? AMPS 317, Bouncing Stopped

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Mistryst

Mistryst

Member Since 2023
Hi Everyone,

I'm fairly new to everything and absorbed as much information as I could since Khaleesi, my cat, was diagnosed with diabetes on March 16 2023 after an emergency hospitalization.

She was prescribed 2u of Vetsilun every 12 Hours.

After a few low PMPS readings on 3/24, I called the vet to talk about an adjustment to her insulin dosage, they agreed we should lower to 1.5u.

After adjusting her dosage to 1.5u, her PMPS shot up to 571 on 3/25. I adjusted that nights dosage up to 2.25u, and stayed at 2u afterwards.

Her BS started trending in a much better direction until 3/28 where it was back at 526 for the AMPS and 584 for the PMPS. Worried about such high numbers I gave her 2.5u that night.

3/29 her AMPS was 364, so I readjusted to 2u, and that night PMPS was 546, so back to 2.5u.

3/30 her AMPS was 498. Gave her 2.5u. Her +4 was 86 and her +6 was 151. Due to low reading at +4 I gave her roughly 1 tablespoon of high carb hard food to avoid a potential hypo episode. Tonight her PMPS was HI on the glucometer meaning 600+. I tested twice, got HI twice. I adjusted the dose to 2.25u due to low nadir.

I'm going to call the vet and report my numbers, and ask about switching to Lantus.

Other then calling the Vet I am at a loss at what's happening to my baby and how to help her.

She is on a low carb, wet food only, fancy feast diet. Hard food was only given on 3/30 to help combat low blood sugar.
 
Do you think you could set up your signature so we can see all about Khaleesi please? It will appear at the end of all your posts and tell us about your kitty.
Here is a link how to do it. You will find it at the end of HELP US HELP YOU

Are you feeding Khaleesi 30 minutes before you give the insulin?
You need to test the BG, feed then wait 30 minutes before feeding because Vetsulin is a harsh insulin and hits fast and the cat need to have food aboard when the insulin takes effect.
You then need to give some food…a couple of teaspoons of low carb food a couple of times in the first 4 or 5 hours after the insulin. So try giving food at +2 and +4 after the dose every cycle.

You also need to be testing during every cycle if possible to see how low the dose is taking Khaleesi.
It is the lowest point in the cycle which tells us if the dose is right or too little or too much.
You have no tests at all in the pm cycles and cats often drop lower at night. So we have no idea if this is happening to Khaleesi, but I suspect that this is what is happening.
Looking at your spreadsheet it seems to me that you are giving too much insulin. There is not a lot of data on the SS but I can see your kitty is dropping low and then bouncing up high again. This does not mean you increase the dose.
Here is the definition of bouncing
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Here is what you need to do
  • You need to reduce the dose after the 61 in the am cycle. I would go back to 1.5 units that the vet advised.
  • Don’t chop and change the dose when you see a high preshot BG. You kitty is bouncing and you don’t change the dose because of bouncing
  • Try and get some tests in during every cycle so we can see how well the dose is working.
  • If you are unsure what to do, please post and ask for advice.
  • Yes I would ask the vet about swapping to Lantus. Please check here about the best dose to start the new insulin.
I am going to tag @Suzanne & Darcy as she is a vetsulin user.
Please let us know how you get on at the vet.
 
Added more to signature.

Khaleesi is being fed an entire low carb Fancy Feast can, 30 mins before her insulin injections.

I have Churu lickable treats, goats milk and Purebites dehydrated chicken and shrimps. I can start incorporating these into her +2 and +4.

Her PM cycles aren't being monitored because her insulin schedule is 12 pm - 12 am. This was the time she got her first dose at the vet, and the schedule they gave me. I've been waiting for her BG to stabilize before attempting to change her schedule.

If I go back to 1.5u it looks like her nadirs won't fall below 200. The beginners guide to vetsulin recommend a .25 increase when nadirs are above 150?

Also. Thank you for replying so quickly and with information.
 
If you do switch to lantus we can suggest getting the generic lantus , lantus is very expensive in the US. Many members use the generic lantus. You would also need U-100 syringes with half unit markings
 
With the caveat that I am not even close to being an experienced member here:

If your cat’s body has gotten used to high blood sugar levels (e.g., 400) then even a nadir of 200 might trick her body into thinking her blood sugar is dropping too much, too quickly. Her body will release more glucose to counteract this “dangerous” drop and that will shoot her numbers up even higher at the end of the cycle (e.g., 600). That’s why you start with low doses and increase slowly. It gives the body a chance to adjust gradually to lower and lower nadirs. It’s also why you consider nadirs when changing dosing, not AMPS or PMPS numbers, since those can be “reactionary” numbers.

Diabetes regulation is a slow game. You can’t rush the body into reaching a healthy nadir. Based on your spreadsheet I would definitely go back to the vet recommended dose. Hold that dose for at least a few days so that the body has time to get used to the dose and you can actually see how it’s affected Khaleesi. Get a bunch of mid cycle tests to find the nadir. Then increase or decrease by small increments (0.25u) depending on what you learn.
 
As Bron noted and plumsteal alluded to in the post above, you're seeing high numbers due to Khaleesi dropping from the 400s into double digits. You also don't know if this is happening at night. To add to the complexity, Vetsulin typically wears off well before the end of the 12-hour cycle.

As long as Khaleesi was not diagnosed with ketones, you could skip a shot and pick when you want to schedule your next shot. I'm always perplexed with why a vet would have a caregiver on a dosing schedule that was at 12:00. Obviously, an earlier time is more functional for you!
 
Tested her this morning. Initially got another "Hi" reading. Retested immediately with larger blood sample and got 497mg. Wondering now if the other "Hi" readings were due to insufficient blood samples.

Called the Vet, waiting for a callback regarding her levels and changing insulin.

Returned her dosage to 1.5u, due to consensus that I may have been overdosing and causing a bounce.

Will start curves for am and pm cycles to see how she handles the dosage.

Just did a +3 it's at 181.

A question regarding the "Generic" Lantus. Is the Generic Lantus just "Insulin Glargine"
This one. Would this be the correct one to switch too? The rite aid one seems affordable.
 
Mistryst said:
A question regarding the "Generic" Lantus. Is the Generic Lantus just "Insulin Glargine"
This one. Would this be the correct one to switch too? The rite aid one seems affordable.
Click to expand...
Yes this is the correct insulin. Semglee is a biosimilar insulin..same as Lantus.
Mistryst said:
Just did a +3 it's at 181.
Click to expand...
That's quite a drop at +3. Did you give a snack? I would test again +4.
That is a drop of 316 (average of 105 an hour which is more than enough to trigger a bounce.
Lantus onsets around +2 so if you give a snack at +2 that will help slow the drop. And it looks like she drops early in the cycle so I would try another snack at +3 to see if that helps as well. The idea is to slow the drop so that it doesn't trigger a bounce.
 
Bron and Sheba (GA) said:
Yes this is the correct insulin. Semglee is a biosimilar insulin..same as Lantus.

That's quite a drop at +3. Did you give a snack? I would test again +4.
That is a drop of 316 (average of 105 an hour which is more than enough to trigger a bounce.
Lantus onsets around +2 so if you give a snack at +2 that will help slow the drop. And it looks like she drops early in the cycle so I would try another snack at +3 to see if that helps as well. The idea is to slow the drop so that it doesn't trigger a bounce.
Click to expand...

She is on Vetsilun, probably why she is dropping early in the cycle. She got a LC snack at +3 and +5.

Her +5 reading was 434mg. No more snacks till after next shot.

I believe her Nadir is around the +4, +4.5 mark. I have alarms set to do a +2,+4 and +6 for her PM cycles. So we can see how her 1.5u dosage affects her at night.

I'm certain her BG levels at the PMps will be in the high 500s or HI again, tonight. I will be swapping back to my old Glucometer, as the relion compact seems to give me some crazy variances, sometimes over 100mg difference. I'll do a +8 for the last part of the am cycle.
 
Mistryst said:
he is on Vetsilun, probably why she is dropping early in the cycle. She got a LC snack at +3 and +5.
Click to expand...
Yes of course she is on vetsulin...I got side-tracked talking about lantus :banghead:
I would give her earlier snacks on vetsulin to try and slow down the drop. Even a +1 snack if she will eat it, and again +3
Mistryst said:
Her +5 reading was 434mg.
Click to expand...
Yes that looks like a bounce starting.
Hopefully once you swap over to lantus, you wont have the fast drops early on that can trigger bounces. And lantus lasts longer than vetsulin.
 
Okay it's midnight. Her +8 was 327 and her PMPS was 317.

I just fed her. Realizing now this was a dumb idea, as I should've stalled and checked her again in 20, to see if her levels were rising.

Do I follow through the the 1.5u dosage?

Or should I skip this dose and change her schedule to something more manageable like 6-6? ( 6 hours from now.)
 
Mistryst said:
Okay it's midnight. Her +8 was 327 and her PMPS was 317.

I just fed her. Realizing now this was a dumb idea, as I should've stalled and checked her again in 20, to see if her levels were rising.

Do I follow through the the 1.5u dosage?

Or should I skip this dose and change her schedule to something more manageable like 6-6? ( 6 hours from now.)
Click to expand...
I would not have stalled with a preshot of 317. We stall when the preshot is much lower than that.
As long as there were no ketones at diagnosis... I would take this opportunity to skip the dose and start again at 6:6 if that time schedule suits you.
Just feed as normal now and start again at 6am
How does that sound?
 
No ketones were present at diagnosis, and we have the ketone pee strips that we test her weekly with.

I will push this to 6am, and resume 1.5u dose then. I'm happy and a lot less panicky now that her numbers are far away from the 500s and 600s.

Thank You Bron, Plum, Diane and Sienna for walking me this far.
 
6 AM. New cycle and schedule. AMPS 600. Gave LC FF. 1.5u @6:30. Will follow up with +2,+4 and +6.
 
+2, 101mg. Seems like a drastic drop.Wonder if 1.5u is too high. Gave a LC Churu treat after to slow drop. Will check at +3 to see if she needs higher carbs.

If it goes below 90 I am adjusting the dosage to 1.25u, as recommended by the Beginners Guide to Vetsilun here on FDMB.
 
+3 she is down to 51mg should I start putting honey in her gums?

Gave her 16% Carb of Friskies Gravy. Will check again in 30.
 
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I'm sorry no one got back to you sooner. Especially with Vetsulin, when you saw the drop between your AMPS (600) and +2 (101), I would have suggested you give Khaleesi some high carb food -- a teaspoon or two. That's a huge drop in numbers! Worst case scenario is that there is a lot of momentum driving those numbers down.

At this point, I would give your cat some low carb food to ensure she stays I a safe range.

You will want to reduce the dose to 1.25u tonight.
 
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