@JanetNJ ,
@Marje and Gracie ,
Any ideas? I'm hoping there's a method to the madness that you can see that makes sense.
Before I go into what I’m observing, usually when we move from one insulin to another, we keep the same SS with all the data on that tab. I can do this for you and it’s really helpful for us to be able to look back without having to switch tabs. Please PM me so I can get editing rights to put these all on one 2021 tab. Thank you. Also, am I correct in assuming you are following SLGS as recommended in the
PZ Sticky on dosing methods? You’ll find he does better if you are following a specific dosing method. And I’d recommend, if you haven’t done so, that you read all the stickys on the PZ ISG.
First, what you saw on 9/6 was what we call the “high before the break”. He started a bounce on 9/4 after the green BGs the night before. On 9/5, he started to clear it but didn’t get any lower than the 100s which is not atypical. Then you saw the high before the break on 9/6 a.m. cycle and he cleared the bounce to just the 100s. Here is another example where the kitty went up into black BGs (I have other examples but they aren’t as similar to Magic’s as this one).
Milo’s SS look at 8/7; you can see he then cleared the bounce
Unfortunately, we have not ever figured out why this occurs but it occurs with a real frequency in diabetic cats clearing a bounce. My own kitty did it frequently as well. Many times, it’s a signal that a dose reduction might be forthcoming but not always. However, because it can also cause the bounce clearing to be more active, it’s best to monitor the cycle following a high before the break.
He started another bounce the a.m. cycle of 9/7 and even though you are seeing some pink and red BGs and might think those would be a high before the break, if you consider that meters can have a 20% variance from reading to reading, he’s pretty flat. In other words, for also night, 80% of 436 is 349 so he didn’t really change much from +2 thought +6 last night or even this morning. I can’t explain his 230 at PMPS last night. There are times when we don’t really understand why the BG did a specific thing; I know that isn’t helpful but because we are dealing with a hormone (insulin) and not a medication, it isn’t always predictable.
On 8/29 when he was on Vetsulin, I explained this in a
previous thread (I added the bold today).
Starting at 4u is safe but I would not be surprised at all if you will need to increase to 4.5u. The reason is because I don’t think the low BGs you saw on 8/29 are indicative that that dose is too much for Magic. Why?
- Magic was clearing a bounce from the fast drop and the 90s on 8/27.
- Bounce clearing cycles such as the 8/29 a.m. cycle are always going to be really active.
- Vetsulin can cause bounce clearing cycles to be even more active and if the curve is not fed from the onset, you will see the exact kind of cycle you saw.
- Magic’s BG was not that low; 61 on an AT is not considered to be a “HYPO” BG. I read that he was under the bed when he normally is not but that was most likely because it doesn’t feel good for a BG to drop that fast even if the drop is from 600 to 400 in a such a short time span. While we would always reduce the dose for a BG below 90 for a cat on Vetsulin, it doesn’t mean that reduction will always hold given the fast drop.
- It appears he had no food in between his PS meal and his onset. This often happens with cats regardless of insulin. For example, with cats on Lantus, we suggest feeding several minimeals because it helps to slow the drop and avoid this bounce/dive thing he has going on.
What we have found with insulins is, typically, just feeding a large meal all at once doesn’t work with the insulin as it onsets. Vetsulin had a quick onset so you had to feed before you shot but if you did not continue to feed as it was continuing to it’s peak action, and add a bounce clearing on top of it, you are going to get the kind of cycle you saw. On 9/3 PM cycle, you fed at PS and +4 but he would have done better if you’d been feeding minimeals in the hours between.
PZ onsets later than Vetsulin and each CG needs to find out where their own cat specifically onsets. We can say, in general, that PZ or Lantus onset at +2 but some cats will onset earlier or later. For Magic, to effectively manage his cycles, you’ll need to understand where his onset, nadir, and duration occur and also realize they can shift around a bit.
- Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
- Peak/Nadir - the lowest point in the cycle
- Duration - the length of time insulin continues to lower blood glucose
The BG will often drop quickly at onset in a cat that is not yet tightly regulated. That sudden drop can start a bounce; the BG does not have to drop low to initiate a bounce; it might just drop quickly and that’s what you’ve seen. By feeding the curve with minimeals (you might have to use an auto feeder which many, many members do here), it helps to work with the insulin. You also have to figure out what % LC food works best for Magic. As an example, as many new members do, when we came here we thought the lower the % calories from carbs the better so we went with foods that were 0-3% calories from carbs. Subsequently, an experienced member and moderator, told me they had found out over the years that many cats actually do better with carbs in the 6-10% range. We started feeding Gracie foods that had that range of calories from carbs and she did much better but we also had to feed minimeals.
Feeding minimeals is an art as much as a science. Some cats do well with minimeals at PS, +1, +2, +3 and others need a totally different schedule based on their onset, nadir, and duration.
I hope this helps. Please ask questions. It’s alot to absorb.
