Need advice, please, with Bouncing Beau’s dose

Sharon555

Sharon555

Active Member
Where to start? I’m just not sure what is going on with Beau. Until the end of December, he seemed to be doing fairly well on 2.75U. Then we had some higher than usual “bounces”, even one test in the 500s. As we started the new year, it was almost like a completely different cat between the daytime and night cycles. He seems to be all over the place. Is he bouncing? Or is his dose too low? But he’s still getting some greens at night until the last couple of days. I fear if we increase he’ll start going too low again at night. He has some cycles where he just drops the majority of the cycle. I am really at a loss right now. Do I need to be worried about him? All of those high tests scare me, but could this be a case where the highs actually mean his dose is too high? I am just at a loss as to what to do. I feel like I am doing something wrong. I really need some advice please.
 
Hi Sharon. I’ve thought about you and Beau several times over the holidays. I think it looks like Beau is a bit overdue for an increase. He is still quite a bouncy boy. You are doing so well with testing and putting the data on the sheet. Now, we may eventually find that Beau needs a slightly smaller dose at night, but he may surprise us. It’s not common to recommend a different dose for the p.m. cycle than the a.m. cycle, but in some cases it’s been for the best. Of course, it may just be that with certain evening preshot numbers, you may need to reduce slightly, but Beau may surprise us as well. He seems to keep himself out of lime green, doesn’t he? If Beau were my baby, I would go ahead with an increase of .25 units up to a 3 unit dose.

If you were overdosing Beau and he had been on this dose for such a long time, he would have gone into lime green.

Cats insulin needs do not always stay the same and will fluctuate over time. You can try the increase now and see how it goes. You are doing MPM, so I really do feel like we need to take a look at the doses every three days and if the nadirs aren’t in the target range of 50-90 then an increase or fattening of the dose should be done.
 
Suzanne & Darcy said:
Hi Sharon. I’ve thought about you and Beau several times over the holidays. I think it looks like Beau is a bit overdue for an increase. He is still quite a bouncy boy. You are doing so well with testing and putting the data on the sheet. Now, we may eventually find that Beau needs a slightly smaller dose at night, but he may surprise us. It’s not common to recommend a different dose for the p.m. cycle than the a.m. cycle, but in some cases it’s been for the best. Of course, it may just be that with certain evening preshot numbers, you may need to reduce slightly, but Beau may surprise us as well. He seems to keep himself out of lime green, doesn’t he? If Beau were my baby, I would go ahead with an increase of .25 units up to a 3 unit dose.

If you were overdosing Beau and he had been on this dose for such a long time, he would have gone into lime green.

Cats insulin needs do not always stay the same and will fluctuate over time. You can try the increase now and see how it goes. You are doing MPM, so I really do feel like we need to take a look at the doses every three days and if the nadirs aren’t in the target range of 50-90 then an increase or fattening of the dose should be done.
Click to expand...



Thank you so much for responding, Suzanne. I’ve been so rattled about Beau’s fluctuating numbers and have been worried about the toll it’s taking on my boy. I did wonder a few times, especially lately, about a different dose at night. He did drop many times into the 50s, but never into those lime numbers, which was a relief. Then those huge bounces during the day really scared me.

I’ll increase him to 3 units in the morning. Hopefully he’ll even out and we’ll lose those pinks. I’ll be more proactive about changing his dose if his nadirs aren’t green. I’ll keep a close eye on those evening preshots. Maybe I can find a cutoff where I know I should give him a skinny dose. Those green nights keep me awake because he has been so inconsistent.

I had read early on that if a cat doesn’t go into remission in the first 6 months, then he never will. That really concerns me. How true is that? I can’t even get him to have consistent numbers. I have lost a lot of sleep, worried constantly and shed many tears lately.
 
Oh, I feel awful about that, but I do understand how it all feels. We have had cats on this Board who have gone into remission after two years, so I don’t know what to say about that. Every cat is different and every cat has their own story, just like people. Let’s try to really work with Beau to see if he can get into better numbers and perhaps earn some reductions. That would be a start. You test a lot so I know you can keep him safe. I can see from your spreadsheet how much sleep you have lost!
 
I will be very happy to get him back into good numbers. It’s so obvious how much better he feels when he is. And I know I need to remember that it isn’t a sprint for most of our babies, but a marathon. :D
 
And it’s not like his numbers are awful. He still is seeing a lot of blue and a lot of people would be very happy with that. I think the pinks are just him being bouncy. But I do think we can at least try to get better numbers. Let’s see.
 
Suzanne & Darcy said:
Oh boy, Sharon! You had a green today! I was just checking in on Beau and saw it. I'm excited about it!
Click to expand...

Beau was doing well on the dose increase to 3 units. Most of the green nadirs came at night, with only a few during the day. He also had some bounces which cleared pretty quickly. On 1/11 he had that PMPS of 68. I have felt pretty confident shooting in the 60s, but in hindsight I should have done a skinny or partial dose because he just kept going down. So, when he had the PMPS of 94, I fed him a little higher carb food. I was again surprised that he just went down. I double checked the 42 and it was the same. I went into panic mode, of course, and gave him some gravy from a 15 carb. He was up to 78 within 2 hours.
I forgot to reduce his dose this morning, but I will tonight. He just seems to be somewhere between 2.75 and 3 units. After that huge bounce at AMPS, he is already down to 107 at +5.
 
Sharon555 said:
Beau was doing well on the dose increase to 3 units. Most of the green nadirs came at night, with only a few during the day. He also had some bounces which cleared pretty quickly. On 1/11 he had that PMPS of 68. I have felt pretty confident shooting in the 60s, but in hindsight I should have done a skinny or partial dose because he just kept going down. So, when he had the PMPS of 94, I fed him a little higher carb food. I was again surprised that he just went down. I double checked the 42 and it was the same. I went into panic mode, of course, and gave him some gravy from a 15 carb. He was up to 78 within 2 hours.
I forgot to reduce his dose this morning, but I will tonight. He just seems to be somewhere between 2.75 and 3 units. After that huge bounce at AMPS, he is already down to 107 at +5.
Click to expand...
I would feed some ten percent carbs now. If that doesn’t slow him down a bit, I would give a little MC.
 
Suzanne & Darcy said:
I would feed some ten percent carbs now. If that doesn’t slow him down a bit, I would give a little MC.
Click to expand...

I will do that because his pattern most of the time at this point is to continue to go down until PMPS.
Do you agree that the 3 units seems like just a bit too much? Even before that lime last night?
 
That definitely slowed him down. He’s up to 125. This has taught me something. He eats the savory centers because he is carb sensitive and they are less than 2 carbs. So when I try to stop a drop, I usually use something between 4 and 6, but it doesn’t seem to be very effective. Next time I’ll definitely go to a 9 or 10. That seemed to do the trick. Thank you.
 
I think yesterday is an example of how he was breaking a bounce and was therefore trending downward all day toward PMPS, and then he had his PM shot and just kept going. And yes, if you have given the higher end low carb like 9-10 percent (but still considered lower carb) at +2 last night, or even gone with a little higher low carb for his evening meal (since he'd been trending downward all day) that could have slowed him enough to keep him from going lime.

Some days he's just not getting great duration (when he goes down and back up again pretty high in a single cycle) and other days I see he's clearing bounces and going down, down (those times you really need to feed his curve -- and some of that will be trial and error for you in experimenting with carb percentages, while still keeping things at 10 percent and under if possible. Of course, if he goes under 50, you need to get more aggressive with the carb, but you already know that. :-)

As for the dose. I don't necessarily thing that the 3 units was "too much" for him. As long as you are not doing things like always feeding him HC food to keep him from going under 50 (which is not what you are doing) then I don't necessarily think 3 units is too much for Beau. His numbers overall on 3 units were better.
 
Suzanne & Darcy said:
I think yesterday is an example of how he was breaking a bounce and was therefore trending downward all day toward PMPS, and then he had his PM shot and just kept going. And yes, if you have given the higher end low carb like 9-10 percent (but still considered lower carb) at +2 last night, or even gone with a little higher low carb for his evening meal (since he'd been trending downward all day) that could have slowed him enough to keep him from going lime.

Some days he's just not getting great duration (when he goes down and back up again pretty high in a single cycle) and other days I see he's clearing bounces and going down, down (those times you really need to feed his curve -- and some of that will be trial and error for you in experimenting with carb percentages, while still keeping things at 10 percent and under if possible. Of course, if he goes under 50, you need to get more aggressive with the carb, but you already know that. :)

As for the dose. I don't necessarily thing that the 3 units was "too much" for him. As long as you are not doing things like always feeding him HC food to keep him from going under 50 (which is not what you are doing) then I don't necessarily think 3 units is too much for Beau. His numbers overall on 3 units were better.
Click to expand...

I understand everything you’re saying. Had I tried to feed that drop sooner or with higher carbs, he would have, most likely not hit that lime. Even though it would mean a reduction, I was a little disappointed because, overall, he had been doing well at 3 units.

Do you recommend that I go ahead with the reduction back down to 2.75? Or should I stick with the 3 a while longer to see where it goes and be more attentive and proactive with feeding his drops? He’ll be ready for dinner and his shot in two hours from now.

Once again, as we noticed at 2.75 before the increase, he tends to have much better cycles at night. You even brought up the possibility that, at some point, his day and night dosages be different.
 
Here’s what the MPM dosing protocol says:

  • If your cat is between six months to a year of diagnosis, look at the overall picture of your data to determine if a 0.25u reduction is warranted on a single number below 50.
    • Prozinc can be a little volatile at times, and there will be the occasional random drop. If you have a consistent body of mid-cycle tests that indicate the low number is unusual, you may consider holding the dose and continuing to monitor or you may choose to just shave a little off the dose.
    • If the low number appears to indicate a general downward trend of numbers, then it may indicate that you should indeed lower the dose.
    • If your cat is more than a year since diagnosis, a single number between 40-50 should not mean a full 0.25u reduction. You may shave a little off the next dose, or just hold the dose and continue to monitor.
    • Additional numbers between 40-50 in the days following would indicate the dose should be reduced.
    • Any cat, regardless of time since diagnosis should receive a reduction if there is a number below 40.
 
Suzanne & Darcy said:
Here’s what the MPM dosing protocol says:

  • If your cat is between six months to a year of diagnosis, look at the overall picture of your data to determine if a 0.25u reduction is warranted on a single number below 50.
    • Prozinc can be a little volatile at times, and there will be the occasional random drop. If you have a consistent body of mid-cycle tests that indicate the low number is unusual, you may consider holding the dose and continuing to monitor or you may choose to just shave a little off the dose.
    • If the low number appears to indicate a general downward trend of numbers, then it may indicate that you should indeed lower the dose.
    • If your cat is more than a year since diagnosis, a single number between 40-50 should not mean a full 0.25u reduction. You may shave a little off the next dose, or just hold the dose and continue to monitor.
    • Additional numbers between 40-50 in the days following would indicate the dose should be reduced.
    • Any cat, regardless of time since diagnosis should receive a reduction if there is a number below 40.
Click to expand...

He is 8 months into his diagnosis. Given the protocol, I think that I will hold the current dose of 3. I’ll monitor him closely. We are a week into it and I think that the lime was unusual. I feel it could have been avoided, either with a skinny dose or a higher carb meal. I need to be more vigilant and aware of a downward trend before giving a full dose. If he drops low again, especially in the near future, I will take a reduction.

He really just seems to almost be between 2.75 and 3 units.

Would it be possible for you to check on us periodically and give input?
 
I agree. That lime was an outlier. If he does it again then for safety sake you should reduce. I will check in on you guys! And don’t hesitate to prod me either. Write something on this thread or PM me.
 
Suzanne & Darcy said:
I agree. That lime was an outlier. If he does it again then for safety sake you should reduce. I will check in on you guys! And don’t hesitate to prod me either. Write something on this thread or PM me.
Click to expand...

Thank you! I really value and appreciate your input. I know it feels like Beau and I have been at this for an eternity, but it’s been such a short time in the whole diabetic scheme.
 
Yes, he did. That made me happy. Thanks for checking. Also a blue AMPS. It was a good day. Much more balanced. The 58 was a little low, but came up with a 9 carb snack.
 
Last edited:
It’s really helpful how you are writing down what you are feeding and when. It’s good to see that the 9 percent carb food did stabilize him and he verified gradually came up and it didn’t cause a huge spike in BG. Good cycle last night and I expect it to be good today. I was happy to see his AMPS today. :)
 
Suzanne & Darcy said:
It’s really helpful how you are writing down what you are feeding and when. It’s good to see that the 9 percent carb food did stabilize him and he verified gradually came up and it didn’t cause a huge spike in BG. Good cycle last night and I expect it to be good today. I was happy to see his AMPS today. :)
Click to expand...

I’m very pleased with last night, as well the start to today. I’ve realized that the 4 and 5 carb are high enough to prevent a further drop but don’t do much to raise his BG. In the beginning, those 4 and 5 carb pates were too high for his meals, but I may try again. One thing at a time, though. For now it’s managing those drops. :D
 
I’m really happy to see these good cycles for Beau. It looks like 3 units is really a dose for him for right now, and you are managing it all with low carb food. You are doing an excellent job. How is Beau doing besides his numbers?
 
I am happy also. He’s always had a couple of small meals during the day and between +3 and +4 PMPS. But they’ve always been his usual very low carb, about 1%, food. I am really able to see now the benefit of using the higher low carb meals to control his BG. It feels a little counter-intuitive to me to use food to slow and stop the drops. Like if I didn’t he would drop low enough for a reduction. But I know those big drops are hard on him and as long as I’m using low carb it’s good. Just feels weird.

The blue this morning was a pleasant sight. I fed him a 6 carb breakfast to 1) see how it affects him and 2) because I need to leave for about 4 hours this afternoon and I didn’t want him to drop too low while I’m gone. So I don’t know how much of that +2 380 is because of the food and how much is a bounce.

I can tell that Beau feels better during these recent cycles. He wants to snuggle more and is more active, playing with toys (as much as a 19-year-old cat will, that is) and rolling around in catnip. I’ve noticed he’s not eating quite as much at mealtime either. I’m assuming that’s due to his lower numbers and that he’s eating higher carb extra meals during the cycle, so he’s feeling full.

It feels good that I finally have some control. It took me awhile because I was afraid of the higher carb low foods since he’s always been carb sensitive. But, as I said, I’m convinced of their value. If he feels good, I feel good. :D
 
My poor sweet Beau Beau Boy! I feel like, in an attempt to avoid too low BGs in my nearly 5 hour absence, I sabotaged the good cycles he’s had. Because he had the low 134 AMPS, I was concerned he would drop low as he has the last few cycles while I was gone. So I gave him a 6 carb breakfast. I did not consider that he might also experience a bounce. He jumped to 380 at +2, then 402 at +3. When I returned and tested him at +9, he was still at 404. Maybe he dropped some then came back up, but I’m worried that he stayed so high all day. He must have felt awful!!
 
Don’t be so hard on yourself!!! I do not believe that a simply 6 percent carb breakfast sent him from 138 to 380 in two hours. It’s just not the pattern of what we’ve seen when eau eats 6 percent carbs. It’s going to be okay!
 
Sharon555 said:
ime either. I’m assuming that’s due to his lower numbers
Click to expand...
That is typical of lower numbers. He can now put more of his food to use and should not need to eat as much.
Sharon555 said:
I am really able to see now the benefit of using the higher low carb meals to control his BG. It feels a little counter-intuitive to me to use food to slow and stop the drops. Like if I didn’t he would drop low enough for a reduction.
Click to expand...
There’s a big difference in using various low carb foods to help give smoother cycles and using HC to prevent a reduction. That’s not at all what we’re doing here. Every cat is different and some cats only need ultra LC while others do better with a few more carbs.
 
You do such a good job of explaining what’s going on. And keeping me calm. I get so scared when he bounces up, especially into red. I’m always worried about him. I hope we have a better cycle tonight and return to the good ones tomorrow.
 
That was very interesting! I have always tried to keep Beau’s carbs as low as possible, so started feeding him the Savory Feasts, which are 0 - 1 carbs. But there have definitely been times when he would go through a period of higher BG numbers and that confused me and didn’t make sense. This last week or so is the first time I have used 8 - 10 carbs mid-cycle to try to regulate him. I haven’t really seen it making him spike, but keeping him level or with slow rises. I’ve always been afraid that they would cause him to spike, which he did at the beginning of this journey when he ate the higher carbs. I’m going to try using this higher low carb flavors for his extra meals during the day instead of the savory feasts and see what happens.

Do you think today’s reds were a spike from the great low cycle yesterday? With the PMPS of 415, I’m thinking he was probably flatlined right around 400 all day while I was gone. I really hate when I have to leave him all day.
 
We’ve recovered from that bounce :mad: thankfully.
I do have a question I keep meaning to ask. What is too much of a drop? Today Beau went from 222 @+2 to 142 @+4. That’s a difference of 60. I know that’s a decent drop over one hour,but is that a big enough drop over 2 hours that I should have fed then instead of waiting until he hit 70 @+5.5? That was a drop of 70 (half) over 90 minutes. Maybe if I had started feeding the drop at +4 we would not now be at 58 @ +7? I want to avoid him going low enough to trigger a bounce, which seems to happen when he hits the 50s.
I am really trying to “study” more what is happening and determining the cause.
 
Last edited:
Suzanne & Darcy said:
I see you reduced him back down to 2.75 units
Click to expand...

I did. Day before yesterday was pretty crazy! I kept feeding and testing during the day. He did go up, slowly, and ended at 93 PMPS. When I went back and looked at the last two green PMPS I saw that he just kept going down, so I fed him a higher PM meal, some 8 and 9 carb, hoping that would keep him from dropping. He was at 100 at +1, but was already heading down at +2. I worked hard to keep him from dropping, but he ended going into the lime, 48, by +4. So I reduced him back to 2.75 units. It seems like the 3 units works for awhile, but he ends up in the lime eventually. I was hoping it would be a good place for him, but I guess not. He had a good day today after clearing the bounce with a nadir of 102. Hopefully I can keep him at 2.75.
 
He certainly is a tough one. And so bouncy. With the lime only being a 48, I don’t know that I would have reduced his dose. It’s a judgment call. And it was the second time it had happened on 3 units. You possibly could have retested the same blood and gotten a 50 or more, but, if he was really difficult to bring up and if you had already been proactive with the feeding, which you were, I think it is a good idea to reduce for now and see how it goes after he stops bouncing (if you can catch that moment!). Some cats do go back and forth a lot between two doses like that. I would not hesitate to raise him back up to 3 units if the numbers warrant it; this could give him more time to acclimate to lower numbers. So he may stay there for a little while and then need a reduction again. Maybe one time the reduction will actually stick! Cats don’t always react the same way each time to a dose that they’ve been on before as insulin needs do change over time. For now, keep up the good work. I hope he’s still feeling snuggly.
 
I really feel like we’ve almost hit that sweet spot, somewhere between 2.75 and 3 units. My tendency to be a bit OCD forces me to check those high and low numbers. When I retested after the 48, it was the same. A couple of cycles later, it did occur to me that I should have just held the 3 units. That was the longest he’d been at that dosage. He hasn’t had any greens yet at 2.75 and only a few blues, so I’m going to hold this dose for a few more days and see what happens. That morning cycle on the 23rd had me feeling hopeful, but it was shortlived. He’s still feeling snuggly, but not quite like he was with all of the greens.
 
Last edited:
Yep, I might have held the 3 units, but I wasn’t the one there on site to feed and test. I agree with holding a little longer to see if he needs to go back up. It’s good that he likes the greens.
 
Maybe you were right and I should have held that dose of 3 units. Here we are about 10 days into the reduction to 2.75. Beau had a couple of good cycles and I was encouraged, but he’s mostly been all over the place. I’m feeling like I need to go back to 3. I think I’ve learned a lot about using the higher low carb foods to hold off drops and need to use them sooner. Please look over his recent SS when you get the opportunity and let me know what you think.
 
Last edited:
I’m not sure. Some of your nadirs are quite in a good low green place. I do see that he is bouncy, as we know. In some cases where he goes up quite a bit at the end of the cycle, it’s loss of duration. I would definitely try to not give snacks after nadir (I believe you already do this) and you might want to back off just a touch with the carbs mid cycle, but of course it depends on the numbers. So you can try to increase again to see if you can even do better; it would require aggressive monitoring. If he can get more and longer stretches in green that would be good. Who knows, you may bounce back and forth between the two doses. Cats don’t always behave the same way when going back to a previous dose. If he has a particularly low preshot number though, you may want to take a one-time dose reduction.
 
OK. I think I’ll hold it a few more days to see if we can get back into some green nadirs. If not, I’ll increase. I rarely give any snacks after +6 or +7, which is where his nadirs usually are. And, if so, it’s when his numbers have dropped. I’ll go with the 4 and 5 carbs instead of 9 and 10, unless we’re working with a drop. When he has those low preshots, I could do a .25 one time reduction? I’ve never done that and then end up combatting the lower numbers with food. I can’t believe I am still learning after 9 months. Is there a way to resolve a loss of duration? It seems to come more at the AMPS.

I have a question about the prozinc. I’m dealing with that and the shots for FIP for a foster. I’m so used to seeing the GS as perfectly clear. I roll the vial of prozinc before I draw the shot for Beau and never really look at it and can’t remember if it should be clear or slightly cloudy after rolling. I’m almost at the bottom of the vial (just below the label) and tonight noticed a layer of white at the bottom of the vial. It mixed after rolling. I’m feeling like I’m second guessing myself as to whether the insulin is usually a little cloudy or not. Is it bad because of that cloudy layer at the bottom? o_O
 
Last edited:
I like that decision. I think it os what I would do with my own cat. He is getting good nadirs a lot of the time.
As to the insulin,the Boehringer Ingelheim website says:
One mixed, PROZINC suspension has a white, cloudy appearance. Clumps or visible white particles can form in insulin suspensions: do not use the product if clumps or visible white particles persist after gently rolling the vial.

So the cloudiness is okay as long as you don’t have particulates in there.
 
Suzanne & Darcy said:
I like that decision. I think it os what I would do with my own cat. He is getting good nadirs a lot of the time.
As to the insulin,the Boehringer Ingelheim website says:
One mixed, PROZINC suspension has a white, cloudy appearance. Clumps or visible white particles can form in insulin suspensions: do not use the product if clumps or visible white particles persist after gently rolling the vial.

So the cloudiness is okay as long as you don’t have particulates in there.
Click to expand...

Thank you!! I just sort of panicked slightly about the insulin. I feel much better now.

I do like the blue nadirs, which have been common at night. Green would be better, but I don’t get upset about the blues.
 
Oh, so anyway, I woke up thinking about Beau this morning. Since you are going to hold the 2.75 dose for a few more days (which is a good idea,) see if you can back off the carbs just at a few strategic points to see if he will still surf in green. It’s such a tricky thing, and every cat truly is different. You are getting better and better at this. On the morning of 1/31 it looks like he didn’t need the 8 percent carbs at +2 a.m. cycle when he was in pink. But on the morning of 1/28, he may have needed a few more carbs at breakfast.

What is he eating for breakfast? If he starts out with an AMPS of about 200, it looks like it would be fine to go with a few more carbs.

Of course, every cycle cannot be taken in isolation. The feeding suggestions sound so simplistic, but all of this depends upon what he was doing before — is he trending down from previous numbers or has he moved higher from previous low numbers, etc.
 
I’m happy you enjoyed the video. It really is am excellent depiction of what he is like on the healthy numbers. I love watching it. There is minimal supervision when my “big kitties” are on the deck. It’s massive, 10 x 60, with plenty of room to run. It’s also high, about 12’ on one end and 16’ on the other. They really have no desire to jump off. I am out there when the teenage fosters go out, however. Never quite sure what they will do.

I don’t recall why I gave Beau higher carbs on 1/31. That’s not like me, starting with a yellow and in pink at +2. I wonder if I posted it in the wrong row.

He has been eating the Savory Centers, which are between 1 and 2 carbs, for breakfast. I have noticed that, when he is at a very low 200 or in blue that he does not go up at +2, especially at night.
I’ll start experimenting with higher carbs at breakfast on the days, maybe 4 or 5, to see what happens. I think I should also test at +1 at times to see if he starts down that soon.

Thank you for the suggestions!
 
Oh well then, if you ay have written that on the wrong row, it doesn’t apply. He just seemed to jump up a bit on that day so I thought it must be the food.
 
He is adorable. And good for you doing the FIP treatment. How far along are you with that cat? Did you say it was a foster cat?
 
You must log in or register to reply here.
Back
Top