Question about Bounces and what to do about them

[Dee Dee C]

Hi there and Happy Friday to everyone!

My question is about bouncing: When a kitty bounces due to a bg that drops quickly, but doesn't get down into a danger zone, should I consider a dosage reduction?

My wonderful boy Clarence decided today would be a good day to make a quick drop down from his AMPS of 321 to 106 by about +4 and I know that was more of a drop than he usually does. He came running in all hungry, so I went ahead and tested him and gave him some food and then just tried to get him to enjoy the better numbers for awhile and tested him a couple more times to make sure he didn't drop too low for safety. I'm sure this will result in a bounce for him and so I'm wondering whether I should consider backing off his dose for the evening or even longer.

He is currently getting 1.25u of Vetsulin. He had a very low drop a little over a week ago, so I reduced him to 1u for 4 days and then increased him back up to 1.25 a couple of days ago. If there is anyone that could take a look at his spreadsheet and offer some feedback, I would appreciate it a lot!

Thank you,
DD​

 

[CandyH & Catcat]

from my experience with it, Vetsulin does drop the BG soon and quickly -- bounces come with the territory

you can ease this up a bit by feeding mini meals or snacks frequently through the first half of the cycle -- this may shorten the duration somewhat, but Vetsulin rarely lasts the 12 hours anyway

other than that, you can't do much about bounces, unless you want him to stay at higher BGs -- the good dose will drop him into "normal" or "near normal" numbers for part of the cycle -- and as he becomes accustomed to those levels, the bounces will get smaller, recovery will come sooner

Linda ( MrWorfMen's Mom ) is a wizard at guiding you through these cycles -- if you want you can take a look at the first half of Catcat's Spreadsheet to see how it goes, though I didn't make notes on that as to when and how much I fed him

 

[Dee Dee C]

you can ease this up a bit by feeding mini meals or snacks frequently through the first half of the cycle -- this may shorten the duration somewhat, but Vetsulin rarely lasts the 12 hours anyway

Thanks, Candy. How is Catcat doing?

I will take a look at Catcat's SS. Clarence usually eats 'mini meals' in the first half of the cycle and this morning he had even more at breakfast and ate a little extra after breakfast, then had a small amount after I tested him at +3.4. He had already dropped quite a bit by that point. I don't understand why he will be having a pattern for awhile and then suddenly have a day where he drops faster and lower than usual. I'm actually wondering if I should try to get him on a different insulin.

Do you think I should maybe give him a reduced dose tonight?

 

[Dee Dee C]

Linda ( MrWorfMen's Mom ) is a wizard at guiding you through these cycles

I will tag her and see if she is available to give input.
@MrWorfMen's Mom

 

[FurBabiesMama]

Often, with a bouncy cat, you just have to let it work itself out. If the dose is not taking him too low or causing a situation where one PS is high and the other is too low to give the planned dose, holding the dose until his body adjusts may be the answer. Feeding at strategic times could help some, maybe. I have never used Vetsulin. So, someone who has will probably come along and give you more specific assistance. I did use ProZinc, and Mia was bouncy. We got to a point where I had to change insulins (LOVE Levemir!) because she was staying higher than I wanted her to be around pre-shot times, but if I raised her dose at all I risked her going too low during the cycle, so we were stuck. She has done wonderfully on Levemir due to the 'smoother' action of it - no harsh ups and downs.

By the way, I see you feed him 3 to 4 cans of FF a day. How much does he weigh? I don't know what flavor you feed him, but the classic chicken has 99 calories per can, so that would be a lot of calories, so I am thinking he must be a 15 to 20lb cat? (Based on the formula of 20 calories per lb of healthy body weight.)

 

[Dee Dee C]

Often, with a bouncy cat, you just have to let it work itself out. If the dose is not taking him too low or causing a situation where one PS is high and the other is too low to give the planned dose, holding the dose until his body adjusts may be the answer. Feeding at strategic times could help some, maybe. I have never used Vetsulin. So, someone who has will probably come along and give you more specific assistance. I did use ProZinc, and Mia was bouncy. We got to a point where I had to change insulins (LOVE Levemir!) because she was staying higher than I wanted her to be around pre-shot times, but if I raised her dose at all I risked her going too low during the cycle, so we were stuck. She has done wonderfully on Levemir due to the 'smoother' action of it - no harsh ups and downs.

By the way, I see you feed him 3 to 4 cans of FF a day. How much does he weigh? I don't know what flavor you feed him, but the classic chicken has 99 calories per can, so that would be a lot of calories, so I am thinking he must be a 15 to 20lb cat? (Based on the formula of 20 calories per lb of healthy body weight.)

My main concern is that when he has gone too low -- below the safety limit -- then he seems to be overly sensitive to the insulin and drops low for a few cycles even on a lower dose (guess that's normal). This time he did not go so low, but will he be sensitized to the insulin now anyway?

Yes, For breakfast and for dinner he gets one can of Chicken and Beef + whatever he wants of Chicken and Liver (usually 1/3 to 1/2 of a can). Then he gets Chicken and Liver throughout the 1st half of the cycle as he wants - usually in small portions. I don't have a scale, he had lost weight before he was diagnosed and was down to around 12 1/2 lbs. He gained about a lb. back and was around 13 - 14 lbs for awhile. I think his normal summer weight is around 14-15 lbs and in the winter he weighed around 18.

 

[MrWorfMen's Mom]

Looks like Clarence just broke through a bounce. And now he's liable/likely to have another one. There is no need to lower the dose unless he goes below 90. He's close and he will need you to monitor him by +3 tonight to make sure he isn't headed too low but he should be fine and may even be up if he bounces again.

 

[Dee Dee C]

Thank you, Linda!

I will go ahead and give the 1.25 and I will monitor him tonight. Every time he does something like this I think I must be doing something wrong, that it is my fault somehow. He didn't go below 90, but he was totally acting food crazed and was definitely as 'happy' at that low as he as been at some of the mid-upper 100s.

I am truly grateful for this forum and the wisdom out here. And you are an angel, Linda, for all the kitty's and caregivers you help out!

Linda, do you think I should consider a different type of insulin? I'm not even sure what ones are available here, I know my vet made it sound as tho the only other choice would be Pro-Zinc, but he said it is basically the same as Vetsulin (which I don't think is quite accurate, but I understand what he was getting at).

 

[MrWorfMen's Mom]

Vetsulin and ProZinc are both In and Out insulins which means the shot has a limited duration of effect and once each shot is used up, BG goes back up. The big differences between Vetsulin & ProZinc are that Vetsulin tends to drop BG much faster early in the cycle (nadir can be as early as +3) and it doesn't usually last the full 12 hours. It often peters out by 10 hours and in as little as 8 for some cats. ProZinc drops BG somewhat slower, less sharply and nadir doesn't occur until between +4 and +7 post shot (ECID). While the duration of ProZinc is usually 12 hours but it can last as long as 14. It is a good insulin for cats. Both Vetsulin and ProZinc are a bit more forgiving about shot times if the every 12 hour shot schedule is a problem for the caregiver.

The other choices are known as depot insulins....Lantus, Basaglar (generic Lantus) and Levemir. They are all excellent for cats but they need a more consistent shot schedule. There are specific methods and protocols here for using these insulins with more detailed guidelines that have been proven to work well. All of these insulins work build up a storage shed of insulin so even though you are shooting every 12 hours, there is always a depot of insulin available for the body to draw on which keeps BG more stable and predictable. Drops tend to start later and last longer through the cycle and usually are a gradual slide rather than an abrupt drop. This lessens the bouncing effect so prevalent with the In & Out insulins.

I've seen cats go into remission on all the insulins but more do so on Lantus/Levemir. Research suggests ProZinc can be just as successful as Lantus/Levemir. Vetsulin definitely doesn't enjoy as much success.

Clarence isn't doing too bad and I think you could raise the dose a bit to see if you can get those pre-shots/midcycles down a bit more. That said, he is on a bit of a roller coaster ride which is typical for Vetsulin and he might do better/feel better on ProZinc or Lantus. Why don't you read through the stickies for both those options and see what you think would work best for you and Clarence.

One thing to note is that the alternatives to Vetsulin are more expensive. ProZinc I believe is about $100 for a vial at Chewys. Lantus is horribly expensive in the US but you can get a good year+ supply from Canada for about $200 so over all it might be the most cost effective in the long run.

 

[Dee Dee C]

Clarence isn't doing too bad and I think you could raise the dose a bit to see if you can get those pre-shots/midcycles down a bit more.

I was thinking (again) of increasing to 1.5 and was actually thinking I would do that, until today. Remember a week or so ago when I was planning to increase to 1.5 and he had that one day that he dropped really low down to 48? Still, I think he would do better on a slightly higher dose. I don't think I could give consistent shots if I tried to give between 1.25 and 1.5. Maybe he just needs a little more time on the 1.25 before I increase. I remember reading that it wasn't recommended to increase more than once in a 1 or 2 week time frame -- I think that was in the AAHA guidelines.

 

[Dee Dee C]

That said, he is on a bit of a roller coaster ride which is typical for Vetsulin and he might do better/feel better on ProZinc or Lantus. Why don't you read through the stickies for both those options and see what you think would work best for you and Clarence.

One thing to note is that the alternatives to Vetsulin are more expensive. ProZinc I believe is about $100 for a vial at Chewys. Lantus is horribly expensive in the US but you can get a good year+ supply from Canada for about $200 so over all it might be the most cost effective in the long run.

I started to read some of the info on Lantus, but haven't gotten thru it all yet. I will read the ProZinc info as well. As far as the cost goes, yeah, I'm aware that Lantus is thru the roof expensive -- like $300 on Chewy. I just really want my cat to feel better, and whatever it takes. I rescued him from the shelter here when he was about 2 -- I wasn't looking for a kitty, but he tugged at my scarf thru the cage he was in and after I left I couldn't stop thinking about him, he reminded me a lot of my very first kitty when I was a kid -- I even had a dream about him that night -- I just had to adopt him, lol! He has been the best cat, too, everyone just loves him and he has brought me so much pleasure over the years, I definitely owe it to him to take the best care of him that I can. Sorry, I'm rambling...

I will read thru the stuff and see what I think. I will talk to the vet about it, are the vets here likely to be willing to prescribe an insulin that isn't approved for cats by the FDA, I wonder?

Thanks again, Linda. As always, I appreciate your time, and Clarence, too!

 

[MrWorfMen's Mom]

While the FDA may not have approved Lantus for cats specifically, there is more than enough research and data available to your vet to prove it's not only a viable but a very safe and good option. Your vet may stick to the Vetsulin because that's what he/she is most familiar with or they may have few diabetic cat clients and had no reason to stay up to date on feline diabetes practices or they know how expensive Lantus can be and assume that would have most clients giving up on their cats so they don't recommend it. They cannot legally tell you to order from Canada. The use of Lantus is fairly common in the US but I would venture a guess that it's more common in urban settings whereas rural settings might tend more toward the older insulins likely because they would see less diabetic cats. Levemir is a newer insulin that hasn't been used as extensively yet but is gaining in popularity and some vets are not familiar with it.

I love hearing your "love story" with Clarence and it warms my heart when I hear folks talk about their pets in that way. I have often said I get far more from my furry kids than I could ever give them back.

Insulin needs can change over time and sometimes our kitties just get kind of stuck and they need a little dose increase to get BG moving again. I know Clarence went low once but that doesn't mean he'll do it again. Try the increase when you can monitor him and he will be fine.

 

[Dee Dee C]

You have probably gone to bed, if so, I hope you got a good night's sleep.

His +3 was 279, so he will be fine tonight, just like you said. I fed him a snack (he usually gets one if he wants one at his +3), I may test him if I get up in the night just to see where he is. But I'm sure he will be fine.
Thanks so much from both of us.

 

[FurBabiesMama]

It is normally a good idea to give an insulin at least 6 months before changing to give it a solid chance, especially if the cat is reacting to it. Of the four insulins commonly used for cats, Vetsulin is the shortest acting and causes the quickest, harshest drops. So, you may very well end up having to change, but I would give it a bit more time before deciding. Cats can have success on Vetsulin, but statistically, the greater success is with the other insulin types.

 

[Dee Dee C]

It is normally a good idea to give an insulin at least 6 months before changing to give it a solid chance, especially if the cat is reacting to it. Of the four insulins commonly used for cats, Vetsulin is the shortest acting and causes the quickest, harshest drops. So, you may very well end up having to change, but I would give it a bit more time before deciding. Cats can have success on Vetsulin, but statistically, the greater success is with the other insulin types.

Thanks, FurBabiesMama, I will keep that in mind. I will read what I can about the others and perhaps talk to the vet about options just to be prepared in the event I decide it would be better for him to switch.

 

[Dee Dee C]

His +3 this morning was 224, down quite a bit from his AMPS of 330, which I'm sure has to do with bouncing. I fed him his usual +3 and some extra because he was so hungry. Hopefully that will slow him down an little.