? What is an example of bouncing?

Butterscotch's Pawrents

Butterscotch's Pawrents

Member Since 2019
I posted these questions the other day but didn't really get any answers about this specifically.
Firstly, I'd love for some of the more experienced members to review our SS and share any thoughts about what you see there.
What do her number trends reflect, what do you think is happening?

*** When people say a cat is bouncing, could you explain with examples what this looks like in terms of numbers? (Ex Goes from 300 to 100, or 50 to 400 etc) I understand the physiological process of bouncing but exactly what does this look like in numbers? How big of a jump high/low do the numbers have to go to know it's a bounce? ***

I have read and reread all the stickys on the main forum and on the Lantus forum. I also try reading several posts from others and reviewing other SS to try to wrap my head around it all. But I feel like I'm just treading water in the dark still. I don't feel like I'm on a clear path as to what I'm looking for in terms of how to adjust her dosing.

Thank you
 
ECID but for me, I know it's a bounce when numbers sort of skyrocket up. You can see that with Butterscotch's last PM cycle.

With Ming, I try really hard to chase his low numbers and cushion him when he's diving so as to not trigger a nasty bounce. I load him up with MC or HC when I see low numbers too early on in the cycle (before nadir) even when numbers are safe or nice because the sudden dive or low, will just make his numbers go up to the pinks.

When he first started, any colours other than pink, red, or black, would cause a bounce. That's what I suspect is happening with Butterscotch. They're just not used to those nicer numbers.

It's a frustrating phenomenon in the beginning and I remember desperately wanting to find a REASON why he bounced and just asking if every high number is a bounce and why should I increase if he is producing nice low numbers when he's not bouncing? But I've learned the little nuances with Ming over time and also have just started to accept that he bounces a lot and too much. Sometimes a new dose will give an extra push and bring numbers down and then cause a big bounce. But then the depot stabilizes and shows its true strength and that's usually when I (or an expert) tells me what the dose is doing.

Bounces now, for Ming, are shorter in duration. Sometimes they clear as quickly as the next cycle.

There are also other things going on in the background that we just might not be aware of. Things like how medications affect BG, stress, glucose toxicity, or unknown pain/inflammation.

Hope my response gives you some answers. :)
 
Butterscotch's Pawrents said:
I don't feel like I'm on a clear path as to what I'm looking for in terms of how to adjust her dosing.
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I just looked at your spreadsheet and I will note that your daily adjustments of dosage are really not in accordance with protocols used here., or useful in providing accurate information for you. A steady consistent dose for at least three cycles (possibly more) that's 6 shots AM and PM - is going help to show you whether the dose is working or not.

By giving 1.5, then 2.5 further down to a 2F Units is not going to tell you what's working. Lantus is not dosed on pre-shot values, it is dosed on the lowest BG of each cycle, and is only increased or decreased after it has been determined that the consistent dose is not working well. In addition, doses of Lantus are usually increased or decreased by 0.25 Units so you don't bypass the best dose.

Actually it's looking like Butterscotch is getting better blood sugar values, it just takes time for a body, even a cat's body, to adjust to the insulin hormone. Patience is the name of this game, same with any chronic condition or disease.

That blue 173 at PMPS last night was a response to the insulin, then Butterscotch's body went 'Whoa, that's not what I'm used to!" and her body response was to release hormones and glycogen to get it back to what it was used to (the 337 at +3)..not what it ideally should be. That was a bounce.

And there no concrete absolute numbers of what bounce BG numbers are, it's all relative. It could be a big bounce from a very high number to a very low number (or vice versa), or a small bounce from a middling number up or down. And every cat really is different and will or may reflect different bouncing scenarios, even from cycle to cycle.
 
Idjit's mom said:
I just looked at your spreadsheet and I will note that your daily adjustments of dosage are really not in accordance with protocols used here., or useful in providing accurate information for you. A steady consistent dose for at least three cycles (possibly more) that's 6 shots AM and PM - is going help to show you whether the dose is working or not.

By giving 1.5, then 2.5 further down to a 2F Units is not going to tell you what's working. Lantus is not dosed on pre-shot values, it is dosed on the lowest BG of each cycle, and is only increased or decreased after it has been determined that the consistent dose is not working well. In addition, doses of Lantus are usually increased or decreased by 0.25 Units so you don't bypass the best dose.

Actually it's looking like Butterscotch is getting better blood sugar values, it just takes time for a body, even a cat's body, to adjust to the insulin hormone. Patience is the name of this game, same with any chronic condition or disease.

That blue 173 at PMPS last night was a response to the insulin, then Butterscotch's body went 'Whoa, that's not what I'm used to!" and her body response was to release hormones and glycogen to get it back to what it was used to (the 337 at +3)..not what it ideally should be. That was a bounce.

And there no concrete absolute numbers of what bounce BG numbers are, it's all relative. It could be a big bounce from a very high number to a very low number (or vice versa), or a small bounce from a middling number up or down. And every cat really is different and will or may reflect different bouncing scenarios, even from cycle to cycle.
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So, I'll say that the dose adjustments that we made (the 1.5 and the 2.5) were in collaboration with members on the forum. If I'm interpreting the SLGS protocol, dose reductions do not need to be held for any given amount of time. And then it says to resume at the last best dose. (Please correct me if I'm interpreting that wrong) Since I was trying to avoid a bounce I resumed the dose to slightly less than what it had been. Everyone on here keeps saying her dose is too high, so I figured best not to resume at the original dose. (My syringes are on full unit increments so I find it hard to measure anything less than 0.5U) I'm feeling very overwhelmed and conflicted regarding how to do the dose adjustments. Could you suggest what you might have done with her doses if you had gotten those two blue numbers? I have posted several times a "stalling" question for her preshot numbers but have not gotten advice. I've let her insulin get off track by 30-60min just waiting for help and then I just have to dose to not delay her insulin too long. If you could suggest what you would have done in my shoes then next time a similar event happens I can pull from that suggestion. That would help me very much :)
I want nothing more than to be able to follow the protocol well and start seeing better numbers. Just having trouble relating the protocol to actual practice. I feel that I need some real life examples to be able to apply it.
 
Crista & Ming said:
ECID but for me, I know it's a bounce when numbers sort of skyrocket up. You can see that with Butterscotch's last PM cycle.

With Ming, I try really hard to chase his low numbers and cushion him when he's diving so as to not trigger a nasty bounce. I load him up with MC or HC when I see low numbers too early on in the cycle (before nadir) even when numbers are safe or nice because the sudden dive or low, will just make his numbers go up to the pinks.

When he first started, any colours other than pink, red, or black, would cause a bounce. That's what I suspect is happening with Butterscotch. They're just not used to those nicer numbers.

It's a frustrating phenomenon in the beginning and I remember desperately wanting to find a REASON why he bounced and just asking if every high number is a bounce and why should I increase if he is producing nice low numbers when he's not bouncing? But I've learned the little nuances with Ming over time and also have just started to accept that he bounces a lot and too much. Sometimes a new dose will give an extra push and bring numbers down and then cause a big bounce. But then the depot stabilizes and shows its true strength and that's usually when I (or an expert) tells me what the dose is doing.

Bounces now, for Ming, are shorter in duration. Sometimes they clear as quickly as the next cycle.

There are also other things going on in the background that we just might not be aware of. Things like how medications affect BG, stress, glucose toxicity, or unknown pain/inflammation.

Hope my response gives you some answers. :)
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I feel like her low numbers are coming after when the nadir should be/at her preshot time. Not sure what this means. Should I be feeding her more around when the nadir should be in order to prevent that?
 
I apologize that I was not aware of the consultation with other members regarding the change in doses. I did not go back and read all the threads you have created.

I know, and remember so very well, how confusing and overwhelming it is when you are just learning to cope with the insulin doses and getting the help you are asking for in a timely manner. All I was doing was reiterating information I have learned here about changing the doses pretty quickly. I will butt out and let the more experienced continue to advise you. I do not want you to feel anymore confused or overwhelmed than you already do. Again, my apologies.

It would be helpful to you if you can find syringes with half unit markings, to make those finer dose adjustments. Or perhaps explore using calipers to measure the half or quarter unit increases or decreases.
http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

I'm sorry that you haven't rec'd responses when you were stalling and asking for help, sometimes experienced and advising members are not available just when you need that assistance. You are doing the very best you know how to do at this point. If you have posted here in the Lantus forum stalling and waiting for help, be sure to put that in your title, and you can also cross post in the Main Health forum if you are not getting a timely response.
 
Idjit's mom said:
I apologize that I was not aware of the consultation with other members regarding the change in doses. I did not go back and read all the threads you have created.

I know, and remember so very well, how confusing and overwhelming it is when you are just learning to cope with the insulin doses and getting the help you are asking for in a timely manner. All I was doing was reiterating information I have learned here about changing the doses pretty quickly. I will butt out and let the more experienced continue to advise you. I do not want you to feel anymore confused or overwhelmed than you already do. Again, my apologies.

It would be helpful to you if you can find syringes with half unit markings, to make those finer dose adjustments. Or perhaps explore using calipers to measure the half or quarter unit increases or decreases.
http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

I'm sorry that you haven't rec'd responses when you were stalling and asking for help, sometimes experienced and advising members are not available just when you need that assistance. You are doing the very best you know how to do at this point. If you have posted here in the Lantus forum stalling and waiting for help, be sure to put that in your title, and you can also cross post in the Main Health forum if you are not getting a timely response.
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I'm so sorry, I did not mean for that to come across as wanting you to butt out. I was honestly feeling a little judged for the decisions that I made. But I understand that it is difficult to communicate in writing, what one is really thinking/feeling. I am so completely greatful for each and every person's suggestions. Please don't feel that I don't want your advice, because I so desperately want help. I'm so frustrated with this process, overwhelmed and confused that I'm literally in tears because I just don't know what to do. I second guess every decision and I feel like I'm just shooting in the dark hoping I'm aiming at the right target.
I have printed out, highlighted, taken notes on the Lantus protocols and I read them multiple times each day. But I just feel like the info is so black and white with no solutions for the gray areas. I know, I know, ECID and no one has a crystal ball. But I just wish I could see some examples of what to do in different scenarios. It really would help if anyone could lay out some suggestions on how they would have dosed Butterscotch based on our SS so I could learn from my mistakes.
 
Wendy&Neko said:
Here is the link to your previous post, for continuity http://www.felinediabetes.com/FDMB/threads/lower-than-usual-pmps-what-to-do.218973/

In that post, I suggested holding the same dose for 7 days. Nothing wrong with nadirs at preshot, my girl did it all the time. It means I was always home and awake for the lows. :)

Any chance of you getting syringes with half unit markings?
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Should I have held the dose even with the lower preshot reading? I just got so nervous that I couldn't be awake all night to test her and I'm terrified of a hypo episode. I thought the low numbers would cause a bounce and if I gave her the same amount of insulin I'd just make the drop worse and then cause a more severe bounce. I understand holding the dose 7 days if numbers are relatively the same or go down gradually. My understanding of the SLGS is if the preshot is lower than usual to hold the dose or reduce it. So that was my intent behind the reduction. But maybe I'm interpreting that wrong? I'm sure everyone feels confused at first but I really feel dumb, like I just don't get it :(

Where do folks buy the half unit marked syringes? My local stores don't seem to carry them.

Thank you in advance for any feedback you can provide. I'm here to learn.
 
I know exactly how you're feeling. A lot of times some of the info gets communicated in the manner of telling you what you did wrong, with no clear explanation of what would have been right, so it comes across as judgy. Went through that a bit myself recently. Just have to take it for what it is, generally the people who offer the info do know what they're talking about, but at the end of the day every cat is different and you're the one holding the syringe. That said, the protocols do work and the closer you can adhere to them, the better.

So, my perspective on what I would have done. Right off the bat, the more consistent you can be with dose times, the better. The variations I'm seeing in dose times over the past few days can further complicate things, since it winds up making the glucose act like you did either a reduction or an increase.

Bouncing is really the biggest thing that is going to trip you up. Bouncing happens when the cat starts to get lower numbers for the first time and the body compensates by jacking the glucose up. And "low numbers" doesn't necessarily mean <50 or <100, it's any number lower than they're used to. Judging by the spreadsheet, it looks like the blue numbers, upper 100s, are probably pretty new and are triggering bounces. You can see this last night when you had the 188 and then it shot up to 337 3 hours later. I don't think it's ever explicitly mentioned anywhere in the protocol info but all of it is really about managing the bounces. Keeping the dose time consistent is so you don't hit abnormally low numbers and trigger a bounce. Increasing or decreasing by a set amount is also so you don't go too low too fast and trigger a bounce. And holding the dose for a set amount of time is so that you're not increasing the dose based on bounce numbers, which is again going to make you go too low too fast when they clear the bounce and then trigger more bounces or even go hypo.

So my three pieces of advice would be:
1)Try to get as consistent as possible on dose timing. You can vary by a total of 30 minutes each day. Either 30 minutes early or late on one shot or 15 minutes on both. But consistent is better.
2)Follow the protocols as far as increases or decreases and dose duration go. I'm not sure who told you to increase or decrease the dose like you did but I don't see anything that would have warranted it. Maybe you had something go on those days that called for it, but based purely on the spreadsheet, it should have stayed the same.
3)Try to get a few more tests. +2/+3 are especially helpful in seeing which way the cat is going to go for that cycle. A higher number than PS is generally going to give a safe curve but an equal or lower number means they're probably going to hit a new low. Based on the tests you do have I'd guess you're not as available during the day, which is fine, but getting at least the evening +2/+3 can be helpful.

And as far as dose, it looks like you should be back at 2.5, at least. Possibly 2.75 but there's so much variation it's hard to tell what the full depot would have done.
 
Butterscotch's Pawrents said:
I'm terrified of a hypo episode.
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And here's another bit of wisdom I'll leave you with, the hypo threat is overblown. Most of the dosing protocol documents really put the fear of god into you about hypos, and yes it can be life threatening and needs to be taken seriously, but it's rare and you have to really screw up to get it. In all the years this board has been running no one has ever lost a cat to hypo. The bouncing is the body's natural defense against hypo, so they will protect themselves. Being .25 or .5u off the mark when you're around the 3u range is most likely not going to kill your cat. So be mindful of it but don't let the fear of it paralyze you or bring you to tears.
 
Butterscotch's Pawrents said:
I'm so sorry, I did not mean for that to come across as wanting you to butt out. I was honestly feeling a little judged for the decisions that I made. But I understand that it is difficult to communicate in writing, what one is really thinking/feeling. I am so completely greatful for each and every person's suggestions. Please don't feel that I don't want your advice, because I so desperately want help. I'm so frustrated with this process, overwhelmed and confused that I'm literally in tears because I just don't know what to do. I second guess every decision and I feel like I'm just shooting in the dark hoping I'm aiming at the right target.
I have printed out, highlighted, taken notes on the Lantus protocols and I read them multiple times each day. But I just feel like the info is so black and white with no solutions for the gray areas. I know, I know, ECID and no one has a crystal ball. But I just wish I could see some examples of what to do in different scenarios. It really would help if anyone could lay out some suggestions on how they would have dosed Butterscotch based on our SS so I could learn from my mistakes.
Click to expand...
You didn't come across that way at all, you were just explaining where you were coming from. You are not being judged, we are just trying to help...and it does get more confusing the more advice you get from different members. I am not very experienced with dosing. We were still learning to test when Idjit just slid gracefully (well gracefully for him! ;)) into remission. I didn't have a clue as to what I was doing! But in the 15 -16 months I have been on the board, reading and learning, some things have stuck. It will happen for you too. Honestly!

I would pick one or two people to primarily listen to, Wendy is very knowledgeable and experienced and will not steer you wrong. Choose one dose and stick to the timeline for cycles to see what happens, get directions from an experienced member for a "no shoot" pre-test number, keep stalling and posting for help when you need to. Don't worry if Butterscotch bounces into a high number, she will come down! If you get very low BG, below 68 refer to the Hypo instructions and post a 911 thread. Have the instructions printed out, and have your Hypo Tool Box ready. You can steer low BG with medium carb or high carb food, with Karo or honey.

It's going to make sense, just takes time and patience. You are actually doing what's best for Butterscotch right now, insulin, diet and testing. Take deep breaths, take a walk, eat a chocolate bar or drink a glass of wine. You didn't learn to talk, read or walk overnight or over weeks even. Look how long school took! You can do this, you are doing it. Big Hug:bighug::bighug:
Justin & Sebastian said:
In all the years this board has been running no one has ever lost a cat to hypo.
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Not true, we have lost cats and it's heartbreaking. I have spent several all nighters online with members whose cats are in hypo and it took a long time for them to get to safe numbers without dropping again. And that's just me in the last year and a half. I can't speak for other or long time members, but I bet there are many.
 
The reduced dose when you got your blue PMPS was a good opportunity to learn. These types of decisions are not mistakes but just chances to see what your kitty does.

The “ideal” decision for last night would’ve been to shoot the regular dose. Its great that you stalled 20 mins and saw that the number was going up/was essentially the same numbers. It was above 150 as well which for SLGS is safe to shoot. If you felt confident, had all the tools at hand, then shooting the regular dose would’ve been doable. It might have created a long night of testing but you can see that Butterscotch bounced way up! So I suspect if you shot the regular dose, she would’ve went up anyway.

For now, you are restarting with a new dose that hopefully you can hold for 7 days.
 
Idjit's mom said:
Not true, we have lost cats and it's heartbreaking.
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I was told otherwise. Either way, it's my opinion that the approach to hypos that is being presented does more harm than good. I've been paying more attention to other people's threads over the past couple weeks and there have been several new people and almost every one of them has been terrified of hypos. To the point that they're making the wrong decisions when it comes to dosing, either decreasing early or too much, which then causes higher numbers, which they then get scolded for. It's a bad experience all around.
 
It was fine to do the one time reduced dose of 2.F, but go back to 2.5 units after that. So back to 2.5 units tomorrow morning. Butterscotch did not earn a reduction in dose, which is done by going under 90. And the thing about the one time reduced dose, is that the depot of the preceding shots will typically influence how the cycle would go anyway. It is fine to do when you are new and a good chance to gather data. Just don’t assume a one time reduction in dose will have the impact you think it will, because of that depot.

As for hypos, it is good to have a healthy concern of them. Test blood sugar regularly and have a hypo kit stocked. I have seen hypos on this board. They usually happen because the dose was started too high, not enough testing was done, the dosing methods were not followed in regards to dose changes, a wrong dose was given accidentally, or an underlying medical condition was present that impacted blood sugar.
 
you mentioned lower values just before Preshot time -- I've been advised by a longtime member here that it DOES happen sometimes on Lantus (it's more common on Vetsulin which is a mixture of two different-acting insulins)

check Catcat's spreadsheet -- we're getting that on occasion too

by the way, we're just a little bit south of you, between McKenna and Yelm

if you ever need a great vet, there's one down here
 
Justin & Sebastian said:
I know exactly how you're feeling. A lot of times some of the info gets communicated in the manner of telling you what you did wrong, with no clear explanation of what would have been right, so it comes across as judgy. Went through that a bit myself recently. Just have to take it for what it is, generally the people who offer the info do know what they're talking about, but at the end of the day every cat is different and you're the one holding the syringe. That said, the protocols do work and the closer you can adhere to them, the better.

So, my perspective on what I would have done. Right off the bat, the more consistent you can be with dose times, the better. The variations I'm seeing in dose times over the past few days can further complicate things, since it winds up making the glucose act like you did either a reduction or an increase.

Bouncing is really the biggest thing that is going to trip you up. Bouncing happens when the cat starts to get lower numbers for the first time and the body compensates by jacking the glucose up. And "low numbers" doesn't necessarily mean <50 or <100, it's any number lower than they're used to. Judging by the spreadsheet, it looks like the blue numbers, upper 100s, are probably pretty new and are triggering bounces. You can see this last night when you had the 188 and then it shot up to 337 3 hours later. I don't think it's ever explicitly mentioned anywhere in the protocol info but all of it is really about managing the bounces. Keeping the dose time consistent is so you don't hit abnormally low numbers and trigger a bounce. Increasing or decreasing by a set amount is also so you don't go too low too fast and trigger a bounce. And holding the dose for a set amount of time is so that you're not increasing the dose based on bounce numbers, which is again going to make you go too low too fast when they clear the bounce and then trigger more bounces or even go hypo.

So my three pieces of advice would be:
1)Try to get as consistent as possible on dose timing. You can vary by a total of 30 minutes each day. Either 30 minutes early or late on one shot or 15 minutes on both. But consistent is better.
2)Follow the protocols as far as increases or decreases and dose duration go. I'm not sure who told you to increase or decrease the dose like you did but I don't see anything that would have warranted it. Maybe you had something go on those days that called for it, but based purely on the spreadsheet, it should have stayed the same.
3)Try to get a few more tests. +2/+3 are especially helpful in seeing which way the cat is going to go for that cycle. A higher number than PS is generally going to give a safe curve but an equal or lower number means they're probably going to hit a new low. Based on the tests you do have I'd guess you're not as available during the day, which is fine, but getting at least the evening +2/+3 can be helpful.

And as far as dose, it looks like you should be back at 2.5, at least. Possibly 2.75 but there's so much variation it's hard to tell what the full depot would have done.
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Thank you, I think that sums up how I'm feeling. It is difficult to hear that you have done something wrong but not get clear/specific answers to how you should have done it better. I know that I'm not doing things exactly right and that's why I'm asking for help.
The reason the dose times were off were because I had the blue number for the first time and was waiting for help..... and I was scared to dose her without advice. Then when I did finally dose her, I think it was an hour late. I was instructed that I had to get the dose back on track by readjusting by 15min for each dose. So, it took some time. The only other reason why sometimes times are off is because our kitty really struggles with eating, and if I don't get her to eat at least 3oz I don't feel comfortable dosing her. I know I've been told its ok to feed after the insulin, but our kitty does not reliably eat so I would be to afraid I'd dose her and then she would refuse to eat anything for hours. So, then her insulin is late as I'm trying to coax her to eat.

In the SLGS protocol it says:
How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
I guess I'm getting hung up on this. Every time I post, people are telling me I don't have enough data. So I'm following this piece above. It says when your preshot is way below the usual value (definitely that first blue was a huge drop for her) and you don't have much data, and it is between 150-200 (which it was) then you can give nothing or a token dose etc. So per the advice of a member I ended up giving the 1.5units, this was more than a token dose but half what she had been getting. But I keep having people tell me I should have just given the full dose. Soooooo, I'm confused. Am I reading this part of the protocol wrong?
Also, while I have this here, when would you feed, test in a couple hours and then "make a decision" (which I presume means to possibly give insulin)? Because wouldn't your insulin dose now be 2hrs late? That seems way too late to give.

Thank you for your suggestions as well. :)
 
Idjit's mom said:
You didn't come across that way at all, you were just explaining where you were coming from. You are not being judged, we are just trying to help...and it does get more confusing the more advice you get from different members. I am not very experienced with dosing. We were still learning to test when Idjit just slid gracefully (well gracefully for him! ;)) into remission. I didn't have a clue as to what I was doing! But in the 15 -16 months I have been on the board, reading and learning, some things have stuck. It will happen for you too. Honestly!

I would pick one or two people to primarily listen to, Wendy is very knowledgeable and experienced and will not steer you wrong. Choose one dose and stick to the timeline for cycles to see what happens, get directions from an experienced member for a "no shoot" pre-test number, keep stalling and posting for help when you need to. Don't worry if Butterscotch bounces into a high number, she will come down! If you get very low BG, below 68 refer to the Hypo instructions and post a 911 thread. Have the instructions printed out, and have your Hypo Tool Box ready. You can steer low BG with medium carb or high carb food, with Karo or honey.

It's going to make sense, just takes time and patience. You are actually doing what's best for Butterscotch right now, insulin, diet and testing. Take deep breaths, take a walk, eat a chocolate bar or drink a glass of wine. You didn't learn to talk, read or walk overnight or over weeks even. Look how long school took! You can do this, you are doing it. Big Hug:bighug::bighug:

Not true, we have lost cats and it's heartbreaking. I have spent several all nighters online with members whose cats are in hypo and it took a long time for them to get to safe numbers without dropping again. And that's just me in the last year and a half. I can't speak for other or long time members, but I bet there are many.
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Thank you for understanding. I just want everyone to know how truly grateful I am for each and every piece of wisdom. :D It has been very hard to unwind and both hubby and I have cast our selfcare to the side. I feel like all we do is go to work and come home to research and care for Butterscotch. But, we need to listen to your advice and do something to relax. We can take care of her if we aren't caring for ourselves.

Any experienced members out there want to give me advice on a good "no shoot" pre-test number?
 
Crista & Ming said:
The reduced dose when you got your blue PMPS was a good opportunity to learn. These types of decisions are not mistakes but just chances to see what your kitty does.

The “ideal” decision for last night would’ve been to shoot the regular dose. Its great that you stalled 20 mins and saw that the number was going up/was essentially the same numbers. It was above 150 as well which for SLGS is safe to shoot. If you felt confident, had all the tools at hand, then shooting the regular dose would’ve been doable. It might have created a long night of testing but you can see that Butterscotch bounced way up! So I suspect if you shot the regular dose, she would’ve went up anyway.

For now, you are restarting with a new dose that hopefully you can hold for 7 days.
Click to expand...


I'm being thrown off by this piece from the protocol for people who haven't collected a lot of data on their cats yet.
****
How to handle a lower than normal preshot number:
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
***
Because my number was between 150-200 I read this as not to give the full dose.

Each time I post, I receive comments that I don't have enough data. So, I'm following this section of the protocol. Maybe I do have enough data to not follow this portion?
 
Wendy&Neko said:
It was fine to do the one time reduced dose of 2.F, but go back to 2.5 units after that. So back to 2.5 units tomorrow morning. Butterscotch did not earn a reduction in dose, which is done by going under 90. And the thing about the one time reduced dose, is that the depot of the preceding shots will typically influence how the cycle would go anyway. It is fine to do when you are new and a good chance to gather data. Just don’t assume a one time reduction in dose will have the impact you think it will, because of that depot.

As for hypos, it is good to have a healthy concern of them. Test blood sugar regularly and have a hypo kit stocked. I have seen hypos on this board. They usually happen because the dose was started too high, not enough testing was done, the dosing methods were not followed in regards to dose changes, a wrong dose was given accidentally, or an underlying medical condition was present that impacted blood sugar.
Click to expand...

Thank you, that was very helpful information. I am one to learn from trial and error and from practicing specific examples. I will resume at 2.5 tomorrow. :D
Any other specific things you can advise would be greatly appreciated. Such as, at what number should I not shoot? If I get another blue for a preshot, should I cut the dose or give it? What do you do when you see bouncing, do you just keep the dose the same and wait it out? (I feel like her whole spreadsheet is bouncing :/ )
 
Butterscotch's Pawrents said:
We can take care of her if we aren't caring for ourselves.
Click to expand...
Exactly. My dear, I can completely empathize with you at this stage in the game. I would spend time into the wee hours peering at my Fire tablet trying to make sense of all the stuff I was reading on the Lantus forum and elsewhere, reading post after post and then in the daytime stop myself from braining my husband because he didn't know how to help me test Idjit. We worked that out and he still has his brains (kind of).

I had to figure out how to inject the insulin, I am a chubby stiff old woman with bad knees and hips, and Idjit doesn't tolerate being up on a higher surface like a table, or carried around very well, plus he's a big kitty and I can't carry him far, or get down on the floor. So, we were still learning to test, and we were NOT good at it, I had to spread a towel on my bed, fix the syringe, get Idjit's food ready and we decamped to the bedroom. Cat head in food dish, and I was able to give the shot. The things we do! Someday, maybe not soon, but someday you will be telling another new member what you did, how you felt and offer support.

Yes, please take care of yourselves. Butterscotch can't do any of this stuff by herself and she needs you sane and healthy. :cat:
 
it's a process of baby steps when you first start, and yes it's stressful, it takes over your mind and your life and your emotions

you shoulder the responsibility and yet you also wind up being told to relax and breathe; which truly is good advice only it seems counterintuitive

add to that -- ECID -- every cat IS different, none of them read the manual, none of them respond like you'd think they would

so it's feeling your way in a fog, and sometimes you have to ignore conflicting advice and try to make sense of it all

been there, done that, still there, still doing that ...
I'm ready for the T shirt that says : I HAVE A DIABETIC CAT AND I'M THE CAREGIVER -- DON'T BOTHER ME

was just talking to a neighbor who cared for his diabetic cat for 15 years ! yes, it's a long term deal

hugs and stuff -- :bighug::bighug::bighug:
 
CandyH & Catcat said:
you mentioned lower values just before Preshot time -- I've been advised by a longtime member here that it DOES happen sometimes on Lantus (it's more common on Vetsulin which is a mixture of two different-acting insulins)

check Catcat's spreadsheet -- we're getting that on occasion too

by the way, we're just a little bit south of you, between McKenna and Yelm

if you ever need a great vet, there's one down here
Click to expand...

Oh, how I wish we could find a great vet near by. We actually live NE of Tacoma and are driving 40min to see a vet in Tacoma which is our third vet o_O That vet wanted us to up her dose to 4 units on Mon :confused:
I will review Catcat's SS ;) Do you know what the lower values right before preshot mean or how they are related to her nadir?
 
too far to drive unless you can't get in anywhere else -- on hwy 507 just north of McKenna -- close to an hour drive for you

Dr Bretta Bauman at Horse Cart -- https://horsecart.vet/about/

and if you wonder about bounces -- all you have to do is look at Catcat's SS -- nice line of blues and then it goes yellow and pink
several greens and then ... high yellow again
 
Idjit's mom said:
Exactly. My dear, I can completely empathize with you at this stage in the game. I would spend time into the wee hours peering at my Fire tablet trying to make sense of all the stuff I was reading on the Lantus forum and elsewhere, reading post after post and then in the daytime stop myself from braining my husband because he didn't know how to help me test Idjit. We worked that out and he still has his brains (kind of).

I had to figure out how to inject the insulin, I am a chubby stiff old woman with bad knees and hips, and Idjit doesn't tolerate being up on a higher surface like a table, or carried around very well, plus he's a big kitty and I can't carry him far, or get down on the floor. So, we were still learning to test, and we were NOT good at it, I had to spread a towel on my bed, fix the syringe, get Idjit's food ready and we decamped to the bedroom. Cat head in food dish, and I was able to give the shot. The things we do! Someday, maybe not soon, but someday you will be telling another new member what you did, how you felt and offer support.

Yes, please take care of yourselves. Butterscotch can't do any of this stuff by herself and she needs you sane and healthy. :cat:
Click to expand...

Thank you, I needed to read that. I needed to be reminded that everyone struggles at first and has their own challenges but someday I will have it figured out! Thankfully our girl is relatively well tempered and hubby and I are still young and able to be flexible to literally meet her needs. Its so easy to get lost in all of this and I'm not seeing the light yet. I don't even want to know how overwhelmed I'm going to feel when my brain really wraps its mind around the lifetime commitment we just signed up for :nailbiting:
 
I am calling it a night, I hope you will too, soon. You need some rest and downtime. Tomorrow is another day and worry only wears you out without solving any problems. I probably have worried years off my life, and it never solved a darn thing! Sweet and peaceful dreams.
 
sleep my child and peace attend thee
all through the night
guardian angels God will send thee
all through the night
soft the drowsy hours are creeping
hill and vale in slumber steeping
I my loving vigil keeping
all through the night
 
Butterscotch's Pawrents said:
Such as, at what number should I not shoot? If I get another blue for a preshot, should I cut the dose or give it? What do you do when you see bouncing, do you just keep the dose the same and wait it out? (I feel like her whole spreadsheet is bouncing :/ )
Click to expand...
It took Neko a year before she stopped bouncing to reds and just pinks. :rolleyes: She had a few other things going on too. Try to ignore the bounces, they are perfectly normal for newly diabetic cats.

The answer on what to do with a blue preshot depends on your comfort level, data to date, and ability to monitor. Gradually you will lower the dose at which you shoot the full dose. Experienced SLGS peeps shoot anything 90 and above, as long as they have the data to say it's safe to do so. With TR, that number is 50. But it takes a while to get there. And if it's the lowest number yet and you are heading out the door, you'll have a different answer to seeing a 199 and you home for the day. Right now I'd still consider you in the new and collecting data phase. Next time you see a blue and aren't sure what to do, do NOT feed, and post here for help. Hopefully someone will respond with some options and walk you through it.
 
Wendy&Neko said:
It took Neko a year before she stopped bouncing to reds and just pinks. :rolleyes: She had a few other things going on too. Try to ignore the bounces, they are perfectly normal for newly diabetic cats.

The answer on what to do with a blue preshot depends on your comfort level, data to date, and ability to monitor. Gradually you will lower the dose at which you shoot the full dose. Experienced SLGS peeps shoot anything 90 and above, as long as they have the data to say it's safe to do so. With TR, that number is 50. But it takes a while to get there. And if it's the lowest number yet and you are heading out the door, you'll have a different answer to seeing a 199 and you home for the day. Right now I'd still consider you in the new and collecting data phase. Next time you see a blue and aren't sure what to do, do NOT feed, and post here for help. Hopefully someone will respond with some options and walk you through it.
Click to expand...

Its good to know I can ignore the bounces. I think I've been trying to react to them. I guess I'm looking for some sort of baseline/range of preshot numbers and what to do with them because I have twice posted a "stalling -lower than normal preshot " headline and the first time kept waiting and ended up giving the dose at least an hour late and then the second time waited 30min or so and then chose the dose myself, to later wish I'd just given her the full dose. I don't want to keep waiting so long that her dose is completely off (because I know that's not good either) or wait so long that I don't get responses and end up having to decide alone anyway. I know I can't expect someone to always be available and have good advice exactly when I need it. So, I have tried to follow the 'new collecting data' info from the SLGS protocol but when I've reduced a dose based off of those recommendations, it seems that, that isn't actually the recommended thing to do. So if I get another blue number, I'm just wondering if I should shoot the full dose next time? I'm hoping maybe someone could walk me through a couple "potential" scenarios. Or maybe back track and look at the two blues I did get and suggest how they would have handled them.
 
Idjit's mom said:
I am calling it a night, I hope you will too, soon. You need some rest and downtime. Tomorrow is another day and worry only wears you out without solving any problems. I probably have worried years off my life, and it never solved a darn thing! Sweet and peaceful dreams.
Click to expand...

CandyH & Catcat said:
sleep my child and peace attend thee
all through the night
guardian angels God will send thee
all through the night
soft the drowsy hours are creeping
hill and vale in slumber steeping
I my loving vigil keeping
all through the night
Click to expand...

Good night ladies and thank you for your kind and soothing words :bighug::bighug:
 
Butterscotch's Pawrents said:
Where do folks buy the half unit marked syringes? My local stores don't seem to carry them.
Click to expand...

You can get them at WalMart (although if you ask, they'll probably tell you there's no such thing....don't listen to them) These are the syringes you want to get. 3/10ml, 31 gauge insulin syringes.
Relion syringes.jpg
 
You have to go to the counter and ask for them....You don't have to order them special (you might want to take the picture too.....WalMart employee's aren't really known for knowing what they're talking about, especially in the pharmacy)

30 gauge are OK too (just in case they don't have the 31 gauge) but you want the 3/10mL

All of their 3/10ml syringes come with half unit markings
 
Butterscotch's Pawrents said:
So if I get another blue number, I'm just wondering if I should shoot the full dose next time? I'm hoping maybe someone could walk me through a couple "potential" scenarios. Or maybe back track and look at the two blues I did get and suggest how they would have handled them.
Click to expand...
Depends whether kitty is going up or down at the time of preshot, how low a blue, whether you are home to monitor and have high carb food and plenty of test strips. You might want to look at other peoples posts that are shooting blue, especially the new ones, and see how they handled it. My first low number no one was around to help, but I'd done plenty of reading of others posts to know what to do by then.
 
+6 just now is 138, a new low for her.:cool: Just fed her a tablespoon of LC food to help prevent a bounce. She started with AMPS 316 and PMPS 239

(using a pet meter so the 138 would look lower on a human meter)

I'm not trying to titrate the dose, but given that she's been on the 2.F units for 3 cycles and still got this low blue, do I still shoot the 2.5 units as we discussed earlier? @Wendy&Neko
 
A couple of thoughts...

For those of us who have used TR, and even now when SLGS has been an approach on this board for a while (it wasn't for quite some time), it can be hard to understand the nuances of SLGS. I think what was unclear is that with a lower than expected pre-shot, the instructions for what to do are meant to reflect options for the current cycle. So you skip, shoot a reduced dose, or stall for one cycle only providing the lower than expected pre-shot is above 90. Also, given that each of these options has an effect on the depot, it's best to choose one vs combining so you stall and then shoot a reduced dose. The rationale is that stalling acts like a reduced dose so the numbers may suffer from a double whammy if you stall AND reduce.

As others have noted, you will drive yourself crazy if you try to control bounces by adjusting the dose. Bounces are normal, albeit very annoying. In essence, they offer some protection for your kitty. Bounces occur in response to low numbers, numbers that are lower than what your cat is used to, or a fast drop in numbers. Your cat's liver and pancreas release a stored form of glucose along with counterregulatory hormones as a means of protection from unduly low numbers an the numbers spike upward. By lowering the dose, all that generally happens is that your cat isn't getting enough insulin and you waste time since you have to eventually raise the dose back up.

I'm guessing that the reason you don't get a timely reply if you are posting an asking for help some evenings is when you're posting. The time stamp in my time zone (EDT) is around 3:30 AM for your post above. We have a few night owls on the board and some members from around the world but for those of us on the east coast, I've been asleep for hours.

In response to your question above, yes, you shoot your 2.5u dose. I could likely argue a case for you to stick with the 2.0 dose since that's what you've been shooting for 3 cycles. It may be a matter of seeing what the AMPS test tells you. As you can see, even with experienced members, we sometimes have differences of opinion.

I also want to comment on @Justin & Sebastian"s point about hypoglycemia. We differentiate between low numbers and symptomatic hypoglycemia. Way too many people view low numbers as the same as hypoglycemia. They are different. Many of our kitties dip their toes in low, sometimes scary low numbers and are fine. However, they are fine because you are testing, catch the low number and intervene -- hence the value of home testing. I don't think there is a person here who would say numbers below 40 are safe for a long period of time. If your cat is showing symptoms of hypoglycemia, even if the numbers are in the 60s, you have to intervene. It is the presence of symptoms that is the critical factor along with the knowledge of what is safe (above 40 - 50 on a human meter) in general and how your cat responds to low numbers. Remember, that with TR, numbers that signal a dose reduction are lower than with SLGS and TR has been published in vet journals and had to meet requirements for safety. Symptomatic hypoglycemia is not trivial. There is a post on the FDMB Facebook group that was saved -- Baxter's mom was not a fan of home testing and Baxter suffered from a severe hypoglycemic episode. He's lucky to be alive and had residual neurologic deficits. Baxter's mom has become a huge proponent of home testing. IMHO, it's good to have a healthy respect for the consequences of low numbers but it's also important to develop the confidence to handle those numbers effectively.

 
Sienne and Gabby (GA) said:
A couple of thoughts...

For those of us who have used TR, and even now when SLGS has been an approach on this board for a while (it wasn't for quite some time), it can be hard to understand the nuances of SLGS. I think what was unclear is that with a lower than expected pre-shot, the instructions for what to do are meant to reflect options for the current cycle. So you skip, shoot a reduced dose, or stall for one cycle only providing the lower than expected pre-shot is above 90. Also, given that each of these options has an effect on the depot, it's best to choose one vs combining so you stall and then shoot a reduced dose. The rationale is that stalling acts like a reduced dose so the numbers may suffer from a double whammy if you stall AND reduce.

As others have noted, you will drive yourself crazy if you try to control bounces by adjusting the dose. Bounces are normal, albeit very annoying. In essence, they offer some protection for your kitty. Bounces occur in response to low numbers, numbers that are lower than what your cat is used to, or a fast drop in numbers. Your cat's liver and pancreas release a stored form of glucose along with counterregulatory hormones as a means of protection from unduly low numbers an the numbers spike upward. By lowering the dose, all that generally happens is that your cat isn't getting enough insulin and you waste time since you have to eventually raise the dose back up.

I'm guessing that the reason you don't get a timely reply if you are posting an asking for help some evenings is when you're posting. The time stamp in my time zone (EDT) is around 3:30 AM for your post above. We have a few night owls on the board and some members from around the world but for those of us on the east coast, I've been asleep for hours.

In response to your question above, yes, you shoot your 2.5u dose. I could likely argue a case for you to stick with the 2.0 dose since that's what you've been shooting for 3 cycles. It may be a matter of seeing what the AMPS test tells you. As you can see, even with experienced members, we sometimes have differences of opinion.

I also want to comment on @Justin & Sebastian"s point about hypoglycemia. We differentiate between low numbers and symptomatic hypoglycemia. Way too many people view low numbers as the same as hypoglycemia. They are different. Many of our kitties dip their toes in low, sometimes scary low numbers and are fine. However, they are fine because you are testing, catch the low number and intervene -- hence the value of home testing. I don't think there is a person here who would say numbers below 40 are safe for a long period of time. If your cat is showing symptoms of hypoglycemia, even if the numbers are in the 60s, you have to intervene. It is the presence of symptoms that is the critical factor along with the knowledge of what is safe (above 40 - 50 on a human meter) in general and how your cat responds to low numbers. Remember, that with TR, numbers that signal a dose reduction are lower than with SLGS and TR has been published in vet journals and had to meet requirements for safety. Symptomatic hypoglycemia is not trivial. There is a post on the FDMB Facebook group that was saved -- Baxter's mom was not a fan of home testing and Baxter suffered from a severe hypoglycemic episode. He's lucky to be alive and had residual neurologic deficits. Baxter's mom has become a huge proponent of home testing. IMHO, it's good to have a healthy respect for the consequences of low numbers but it's also important to develop the confidence to handle those numbers effectively.
Click to expand...
Thank you for explaining some thoughts on the nuances of SLGS. That actually helped quite a bit.
Normally my posts regarding doses are around 6am (the current time I'm posting this), or 6pm which would be around 9am/9pm your time. Last night/early morning post was unusual. I was trying to capture some overnight data and have today off so sleeping in is possible ;)
Our +9 (250) overnight and the AMPS (249) today held nicely. Other than the blue values this is one of her lower preshot values.
Thoughts on the 2F vs 2.5?

I completely understand the risks of symptomatic hypo and would not take that lightly.
 
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