? 1/31/2016 Conan AMPS 429, +2 330, +4 162, +6 212, +8 600, PMPS 705!!, +2 425 - I'm dizzy!

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Jessica & Conan

Jessica & Conan

Member Since 2016
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As discussed in yesterday's post, Conan has been (or appears to be) bouncing repeatedly - on a multi-day or daily basis, and now it's getting pretty extreme (today down from 330 to 162 in 2 hours, then up from 162 to 600 in 4 hours!). Some days in there he just seemed to be on a high plateau.

I had thought that the high numbers maybe meant he needed a dose increase, but now after reading advice on my earlier posts and other links I found here, and noting that he consistently does achieve (occasional) target levels, I am wondering if this is perhaps a sign that I need to actually try *reducing* his dose. See e.g. this: Somogyi rebound. When faced with this sort of pattern, has anyone found reducing dose to help? Could lowering his dose from 1 to .75 perhaps help him emerge from this cycle of bouncing/rebounding? The vet started him at 1 - but he only weighs 8.5 lbs or so, so 1 is not necessarily a conservative dose for him based on weight.
 
No, I wouldn't recommend reducing his dose

Unfortunately, bouncing is a very frustrating part of the sugardance that we just have to live with.....The key to giving Conan the best chance possible at remission or regulation is to keep getting him into normal numbers as often as possible so his pancreas can possibly heal

The existence of TRUE "somogyi rebound" is a hotly debated topic, but here, the general consensus is that it's never been really proven to exist. Vets like to throw big words around and this is one of them, but the original research was done on a very small group of humans back in the 1930's and there's never been any further "proof" that it exists

Actually, 1 unit is pretty close to the starting dose we'd suggest...at his weight, the starting dose would work out to be .966 U (although we'll occasionally suggest starting a little lower)

I don't see anything in his numbers that suggests he's getting too much insulin....just that he's a very bouncy kitty
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FYI: Unfortunately, the Pet Diabetes Wikia is sorely out-of-date.

Some excellent posts on Somogyi Rebound:

http://www.felinediabetes.com/FDMB/threads/somogyi-and-bounces.138412/#post-1427057
http://www.felinediabetes.com/FDMB/threads/somogyi-and-bounces.138412/#post-1427115

Up-to-date info on Somogyi (published research, done on cats): Journal of Feline Medicine and Surgery-

Jessica & Conan said:
When faced with this sort of pattern, has anyone found reducing dose to help?
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Rarely. In most cases the answer is to increase the dose if for no other reason than glucose toxicity has set in. Lowering the dose is old school thinking. From what I've seen over the years I've been here is all decreasing does in this type of situation is cause the caregiver more effort, time, and expense to get back to the point kitty was at prior to reducing the dose... often having to surpass the dose kitty was once getting.

The prednisolone may be influencing Conan's BG numbers, but with as much as you test, I wouldn't think twice about increasing the dose to 1.25 units.

Just my thoughts...
 
Thank you, both of you! Thanks for those links; I like having research to rely on, and to help me better understand what's going on. No reason for me to consider decreasing.

My inclination has been to increase by .25, but I've been waiting to see if he evens out from this ongoing bouncing. . Are the effects of such increases with Lantus usually seen immediately - the day of the increase? Or a bit delayed, like the second or third days? Because there are some days I can't test until +8, I'd like to time any increase so I'll be able to be there for testing on the days he's most likely to feel the effects.

The Pred unfortunately is always going to influence his numbers, since it's not likely to change in the foreseeable future - it's almost certainly the reason we're in this situation at all. Since I give it very consistently, always at the same time in relation to the BG tests and insulin dosing, hopefully the influence will be consistent as well.
 
Jessica & Conan said:
Are the effects of such increases with Lantus usually seen immediately - the day of the increase?
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Providing one doesn't increase the dose as a bounce is clearing, the answer is usually not because of Lantus being a depot insulin. The effects are cumulative. One dose builds upon the next.

I've known many caregivers who work M-F to increase a dose on a Friday morning so they can get an idea of what the new dose will do before going back to work on Monday morning.

As time goes on, you'll see a pattern developing with Conan. The data will give you a better idea of when you'll see the effects of an increase.
 
Jessica, did I pass this link "Where Can I Find?" on to you yet? It can help you find info that is pretty up-to-date, including on Somogyii. There is a wealth of info on this site, including within people's condos (threads). When I was new, I often knew I'd seen info somewhere, but didn't know exactly where. Perhaps that will help you - I'd suggest bookmarking it.

When a cat shows the effects from a dose increase varies. Some cats get New Dose Wonkiness, some don't. Some cats can show the effect of an increase in the first cycle, many will show it by the third cycle. We hold the dose at least 3 days (6 cycles) so that we can see as clearly as possible what the dose can do once the depot has increased with the new, larger dose.

So that's a non-answer, because it really does depend on Conan. It's a pattern that you will begin to see, though, as you increase.
 
So is it common or expected for the bouncing to be this wild and extreme?? I'm starting to get a little worried about him. For the first almost two weeks he was all over the place, sure, but not such abrupt extreme changes, not like this - not almost 600 swing in a single day, from 400s down to 162 up to 705 and now back down to the mid-400s, in the space of 12 hours or so! I feel like a broken record but...I have no experience, and the other (all recent) bouncing posts I've read here just haven't been anywhere nearly as extreme as Conan's numbers. Do other cats even go up to 700??

Is this damaging him? Is there something else I should be doing, other than being patient and continuing on as I am?

Julie, thank you for that link, I have bookmarked it!

Chris, meant to say, I love your bouncing kitty, I'm mesmerized by it... Conan definitely seems to have springs today.
 
some kitties just bounce. There's nothing unusual here in his bouncing. Especially for a kitty that is just starting out on insulin. Many cats have been in high numbers for a while before they get diagnosed with diabetes, and by then, their body has decided that high numbers are the norm. That's the Glucose Toxicity that Jill was referring to above. So when you bring the blood sugar down, the body "bounces" to bring it back up from the perceived hypo - even if the "lows" were in the 200's.

All you can do is keep bringing his blood sugar into normal range and hoping it will lessen and settle down.

One thing you can do is to try to prevent him from dropping so fast. When you're home, you can feed him if you catch his blood sugar beginning to drop too quickly. How quickly is too quickly? That depends on the cat, but for at least some cats, anything over 50 points per hour would be enough to trigger another bounce.

He'll get there, Jessica. This is very early on in his treatment, but as you increase his dose methodically, you'll get results. When I started people told me this was a marathon, not a sprint. It takes time to get a kitty regulated, but you're on the right track.
 
Thanks Julie! I'm kind of an over-analyzer and over-researcher, and I have to fight for patience when things don't seem logical and consistent - which would be just about always, when it comes to animals! And I am aware that I am totally in the deep end here - I have no foundation of knowledge or experience from which to be able to assess what's happening, which leaves me feeling helpless.

I've been doing more reading on the forum about bouncing and dosing, and I think that attempting to adhere to TR might be a good idea, because it would give Conan and me a known structure to work within. I think I'd need to be a bit on the conservative side because of both my non-ideal schedule and the fact that we're still starting out, so I'm still learning his patterns - and I need to understand it a little better (eg, is the "nadir" used to determine dose changes the single lowest measurement during the period, or an average, or the most recent one, or something else? And does the fact that he might be bouncing affect whether or when to increase?). But I think using the protocol as a guide and structure, knowing it's got research and a lot of experience and testing behind it, might help me feel less like I'm completely floundering.

I also have not yet done anything with regard to ketones - haven't ever measured his or even thought about them.

I think feeding Conan some smaller meals during the day is a great idea. He'd like it, and on days when I do that now (indicated on my ss), his BG has actually evened out - gone down if it was high. I'll add it on other days as well, either regularly or as needed based on testing.

Thank you for your help and patience!
 
Looks like you have an IBD/diabetic combo as well!!!

One option to maybe discuss with your vet is switching the pred for budesonide.....Skooter is also a steriod induced diabetic and one of the first things we did was ween him off the pred and switch him to budesonide. The switch doesn't help all cats but it has done wonders for Skoots, with his BG numbers as well as IBD.....sure he still vomits occasionally but that is it.....

I see Conan is on it for two reasons so not sure if its an option but maybe worth a discussion at least?
 
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