? 9/12 Henri PMPS 234, +1 268, +2 286, +3 312, +4 275, bounce/high numbers

https://www.felinediabetes.com/FDMB...152-2-200-4-145-5-131-6-119-tr-dosing.235113/

above is the link to yesterdays post.

I see that Henri has bounced again. Her number is soooo high this morning! Should I be concerned? My vet told me anything over 300 can do damage to the organs. Is there something I am doing wrong?

Is there a way to help a bounce once you're already in it or is their a way to help prevent a bounce?
It's from my understanding that a bounce is due to very low numbers or a big drop even if numbers are within normal range.

My thought is, if she tends to bounce from being in the low 100's, if I use food to help try to keep her in the high 100's could I get her body used to being at that number,. Once she's used to that number I could stop using food to manipulate and her her body used to the newer low number?
Or is that not how insulin and tight regulation work. I have some stickys to read still...I am trying to catch up...it's just a lot with work and no sleep

Her numbers are:
AMPS 449, +1 485

https://docs.google.com/spreadsheets/d/1OG2DE6K4Qn7i8E1vlvwgISq4hp_Pv9_8b-80OdX7zts/edit?usp=sharing

 

Bounces happen when kitties aren't used to low numbers "for them". Henri is not used to those beachy blue numbers and she thinks she needs to protect herself from them. Kitties have stores of glucogen, glycogen and counter-regulatory hormones that they will release into their bloodstream when they perceive that they are too low, as a way of protecting themselves. What constitutes "too low" is relative to what numbers the cat is used to. Henri is so used to very high numbers that she thinks she needs protecting from blue numbers.

If you look at other kitties spreadsheets, you will see other kitties bounce just as high, if not higher. And it can happen for a while. I remember someone mentioning their cat was bouncy for a year. Henri will give up her trampoline when she is good and ready to. And also of note, bounces can last for days.

The way to get past the bounces is for her to spend time in the lower numbers, so I would not recommend keeping her high to ward off bounces. The more she experiences lower numbers, the better. She will get used to them in time, and then she will stop with the bouncing.

 

It can take up to sic cycles to clear so its a save some strips day. Take time for you!

 

Ok...thank you for the detailed explanation!
I'll just have to get used to a bouncy kitty fir awhile lol

Do I have to worry about organ damage with the numbers getting super high like that? Is there a high number that's too high and dangerous when bouncing? Like 600, 700 etc

 

I'll let my husband know to lighten up on the testing then

Yeah...we've gone through A LOT of strips lol

 

It would take high numbers for a long time for organ damage. Don’t worry about that. You can’t go any faster than Henri tells you by his numbers. Going hypo can be dangerous too. We won’t let him be too high for too long. Nobody wants to see DKA or hypo.

 

So too high numbers is what causes DKA (diabetic ketoacidosis) im assuming that's what DKA stands for?

I urine test her ketones almost every day. When I work 10 hour days its but harder.
Shes never tested more than trace

 

Perfect. As I understand it too little food, too high BG, not enough insulin, not enough hydration can cause it. I’m no expert there as I was fortunate not to have to deal with it. It’s why if there’s a history of it as in your case you don’t want to skip shots if at all possible and daily ketone tests are great. Are you using ketone strips to test? There are meters that test both blood and bg so you might want to get one and use it once a day.

 

Ri

Right now im using the strips but I do plan on getting a meter to test it in the blood. I just haven't gotten around to it yet. Theres so many im not sure which is a good one to get lol

I was thinking id use the meter once or twice a week when I can't do the urine one and the other days ill use the urine test strips. They're actually pretty easy with the plastic litter i have.

 

Only if they are up there for the long time, short periods of time are OK.

DKA also includes infection or systematic inflammation.

If you are following TR, it's past time for an increase. The goal is mostly greens and this dose isn't giving that to you.

A tip on testing (especially at night) - if Henri is flat or rising without having had any higher carb food for a couple hours, you can go to sleep. Last night at +7 was fine to stop testing. As you learn Henri's patterns, and when he likes to go low, you'll be able to go to sleep earlier, or at least know when to sleep and set an alarm for later.

 

Should i still be increasing the dose

We lowered the dose 9 days ago bc she dropped into the mid 50's and it took me an hr and a half to get her back up again.
Everyone told me that shes bouncing and thats why her nimbers are all over the place

 

The reduction point when following TR is when kitties go below 50 on a human meter. When you got the 50's before, looks like she was up to the 80's almost right away. People might have suggested a reduction because you were fairly new, and it's easier to go up the dosing ladder when you are new, than to fight low numbers when you are still learning the basics, like testing.

Henri won't stop bouncing until she gets used to being in normal blood sugar numbers. That means spending more time in nice safe healing greens. 0.75 units is not getting her there.

To quote from the TR protocol:
Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
• Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
• Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

 

Interesting...i didn't realize. Does it make a difference that it took my giving her high carb food to get her into the 90's that day she dropped?

 

No, if a cat needs a reduction, they'll show you the under 50. We want to get her to a dose where most of her time is greens and blues.

 

Not usually. When they want a reduction they generally really fall under the 50. You can postpone earning one by steering with food. That keeps them in healing numbers longer and longer. A good example is Jax. Susanne Steered him for a few days and in spite of trying to hold him off a reduction was earned.

I would have to go back and read your condos to see why we did what we did at the time. I can’t remember.

 

Looks like the vomiting and no appetite had us concerned after a quick look at your ss.

 

Ok.

I had gotten the advice through the FB group bc I hadn't figured out how to set up my forum account yet.

So, even though she's spent time in the blues and yellows, we want the yellows and greens before a drop in dose.

Should I up her dose tonight...to what it was before then... 1 unit 2x a day instead of the .75 2x a day? Or should I wait to see what her PMPS is (which is in about 20 minutes). It seems her PMPS have been on the lower end while her AMPS numbers have been kind of high. I updated my spreadsheet and I'm about to update the post title

And then to clarify, If she drops below 50, that's when I either use MC or HC food to bring her numbers back up? and what is my goal to bringing it up to...into the 80's? I'm not sure I have any HC food, I KNOW I have medium cab food though. The food I have is 13-14%

 

What is SS?

 

I updated the post title and her spreadsheet. I realized I had typed in a couple of the numbers wrong. Could you take a 2nd look at it and tell me what you think about tonights dose and upping her dose in general?

 

How’s his appetite? Any vomiting? Acting normal?

SS is spreadsheet. Sorry. I forget not all know our shortcuts.

 

Can you monitor as long as needed? Do you have plenty of test strips, high carb food, and honey or Karro if needed? As Wendy wrote it is time for an increase according to TR. Post the PMPS. Then don’t feed until you get a response.

 

She is still on the appetite stimulant and anti-nausea med but has done great with food so far today. She's at 133 calories for the day already and normally she's closer to 75-100 calories. I just gave her 1 unit...I hope that was OK. Her dosing time came around and I figured since her PMPS was a little higher than it has been (maybe bc of all the food she ate?) that I would just do it.

 

I can monitor all night if needed. I'll be tired but it's doable. The PMPS was 234 and I did dose with 1 unit, but I havent fed her yet....can I? shes begging lol

Also, I dont have any HC food but I do have MC food (13%-14%), honey and lots of test strips. I can run out now to look for HC food if you think I should

 

It’s fine. Get a +1 and +2. The +2 should be an indication of what lies ahead for tonight. If the same or lower than the PMPS it likely be an active cycle meaning lots of movement and the need to test more.

 

I do have fancy feast gravy lovers. The cat food nutritional information chart says its high carb but when I type it into the carb calcualator I get 13-14%

 

Gravy lovers is high carb. Carbs are all in the gravy and not much in the pieces. Do you have honey or syrup?.

 

a

And just to clarify bc I know I'm asking so many different questions right in a row...but it's OK to feed her?

 

I have homey and syrup but I did put some honey in a litte jar in her hypo kit. along with the directions on what to do lol

I printed out a bunch of the stickys, hopefully I'll have enough energy to read through them at some point. It's like being back in college. I need a hard copy in front of me to hi-light if I'm going to absorb any of the information lol

 

I was the same way. It’s especially fun at 12-2 a.m when everyone is sleeping. The only reason had you not shot to hold off would have been it’s much easier ion a day cycle.

 

Definitely feed. I missed that one. It’s generally test, feed, shoot. You test to see if safe to give insulin. If in doubt, Stall and don’t feed and post for help. If a BG you are comfortable shooting you feed to make sure she will eat. Then you shoot.

 

That explains things, they aren't supposed to give dosing advice there.

I'm glad you increased. That +2 will give an indicator of whether it'll be a cycle needing more monitoring.

 

OK...thanks! I fed and she inhaled another 70 calories. She's almost at my goal of 220. The vet had a goal of 180 calories daily but she says bc that's what an 11 lb sedentary cat should be eating. except shed 14.2 lbs and with everything that has gone on with the hepatic lipidosis (we won't know until our next ultrasound if that's resolved) I think she should be eating for her current weight..or maybe 1 lb lighter but not 3+ pounds lighter. That's a fairly big calorie deficit for a cat.
Im about to update the spreadsheet but her +1 was 268 (up 34 from her PMPS)

 

That’s a good bump.

 

That's my fault. I was in a panic and hadn't figured out how to use the forum yet. I think the advice was not to actually lower my dose but the vet had wanted to lower it to .5 in the evening and 1 in the morning and I was advised to split it up evenly because of the way lantus works?

what am I looking for in my +2 to know if I'm going to get any sleep tonight lol She also ate a nice meal at 7 which is her PMPS and when I dosed her with 1 unit of lantus

 

For many cats (not mine though), the +2 is a good indicator of how the cycle will go. A "typical" Lantus cycle with some downward movement has a +2 around the same as the preshot. A higher +2 means a quiet cycle and sleep. A lower +2 means a more active cycle that warrant later tests.

 

If the same or lower than the PMPS there’s likely to be lots of action.

 

ah...OK that makes sense. her +2 is still going up so maybe I get a little sleep tonight?! That's a VERY exciting thought!
I was just looking over her previous testing and the days where her +2 was lower and I see what you mean. The one day it did it was the day I got into the green.

 

ECID though. Max let me know between +2 and +3. Some cats a +1 is a clue but max always had a food bump. Once you have more data you will get to know Henri.

 

Thanks for all your help! Ill probably continue to test while I'm awake (until 10 or 11) and then set am alarm for maybe 3 am just to play it safe...this is all still so new to me

 

You really will likely not need the +6 but if it makes you feel better go for it.

 

It will lol
I'm such a helicopter mom lol Lucky for me taking her BG doesn't even phase her. And I don't even always get it on the first try. I like to be able to see the numbers on the spreadsheet. I feel like the more I see and he more I can compare to other days, the more I am starting to understand it and maybe even more important...becoming more comfortable with everything.

I'm so confused to see her number rising up to the pink when she's had a higher dose of insulin...although she has been getting more pink numbers lately...so I guess her body is adjusting. I REALLY hope I never have to go above the 1 unit :/

 

Usually you won’t see a change on the first shot of a new dose when you increase but it is possible. It can take six cycles to see what it might do which is why you don’t increase any faster. When you decrease the old depot is in play so that cycle can be a very active one though.

 

Ah... very interesting!

Tomorrow im going to reread all my posts and write down all these important tidbits so ill remember them

 

Another phenomenon for you is New Dose Wonkiness. Have a good sleep!

 

I forgot that one Wendy.

 

I'll give this a read.
Her +4 started going down. Its 275