Help to Understand Skipper's Values

Kathy4Skipper

Kathy4Skipper

Member Since 2021
This was the fourth day after the fur shot, and I was hoping Skipper's numbers would be settled out by now. I'm trying to be very consistent, but today's numbers were strange.

I'm feeding twice a day because 1.) That's the way he's always been fed, 2.) That's what my awesome vet wants me to do, for now, 3.) It's my routine for all the cats.

I can't test at night since the shot time is stuck at 8am/8pm. I'll start doing bedtime tests once I can move the shot time up to an earlier hour.

I know I'm supposed to wait a full week at the 1.5u dose, but I'm just a little confused.

Will you please look at Skipper's spreadsheet and share some insight on what's going on? Thanks!
 
Kathy4Skipper said:
This was the fourth day after the fur shot, and I was hoping Skipper's numbers would be settled out by now. I'm trying to be very consistent, but today's numbers were strange.

I'm feeding twice a day because 1.) That's the way he's always been fed, 2.) That's what my awesome vet wants me to do, for now, 3.) It's my routine for all the cats.

I can't test at night since the shot time is stuck at 8am/8pm. I'll start doing bedtime tests once I can move the shot time up to an earlier hour.

I know I'm supposed to wait a full week at the 1.5u dose, but I'm just a little confused.

Will you please look at Skipper's spreadsheet and share some insight on what's going on? Thanks!
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If it were my cat i would do 2 units starting tomorrow morning.

I see hes on Benezapril. Does he have ckd?
 
JanetNJ said:
If it were my cat i would do 2 units starting tomorrow morning.

I see hes on Benezapril. Does he have ckd?
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Yes, he is a ckd kitty.

Since we are still so new at this, I'd be comfortable going up to 1.75u tomorrow morning.
Unless he pulls an AMPS of 285 like he did this morning.

Why do you think he was flat most of the day?
 
Once I switched my sugar cat to 4 smaller meals a day I saw some big improvements in bg. I wonder if you kitty could benefit like mine did? He shoots up in bg if he misses one of his 4 meals
 
Kathy4Skipper said:
Yes, he is a ckd kitty.

Since we are still so new at this, I'd be comfortable going up to 1.75u tomorrow morning.
Unless he pulls an AMPS of 285 like he did this morning.

Why do you think he was flat most of the day?
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I think his dose isn't enough. We want to aim to get the nadir closer to 100. I'm glad you are planning on getting a before bed reading. It may give us more insight as to what is going on. I used to test 6/6pm then at 10-11 pm to get an idea of what the evening cycle was doing.
 
Katsallday said:
Once I switched my sugar cat to 4 smaller meals a day I saw some big improvements in bg. I wonder if you kitty could benefit like mine did? He shoots up in bg if he misses one of his 4 meals
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Looking at your spreadsheet, it looks like you never sleep! :coffee: Am I reading it correctly that you feed/test at 2am, 8am, 2pm, and 8pm?
 
JanetNJ said:
I think his dose isn't enough. We want to aim to get the nadir closer to 100. I'm glad you are planning on getting a before bed reading. It may give us more insight as to what is going on. I used to test 6/6pm then at 10-11 pm to get an idea of what the evening cycle was doing.
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Skipper's AMPS was 397 so I gave him 1.75u this morning.

Btw, I tried to look up "cycle" in the dictionary but I didn't see it listed. How long is a cycle? Is it 12 hours?
 
Kathy4Skipper said:
Looking at your spreadsheet, it looks like you never sleep! :coffee: Am I reading it correctly that you feed/test at 2am, 8am, 2pm, and 8pm?
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Haha my baby is in remission now but I do feed at 2 8 2 8 lol! It's what I've found to best suit his BG! It's wild that his fasting BG is higher than his post meal BG so I just feed him alot
 
Kathy4Skipper said:
Why do you think he was flat most of the day?
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It is possible that he went lower earlier in the day yesterday. If you look at my day from 6/24 it probably would’ve looked similar if I hadn’t tested before +6 (would’ve looked like he stayed relatively flat then spiked at the end of the day). He actually went low at +3 and was high at the end of the day because he bounced from that. Of course it’s hard to say because George has also seen his fair share of pretty flat days.

One thing that I wish I would’ve done earlier is not have been scared to shoot lower numbers. For a long time his numbers were so high that when I saw a yellow at pre-shot I would want to reduce the dose, but that ended up setting him back, so I would definitely recommend following the dosing protocol when it comes to shoot/no shoot numbers at full doses. Once I stopped reducing, George started seeing much better numbers (and I felt like I lost a lot of time getting him into good numbers before that).
 
Every cat is different, but if these were George’s numbers for today it would look like he was heading into a bounce break tonight. Maybe @FrostD can take a look to see if she agrees or has any insight to add.
 
I'm not sure if anyone has explained bouncing to you, but when a cat's BG drops faster or goes lower than they're used to, the liver can "panic" and release sugar into the bloodstream. There's nothing to do about it, they eventually get used to lower numbers and bounce less often. A bounce generally clears in 2-4 cycles.

So I think Skipper has been bouncing a bit - when you see those big drops like on the 23rd, it's a pretty sure guess he'll bounce. Now what makes things tricky is the bounce break - it can often drop a cat lower than usual...and then sometimes trigger another bounce. If you look at the 25th, he was dropping coming into shot time, a pretty sure sign of a bounce break (although they can happen any time in the cycle). That's very likely where the yellow preshot came from on the 26th, he broke the bounce overnight and kept coming down.

It looks like he's.on track to do the same tonight. Let's see where he is at preshot. Can you monitor during the night? Do you have a hypo kit? How far off schedule can you be(meaning how long can you delay the shot if needed)? That will influence the decision if he's under 200.
 
FrostD said:
It looks like he's.on track to do the same tonight. Let's see where he is at preshot. Can you monitor during the night? Do you have a hypo kit? How far off schedule can you be(meaning how long can you delay the shot if needed)? That will influence the decision if he's under 200.
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I tested him just now... 15 minutes early so I could reply to you.

His PMPS is 293. Please take another look at his spreadsheet to see what might happen overnight. I have high-carb dry food and Karo syrup on hand, but I can't really monitor him overnight because of my sleep schedule since tomorrow is Monday (work).

Do you think it's safe to give the new 1.75u?
 
Hshray said:
Every cat is different, but if these were George’s numbers for today it would look like he was heading into a bounce break tonight.
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What does "bounce break" mean? Is a bounce when they go too high? or go too low? Or just go too far one way or the other?
 
Kathy4Skipper said:
I tested him just now... 15 minutes early so I could reply to you.

His PMPS is 293. Please take another look at his spreadsheet to see what might happen overnight. I have high-carb dry food and Karo syrup on hand, but I can't really monitor him overnight because of my sleep schedule since tomorrow is Monday (work).

Do you think it's safe to give the new 1.75u?
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Yes I do. Today looks like a late nadir rather than a bounce break, which is good!

I'll edit with bounce break explanation in a minute just wanted to get you yes/no answer.

Edit:
A bounce break is when the bounce, which I described earlier, is over. The liver stops panicking and throwing glucose into the blood...for the time being anyway. So the cats BG comes down naturally, but at the same time you're still giving insulin. So the insulin brings it down further. Anecdotally, in my experience, most bounce breaks return the cat to pre-bounce numbers. But if the timing is right with insulin, it can go up to 20 points lower. Every cat is different of course, some may drop more. With the data you do have, that seems to be the case for Skipper too.


Cats on ProZinc usually nadir between +6 and +8, it can vary by day, cycle, etc. Hilary's cat George is an interesting exception, he tends to nadir much earlier. Today was the first +8 test you've gotten, so it was hard to tell if he was going to continually drop towards shot time (as with a bounce break), or come back up a little bit (as with a normal cycle).

Today's late nadir is good because it means his liver didn't panic, and this is a chance to "catch" lower numbers and hold onto them. However, sometimes cats do get delayed bounces, so don't be dismayed is he's pink or higher in the morning
 
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FrostD said:
Yes I do. Today looks like a late nadir rather than a bounce break, which is good!

I'll edit with bounce break explanation in a minute just wanted to get you yes/no answer
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Thank you so much for your quick reply! :bighug: I'll go ahead and give him his shot now!
 
Kathy4Skipper said:
I tested him just now... 15 minutes early so I could reply to you.

His PMPS is 293. Please take another look at his spreadsheet to see what might happen overnight. I have high-carb dry food and Karo syrup on hand, but I can't really monitor him overnight because of my sleep schedule since tomorrow is Monday (work).

Do you think it's safe to give the new 1.75u?
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Yes... Good to shoot
 
Kathy4Skipper said:
What does "bounce break" mean? Is a bounce when they go too high? or go too low? Or just go too far one way or the other?
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I was out and about but saw Melissa gave a great explanation so didn’t write back right away. Like she mentioned George nadirs early so I pretty much have to get a test at +2 or +3 because when he breaks his bounces his numbers come down really hard and fast. I have a very bouncy kitty, but with any luck Skipper will have later nadirs and hopefully a smoother ride.
 
Hshray said:
I was out and about but saw Melissa gave a great explanation so didn’t write back right away. Like she mentioned George nadirs early so I pretty much have to get a test at +2 or +3 because when he breaks his bounces his numbers come down really hard and fast. I have a very bouncy kitty, but with any luck Skipper will have later nadirs and hopefully a smoother ride.
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I didn't know a cat could nadir so early! Thank you for telling me more about George.
 
@FrostD I tried to combine everything you told me and I added some extra notes to make sure I understand the bounce and bounce break.

Will you please read and edit this to make sure I'm correct?

When a cat’s Blood Glucose (BG) drops faster or goes lower than they’re used to, the liver can “panic” and release sugar into the bloodstream, causing BG values to rise extra high. This response is called a bounce. There’s nothing to do about it; they eventually get used to lower numbers and bounce less often. A bounce generally clears in 2-4 cycles. A cycle is a 12-hour period. 2 cycles = 24 hours, and 4 cycles = 48 hours.

A bounce break is with the bounce is over, and the BG is going down. The liver stops panicking and throwing glucose into the blood... for the time being anyway. The cat’s BG comes down naturally, but at the same time, you’re still giving insulin, so the insulin brings it down further. Anecdotally, in my experience, most bounce breaks return the cat to pre-bounce numbers. But depending on the timing with insulin, it can go 20 points lower. Every cat is different, of course, and some cats may drop more. Bounce breaks can happen anytime in the cycle. For example, a low pre-shot value can occur when a bounce break happens during the cycle, and the BG continues to drop towards shot time. (In a normal cycle, the BG rises toward shot time.)

When you see big BG value drops, it’s a pretty sure guess the cat will bounce. Now what makes things tricky is the bounce break - it can often drop a cat lower than usual...and then sometimes trigger another bounce.
Author: FrostD
 
Kathy4Skipper said:
@FrostD I tried to combine everything you told me and I added some extra notes to make sure I understand the bounce and bounce break.

Will you please read and edit this to make sure I'm correct?

When a cat’s Blood Glucose (BG) drops faster or goes lower than they’re used to, the liver can “panic” and release sugar into the bloodstream, causing BG values to rise extra high. This response is called a bounce. There’s nothing to do about it; they eventually get used to lower numbers and bounce less often. A bounce generally clears in 2-4 cycles. A cycle is a 12-hour period. 2 cycles = 24 hours, and 4 cycles = 48 hours.

A bounce break is with the bounce is over, and the BG is going down. The liver stops panicking and throwing glucose into the blood... for the time being anyway. The cat’s BG comes down naturally, but at the same time, you’re still giving insulin, so the insulin brings it down further. Anecdotally, in my experience, most bounce breaks return the cat to pre-bounce numbers. But depending on the timing with insulin, it can go 20 points lower. Every cat is different, of course, and some cats may drop more. Bounce breaks can happen anytime in the cycle. For example, a low pre-shot value can occur when a bounce break happens during the cycle, and the BG continues to drop towards shot time. (In a normal cycle, the BG rises toward shot time.)

When you see big BG value drops, it’s a pretty sure guess the cat will bounce. Now what makes things tricky is the bounce break - it can often drop a cat lower than usual...and then sometimes trigger another bounce.
Author: FrostD
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You got it!

Over time you'll start to see his patterns and it'll get a little easier to predict
 
FrostD said:
You got it!

Over time you'll start to see his patterns and it'll get a little easier to predict
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Thank you so much! I'll keep a watch on his patterns to see what I can learn.

I tested Skipper at +4 last night and he was 410. That's as late as I could stay up. :coffee:

You predicted it right on the pink this morning. AMPS: 369
FrostD said:
sometimes cats do get delayed bounces, so don't be dismayed if he's pink or higher in the morning
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So, do you think he bounced last night?
 
Kathy4Skipper said:
Thank you so much! I'll keep a watch on his patterns to see what I can learn.

I tested Skipper at +4 last night and he was 410. That's as late as I could stay up. :coffee:

You predicted it right on the pink this morning. AMPS: 369

So, do you think he bounced last night?
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Hey look at that, sometimes my crystal ball works!

It's a little bit hard to say. That 410 is more than I'd expect from a food bump that far into the cycle, but factoring in meter variance (up to 20%) it could be a normal cycle. Usually bounces are a little bigger, but not always.

Either way, pink is progress!
 
Kathy4Skipper said:
He seems to be feeling ok. Ate well this morning.

Maybe we're bouncing now. His morning +5 is 459. :(
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Yeah that looks like a bounce to me. I'd like to reiterate that I'm still kinda new to FD and to listen to anyone else here over me, but what I'm guessing happened is his pmps was quite low compared to his normal value. I assume he dipped in the night and now he's bouncing. @FrostD do you think I'm close with this logic?
 
Are you sure he's only getting 3% Nulo food? Being an outdoor cat, is there a chance he's getting into other things?

It could just be a flat-ish cycle, they happen sometimes. It's possible he dipped lower again during the night to set off another bounce, but it's not quite reading that way to me (when he bounces, he tends to go high red or black midcycle or at PS). More like there's a higher carb food in the mix somewhere OR he's getting late onset. So he continues to rise to about +4/+5 then he gets the onset and starts to go down.

I wouldn't go too crazy trying to analyze everything right now, just the general trends are helpful. The important takeaway is that he definitely needs more insulin, but we have to be patient in doing the increases.
 
Good job getting that reading last night. I still think you should try 2. I think there's a bit of insulin resistance going on.
 
@FrostD Skipper is an indoor cat only, so there isn't any chance that he's getting other food. I've been very routine with the amount of food and the feeding time. His +6 was 352. The protocol is to wait a week before increasing insulin, right?

@JanetNJ What do you mean to try 2. Do you mean get 2 readings in at night?
 
Kathy4Skipper said:
@FrostD Skipper is an indoor cat only, so there isn't any chance that he's getting other food. I've been very routine with the amount of food and the feeding time. His +6 was 352. The protocol is to wait a week before increasing insulin, right?

@JanetNJ What do you mean to try 2. Do you mean get 2 readings in at night?
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No I mean 2 units. Your lows are no where near the low 100's so I think a slightly bigger increase would be helpful.
 
Kathy4Skipper said:
@FrostD Skipper is an indoor cat only, so there isn't any chance that he's getting other food. I've been very routine with the amount of food and the feeding time. His +6 was 352. The protocol is to wait a week before increasing insulin, right?

@JanetNJ What do you mean to try 2. Do you mean get 2 readings in at night?
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Oh sorry I had him confused with a different cat.

On SLGS, as it's written, yes wait a week. Once you can more reliably test at night you could try the Modified Method which allows for quicker increases.
 
FrostD said:
On SLGS, as it's written, yes wait a week. Once you can more reliably test at night you could try the Modified Method which allows for quicker increases.
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Ok, thanks.

I just tested again and he coming down fast. +7 = 278
So I think that might correlate with your late-onset theory?
 
Kathy4Skipper said:
@FrostD I saw this one coming... PMPS = 167
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I'll wait 20 minutes without feeding and test again to see if his glucose is rising.

He did this on the morning of June 19th. I fed him on that morning and it still took him a full hour to go from 191 to 244. I really don't want to push his shot to 9:15pm because that is just too late.
 
Kathy4Skipper said:
I'll wait 20 minutes without feeding and test again to see if his glucose is rising.

He did this on the morning of June 19th. I fed him on that morning and it still took him a full hour to go from 191 to 244. I really don't want to push his shot to 9:15pm because that is just too late.
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Ok let's see where he's at in 20.

If he's flat or barely rising, you can also do a reduced or token dose. A reduced dose is around half the normal dose, token more like 10-20%. It's generally better to give some insulin vs skip altogether

If he's still going down (150 or less) I'd just skip altogether.
 
FrostD said:
Ok let's see where he's at in 20.
If he's flat or barely rising, you can also do a reduced or token dose. A reduced dose is around half the normal dose, token more like 10-20%. It's generally better to give some insulin vs skip altogether
If he's still going down (150 or less) I'd just skip altogether.
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PMPS+24minutes = 197
 
Kathy4Skipper said:
I think I'll do the token dose. 15% of 1.75 is about 0.25ml for tonight.
Then I can shoot at 7am tomorrow to get back to a normal schedule.
What are your thoughts?
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I certainly understand your hesitation. He's never even come close to dangerously low, so I think full dose is safe to give. Remember that insulin isn't "linear", just because he drops 200 points at higher numbers doesn't mean he'll go down that much here.

It's your call and what you're comfortable with, but these are the opportunities to start catching lower numbers and bring him down overall. By giving a smaller dose, chances are he'll be back in red/black in the morning, and the cycle of high numbers continues. To be fair he'll probably end up pink/red anyway because I'm expecting a bounce.
 
FrostD said:
I certainly understand your hesitation. He's never even come close to dangerously low, so I think full dose is safe to give. Remember that insulin isn't "linear", just because he drops 200 points at higher numbers doesn't mean he'll go down that much here.
It's your call and what you're comfortable with, but these are the opportunities to start catching lower numbers and bring him down overall.
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Normally, I've read not to push a shot more than one hour earlier. If I give a low dose tonight, can I shoot a normal dose two hours early tomorrow morning? Will this work?
 
Kathy4Skipper said:
I think I'll do the token dose. 15% of 1.75 is about 0.25ml for tonight.
Then I can shoot at 7am tomorrow to get back to a normal schedule.
What are your thoughts?
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Also, you can try 7am with reduced dose, but know you'll probably be shooting a dropping number there too. Less insulin doesn't change how the cat reacts, hell still likely see late onset and nadir. We generally recommend working back an hour at a time.
 
FrostD said:
Also, you can try 7am with reduced dose, but know you'll probably be shooting a dropping number there too. Less insulin doesn't change how the cat reacts, hell still likely see late onset and nadir. We generally recommend working back an hour at a time.
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I just tested at no-shot+1 and he is at 313. Now (in my mind:woot:) it is safe to shoot the full dose, I'm assuming.
So, the ProZinc won't have a cumulative effect... he will still have his late-onset and nadir at his normal +8? I am correct?
 
Kathy4Skipper said:
I just tested at no-shot+1 and he is at 313. Now (in my mind:woot:) it is safe to shoot the full dose, I'm assuming.
So, the ProZinc won't have a cumulative effect... he will still have his late-onset and nadir at his normal +8? I am correct?
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Yep! And correct. There will be a very slight overlap and he may be a little lower than usual earlier in the cycle, but should still see same overall pattern.
 
FrostD said:
Yep! And correct.
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Good! Thanks for understanding that I was asking about the overlap since I read that ProZinc can last 12-14hours depending on the cat.
FrostD said:
There will be a very slight overlap and he may be a little lower than usual earlier in the cycle, but should still see same overall pattern.
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This is great information to know! :bighug:
I gave the full dose of 1.75u about 30 minutes after his 313 value. So, 1.5 hours later than normal. I really must come up with a way to shoot earlier in the day. I think 7am/pm will be best since that's the normal mealtime around here.
 
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