? still in and out of dive/bounce cycles

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hailey & oscar

hailey & oscar

Member Since 2020
hi all,
oscar has been working through the last month and change with lots of progress, or so it seemed.
with incredible help and guidance from this message board we got him down to a drop dose of his prozinc- stepping from 1unit, to .5, to .25, to .1, to a drop dose.
he gets fed twice a day with 3-4 interval feedings between both meals, usually at +2, +4, +6, +8 give or take. overnight he is eating from a rotating auto feeder and i have been around in the daytime to give snacks myself.
spreadsheet checks are done before i give him the snacks.

what i’m having some difficulty understanding are his repeated lows in the morning, usually much too low to shoot and despite overnight food. then it seems like he stays in a blue/green zone for a while but ends up spiking later on closer to pm dose, and the peaks of those highs have been creeping higher in the last few days.

does it seem that he might be caught in a bounce cycle still after this many days?

when is it safe to lower the no-shoot number? we are still using 200 as the no shoot number but with the micro dose, i wonder if we can lower it.
alternately i am wondering if he needs to increase his dose after all....

this morning he has his lowest pre-shot number of any, at 46.
the only pattern i seem to be noticing are his lows in the morning and a late spike before evening meal. doesn’t seem that he is going that low overnight, i have managed to get readings through most of the overnight cycle even if not on the same night, seems to be at its lowest right before breakfast. going to try and get a +9,10 tomorrow before he would test amps

i have been testing for ketones intermittently which have read negative. a few days prior i noticed more urine output, but it has seemed to decrease in the last day or two once again.

if he has to skip a shot, should i avoid him snacking as much or completely ? rather, would that only contribute to a spike ? or better to be consistent with the feeding. the lack of consistency and our inability to deliver two doses per day consistently seems like i’m not getting something right despite trying!
have been reading up on more advanced options with prozinc like spacing shots a bit differently than 12/12, ie 11/13, but didn’t want to introduce any other changes too swiftly from us lowering dosage and being fully transitioned to lc food.

unsure of how to link my previous thread which offers some more context and detail over the last several weeks of oscars journey but can try to figure out how to attach that!
 
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I'm way too much of a noobie to give dosing advice, but more experienced members will be in soon. I do know when my Billy was having a similar issue, MrWorfman'sMom was trying to work with me to get two doses in, because the steady amount is important. You can take a look at Billy's spreadsheet to see some similar bouncing before he started heading into remission (fingers crossed).

I wanted to ask what food are you feeding? As someone recently told me, going too low on carbs doesn't work for all cats. If you are feeding super-low carb wet food, you might want to try something with a little more carb for at night. Nothing crazy, just something under 10% instead of hardly any to zero. Might get that morning number up so you can get a drop dose in both shot times. The lower numbers are awesome, but maybe getting to where you can give both doses will help your baby continue to make more progress.
 
ss updated
i agree and want him to get a steady dosage going.
however this morning i tested him at +9, he would have only eaten 30 minutes prior as that’s when the final snack rotates around and the container was empty. he read 74
and AMPS read 46, which is the lowest he’s shown altogether - so we’re obviously skipping again, i’ve just fed him a meal now and will recheck in 30 mins to see what he’s raised to.

as far as food he’s in the purina dm pate, which shows 6% carbs on the chart. think that’s not enough? i can try to get an alternative nighttime food if it seems he needs more. he was transitioning off of royal cabin urinary so dry and wet so he has had a massive shift in diet and it definitely brought his levels down. but he’s been on this food now exclusively for about two weeks.
 
I would first try skipping a PM shot even though it is like in the 300's to merit a shot. If the morning (or later PM shots after the no shot show a similar high BG) I would give a drop as temporary solution and for long term get a longer lasting insulin like Lantus/Levemir. My Wiggles is not as bad as yours. He is on Levemir and gets between 0 and 0.2. units. If I have to skip a shot he only go into the mid 200s. If he in the low 100s and I give him 0.2 he can drop to <50 ~3 hours after shot.
 
I would think 6% carbs would be plenty. I have to admit, I'm puzzled. Unfortunately, our two most experienced members with ProZinc aren't available right now. I think one's on vacation and MrWorfman'sMom is grieving the loss of one of her furbabies.

The Lantus is certainly an option. I know some folks vary schedule. For example, give evening dose at +11 instead of 12, and then morning dose at +12. That extra hour for the drop to wear off might make all the difference. Or it might not do anything. Might be worth a try, though. How much is Oscar eating at night? Is it possible he's not eating as well as he does during the day? A little extra wet food left out at night, and picked up 2 hours before shot time might help. You could also try a lower carb food during the day and the Purina at night. Some of the Fancy Feast pates are quite low carb.

And I'll remind you that I'm a newbie. So take suggestions with a grain of salt.
 
i’m feeling a little sheepish about inquiring with my vet on asking to change up the insulin with his chart looking the way it is, like i might get some pushback about decreasing his dose when they advised me to keep it at 1 unit despite him hitting lows in the am. (in my previous thread post i mention that i called them one morning when he tested in the 70s and they advised me to shoot anyway- i heeded their advice and he did not drop into hypo but he was still transitioning out of HC food into LC food and was only fed 2x per day so i was hawk eyeing him all day and giving food - date 1/7 on ss for ref....) he is now snacking intermittently between meals and fully on the lc wet food, which definitely impacted him overall but feels
though has plateaued.
point being, if i bring that up with them i feel they may say i need to up the dosage again but might advise me more drastically than necessary?


ss updated as of just now, he’s hit a high mid 300s again today.

would it be possible that his lows in the am are because he hits nadir super late, like +10?

i’m considering skipping the evening dosage tonite, i have not been around during the last few days to be able
to monitor his levels after administering an am shot which i would like to do.

i’ve also had a bit of discrepancy with my meter readings as noted in my remarks for today on ss, do you ever have issues with testing opposite ears? i try to switch it up since i’m pricking him so many times every day, but i feel like there can be some inconsistency. i always calibrate the strips before i use them and it has not been off the scale so far, but i also sometimes notice i hit the vein and not a capillary and wonder if that has anything to do with skew, or not at all. bleeds more of course...

all this to say i am still feeling at a loss with things, it seems like his numbers might be trending upwards but with the strange overnight cycles i’m insure of how to proceed. just fed a final snack before dinner in a few hours and going to recheck then.
 
How much is he eating in the evening cycle? About the same as daytime or less? It would be very unusual for a nadir to hit that late. To me, those higher numbers look like you could still be getting some bounce. If it were me, I would not increase dose, no matter what vet said. I'm expecting some push back from my vet too, but if I'd followed his advice, I would have given Billy 2 units when his BGL was only 52. Not good. In the end, you hold the needle. It's up to you to decide what's best for your cat.

Personally, I'd stay on the drop dose and see if those numbers drop further and stabilize more. Skip the dose when you must, but do test for ketones if you can. Of course it's best if Oscar gets two doses a day, but you're already down to a drop. I don't know what you can do that you aren't already doing.
 
he’s also almost at 400 pmps so i’m not going to skip the dose tonight. i’m going to reassess in the morning... if anything he had less to eat today during the day because i was out working
typically he’s been eating 1/2 can at mealtimes and 1/2 can between each mealtime spaced between 4 intervals each. so 2 cans per day. i’ve been off a lot lately so able to regularly feed snacks. overnight he has a timed feeder. i’m going to level this amount down a bit once he is back at weight and maintaining...
 
it’s 6% according to the chart
he ate the entire carousel of food overnight, and tested again at 69 this amps.
 
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Larry's suggestion has merit providing that the issue is one of duration. I'm not comfortable concluding that is the issue. Rather, it looks like Oscar is bouncing. That being the case, increasing the carbs may help to prevent the lower numbers which trigger a bounce. I've asked to get some additional eyes on your spreadsheet.
 
I agree with Sienne that I would take the carbs up to 10%. The goal is to try and get him to flatten out and feeding a little higher carbs can help.

Timing of the feeding is also important but the time at which you need to feed him is during the night probably while you are sleeping. He’s in a dive/bounce cycle and the dropping is occurring overnight so you wake up to a low AMPS. Do you have a way of setting up an auto feeder at night that only he can access that has higher carb food, again 10% but you might have to go a bit higher like 13% to try and get him to flatten out.

As an example, on the drop dose, at PMPS, he was in yellow and dropped alot by +2. The solution there is to start testing at +1 and try to catch the drop before it happens so he doesn’t go as low. But with him having this odd cycle of dropping late at night, it’s harder to catch the drop and feed it without being a zombie which we don’t want.

As a member progresses with data and knowing their cat, they can lower the “no shoot” number. However, in this instance, I wouldn’t drop it below 100 especially if you can’t be there to test and feed the curve. I would especially focus on getting some higher LC food in him by +10 during the night so that, perhaps, his AMPS will be higher.

One other thought, until we can get this cycle controlled, is to stall, feed a small LC snack (really LC; like 2-3%) and then shoot the rise with a drop, then feed a little more food that is higher LC; test sooner rather than later to be sure he won’t drop. Subsequent meals could be 10%. But what we are trying to do is just get a “soft” rise at AMPS. We don’t want to use a very high LC food, boost him way up, and then have him drop when he onsets. At the end of the cycle, hopefully a very LC food could boost him a bit and then after you shoot, a higher LC food could help him surf.
 
ss updated - remark regarding testing inconsistency from just now, swapping ears and testing/retesting immediately or within several minutes- he has maintained a good level today so far with minimal snacking, just after each retest we’ve done (so 2x today so far and i imagine 1 more in about an hour) this upcoming several hours is where i’ve noticed it definitely spikes but maybe today is something new and different?
either way, his reading first at 100
and i thought wow! gave him a bit of food, retested within 5 minutes after he ate it in opposite ear and read 160. should i always be testing the same ear? i figures it did not matter and try to switch it up each time to give the last one a little rest.
seems a lot to jump in 5 mins with such a small amount of food, so honestly i am wondering if i should think about getting a different meter, since i’ve been second guessing it lately. it’s only about a month old and has been functioning fine so far, or so i’ve thought - and now wonder if all the readings he’s gotten have been accurate. sometimes i will take several just to be sure and one can be skewed but the other two or three are in the same realm.

also i purchased an auto feeder a couple of weeks ago that he’s been using. it contains 4 rounds for overnight snacks which each get 1/8 can totaling 1/2 can (this is after a 1/2 or close to 1/2 can dinner) - so he’s eating at +2.5, +4.5, +6.5 & +8.5 during the nights (and tapping out at 2cans in a 24 hour period). will probably decrease this slightly depending on calorie content of the food mix we end up with. typically he will finish each section out, i think he’s slept through one or two of the rotations since we’ve had it but more often than not it’s cleaned out.

i’m wondering if he needs slightly less food during the day? and we keep it lower lc like what he’s on, (6% or lesser as you mentioned) and then i would get some nighttime food with 10% -13% to put in the feeder overnight? when we began the insulin he was on 20% royal cabin urinary and he smoothly transitioned off, but it affected levels quite a bit just with the food. so maybe this one is now too low.

going to check out some of the options in the chart and see what i can get my hands on today or tomorrow...

also in regard to ss, what would be considered a large drop? is there a point range ? like as your example of him dropping by +2. last night was a bit of a wonky reading but typically he’s coming down 20-30 points after the dose, just wondering how to detect the drop. i can take a +1 tonite to see.
 
hailey & oscar said:
ss updated - remark regarding testing inconsistency from just now, swapping ears and testing/retesting immediately or within several minutes- he has maintained a good level today so far with minimal snacking, just after each retest we’ve done (so 2x today so far and i imagine 1 more in about an hour) this upcoming several hours is where i’ve noticed it definitely spikes but maybe today is something new and different?
either way, his reading first at 100
and i thought wow! gave him a bit of food, retested within 5 minutes after he ate it in opposite ear and read 160. should i always be testing the same ear? i figures it did not matter and try to switch it up each time to give the last one a little rest.
seems a lot to jump in 5 mins with such a small amount of food, so honestly i am wondering if i should think about getting a different meter, since i’ve been second guessing it lately. it’s only about a month old and has been functioning fine so far, or so i’ve thought - and now wonder if all the readings he’s gotten have been accurate. sometimes i will take several just to be sure and one can be skewed but the other two or three are in the same realm.

also i purchased an auto feeder a couple of weeks ago that he’s been using. it contains 4 rounds for overnight snacks which each get 1/8 can totaling 1/2 can (this is after a 1/2 or close to 1/2 can dinner) - so he’s eating at +2.5, +4.5, +6.5 & +8.5 during the nights (and tapping out at 2cans in a 24 hour period). will probably decrease this slightly depending on calorie content of the food mix we end up with. typically he will finish each section out, i think he’s slept through one or two of the rotations since we’ve had it but more often than not it’s cleaned out.

i’m wondering if he needs slightly less food during the day? and we keep it lower lc like what he’s on, (6% or lesser as you mentioned) and then i would get some nighttime food with 10% -13% to put in the feeder overnight? when we began the insulin he was on 20% royal cabin urinary and he smoothly transitioned off, but it affected levels quite a bit just with the food. so maybe this one is now too low.

going to check out some of the options in the chart and see what i can get my hands on today or tomorrow...

also in regard to ss, what would be considered a large drop? is there a point range ? like as your example of him dropping by +2. last night was a bit of a wonky reading but typically he’s coming down 20-30 points after the dose, just wondering how to detect the drop. i can take a +1 tonite to see.
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Testing in the opposite ear should not result in anymore than a 20% meter variance which is what you should get if you test in the same ear twice back-to-back. I wouldn’t retest unless you get a number that seems really inconsistent with the previous number. For instance, if you got an 85 and then an hour later a 300. I would retest that. I’d also retest any numbers that are really low (30s).

I would try and be sure he gets food at +10 at night instead of +8.5. You might want to experiment a little with the times you feed him at night but definitely let the last one be at +10. I would also try and feed him the same amount of food day and night and be sure he gets the calories he needs.

Cats “should” get a food spike one hour after the shot and eating unless it’s a tightly regulated cat or one about to go into remission. If you get a 50 mg/dL drop at any time in an hour, that’s a pretty big drop. The higher they start, the faster they can drop. And, be aware that if you test at +2 and the number is down, say 100, that doesn’t mean he dropped 50/hour necessarily. He could have dropped 30 the first hour and 70 the second which is definitely a big drop.
 
noted on the drops and meter readings. today seemed promising in numbers-he may have eaten a tiny bit less than normal today but i have been trying to keep amounts consistent - at this point hers getting sone excess calories than he would regularly because he is still coming back up to normal weight-but is basically there...

ss updated and in blues all day! first time he’s been under 200 at pmps in a while. stalled and he’s basically there so staying the drop dose, he’s got food for all night, i have adjusted the last overnight feeding to +10 and keeping fingers crossed about tonites cycle :cat:
 
ss updated. seems like the last couple of days oscar may have turned a corner in a good way-we have been able to get both shots in and he’s coming down to nice numbers - so nice that it’s been making me nervous but he hasn’t slipped too low on anything yet, i think i’m just not used to seeing good lows regularly yet... the pm shots have him going into 80s etc but i have been supplementing the 6% with a 12% ff in the auto feeder-i am hoping that that is what has been giving him the higher amps numbers?
i might try to only put the 12% in the first two interval feedings overnight tonite and see how he fares tomorrow morning, instead of jumping the gun on thinking he’s dropping too low....
his ‘curve’ still seems to be awkwardly ‘shaped’ to me, but i do feel like he’s getting somewhere.

i’ve lowered the threshold of no-shot number to ~175, think it’s alright to take it to 150 even?
 
ss updated. thought oscar was a bit on track but he still seems to be having these dive bounce situations. it’s pretty difficult to know if he’s consistently getting the drop dose which is frustrating. i usually sample the dosage with an extra syringe every time before i shoot to feel confident that the drop is actually being suctioned into the needle tube and that when i squeeze there is a drop that exits, but it’s like half of the time i test this it’s not working. i’m not sure how else to measure out that size of dosage. i also tried drawing up a readable amount of insulin and plunging it back to zero, it seems about the same efficacy as the other method. either way his numbers appear to be still possibly trending into more blue and green zones, but still with high spikes here and there. we’ve had him on the 12% carbs food mixed into the purina dm on overnight feedings but i haven’t gone full tilt with the 12% for fear of sending him too high, i am going to try this because he’s been caught in the am lows again.

although one other question i have is when does a number like 50/60 start looking like a good number instead of a borderline hypo number ?
 
hailey & oscar said:
although one other question i have is when does a number like 50/60 start looking like a good number instead of a borderline hypo number ?
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It really depends on the cat. If you look up a "normal" Non-diabetic cat BGL range online, you'll find 80-120. That's certainly where my Billy hangs out, now that he's off insulin. But I know one of our more experienced members mentioned they had a diet regulated cat that dipped lower than that, even down to 40 but with no symptoms of hypo. I'm sure someone with more experience can tell you more about this.
 
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