4/15 Aria - Rebound time?? Need advice

That's the only thing I can think of her numbers today. I gave her the shot at +10 because she was already close to 300, but she's still running high and flat. So I'm going to have to guess that I need to be lowering back to 1.4 or maybe even 1.2. She's peeing on things, but any time she is over 250, she tends to pee on things. She's eating well, though, so that's good.

Inverse curve is rebound, right? The other times she's rebounded it's been really obvious >550 for hours. This is a stuck at 300 kind of thing. So should I shoot at +8 or +10 or is it better for her to wait out to +12? Part of me really wants to go back to TID. However, just found out that DH has an overnight work thing next Saturday, so we'll have to get a cat sitter to shoot while we're gone, which leads me to stick with BID. Then there's the looming vacation. I guess I better call my sitter and make sure she's prepared.

Thanks all!

Edited to add - Ok, so she's starting to drop at +8. Since I've never had her drop before a shot, what do I do? I know I need to give her a reduced shot (I think I know) but how much should I reduce? Back to 1.4 or go lower to 1.2 or 1? Please help straighten out my head before shot time.

ETA - Here we are at +10 - still dropping - 190. As a reminder, we've had a 50% decrease in insulin dosage in the last 2 weeks. I'm thinking that once she's on the rise and over 200, I'll shoot 1 unit for the night and see how she goes.

 

Hey Hope! I'm kind of in the same boat as you ohmygod_smile I'm thinking we need to go back to TID? At least that's what I am going to do. Prudence hit 300 today. She had a low of 42 the other night at only 0.1U, but its been crazy now. I was surfing the net today and came crosses this http://www.phlaunt.com/diabetes/17561156.php I guess now, I am trying to figure out what's causing this.. Dawn phenomenon vs. Somogyi effect. I've been giving pru those freeze dried shrimp before bed. Not sure if that's playing a roll in all of this? We'll figure it out :YMHUG: Give Aria a hug for me!!!


I'm thinking 1.4U since 1.5U brought her to BG35. Are you going TID? if youre going 12/12 I still think 1.4 is wear you want to be at? I think 1U will send her rebound if you're going 12/12? sorry.. let me go look again. I know you're about to shoot soon! Yeah, 1.5U this morning was too much. ok, she will probably raise in the next few hours, so I'd probably shoot 1.2 - if that's scares you.. do a thin 1.2, but i think 1U will be too low,but don't feel bad if you just do the 1U. I know we're going intot he middle of the night now @-)

 

I've actually read about that before. I'm pretty sure what we're seeing is Symogyi rebound. It's almost like I can't quite lower the dose fast enough, but then she'll have a time when it seems like it's too low. Now I'm wondering if I might have been seeing a little bit of the rebound in those days.

I'm waiting until she hits a rise and I'm shooting 1 unit. I figure, at this point, might as well lowball it for a round or two. Who knows, maybe she's getting better P action than I'm thinking and a low dose will show me that. The thing I miss about TID is that even though I was getting staggered sleep, I could see 2 good back to back cycles in a day. With BID, I go to bed and if I wake up, I'll test, but otherwise, I sleep until morning (or try.) I'm going to try and stick with BID for a while, but once we come back next month after vacation, if she's not solidly regulated, I'm going back to TID again until our next vacation. At least until I get a dose that doesn't fluctuate after 2 days.

Michelle, thanks SO much for responding. I was kind of feeling in a bit of a panic over here. I was seeing all these kooky numbers all day. I've dealt with rebound before, but never with rebound and then a late drop. Makes me twitchy. What's with the late drop? How does that factor? So right as the insulin usually wears off she's all of a sudden coming down. Weird. I've been doing web searches, but haven't found squat (except for how to make your own rag rugs which sounds fun AND they're washable for after my pee-er decides to break em in.)

Hugs, sweetie!! I check Pru's SS at least once a day to make sure she's doing ok. Is it possible to get U100 Prozinc or have it diluted? It sounds like when you give a shot, you literally need to give a half a drop and that's getting impossible to pinpoint. I know Gator's has some tricks for measuring to the .05 unit, so maybe he'll have some ideas for ya. I'm also thinking that maybe you were getting the super highs because of the 42. Some liver action going on? If she keeps it up, I'd go for doing an hourly curve so you can see exactly what those numbers are doing to you.

 

ohmygod_smile I forgot that you were going on vacation! OK, Aria... lets not stress mama out ;-) I am hoping she's riding in the blues right now. Although it's still dropping.. I think it will raise soon - or at least you'd think it would, right?

Yeah - about Pru, I PM another member about shooting less than 0.1. she told me this: A fat 0 is the same as a 0+ it is right on the zero line and divides it right in the middle with the plunger. A 0++ is between that and a .1 here's her SS. http://spreadsheets.google.com/pub?key=tYWUiHLQeEc9isrv9hwf73g&output=html I may have to go to this for awhile, but Pru is getting fedup with all of this cat(2)_steam

Sending good numbers our way!!!

 

I had a day recently when I had a dropping numbers +9 through +12 (when I tried TID again) so I just waited really late on 2 cycles to let everything cool down; then I went back to 12/12. I think its too much insulin doing that. Like you said maybe you are getting more P action, which means you could be going longer and longer between shots not TID. I think as they go OTJ they can get longer duration :?: makes sense.

 

Nancy - I'm with you on that. We just switched back to BID because all of a sudden her TID dose was lasting 12-16 hours. So basically, her body decided to go BID.

We're at +14 and she's still dropping. Not sure how long I'm going to stay up and monitor. DD has a sleepover tomorrow night, so I've got crazy girls up all night long. At least now that she's back in blues, she's not peeing on stuff. That's an improvement. She's been eating on and off since she started going down with the numbers. She's happy as a clam, so I guess I'll wait another hour and see where she's at.

I'm pretty much at the point of thinking I'll just shoot 1 unit and see how she rides.

 

studied it a bit more and I think you are still seeing somagi from that 35 the other day. I'm no expert but I'd back off, let it stop bouncing, and then bring her numbers down again gradually, so you don't hit another somagi set back.

 

wow MEMORIES, how old is your daughter? So many lonnnngggg nights with kids who never get tired! Now its the cat :lol: :lol:

 

The late drop is a fairly common PZI pattern, it's turned up a lot here from what I have seen. With Bix it has generally meant the dose was a bit too high. I think of it as their body (liver I guess) resisting the dose, then when it is past peak they feel like it is "safe" and will accept some insulin effect later in the cycle, and/or get a late nadir/better duration from the higher dose. I'm sure there is a better scientific explanation that's just how I think of it.

In her case though, I agree that it looks like it could be a little rebound wearing off from a few cycles ago after that 35, so this drop could have more to do with that than with anything else, i.e. if the rebound is clearing her #s are dropping from that. Personally I wouldn't repeat the dose that gave her the 35 unless she stays higher for at least a few cycles - seems like her body might sort of see that 1.5 coming and go "no way, not falling for THAT this time around!". Well, that's what I would think if I were a kitty liver. :lol:

I think inverse curve is that the dose is too high. Rebound is a low # or a sharp drop followed by high #s, that sometimes will starting coming back down by the end of the same cycle, but it can take up to 3 days for the stuff the liver released to clear. That's acute rebound. Chronic rebound is a high flat curve (well, line, I guess). At least that's how I understand it...

Hope you got things straightened out tonight, I am a little late to the party! :mrgreen: Since it will be a late shot (if you haven't shot already) I would be surprised if you see anything like the action you would on a +12 shot. 1u sounds like a safe bet to me, even if the PS is on the lower side, once her #s are rising. I'd probably try 1.2 for a couple cycles, and if she is getting a U-curve but not great #s, then go up to 1.4. Don't want to wait too long and let her sit in the higher #s and lose progress, but also don't want to perpetuate a rebound cycle if that's what she had.

 

Ya know... I've seen a bit lately about the 'safety' of low numbers. Now we're talking about the "rebound" caused by low numbers. As some of the folks here know, I'm a chicken about low numbers [in part 'cuz my kittah only has 1/2 a liver to somogyi with] so that's were I'm coming from. But for all the talk about how low numbers are ok, we seem to be also talking a lot about how low number can interfere in regulation...

Just sayin' [rebuttals and critiques welcome]. Obviously I realize perfection is not an option for any of us.

 

NOW you tell me! ohmygod_smile

I was such a wuss about shooting before that she stayed too high for too long. So now I try not to be such a chicken about it, but then (of course) she starts dropping her dosage rapidly and hitting really low. Of course the cat shows no signs of problems. Der... I'm sure I had a point here, but I'm sleepy. Thanks for the response guys. We do appreciate it

 

wow curve is awesome- maybe she's on her way to being a once a day kitty for awhile! then otj

I would try to stick with that awhile and see where she goes- let her liver try to pick up the slack, with lots of small meals to say 'good morning Mr P"

 

LOL Nancy! I just read your message after hand delivering a plate of food to her. DH finds it amusing, although he gets squicked out when I heat it in the microwave. Oh and DD is 7 (and a 3/4 if you ask her) and fabulously fun. I don't know about boys yet, DS is only 4, but since DD turned 2, our house has turned into sleepover/playdate central. Usually a bunch of pretweens singing karaoke at god forsaken hours of the night. I often ask my neighbors if they were too loud... and yes, I know that does not bode well for the teenage years

 

On low #s, I have always liked the rule of thumb that 1 # below 50 = immediate dose reduction. (And I adapt it to mean # getting pretty close to 50, unless you have just lowered the dose and are expecting reduction in overlap.) I think Tilly is a little more aggressive than that, but personally that makes me a little nervous, plus it is for different insulins. I for one have gotten a little careless with it since I have experience with Bix that he will "eat off" the excess insulin. But really that is risky. From what I understand, hypo (as in actual nastiness, not just low #s) can appear w/o warning, and they can be fine one minute, and not fine the next.

It is tough though, especially I think when you have ketones to dodge like many of the cats here. Ultimately for me it comes down to lifestyle and choosing what works for your cat and you. When someone has the opportunity to shoot more aggressively and check for low #s and watch their cat, with a mind to going OTJ if possible, I think it's not such a bad thing. Rebound is a risk as well as hypo, but I think of it as a calculated risk as long as you are there to monitor. For other cats/beans, I don't think any of that is appropriate, it is about QOL, and there is no reason to take those risks, if for one reason or another OTJ is not the goal (and I don't think there is any need for it to be the goal for anyone really, though I personally am not ready to give up the dream).

With PZI, it seems like for a # of cats you have to shoot pretty aggressively to get good #s, and then it is a quick dose reduction path. I think that is true on Lantus too maybe. I'm not sure why (pancreas healing? liver training? just the mysteries of how they process insulin?), but I have seen it repeatedly. For cats like Bix and some others, it seems like they are sort of all-or-nothing. When I got here with him I thought it would be a nice tidy gradual lowering of #s, PSs gently going down to the mid-200s, then 200, then 180, and nadirs nicely reducing from yellows to blues to greens. But instead it was more like being stuck in yellows & pinks, and then all of a sudden a blue/green ride where one false move puts you either too low, or stuck back up high.

Frankly, I wish we had more cheat sheets on this stuff. There is so much that I see each newbie going through in the learning process, struggling with "what does this mean?", "what do I do?", etc., and it just seems like we have a dearth of passed-on wisdom of the finer points of how to use PZI. Well, I know this path has been well-worn, so time to get off the complaining-box. :roll:

Well anyway, just my musings. Thanks for bringing up the point Gator. It is always a balancing act - you put it well once, though I forget exactly - balancing an elephant on the head of a pin?

 

Interesting opinions on this. I'm one that is primarily concerned about too low a number interfering with regulation as G&H mentioned.

My Blue cat is riding low blues and high greens for the past couple of days w/o any insulin, and I myself am questioning whether a small dose will put him into better numbers consistently. As I've mentioned before I am also mainly concerned about mucking up his progress by risking the rebound and not so much the 'hypo' risk.

Normally my tendency is to be aggressive, but there is a very fine line with these numbers. I would think that if the cat does get even slightly better numbers on their own, it's probably worth it to wait. Blue's swings atm are very slight though compared to some of yours which makes for an easier call.

No doubt in my mind that with Somogyi the best bet is to wait it out with a slight reduction in dosing for at least 3 cycles to make sure the cat does not approach the nadir which shot him into rebound numbers. Then it is time to wait for the cat's system to even out a couple days so one can then assess what dosage change would be appropriate. Making too quick an adjustment (or 2 or 3 or 4!) quickly with these rebound issues seems to delay the 'leveling out' period and will set back the cat's progress from what I've seen with many of your SS's.

 

Ari's always been a bit of a puzzle. She'll do well, then tank fast. I've never had her do this rapid of a dose reduction before, so it's all a learning process. She's hanging too low today, so I'm reducing her dose again for the next shot, probably going to skip right over 1 unit and go to .8 and see how she does. It's the weekend and I'll be up early for tomorrow's run, so I'll schedule a middle of the cycle alarm to test sometime around 3 or 4 to see how that holds her.

Besides, sleep is highly overrated

Steve - Don't forget ECID. Blue may dig those low blue numbers and may be happy there. If you notice a consistent creep upwards, I'd bump, but otherwise, test, test, test. I've been checking on you guys the last few days. I wish we had found this site when Aria was first dx'd. I think we would have had a much better 2009

 

I think what Joanna and Bix said is right on. I have seen this happen to a lot of others lately, and we are going through this exact same senario right now too. I am sorry that I have no advice to give, but maybe we can all collect enough data through this to help others in the future!