need more insulin", or seem to say "Don't shoot, due to dropping number"), BUT the NADIRS seem to contradict the impression that an increase, or shot on current cycle, is not needed (because they are higher than they should be for that cat at that point in its insulin treatment). Then, the correct treatment choice or change is delayed or missed. Because the cat's specific "insulin personality", its patterns of what if does in its cycles, are misleading.

The passage highlights how important it is to see the WHOLE picture, not only pre-shots and not only nadirs. Hence the title, becoming data-ready. More data = better treatment choices, especially for cTa with some tricks up their SS-sleaves.

Does that make more sense?
Jane

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

Glad to know I am not the only one who finds this info confusing. I read it, think it makes sense, then the cat gives numbers that make me question what to do with preshot data, nadir vs. now dilemna. Thank goodness for the patient experienced folks here who help us focus in on what matters most for the immediate decision at hand. Sending positive thoughts to you and Charlie.
Leslie

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

The "data ready" section of the sticky you're referring to was written by a very knowledgeable member (Jojo) who is no longer active on the board. Jojo has a particular way of expressing herself in writing that when she was around, made perfect sense. I don't think she's been here for 2+ years so it makes deciphering her notes hard. (It's kind of like moving to an area where you don't recognized the accent. The language is the same but your ears aren't used to hearing it that way.)

What she's describing is a "double dip." Some cats may have a second dip toward the end of the cycle. As a result, the caregiver won't shoot because they see a lower pre-shot value than their +10 or +11. Where the nadir is, tells you how low the dose is taking your cat. So, if you see a double dip, especially if the nadir is in a higher range (e.g., high blues or yellows or even higher), and if you're thinking that the drop at pre-shot is telling you that you might be shooting a dropping number so you don't shoot, that's probably not the best decision.

Keep in mind that the "data ready" info was being written for someone who's very new to Lantus. The purpose is to encourage people to start collecting test data so you're ready to shoot low.

Let me know if you're still confused.

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

You guys are great, so very dedicated to this cause, and super helpful. General principles are what's most important for me right now (as I'm still a newbie and building up my knowledge base little by little). Repetition and experience = retention. Soon I hope a lot of this will become second nature to us. What seems to be important now is to continue to gather data so that when the moment arises, I have the facts to back up the tough decisions. By the way, still seems like every day we have tough decisions, but I'm hoping it will stabilize a bit in the coming weeks.
When it comes time and I need to apply this, I hope someone will be there to coach and guide if required. Thanks, ladies.

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

Of course, Jill! Glad to help :mrgreen:
Jane

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

Jill

One other thing I want to add because I see new members getting very confused about it and how to detect whether they are seeing a "dropping" number or a "second dip".

A dropping number is when the PS starts higher and the BG drops continuously into the next PS. This often happens on lantus when a kitty is clearing a bounce. We are very careful when it comes to new members shooting a dropping number especially if it is low. However, with more experience under one's belt, one can shoot dropping numbers (even lower ones eta: that is, lower SAFE numbers above 50) and take advantage of overlap. What is "more experience"? It is someone who knows their cat; knows how kitty responds to different carbs; knows kitty's onset, nadir, and duration; has data that they understand.

A second dip is a totally different animal and is safe for new members to shoot as long as the PS is above 50 and the new member has been learning gradually how to shoot lower and lower with assistance from experienced members. How to recognize a second dip? Kitty will have a normal lantus curve....higher at PS, lower at nadir, climb back up after nadir, and then comes the dip. But a second dip is higher than the cat's nadir. I would love to show you an example but Charlie is a little bouncy now and so you can't really see the second dip and Gracie is on lev so her cycles are totally different. Oh wait...I know a good one. Take a look at Max's SS. Look at his a.m. cycle of 8/4. His nadir was 48; he came up to 80 at +10 and then dipped back down to 65 at PMPS.

I hope that helps distinguish those two

And yes....there's usually one of us around most of the time to help you all. How is Charlie feeling now?

Re: BUMP 8/5 Charlie Shoot .5? Stall first?

Got it. More clear. I think I still fall into category 2 so I will take it slow unless there's somebody to coach me through.

Charlie is relaxing on the balcony. She still has this slightly rapid breathing thing that I can see when I very carefully watch her belly (movements up and down are more labored than usual, I think), but her numbers are coming down as of +2 so that's already a start. Wonder how low they'll go though as I think it's clear you were right this morning. I didn't shoot, and now it seems her evening PMPS was a sort of bounce, right? I mean, how high does it have to go to be considered a bounce? If the numbers gradually climb up and are higher at AMPS and PMPS, isn't that a normal? Or is a bounce only a bounce when those high numbers don't come down (even after another shot). IE: Right now Charlie is at 18. If she stays in the pink or red zone for the rest of her cycle, that's a bounce.

So far, no more vomiting today (just last night when we were sleeping). Between diarrhea and loose stools this evening. Last antibiotic will be given before bed. Will ask the vet tomorrow about probiotics (without the psyllium, etc).

Re: 8/5 Charlie +12AM 54 SKIPPED PMPS 450 +2 329

Charlie is most likely going to have, during the course of her FD, both kinds of cycles.....dropping and those with a second dip. I actually think her cycle of yesterday where she gave you a 54 at +12 was likely a dropping cycle. She started in the 400s the morning of 8/4 and gradually came down all day into yellow that night....she probably just kept dropping into the 54 at +12.

Her numbers today are from bouncing from the 54 and also somewhat from draining the depot. You probably didn't drain it too much but I'm sure some of those numbers reflect that. Oh gosh...how high can they bounce? Depends on the cat Some cats will bounce into black. When I have the dose perfect for Gracie, she'll bounce only into blue. ECID. Normally, yes, the PSs are the highest with the nadir being the lowest. But in a tightly regulated cat, you might not see much variance at all in their numbers so the "curve" actually looks quite flat. An example would be Jill's Alex. Even though she's on levemir, the curve flattens out, just like lantus, in a TR'd cat. I think one day Alex was AMPS 71, +6 71, PMPS 71 and +6 62.

When you have high numbers, look back at least six cycles and see if in any of those preceding cycles there was a "lower" number. That lower number could be in yellow, blue, or green depending on how high the high numbers are. That's how you can spot a bounce. A bounce might stay high and flat and then clear quickly. But the key is that there was a lower number preceding the high ones. If Charlie stays in pink or red, it's probably bouncing and refilling her shed.

Glad no vomiting. Hope the liquipoo is better after AB is done.

Re: 8/5 Charlie +12AM 54 SKIPPED PMPS 450 +2 329

There may be some bounce, but not shooting also means you're going to see high numbers by your next shot time.

Re: 8/5 Charlie +12AM 54 SKIPPED PMPS 450 +2 329

Thanks guys.

"I'm Kind of a Big Deal"
- Charlie

Re: 8/5 Charlie +12AM 54 SKIPPED PMPS 450 +2 329 +3 315

What a cutie! Charlie definitely knows how to relax. Nothing like red to make pink look good. :roll: It's nice to see her coming down. Woohoo!
Liz

Re: 8/5 Charlie +12AM 54 SKIPPED PMPS 450 +2 329 +3 315 +9 3

Thanks Liz, Anne & Zener! Off the antibiotics now. Lets hope those pinks turn to blues and greens.
;-)