Penny AMPS 395 +3.5h 256 +6h 236

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Robyn and Penny

Robyn and Penny

Member Since 2013
Hey everybody! Never posted in this forum before (usually main health) so if I'm in the wrong place, I apologize! Here's what I posted on FB and Chris referred me to the the board:

I just read that a "bounce" can happen when a cat drops over 100 pts quickly, not necessarily just when they have lower numbers. This has been happening with Penny a lot. She's currently on 1.25u twice per day, and was doing great the first 2 days and now her numbers are up again. I feel like I shouldn't be increasing but her numbers are telling me otherwise. I'm low on strips and my Walmart order hasn't come yet, so I haven't done a full out curve but am getting the "important" numbers. Can you take a look and see if you think this could be bouncing b/c she drops so quickly?

Penny was OTJ from 10.31.13-1.3.15 and has a recent dx of spinal arthritis and she just had her 10th adequan injection on Monday. She's been exercising, losing weight, and making jumps I thought she could never make even though I try to stop her, so I don't believe she's in pain with as active and playful as she's been since we started letting her down the basement for exercise.

I should note that Penny is a social eater so does not eat overnight unless she wakes somebody up. Most nights she gets someone up between 5-6a to eat Young Again kibble. SS in signature. ThankS
 
Hi Robyn! You're in the right place here! Here's your background info from Health

Yes, there are 3 basic reasons for bounces
1. they drop to a very low number
2. they drop a lot of points very quickly
3. they're used to being in high numbers, so even a number that's not "too low" still causes a bounce. (if they're used to being in the 400's and drop into the 200's, that's enough to trigger a bounce....the more time she spends in lower numbers, the more her body will get used to being there and she'll stop bouncing so much and will clear the bounces sooner)

Since this dose has taken her into blues, I think you're seeing some of reason 2 and 3....Penny's body probably hasn't been in blue numbers for awhile, and her liver is reacting like it's "too low" when it's not.

Bounces can take up to 72 hours to clear, so it's important that you know when they're bouncing, and when the dose just isn't high enough. That's where posting here daily and letting the experienced eyes here can really help!

I'd stay at the 1.25 for now since it's gotten her into blue numbers and hold it for at least 8 cycles and see how she does, as well as giving her a little time to clear any bouncing from going lower than she's used to being

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.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
 
Thanks Chris! I held it for 10 cycles so far, so that's why I was thinking to increase tomorrow but I suspected she may be going low in the wee hours or even those fast drops are causing her to bounce and my increasing will make her liver panic more. Gonna get a +4 tonight before i go to bed and see what happens over the weekend to see if she levels out. Like I said on FB, it's like I'm dealing with a different cat this time...
 
Mikey is a big time bouncer. One thing that really helped us clear the bouncing is by slowly bringing him down a level before increasing the dose again. For example, if he's in 300s pre-shots with the majority of mid-cycle tests in the 200s, I'll hold him there for a week or more till I stop seeing wild swings. Then increase the dose (with him, by fats and skinnies because he also really sensitive to dose increases), hold it steady for another week or two till I start seeing more yellows than reds. Increase again till I start seeing more blues, etc....

It seems like it's a much slower process but I've found it keeps his numbers much more stable and actually lower on average (because flat 200s is better than 300s with a couple of >100s thrown in). It also keeps us from backtracking in dosing because too fast of an increase causes him to plummet too low or plateau too high, resulting in either holding that dose for much longer anyway or dropping dose again for safety (since I'm not home all the time to catch those steep drops).
 
Kay, so what you're saying is go down to a skinny 1.25u and hold? She was starting to level out and then threw me an AMPS of 404 and then just 4hours later she was down to 236, then her nadir was 238 so I think that big drop sent her liver into a tailspin...
 
I'm saying that with Mikey (and a few other cats who like to bounce), I've found that holding the dose longer until they stabilize on the dose and stop throwing highs and lows. Then, take them up to the next dose (in Mikey's case, he can only handle skinny and fat increases and not whole .25u increases). Then, I hold him at that dose until his numbers start flattening out in whatever range (200s for example) and bring him up again and keep doing that until his numbers flatten out in the 100s with nadirs below 100.

I only decrease his dose only when he isn't stabilizing on the new dose and keeps bouncing. I bring the dose back down for a little bit till the bouncing stops and then nudge the dose back up again. As long as I'm patient with the dosing, it really helps stop the bouncing.
 
I don't think that's what Kay was suggesting, just giving you an example of what she does with Mikey. You're not seeing anything to suggest a decrease but half the picture is missing. You need to be getting more night tests to see what Penny is doing before any sound decisions can be made. Most people try to at least get one before they go to bed.
 
If you want to check out Mikey's spreadsheet for an example, you might be able to see what I mean.

At the end of the year, I had brought him up to a fat 1.5u. He kept swinging wildly from 300s to 60s and back up again. I decreased him to 1.5u, held it for a couple of weeks till he stopped bouncing up to 300s and then increased back up to a fat 1.5u. Held that for a week till he stopped bouncing up to 300s and then increased again to a skinny 1.75u.

We're on Day 3 of this last increase and his numbers are looking much better this time around without any crazy bouncing setting off even more bouncing.
 
Okay, Kay...I see what you mean. So maybe skinny up her 1.25u dose and see if I can get some flats and then go for the 1.25u again?
 
Either that or continue holding the 1.25u a little longer. Also, get in a few more mid-cycle tests. ;)
 
But, with that being said, Penny looks like she's been doing "pretty well" bounce-wise on the 1.25u with minimal 400s the last few days (404 is pretty close to being under 400) so it might be time for an increase to a fat 1.25 or 1.5u.
 
I think I'm gonna do a fat 1.25 or skinny 1.5 tomorrow morning..although with counting drops and yada yada yada there's probably not that much difference lol. Penny was only on insulin for 6 weeks before so I'm still very much a newbie with syringes and insulin lol
 
I'm going to provide a different viewpoint. Most kitties do better on increases with full .25U increases, unless you are trying to tweak an already green nadir. I'd take Penny up to 1.5U. The most she's gotten on this dose is mid blues. Kitties that are back on insulin after going OTJ once, have a harder time going back into remission the second time. You have to stay on top of things and try to get her back into normal numbers again as quickly as possible. Plus you'll be back on the line. :)

Neither the SLGS or TR protocols call for reducing a dose to even out numbers before increasing. I've very seldom seen it work. Usually reducing just means you get higher and flatter numbers, the cat's body gets used to higher numbers, and then you have to to an even higher dose to get over the glucose toxicity. Been there done that myself.

I also agree with Serryn on those night cycle tests. Either a before bed test or one in the morning if you get up a couple hours before AMPS, can do wonders to fill in the picture. Many cats go lower at night. Neko is a prime example of that. Last year for about 6 months she got all her reductions at night and bounced during the day. Thankfully that's changed. But if I only looked at the day time data, I'd have increased instead of decreased.
 
Thanks Wendy. I think I'm gonna set the alarm for 2am to get that number tonight. Yay. Can't wait to see how they react to this lol. But I def wanna see what she's doing overnight b/c she's a social eater so won't eat at night unless she gets us up in the wee hours of the morning. Penny used to go lower at night but since she relapsed it's like I have a different cat. She's doing fantastic other than her numbers so I wanna get into some more blues and greens. And on those mid blues I was already thinking increase anyway b/c I want green nadirs, for sure!

And her nadir has changed...she was +14 on Levemir before and now she's around +6.
 
Wendy&Neko said:
Neither the SLGS or TR protocols call for reducing a dose to even out numbers before increasing. I've very seldom seen it work. Usually reducing just means you get higher and flatter numbers, the cat's body gets used to higher numbers, and then you have to to an even higher dose to get over the glucose toxicity. Been there done that myself.
Click to expand...

I've seen this work numerous times in bouncy cats in the old Relaxed forum where doses were often held for much longer periods. And sometimes you have to backtrack in dose a little bit to STOP the bouncing, otherwise, I've seen it happen where they end up bypassing a good dose because they were increasing based on bouncing numbers. Yes, bounces only last for approximately 72 hours, but when your cat keeps bouncing (like Mikey does), you end up with back-to-back bounces that make it harder to see what the insulin is really doing.

What I've seen happen many times with holding the dose longer (or even going back to the "last good dose" if necessary) is you get flatter numbers, but not necessarily higher if you take the average of the numbers across the day vs. cherry picking highs vs. lows. For example, a 300 pre-shot with a 60 nadir and then 300s for two to three days is a higher average than 200 pre-shot with 200s for two to three days. No, they might not be getting down immediately into "regulated" range once every three days, but at least you're not causing as many bounces from highs to lows and back up again.

I might be entirely wrong on all of this because most of my exposure has been to Relaxed cats and a lot of them were like Mikey in that they didn't follow the TR rulebook so there were a lot of tweaks in protocol needed to get them stable and into lower numbers. This is why I don't really post in this forum any more now that they're all gone.
 
KPassa said:
I might be entirely wrong on all of this because most of my exposure has been to Relaxed cats and a lot of them were like Mikey in that they didn't follow the TR rulebook so there were a lot of tweaks in protocol needed to get them stable and into lower numbers. This is why I don't really post in this forum any more now that they're all gone.
Click to expand...
Robyn does a great job getting mid cycle tests before increasing. Whether following the SLGS or TR protocols, mid cycle tests are key to safely increasing the dose. I'd seen some Relaxed kitties getting increases without even a curve done, so I can see how your technique might work for them.
 
Well I got my sorry butt up at 2am to get an overnight nadir and she was 213. Then I couldn't fall back asleep for an hour lol. She did have a lower AMPS this morning of 316, so I ended up shooting a skinny 1.5u and we will see how that does. I do want nadirs in the greens but don't want her liver to go into a panic attack, either! lol!!

Add to it a territorial standoff by my ferals outside at 5:30a that ripped me out of bed at the beginning of a snowstorm and that should tell you how the rest of my day is going, right? lol

I will def hold this dose longer than 6 cycles if she gets wonky. Just like with everything else, ECID, and we know our cats better than anybody. I feel like a newbie b/c I'm def dealing with a different cat this time around!

I'm happy to report she lost 5oz this past week!! From 17lb 3oz to 16lb 14oz this morning :) But the thrill of the basement is wearing off and I'm having to be creative to get her to run the steps. Our goal is a minimum of 5X per day but she had been doing a lot more with the thrill of new territory to explore. Hoping she's just having an off day with all the overnight excitement around here lol
 
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