20th Jan Rocky bouncing

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Marlena

Marlena

Member Since 2015
previous
http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/
I have some questions so maybe somebody would be able to answer them please
What do you do when a cat has bouncing high numbers due to steep drop of glucose? Does it mean that insulin dose is too high and needs to be reduced or not?
What does that mean if you reduce the dose pm and next morning BG is high?
I'm getting a bit confused and so tired so please bear with me.
Many thanks
 
Marlena said:
Does it mean that insulin dose is too high and needs to be reduced or not?
Click to expand...
No, bouncing does not necessarily mean that the dose is too high.
If a cat is experiencing rebound because it's dropping into hypoglycemic numbers then the dose is absolutely too high, and needs to be reduced immediately.
If a cat is bouncing because it's having a reaction to numbers that are within 'normal range' - or indeed to numbers that are above normal range (as some cats do), then it may be fine to hold the dose. But as with so many things, there's not a 'one size fits all' answer to this. It really does depend on the individual cat...

...For example, some folks will hold a dose, despite the fact that a cat bounces, so that the cat can experience those lower (ie.normal/near normal) numbers and begin to get accustomed to them. (Remember, when a cat has been hyperglycemic for some time it's body can start to get used to those higher numbers and can perceive lower numbers as a threat. So, it's idea of 'normal' might need to be reset.)

But, there have been folks on the forum who've had very bouncy cats for a while and who've decided to try a different strategy: And that is to reduce the dose to try to get the cat used to a sort of 'medium' range of numbers (just above the 'trigger point') before trying to get it used to 'nearer normal' numbers.

Marlena said:
What does that mean if you reduce the dose pm and next morning BG is high?
Click to expand...
Again, there's no 'one size fits all' answer...

It may simply be that the reduced dose was insufficient.

Or a higher morning BG may mean that the cat has dropped lower during the night, and bounced from that. (Cats may eat less during the night. Caregivers may be less likely to test during the night and catch a low number).

Some folks ascribe their cats higher morning numbers to 'dawn phenomenon'. In humans it is recognised that a surge of hormones causes a rise in morning blood glucose levels http://www.diabetes.org/living-with...re/blood-glucose-control/dawn-phenomenon.html But this may also be extrapolated to animals.

Also, cats that are going into remission (or who have a 'sputtering' pancreas), may sometimes have higher numbers in the morning because they've not eaten for a while, and eating stimulates their pancreas to produce insulin...

Although all of the above can seem rather complicated, if a caregiver collects enough data a pattern (and hopefully cause/reason) can often be observed and addressed.

But this is just my '10 cents'. See what others have to say....

Eliz
 
Many thanks Eliz,
basically I have to make that decision - I think I would like to hold on to the dose for a while and see what happens. But do we really now what high numbers all day long, not moving much might mean? This is what Rocky had all day today.
Rocky's PSPM BG is the same as this morning.
As it is time for his shot I am going to give a go now and pray.
Speak with you later.
PS. Looking at his SS do you see a low BG which is too low so was the cause of a rebound? Does 4.1 mean that? I know I didn't test him at night so we don't know his lowest BG at night but from the SS - is there any number that is too low? What do you think?
 
Marlena said:
Looking at his SS do you see a low BG which is too low so was the cause of a rebound?
Click to expand...
Hi Marlena,
I posted a comment about this in your other thread (ie, I don't know whether bounce was triggered from yesterday's numbers or from what might have happened during the night.)
17.01.2016 Rocky - high numbers, frustrated

Some cats bounce only on quite low numbers, but we have had cats here who may bounce initially even if they only drop to 9 or 10mmol...

I really would like to reassure you that you are doing just fine, Marlena. Honestly! :bighug::bighug::bighug:

Eliz

PS. My 'best guess' about the dosage at this point is that the .75 seems fine as long as Rocky is in higher numbers, but may need to be reduced if/when those numbers start to come down.
 
Many thanks Eliz.
I have done some reading and thinking and came to the conclusion that slowly reducing the dose is my next step.
I suspect that we see here Somogyi rebound, I read this article http://petdiabetes.wikia.com/wiki/Somogyi_rebound. Well, it is a possibility I need to consider.
It is all so confusing and if you are under enormous amount of stress it takes time to really digest things (or at least it is my explanation of being errr.. mentally retarded!).
In my searching for knowledge I found contradicting information and it looks like we really don't know. Some people say that there is no proof that Somogyi effect even exist!
So I came to the decision to slowly reduce the dose, I don't think I will be testing very often in the first few days (I need a rest) and see how Rocky reacts. I think it was my problem from the beginning not to realise you have to make a decision and observe what occurs and react.
Well, wish me luck, I am still learning.
Many thanks for your patience and help.
Marlena
 
(((Marlena))), I am so sorry to hear about the stress you are experiencing. It sounds like you are having a really tough time. So please be very kind to yourself.
Rest. Relax. Do things that you love to do, and that bring you joy.

Regarding Rocky, it may be much simpler than you actually think. But it is all too easy to get overwhelmed in the early days when there seems to be so much information (and some of it conflicting).

I would like to reassure you that bouncing is an extremely common phenomenon. We see it a lot here. And it really isn't anything to worry about (although it can be very frustrating for the caregiver). It's just something that a kitty sometimes needs to go through as it's body becomes accustomed to normal numbers again.

With bouncing, the numbers increase temporarily (for anything up to a few days) and then settle down again. This is what we seem to be seeing with Rocky.
My understanding of Somogyi (if indeed it exists) is that it is high unrelenting numbers caused by chronic overdose. (Someone please correct me if I'm wrong).

If you don't want to do so much testing then it may indeed make sense to reduce the dose.
But please DO continue to at least test before each insulin shot. (Bertie surprised me with a 5.6 this morning, and if I'd gone ahead and given insulin without testing it could have been very dangerous for him).
And perhaps - if you can - try to get one additional test at some point during the first half of the insulin cycle, so that you can hopefully be alerted to any problems? So, four tests a day..? (Without mid-cycle tests you won't know how low he is dropping on any given dose).

I do, of course, wish you luck! We are all here for you. :bighug:

If you want to talk things through at any time then I'm very happy to have a chat on the phone. I'll PM you my home phone number.

Huge hugs to you, Marlena,

Eliz
 
Hi Marlena,

I recognise very well the feelings of stress and frustration; we all want our little ones to be regulated ASAP but unfortunately their little bodies don't follow the script! :banghead:

I think Eliz's suggesting about the four tests per day is a good one. You'll know whether or not it is safe to give Rocky his insulin, and the mid-cycle tests will still give you some picture of how he's responding plus (and it's a big plus!) it will give you peace of mind that he's running in safe numbers while the insulin is active in his system. I've adopted this approach with Saoirse and it definitely helps with the stress levels.

I hope you manage to get some rest; especially in the early days the Sugar Dance can be very draining. It goes without saying but you need to look after you so that you can look after Rocky. Mummy always gets the oxygen mask first. ;)

:bighug:


Mogs
.
 
Dear Girls,
as always you are being very helpful.
No, I'm not giving up on Rocky and I would never stop checking his BG, I know that four times in 24 hours would be minimum. So, of course testing before every shot and at expected nadir, due to work will have to be +6 but some days I will be able to do more testing.
I am still not clear what to do with Somogyi effect because everything I read screams at me: reduce the dose. I'm terrified to go to the vet's because she will say to reduce the dose!
So do people on this forum reduce the dose if they suspect that? The problem is we can not be sure that what's happening with Rocky is Somogyi rebound for a start and also am I right to say that Somogyi is basically caused by too much insulin and do you just ignore it and carry on without changing the dose because it means pushing BG low and see how the cat reacts. Sorry about going on about it but I am trying very hard to understand how it all works, I am feeling like a blind person trying to find her way in London!
In the meantime I reduced Rocky's dose by a miniscule amount. I know time will tell if this works.
 
Marlena said:
Help please,
Rocky's PSPM is 12.1. What dose shell I give?
Click to expand...


I posted this on your other thread:

"Your best bet for dose advice is Elizabeth who is not on right now. First what you should do is DO NOT FEED yet and retest again to see if the number is going up, staying the same or going down. If it is going up then you should be able to shoot but I don't know what sort of dose with the hypurin. If it is the same or lower, wait again without feeding and retest in about another 20 minutes to see what the numbers are doing.. You could try doing the @ Elizabeth and Bertie and that should send an e-mail alert to her."


ETA:

You did shoot a 12.6 a couple of days ago with the 0.75 dose, so you may be safe with your current dose but you would need to be able to monitor her levels for a few tests before bed
 
Last edited:
I agree. If his numbers are on the rise, then it will be safe to inject him, and give him 0.5u.
If he's still dropping, then don't inject him tonight.

He's not letting you relax, is he? You are doing a fantastic job, though!

Big hugs.
 
Elizabeth and Bertie said:
No, bouncing does not necessarily mean that the dose is too high.
If a cat is experiencing rebound because it's dropping into hypoglycemic numbers then the dose is absolutely too high, and needs to be reduced immediately.
If a cat is bouncing because it's having a reaction to numbers that are within 'normal range' - or indeed to numbers that are above normal range (as some cats do), then it may be fine to hold the dose. But as with so many things, there's not a 'one size fits all' answer to this. It really does depend on the individual cat...

...For example, some folks will hold a dose, despite the fact that a cat bounces, so that the cat can experience those lower (ie.normal/near normal) numbers and begin to get accustomed to them. (Remember, when a cat has been hyperglycemic for some time it's body can start to get used to those higher numbers and can perceive lower numbers as a threat. So, it's idea of 'normal' might need to be reset.)

But, there have been folks on the forum who've had very bouncy cats for a while and who've decided to try a different strategy: And that is to reduce the dose to try to get the cat used to a sort of 'medium' range of numbers (just above the 'trigger point') before trying to get it used to 'nearer normal' numbers.


Again, there's no 'one size fits all' answer...

It may simply be that the reduced dose was insufficient.

Or a higher morning BG may mean that the cat has dropped lower during the night, and bounced from that. (Cats may eat less during the night. Caregivers may be less likely to test during the night and catch a low number).

Some folks ascribe their cats higher morning numbers to 'dawn phenomenon'. In humans it is recognised that a surge of hormones causes a rise in morning blood glucose levels http://www.diabetes.org/living-with...re/blood-glucose-control/dawn-phenomenon.html But this may also be extrapolated to animals.

Also, cats that are going into remission (or who have a 'sputtering' pancreas), may sometimes have higher numbers in the morning because they've not eaten for a while, and eating stimulates their pancreas to produce insulin...

Although all of the above can seem rather complicated, if a caregiver collects enough data a pattern (and hopefully cause/reason) can often be observed and addressed.

But this is just my '10 cents'. See what others have to say....

Eliz
Click to expand...
Dear Eliz,
I really like your post. It actually summarises everything I've read on this blog but failed to take in due to brain badly effected by stress. It is very scary to realise how your own chemistry (a dance of hormones and neurotransmitters) do exert an influence on your behaviour and decision making.
Lots of hugs from Marlena and Rocky XXX
 
Hi @Marlena ,

Just wondering how you're getting along?
I see the numbers have been fairly flat so far on that .5 unit (but also without the 'drama' of the drops and bounces on the .75.) And I also see that you've upped the dose by a smidge. That seems like a good idea.
How are you doing with the testing? Are you managing OK? (I know that it's going to be harder for you now that you're back to work (and I hope that's going well BTW!))

Eliz
 
Dear Eliz,
thank you.
Rocky, as you can see on his SS is mostly in pink numbers having one yellow here and there.
I have increased his dose slightly - Juliet and I both thought that maybe this is what should be done. I recon that my fat 0.5 dose is somewhere between 0.5 and 0.75, it is so difficult to master this little syringe! What I'm hoping is that the difference is so small that it should be all right, the idea is to increase ever so slowly.
Unfortunately from the numbers we are getting on his SS it is so difficult to say when there is onset, nadir etc because the numbers are so similar!
But, as per reading I've done here it is still early and we need to wait a week to see what's happening before we do anything.
I'm testing whenever I can, more so during the day but am not doing 2 hours curves as Rocky seems to have more less the same BG all the time. When I start seeing his numbers dropping I can test more often. Do you think it's reasonable?
I just can't wait for his BGs to move into lower ranges and testing would be more pleasant, at the moment my heart goes into overdrive when I read the glucometer, it really is unpleasant!
Rocky seems to feel ok, I spend a lot of time watching what he's doing and try to encourage him to move more so other than drinking a bit and peeing a bit more than usual I don't seem to spot anything worrisome.
Would be nice to have a chat with you soon.
Take care
Marlena XXX
 
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