? Hercules 28/12 AMPS 108/ +4 342 How to avoid so many bounces?

https://www.felinediabetes.com/FDMB...78-bouncing-or-depot-cleaned-bouncing.240564/

Looks like Hercs is bouncing again...

His spreadsheet sometimes looks like mostly bouncing with a few days of "normal readings", mostly followed by crashing. I've been chasing the right dose for 6 months now.

I wonder if I am approaching this wrongly. I feel like it is important to keep everything as constant as possible, so don't change feeding until the crash, most of the time. I wonder if, when I see good numbers (bluish), I need to be more involved and keep him from going to low to avoid this constant cycle of crashing and bouncing? Perhaps keeping him steady for longer is more important than finding the "right" dose?

 

I have the same problem as you with my Phoenix. One way I have found to control high numbers is to skip his midnight snack. If his numbers are above 200, I don't give him a snack. If this is wrong, someone please let me know since I am still learning. Phoenix was diagnosed in March of this year.

I gave a fur shot earlier this week and managed to keep his numbers reasonably controlled by doing this.

 

Thanks for sharing your experience Susan! Hercs is very responsive to food and is usually always happy to eat more.

 

First..can we get your name please? We are all “family” here and it would be nice to call you something other than “Hercules mom”. You can even add it to your signature block so we will all know it as soon as we look at a post Thank you!

A wise, wise member here once told me “don’t chase the dose” and you especially can’t do it with Lantus. Hercules hasn’t been on Lantus very long and so you’ll have to learn to be patient again as if you are starting anew.

You are correct that staying consistent helps but so does, as you suggest, controlling the steep and fast drops that lead to a bounce. Fast drops often lead to harder bounces than lower numbers do. But...having said that, most cats bounce and they do that until they don’t....in other words, until their liver gets used to spending enough time at normal numbers that it gets used to them. Of course, spending time at normal numbers means we systematically have to get to the right dose.

The first thing I will tell you is don’t skinny and fatten the dose as you’ve been doing. We’ve found that newly diagnosed cats do much better if you stick with the 0.25u increases and decreases as they are warranted. SLGS also does not “prescribe” to using skinny and fat doses. That technique (skinny/fat doses) really works best for cats that are mostly in normal numbers and just need some tweaking. It can, on occasion, be used for cats that fail reductions but there are better options.

In looking at his SS, I would not have taken a reduction on 12/21 after a 90 and skipped shot the night before. Reductions on SLGS are earned once the cat drops below 90. Also, and forgive me if you’ve already addressed this but you aren’t feeding dry food and you are testing enough for TR. Any reason why you aren’t doing TR? It really allows you to deal with high numbers a little more quickly.

When he’s clearing a bounce, he’s going to end up giving you the lowest BG at the next PS. You can see this on 12/20 and 12/22 where he cleared the bounce on the a.m. cycle and gave you lower PMPS. It pays to test just a little more on bounce clearing cycles so you can feed a bit to slow the drop.

Many Lantus cats do well with mini meals. For example, take the total number of food he gets in a day and divide it in half....he will get half of it for the a.m. cycle and half for the p.m. Then, with that half portion, divide that into 3-4 mini meals. Many members feed at AMPS, +1, +2, and +3 to help manage the curve. But...ECID so you might have to tweak those feeding times. It’s trial and error to find what best works for Hercules.

Hi Susan....I love that you reach out to other members! It’s best to talk in terms of how many hours since you shot. For example, for some people, midnight might be +2. For others, it might be +7. Saying you feed a midnight snack doesn’t really tell Hercules’ mom anything. And we can’t tell from his SS when midnight is so that’s why it’s important to use the vernacular of hours since shot. But, let’s assume midnight is +6. That is getting close to nadir and any time you feed around nadir, you are going to slow the action of the insulin and shorten duration. That is different from bouncing.

 

Hi Marje!

Thanks for the careful response. I was feeding Hercs 6 meals a day until about a month ago. But I usuaully work away from home evryday. I was "lucky" that hercs was diagnosed during lockdown here in the Uk, so I was able to be home with him. I don't think I can continue to be with home with him beyond end of January. I switched the food and switched insulin in an attempt to get things to a point where I feel like I can leave him at home for 8 hours without food or testing and being OK.
I bought an automated feeder, but there is another cat in the house, so I cannot be sure he eats. So this is why I have settled for SLGS.

Now, I realize I still have probably a month, so perhaps I can try TR for a while. but is it a problem if I do it for a month or so and then stop? I do have the impression though that I would be in the same place, because so far (and I totally get that we are just getting started) it has just been reductions and bouncings....I did have a look at the protocol after Bhooma's comments, but I came out with the impression that I would still be at 0.25U at this point due the low BGs on the 22nd and 27th. or am i misunderstanding something?

 

I feed my kitty, Blaze mini meals. He’s OTJ now but kept the same feeding schedule as when he was on Lantus. Breakfast at 5 am, snacks at +3, 6 and 9. Dinner at 5pm and snacks at +3, 6 and 9. I have an auto feeder, the Petsafe 5, so it has 5 slots for food. Blaze was a bouncy cat too and people would tell me, cats bounce until they don’t anymore. It just takes time for their pancreas to realize that the lower numbers are good. It’s a marathon, not a sprint and Hercules will get used to the lower numbers eventually

 

Hi Hercules Mum

it's not a problem, it might allow you to get him a little closer to a good dose, or even regulated, with the faster dose changes with TR you might be able to get him to a better place before you have to get back to work.
If he is better regulated, and you have a better handle on his numbers you may even feel that you are able to continue with TR when you go back to work.
I always tried not to think to far ahead of myself with FD, take it one cycle at a time.

 

No, it’s not a problem at all. We don’t mix and match them at the same time but you can change methods. We’ve had other members do TR when they were on holiday from work and then switch back. Have you read the post about working full time and doing TR? No pressure...just information.

With TR, he’d still be on 0.5u. With a pet meter, the only BG that would have earned a reduction was the 58 on the 27th.

 

Thank you both! I'll try following TR then until I can no longer

He is bouncing, but it seems like an active cycle despite the tiny dose... so I guess I better stay to 0.25 and count today as day 1. Does that sound good?

 

I followed TR with a full time job, it’s possible!

 

What is your routine like @Sarah and Blaze ? and do you have another cat in the household?

 

The bouncing is because of the lower than usual numbers he saw on december 27 pm cycle. You then reduced to 0.25.

With the decision to do TR I would recommend sticking to the 0.5u dose, the 58 on the human meter did not earn him a reduction. Holding that for at least 6 cycles (or 3 days/there are 2 cycles per day?), making a decision on dosing at the end of those 6 cycles depending on what Hercule's nadirs are (the low point in his cycle). If at any point in those 6 cycles he were to drop below 50 on the human meter then you would reduce.

I guess that Hercule's has some 'civies' (non diabetic cat) brothers/sisters. Are they on a low carb diet as well? do they have kibble?

I have a multiple cat household, I've learnt that with how sneaky they are it is much easier to have them all on a low carb diet.
When I go on holiday I have to transition the civies to a kibble diet (because the cattery won't feed them wet, we are in spain and with the heat it's complicated), it's a nightmare and George, who is in remission now from his diabetes, will get into the kibble if I don't police feeding times like a sergeant major, the occasions where he has got into the kibble (when petsitter was in charge) have resulted in his numbers zooming up even a few pieces of kibble, make a huge difference to the BG of a diabetic cat, be it a cat in remission or one that is still on insulin.
George still has to have regular small meals, so when I am not home I have to separate him from his friends and I use an autofeeder to supply him with his regular snacks, he loves his food and will eat everything in his bowl, (and anyone elses) I had to use the autofeeder to moderate his snacks so he would eat at set times. The others are not obsessive about food, so usually they just have their bowls left down and they free feed when I am out of the house or sleeping.

This link is full of tips for how one may manage TR whilst still doing a full time job, @Sarah and Blaze did a fantastic job of doing just that, her guy is now also in remission (OTJ Off The Juice), I'll let her tell you what she found worked for her, ultimately you will need to adapt what you can do based on your work schedule, but it is possible, and if you are stuck we can try and help you round any particular problems that you face.
here is the link that Marje also posted above which is full of tips for how you may manage TR on a fulltime job, it's a good place to start, and may give you some useful ideas you could work with http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/




Are you using the UK list for the Feringa varieties that are low in carbs? not all flavours are below 10%, the diet for following TR needs to be a solely wet diet and their regular food needs to be below 10%
here is the link to the UK/europe food list, you can check the varieties against what you feed (if you haven't already done so)
https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

 

Thank you so much for defining this term for me! I have been trying to crack it for a while! Yes, he has a buddy , and they spend most of the day snuggled with each other, so it would be cruel to separate them, I think (I have thought about it...). My plan is to transfer her to the same food as him, but of course, the week before he was diagnosed I got 20 kg of kibbles .

He does eat the feringa flavours that are low in carbs, and I have been wondering if I could get them to eat freely... He has alsways been a food vaccum cleaner, and when I adopted his buddy she was hugely overweight.... so I need to figure out how to do it and how to check that it is working.... If you have some suggestions of where to look, I heartily thank you!

right. I will try tomorrow Am, so I can monitor closely. But here is a question, with a bouncy cat, that stays up for up to 3 days (as he did between the 25th and the 28th), wouldn't be dangerous to change doses based on those numbers? Should I wait to know that he is out of a bounce?

Many thanks for your help!

 

I have three cats, Blaze who is diabetic and two non-diabetic kitties. All three kitties made the switch to wet, low carb food when Blaze was diagnosed with diabetes. I got three auto feeders so they all eat at the same time, that makes it a lot easier. When Blaze was on insulin, I would get the amps test and then one more test before I left for work, and that would usually tell me what kind of snacks to leave in the auto feeder, whether is be LC, MC or HC. If I could come home at lunch to test, I would, but it didn’t always work out. Then I would test at PMPS and usually +2/+3 and go from there on whether I would need to get more tests in the evening. It was hard for me to stay up really late on work nights so I fed MC or HC snacks if I couldn’t stay up, if he wasn’t super low.

 

No it wouldn't, the dosing is based on how low a dose is taking a kitty we ignore the bounces, the high flat cycles we see in a bounce are a result of physiological reaction to either.

here is a definition of what we refer to as bouncing

• 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).

In TR we wait a little longer on a dose if kitty is new to seeing green or blue, this gives us time for the bounce to clear and for CG to see if kitty can make it back to good numbers.

So if we look at your example. (for simplification, and illustration purposes I am going to ignore the skinny and fat doses)
Hercules started on 0.5u on Dec 21, he had a green nadir of 77 on the 3rd cycle, you shot a reduced dose on the 4th cycle due to a lower than usual nadir.
This resets the cycle count.
December 23rd now becomes cycle one on 0.5u, cycle 3 sees a green nadir of 97, because Hercules is new to greens you hold this dose for a minimum of 10 cycles (not 6). Cycle 10 bounce has cleared and he gets a nadir of 58 on the pm cycle of December 27.
With a 58, on TR you would have held that 0.5u, then waited to see where she landed once that bounce had cleared. (not much room for an increase with a nadir of 58) If the nadirs are not where you want them to be (usually normal range for TR) then you would take the dose up again, or hold for a little longer if nadirs are still in acceptable range.
In the beginning you may want to run dose increases by those with experience on the forum. Until you get a feel for Hercules patterns.
I tended to suffer from an ITF (itchy trigger finger) so checking with the forum kept me from taking the dose up too quick.

Hoover describes George exactly. He could never free feed, he would just stuff himself silly. He has become much better on the soft LC food, he's not anxious about food, but I swear he sets an alarm for his feeding times, you can set the clock by him.
Sepertating him from the civies is not a big deal for us, he's much older and grumpy and does not want to cuddle with them.
If you don't want to seperate them think of seperatin their food so they each only have access to their own food bowl.
There are microchip feeders that will only open for a specific cat, allowing them to free feed.
Or you can put the food in different rooms for each cat, giving them access via a microchip catflap.
You can make a feed station for each of them that only they can access, again via a micro chip cat flap.
One of our members made a private feeding station for her FD kitty, it doubled as a coffee table
here is the link to the thread and pictures of the finished item, it also includes a link to the instructions that she used to make it.
https://www.felinediabetes.com/FDMB/threads/private-feeder-enclosure-update.163525/

With George I used a feeder with four compartments that rotated, so that I could give him his snacks and have him eat small meals little and often. That way he got his snacks at night or when I was out. He got used to the noise it made and would run up to it the minute it went off, it also had the facility to record a message in your on voice calling him for a snack.

 

Hi Gill,

Thanks for taking the time to explain all this with examples. I have read the method so many times! But the application it is always a bit more tricky with a cat that does not know what he is supposed to do and bounces all the time!

So Hercules has been "experiencing" blue and green numbers for 5 months now. When is he no longer "new to greens"?


I am sorry, but I chickened out of increasing his dose this morning and I need to go out today.... It is probably a mistake, but his AMPS was lower and he has been bouncy a lot! I feel like I need to know abit more how he actually reacts to Lantus, i.e. I don't even know where his nadir is, as we have not been able to stay on a dose for 5 days yet.... but I am listening to all you are saying, and really appreciate it!

 

He is very new to lantus, so until you learn how he is responding to Lantus I would treat them as new for now.
With nadir in the green you would hold for at least 10 cycles.
The thing to watch with a bouncy cat is shooting when a bounce is clearing, you need to be aware that if you shoot as the bounce is clearing they can gather quite some speed, so you might need to feed tactically to slow the drop. An example was on the cycle he hit 58. See how you got a blue pmps on dec 27 dropping from mid pink earlier in the cycle, that was the bounce clearing, that's likely why you got that low green on that day.

How many times are you feeding hercules?
From some comments in the ss it seems as though perhaps it's only at meal times?


.
Guidelines for increasing dose in TR
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.

This morning seems to have been a flat yellow cycle, and this was 5 cycles on 0.25u.
I would hold the 0.25u tonight, that would be cycle 6, as long as you don't see any blue or green then take him up to 0.5u in the morning.

The best way to try to get over the bounces is to get him regularly into the better numbers, his body gets used to it and hopefully the bouncing reduces, some cats bounce more than others, and some bounce all the way to of the juice. Try not to fixate on the bounces, it's the nadirs that govern the dosing decisions.

While you get your head round how lantus works we can certainly help you with the interpretation of the guidlines, I used to always ask the forum for their opinion on whether I should take a dose increase or not, even after I had a handle on the guidelines it was useful to run it by other eyes, sometimes people saw things that I didn't. It's easy to get wrapped up in the ss so you don't see the wood for the trees.

 

It is great that you are thinking along those lines.

Until they are regulated they can nadir at anytime in the cycle, before he was regulated George nadired as early as +1 and as late as +12.5. Though he more often than not nadired around +5.

The reason you are having difficulty with seeing the nadir is that with a bounce there is no real curve the stay flatish and bobble about, you won't see them dip and then rise a nadir will be there because it is simply the lower number in that cycle, but it really doesn't give you much useful information.
On a bounce clearing cycle they can nadir late, like you saw on am cycles of December 22 and December 27.
You need to look at active cycles to see where he is nadiring in those.
So far there are two active cycles pm cycle on the 27th and am cycle on the 24th. So can you see when Hercule's nadired on those two cycles?

You need to continue to assess that as you get active cycles.
And also start asking yourself, when does Hercules onset?

 

At the moment I am feeding him 4 times a day. at shot time and +2 (morning and evening). Was feeding him 3 times each cycle, but decided to try moving to two with an eye of retunrning to work.... I have fed him a bit here and there if I think he might be going down too fast. Funnily enough I have an automated feeder and a chip feeder, but not a automated with chip feeder....

That was why I was a bit worried about changing the dose today, thought maybe he was clearing a bounce and wasn't sure where it would stop.... He has been unhappy about blood checks the last few days... so I am giving him bigger breaks wehn I think it is safe, but he still always surprises me ( as on Dec 27th). I better check him soon, before PMPS!

Exactly! he bounces more than responds!

On the 24th Am and the 27th PM cycles, he seemed to have somesort of well behaved nadir at +6, but in both cases I interfered with some food, so not feeling quite confident this is his pattern, if you see what I mean. I believe he is having a textbook onset between +2 and +3?

 

I haven't seen an automated one with chip feeder either, I think that's why Boo's mum made the feeding enclouser, she could put the autofeeder in it, but only Boo could access it.

With the bouncers slowing downd the drop, as Marje suggested can help, the fast drop contributes/triggers the bounce.
From what I have seen on the board, experienced with George, and with other kitties, is that a few regular snacks in the early part of the cycle can really help with the bouncers, sometimes it's a question of experimenting to see what works for the cat.
Feeding at +2 is a good idea, but if he is only just onsetting as the insulin action increases (through to lets say +6), Hercules will see a sharper drop as his 'fuel' gets used up. If our intention is to flatten the curve, then feeding some mini meals in the early part of the cycle can help to flatten the curve, that in turn given time, can result in minimizing the bouncing
Take a look at Chnoudi ss,
CG tests a lot, has documented all her feeding, Chnoudi was bouncy, we made some suggestions with doses and food which she adopted progressively, changed feeding schedules until we found something that worked for her cat. Much like you she's at home at the moment, and wanted to try to get kitty regulated as best possible while she was in lockdown.

Initially she was feeding amps and pmps and one other meal midcycle, and feeding extra when numbers were too low.
When she introduced scheduled snacks in the early part of the cycle, things started to change, the timings of those snacks were tweaked after a few days to fit Chnoudi cycles once it became clearer what her patterns were.https://docs.google.com/spreadsheet...-oFAIC0vUwQF68i30Du3_hLZkY/edit#gid=361360320
CG succeeded in flattening the curve, Chnoudi started earning reductions, and over the last week the bounces have gone.

With Hercule's if it were me I would give him his main meal at amps/pmps then divide up the rest of his daily allowance into 6 snacks giving 3 regular snacks per cycle +2 +4 +6 (even if he is running high). Do that for a while and see document what happens.

 

Please be sure and start a new thread for his AMPS on 12/30 with a link to this one. Here is the info on posting guidelines. Thank you, Karen!