HUGE Bounce - Concerned

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G & I

G & I

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This is a tremendous bounce and I am very concerned after a relatively peaceful day and evening. Am preparing to give am insulin 2.5U but again, concerned at how high this is. We did just return from the vet an hour ago. AMPS 617 - She hasn't seen this in quite some time - Thoughts - Guidance - What is going on here...

UPDATE - Okay I did another reading with a new strip and new blood. This one says 365
Now what? I just fed her like a minute ago.

2ND UPDATE - Third reading reflects 444 -

Testing Control Strip = 144

Meter set correctly to code on bottle (07)
 
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That is an icky number, for sure! A high bounce isn't unexpected after that long low cycle. Kitties can sometimes be quite dramatic. However, I think given her blood work yesterday, the infection is a likely culprit. Is she on daily antibiotics, or did she get a shot? Does the vet have any ideas on the type of infection? And of course the third possibility is vet stress, although Goma is there enough, and yesterday didn't seem to stay high after, so that seems like the least likely option.

One of the things we try to keep in mind is to not worry about a single number. Pay more attention to the trends. So I would stay with the 2.5u dose, and let's see what she does. Hopefully this is just a strange moment and she'll get back to her normal ranges soon.
 
Djamila said:
That is an icky number, for sure! A high bounce isn't unexpected after that long low cycle. Kitties can sometimes be quite dramatic. However, I think given her blood work yesterday, the infection is a likely culprit. Is she on daily antibiotics, or did she get a shot? Does the vet have any ideas on the type of infection? And of course the third possibility is vet stress, although Goma is there enough, and yesterday didn't seem to stay high after, so that seems like the least likely option.

One of the things we try to keep in mind is to not worry about a single number. Pay more attention to the trends. So I would stay with the 2.5u dose, and let's see what she does. Hopefully this is just a strange moment and she'll get back to her normal ranges soon.
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Understood - I updated my post a couple of times reflecting different readings - What do you think about those?

She is having antibiotics through the subcutaneous injection once a day that includes vitamins and liver meds in addition to 100 ml fluid.
 
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365 and 444 are technically within meter variation. I know it seems like a huge range. But those are both much better than the 617, so that's good to see. I would probably put the 444 into the spreadsheet since it's the middle number.
 
Djamila said:
365 and 444 are technically within meter variation. I know it seems like a huge range. But those are both much better than the 617, so that's good to see. I would probably put the 444 into the spreadsheet since it's the middle number.
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Any ideas about why the meter initially reflected the high(er) number (617). When making decisions I would like to have more faith in the instruments I am using. I went through this previously and tested the meter on another cat. The meter was fine and test this morning using control fluid showed okay number.

Thanks for your patience and the continuing education.
 
Sometimes you just get a wonky test strip. Or too much or too little blood. When I get an unexpected number, I often do exactly what you did - test again. If the second test is close, then I know it was right. If the second test is way off (as yours was), I do the third test and figure out which of the first two is more accurate. I wish the numbers were more accurate too. Unfortunately, this is the best way have for now. The AT2 is probably the most accurate meter out there, and even it (as you have seen) can be less than precise. Try not to worry about it too much. Tonight for example, any of those three numbers still results in the same treatment - 2.5u. So despite the large variation, the decision remains the same. I try to remind myself of that when I get a little crazy about a particular number. :confused:
 
Djamila said:
Sometimes you just get a wonky test strip. Or too much or too little blood. When I get an unexpected number, I often do exactly what you did - test again. If the second test is close, then I know it was right. If the second test is way off (as yours was), I do the third test and figure out which of the first two is more accurate. I wish the numbers were more accurate too. Unfortunately, this is the best way have for now. The AT2 is probably the most accurate meter out there, and even it (as you have seen) can be less than precise. Try not to worry about it too much. Tonight for example, any of those three numbers still results in the same treatment - 2.5u. So despite the large variation, the decision remains the same. I try to remind myself of that when I get a little crazy about a particular number. :confused:
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Okay thank you for your usual thorough response. Note to Self - Don't go crazy about a particular number
 
Yes, nice cycle! Given the lows yesterday, a bounce that got her stuck up in the rafters was expected but it didn't happen. That blue is lovely. Look at the difference in your SS compared to December! :smuggrin:
 
Kris & Teasel said:
Yes, nice cycle! Given the lows yesterday, a bounce that got her stuck up in the rafters was expected but it didn't happen. That blue is lovely. Look at the difference in your SS compared to December! :smuggrin:
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Unfortunately it didn't last - pmps of 545 puts her back in black which I have grown to detest as does she.
 
I hate to see high pre-shot numbers too, but I try to remind myself to focus on the good things. The longer they stay in good numbers, the better. So, even if they are high by pre-shot, if they spent several hours before that in good numbers, it was a good cycle. They are diabetic, they do have high BG, that is why we are giving them the insulin. So, the high pre-shot is a reminder of that.. think of where they would be without the insulin. (I am talking to myself as much as to you. :))
 
FurBabiesMama said:
I hate to see high pre-shot numbers too, but I try to remind myself to focus on the good things. The longer they stay in good numbers, the better. So, even if they are high by pre-shot, if they spent several hours before that in good numbers, it was a good cycle. They are diabetic, they do have high BG, that is why we are giving them the insulin. So, the high pre-shot is a reminder of that.. think of where they would be without the insulin. (I am talking to myself as much as to you. :))
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Thanks for getting me to keep things in perspective. So much going on lately I tend to forget.
 
scs islander said:
Ended quite roughly - pmps of 545. Sigh....I feel terrible for her.
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I feel for both of you because I can remember the way my heart used to sink if Saoirse had a high PS value, especially after a run of better numbers.

:bighug::bighug::bighug:

I don't know whether this might help but any time you get a preshot on the higher side have a look at the first line of Goma's spreadsheet. Today's PMPS may have been 545 but it sure beats the 700s she was running in a month ago at the start of her treatment. Fingers and paws crossed that a month from now Goma's numbers will be showing even more improvement - and she will be feeling much better for it!

We all wish we had magic wands to make our little fur babies better immediately but alas! such wands don't exist. :( Studying the numbers to remind ourselves of the positive progress being made is probably the only thing we can do to help manage our own impatience for them to be fully well again. Hang in there; your girl is definitely heading in the right direction. :)


Mogs
.
 
Critter Mom said:
I feel for both of you because I can remember the way my heart used to sink if Saoirse had a high PS value, especially after a run of better numbers.

:bighug::bighug::bighug:

I don't know whether this might help but any time you get a preshot on the higher side have a look at the first line of Goma's spreadsheet. Today's PMPS may have been 545 but it sure beats the 700s she was running in a month ago at the start of her treatment. Fingers and paws crossed that a month from now Goma's numbers will be showing even more improvement - and she will be feeling much better for it!

We all wish we had magic wands to make our little fur babies better immediately but alas! such wands don't exist. :( Studying the numbers to remind ourselves of the positive progress being made is probably the only thing we can do to help manage our own impatience for them to be fully well again. Hang in there; your girl is definitely heading in the right direction. :)


Mogs
.
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This definitely helps. Thank you.
 
This bouncing action of Goma's can continue for several cycles after that low cycle. She's still doing better than she was. The hope is that it'll calm down and allow you to see the real effect of the 2.5 u dose again. If she stays high-ish we'll likely recommend a dose increase to get her moving again. Just letting you know what might be ahead ... :)
 
Djamila said:
The pre-shot numbers are the last thing to come down. But look how fast she is clearing those bounces now! And really, they have already come down so far since the beginning! Goma is making remarkable progress. :)
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Thanks for the info about the pre-shot numbers being last to lower. Thanks to her guardian angels at FDMB she is becoming a whole new cat. She now sleeps in a more conventional cat style and is without a doubt much more comfortable.
 
scs islander said:
Thanks for the info about the pre-shot numbers being last to lower. Thanks to her guardian angels at FDMB she is becoming a whole new cat. She now sleeps in a more conventional cat style and is without a doubt much more comfortable.
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Oh I’m so glad to hear that! That’s even more important than the numbers - that she is starting to feel better!
 
Djamila said:
Yup, I agree with Kris. She's looking pretty stable at this point, and her nadirs are need to come down a bit more.
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Will need to see the pmps. I am sorry, I do not understand the point of increasing doses when she has trouble balancing where she is at this point. I am totally new to all this, but it appeared the last time I increased prematurely I (Goma) got bit pretty bad.
 
Kris & Teasel said:
Goma's bounces don't seem to last too long. I see that low-ish pink today on your SS. I think we'll be suggesting an increase to 2.75 u in the near future. :)
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Not sure I understand the increase suggestion at this time. Still bouncing like crazy. I know I am new and don't understand a thing about all this but I am just unsure at this point. For some reason, this last bounce took some of the spark out of her.
 
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What we're doing is looking at your data to see how low a dose has taken Goma once she's finished bouncing. We evaluate several cycles at a dose. A bounce shows as a skyrocketing of numbers (up into black in Goma's case) and we look for evidence of that ending as shown by a return to more typical numbers - eg. pinks. Bouncing is very frustrating and it can make it difficult to properly evaluate a dose. To assess a dose we look at how low that dose has taken Goma within several cycles of being at that dose and we ignore the bounce inflated cycles.

To assess a dose you have to look at both pre shot BG levels and nadir levels. If a cat is a bouncer more weight has to be given to nadir levels in the dose assessment because the pre shot numbers are often inflated (as a reaction to the lower nadir - a facet of the bouncing issue). The nadir is important because you want to avoid a dose that takes her too low but you want to see good numbers in the high dark green to low blue range. The hope is that the high pre shot numbers will come down over time but nothing is guaranteed with a bouncy cat. As hard as it is, if your kitty is a bouncer you have to learn to judge doses by looking past that. All this takes time to learn. And it's complicated by the fact that a dose that dropped her low a week or two ago might not do that again. FD and dosing are dynamic, not static, processes. If she's left too long at an ineffective dose (based on nadirs in the previous days) it becomes harder to get her coming down again. The high BG dulls the body's response to the insulin.

Ultimately, you hold the syringe and have the final say on what dose you give her. We can only give advice. :)
 
Yes to everything Kris said. So here is the pattern:

1/11 AM good
1/11 PM high
1/12 AM good
1/12 PM high
1/13 AM high
1/13 PM good
1/14 AM high
1/14 PM good
1/15 AM good
1/15 PM high
1/16 AM high (?) she nadirs late, so not sure on this one yet

The good cycles have blues as a low number for the cycle. Those are the cycles we look at - and at how quickly she moves from a high to a good cycle. Many cats will go good-high-high-high-high.... and then finally get another good cycle. Goma is moving quickly from goods to highs which is a great sign. The goods are also pretty consistent at this point - mid-blue. So far she's being nice and predictable, which is great. The mid-blues are good, but they could be better, which is why Kris suggested a little bump in insulin.

You are right that she could end up with a low cycle when you make the increase, but then she'll most likely settle back down, and hopefully with a slight improvement in the nadirs, and hopefully with the effect of starting to pull the PS numbers down a little lower at the same time.

One strategy you could try if this all makes sense, but just makes you nervous, is to increase in teeny tiny increments. We call them fat and skinny doses. So you don't go all the way from 2.5u to 2.75u at once - instead you go to 2.5u, and then just a teeny bit more for a couple of cycles (a fat 2.5), then a bit more than that (a skinny 2.75), and finally the 2.75. On the spreadsheet then you would type it in as 2.5F, 2.75S, and then 2.75.

And as Kris said, it is always up to you if you want to try this or not. You know Goma the best, and we are always here to support you and walk with you no matter what decision you make. I definitely believe in mama-sense/papa-sense and will trust that you are always making the best decision.
 
Kris & Teasel said:
What we're doing is looking at your data to see how low a dose has taken Goma once she's finished bouncing. We evaluate several cycles at a dose. A bounce shows as a skyrocketing of numbers (up into black in Goma's case) and we look for evidence of that ending as shown by a return to more typical numbers - eg. pinks. Bouncing is very frustrating and it can make it difficult to properly evaluate a dose. To assess a dose we look at how low that dose has taken Goma within several cycles of being at that dose and we ignore the bounce inflated cycles.

To assess a dose you have to look at both pre shot BG levels and nadir levels. If a cat is a bouncer more weight has to be given to nadir levels in the dose assessment because the pre shot numbers are often inflated (as a reaction to the lower nadir - a facet of the bouncing issue). The nadir is important because you want to avoid a dose that takes her too low but you want to see good numbers in the high dark green to low blue range. The hope is that the high pre shot numbers will come down over time but nothing is guaranteed with a bouncy cat. As hard as it is, if your kitty is a bouncer you have to learn to judge doses by looking past that. All this takes time to learn. And it's complicated by the fact that a dose that dropped her low a week or two ago might not do that again. FD and dosing are dynamic, not static, processes. If she's left too long at an ineffective dose (based on nadirs in the previous days) it becomes harder to get her coming down again. The high BG dulls the body's response to the insulin.

Ultimately, you hold the syringe and have the final say on what dose you give her. We can only give advice. :)
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Understand and appreciate the explanation/rationale. I'm just not that smart... - tonights pmps is 583 (I took four readings (poor Goma) since I now don't trust the meter I am using. (I have ordered another for backup anyway) I got a 583, 536, 389, 601. Going with the high 500 (583) which was the first reading, the 389 was probably from blood that had set for a minute or so. I will probably not test again until 8 - 9 hours have passed. Please address the time to increase when it appears most effective. She is still in the middle of this bounce apparently.
 
Djamila said:
Yes to everything Kris said. So here is the pattern:

1/11 AM good
1/11 PM high
1/12 AM good
1/12 PM high
1/13 AM high
1/13 PM good
1/14 AM high
1/14 PM good
1/15 AM good
1/15 PM high
1/16 AM high (?) she nadirs late, so not sure on this one yet

The good cycles have blues as a low number for the cycle. Those are the cycles we look at - and at how quickly she moves from a high to a good cycle. Many cats will go good-high-high-high-high.... and then finally get another good cycle. Goma is moving quickly from goods to highs which is a great sign. The goods are also pretty consistent at this point - mid-blue. So far she's being nice and predictable, which is great. The mid-blues are good, but they could be better, which is why Kris suggested a little bump in insulin.

You are right that she could end up with a low cycle when you make the increase, but then she'll most likely settle back down, and hopefully with a slight improvement in the nadirs, and hopefully with the effect of starting to pull the PS numbers down a little lower at the same time.

One strategy you could try if this all makes sense, but just makes you nervous, is to increase in teeny tiny increments. We call them fat and skinny doses. So you don't go all the way from 2.5u to 2.75u at once - instead you go to 2.5u, and then just a teeny bit more for a couple of cycles (a fat 2.5), then a bit more than that (a skinny 2.75), and finally the 2.75. On the spreadsheet then you would type it in as 2.5F, 2.75S, and then 2.75.

And as Kris said, it is always up to you if you want to try this or not. You know Goma the best, and we are always here to support you and walk with you no matter what decision you make. I definitely believe in mama-sense/papa-sense and will trust that you are always making the best decision.
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As I mentioned to Kris, I appreciate the thorough explanations and rationale but unfortunately I just don't have the smarts to analyze the way I used to. Today's pmps was high at 583 so the bounce continues apparently. I have already taken a good look at the syringe to figure a likely point of 2.75. As also mentioned, if it isn't too much trouble, since you all are monitoring, let me know when it appears most appropriate.
 
It's nothing to do with being smart! We've been here for years and studied thousands of spreadsheets...and over time we've developed a better sense of patterns and what kitties usually will and won't do. Also, it's a lot easier to look at someone else's SS and discern patterns...when it's your own cat, it's harder since you are so scared of making a wrong decision. Even after I started to feel comfortable with making my own decisions, I used to come on here daily and ask what others thought. I didn't want to make the wrong decision and I was always afraid I wasn't reading the data right.

We're here and happy to help!
 
scs islander said:
(I took four readings (poor Goma) since I now don't trust the meter I am using. (I have ordered another for backup anyway) I got a 583, 536, 389, 601
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Hi. Just a comment.. The AlphaTrak is the most accurate meter you can have for testing her. I am glad you explained that the 389 was taken on 'old' blood, because that would have been the only reading out of the four that I would have said was way out of line. Having a backup meter is a great idea though!

For what it's worth, I agree with the other ladies. I would increase the dose. I would do it at an AM dosing just because it is easier to monitor more during the day time. And, I would probably just go to a 'fat' 2.5, putting the plunger of the syringe just over the 2 unit line. My baby was a bouncy ball for months, and I found that very small dosing increases held consistently for several cycles worked best to calm things. It's so good to see Goma's progress. I know you are a ball of nerves and probably cannot appreciate it as much as we 'outsiders' can. :)
 
scs islander said:
Understand and appreciate the explanation/rationale. I'm just not that smart... - tonights pmps is 583 (I took four readings (poor Goma) since I now don't trust the meter I am using. (I have ordered another for backup anyway) I got a 583, 536, 389, 601. Going with the high 500 (583) which was the first reading, the 389 was probably from blood that had set for a minute or so. I will probably not test again until 8 - 9 hours have passed. Please address the time to increase when it appears most effective. She is still in the middle of this bounce apparently.
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Also, I am unsure why she continues to bounce when she has been at the same dose for a long time now. That is what I meant in the other thread about not getting it...I just can't seem to even express correct thoughts now.
 
Yes, to fat and skinny doses for bouncy cats. I do it all the time with my rubber ball of a kitty. If you have half unit marks on your syringes, just nudge the flat top of the plunger up to but barely touching the bottom (relative to the syringe needle) of the 2.5 u line - no daylight between the plunger top and the 2.5 u line. You'll get good at these over time.

As Rachel said, it's nothing to do with being smart and everything to do with looking at many, many SSs. ;)
 
scs islander said:
I am unsure why she continues to bounce when she has been at the same dose for a long time now.
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Her body is used to consistently very high numbers. Relatively speaking, she has spent very little time in 'good' numbers. She is not used to those numbers. You can see on the spreadsheet that a bounce happens every time she hits the blues. She then goes high and stays pretty flat in the pinks for 1 to 2 cycles. At least it is only 1 to 2 cycles! The more she gets into good numbers, the more used to it she will become, and the bouncing should calm down.
 
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