Mia & Monica - Continued (part 3)

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She's had less insulin, and she also dropped into lime green, it's possible that she may react with a bounce and we will see a higher than usual Pmps.

She earns a reduction with that drop into the 30s, and it's the Nadir's that govern our dosing decisions with Lantus, so if she's high at pmps, don't panic and continue shooting the reduced dose. With one proviso, that she's eating and behaving normally, no signs of lethargy or sickness. It would also be a good idea to check for keto es as we've reduced the dose. Not enough insulin can be a trigger to developing ketones especially if there were to be something else going on(inappetence, illness, inflammation), in those circumstances we might make a different decision with regards to dose at pmps.

If all's well stick with the drop dose, if there's any issues with the above, shout out and we'll make a different plan.
 
MonicaT said:
Super nervous to see how high it's going to go until her preshot to be honest
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I agree with what Gill said about ketones, etc. The dosing protocols call for definite reduction with a drop into the 30s. But don’t be upset if you feel her numbers are too high. It’s really not a good idea to rush the process— and it is a process! Many cats will need reductions and then need an increase afterwards. Some go back and forth between does for a while. And some cats really surprise us and don’t need to go back up in dose. Your sweet Mia is doing sooo well in such a short period of time. There are many people who would love to have your spreadsheet numbers for their cat.
 
Gill & George said:
She's had less insulin, and she also dropped into lime green, it's possible that she may react with a bounce and we will see a higher than usual Pmps.

She earns a reduction with that drop into the 30s, and it's the Nadir's that govern our dosing decisions with Lantus, so if she's high at pmps, don't panic and continue shooting the reduced dose. With one proviso, that she's eating and behaving normally, no signs of lethargy or sickness. It would also be a good idea to check for keto es as we've reduced the dose. Not enough insulin can be a trigger to developing ketones especially if there were to be something else going on(inappetence, illness, inflammation), in those circumstances we might make a different decision with regards to dose at pmps.

If all's well stick with the drop dose, if there's any issues with the above, shout out and we'll make a different plan.
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@Gill & George yes I realized after my last post that I have to keep in mind the possibility of bouncing with the next cycles. Not sure if I have asked this before, but is there a general period of time we can expect to see results of a bounce?

Will also try to get in ketone tests daily the next couple of days. And of course keep an eye on her general condition. Thank you :)
 
Suzanne & Darcy said:
I agree with what Gill said about ketones, etc. The dosing protocols call for definite reduction with a drop into the 30s. But don’t be upset if you feel her numbers are too high. It’s really not a good idea to rush the process— and it is a process! Many cats will need reductions and then need an increase afterwards. Some go back and forth between does for a while. And some cats really surprise us and don’t need to go back up in dose. Your sweet Mia is doing sooo well in such a short period of time. There are many people who would love to have your spreadsheet numbers for their cat.
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@Suzanne & Darcy will try to remain cool as a cucumber when testing throughout this cycle and next one, and keep in mind that higher numbers might be from her bouncing. Will ask you too, how long can we see effects from bouncing usually?
And again, thank you for all your help, wise words and support :bighug:
 
MonicaT said:
Not sure if I have asked this before, but is there a general period of time we can expect to see results of a bounce?
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Bounces are when we see high flat numbers for at least one cycle, they can be triggered by a drop into low numbers that the cat is not used to ( not necessarily lime green) and they can last up to a maximum of 6 cycles, but not unusual to see them be anything between 1 and 6.

A long spell in lower than usual numbers or a sharp drop can also trigger them.

To be honest, Mia hasn't been bouncing since she's been on Lantus, so my guess would be that she won't, but time will tell.
 
Gill & George said:
Bounces are when we see high flat numbers for at least one cycle, they can be triggered by a drop into low numbers that the cat is not used to ( not necessarily lime green) and they can last up to a maximum of 6 cycles, but not unusual to see them be anything between 1 and 6.

A long spell in lower than usual numbers or a sharp drop can also trigger them.

To be honest, Mia hasn't been bouncing since she's been on Lantus, so my guess would be that she won't, but time will tell.
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@Gill & George Ah ok, very familiar with bouncing while she was on Caninsulin, just wasn't sure how long the effects could last. Good thing to keep in mind when checking her BG levels the next 3 days then.

This is the first time Mia has gone down into lime green numbers on Lantus though, so I guess we don't know if she has bounced on Lantus or not yet?
 
MonicaT said:
ok, very familiar with bouncing while she was on Caninsulin, just wasn't sure how long the effects could last. Good thing to keep in mind when checking her BG levels the next 3 days then.
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Actually looking at her caninsulin numbers I don't see bouncing, I see lack of duration.

Caniinsulin is an in out insulin, which means when the cycle is over her BG shoots up because there's no insulin available to keep her BG down, so by PS her numbers shoot up, you shoot her next dose and insulin becomes available her BG dived.

Bouncing, as we refer to it on this forum is when a cats body is actually responsible for the high BG readings, irrespective of there being insulin. Think of it as the liver going into 'panic mode' it reacts to a 'percieved dangerous BG level'. (The lower than usual BG numbers etc) And releases hormones that result in glucose being dumped into the blood stream, which results in the spike in BG, and then those levels remain high and flat (we don't see a curve with a defined onset, nadir and duration), by definition we get at least one cycle of high flat numbers and for most cats these high flat numbers will subside (liver stops releasing hormones/glucose) within 6 cycles.

Mia went up and down, which certainly feels like 'bouncing' or at least being on a seesaw, but I see the lack of duration of caninsulin and it's rapid action, and lack of insulin depot being responsible for the crazy cycles you experienced,
 
I don’t see any indication of a bounce yet. I doubt if she will bounce because she’s not shown herself to be a bouncy cat so far. She also had a gentle curve today.
 
Gill & George said:
Actually looking at her caninsulin numbers I don't see bouncing, I see lack of duration.

Caniinsulin is an in out insulin, which means when the cycle is over her BG shoots up because there's no insulin available to keep her BG down, so by PS her numbers shoot up, you shoot her next dose and insulin becomes available her BG dived.

Bouncing, as we refer to it on this forum is when a cats body is actually responsible for the high BG readings, irrespective of there being insulin. Think of it as the liver going into 'panic mode' it reacts to a 'percieved dangerous BG level'. (The lower than usual BG numbers etc) And releases hormones that result in glucose being dumped into the blood stream, which results in the spike in BG, and then those levels remain high and flat (we don't see a curve with a defined onset, nadir and duration), by definition we get at least one cycle of high flat numbers and for most cats these high flat numbers will subside (liver stops releasing hormones/glucose) within 6 cycles.

Mia went up and down, which certainly feels like 'bouncing' or at least being on a seesaw, but I see the lack of duration of caninsulin and it's rapid action, and lack of insulin depot being responsible for the crazy cycles you experienced,
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@Gill & George oh ok, that's a new perspective to me. I am just going by what I have been told on the forum in my previous threads. Which was that her high numbers after having lime green numbers were due to her bouncing because of the liver going into panic mode like you said.
 
Suzanne & Darcy said:
I don’t see any indication of a bounce yet. I doubt if she will bounce because she’s not shown herself to be a bouncy cat so far. She also had a gentle curve today.
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@Suzanne & Darcy Yes she's had very stable numbers today. Her preshot BG will be in around 45min :)

Regarding the "bouncing", have i misunderstood all the previous posts on ny other threads when she was on caninsulin? I feel like we discussed her bouncing due to the lime green numbers on several occasions
 
MonicaT said:
Regarding the "bouncing", have i misunderstood all the previous posts on ny other threads when she was on caninsulin? I feel like we discussed her bouncing due to the lime green numbers on several occasions
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You've probably not.

But folk sometimes don't distinguish well between bounce and lack of duration.

Take a look at George's ss
15/12/2015 as an example, when he first started seeing green.

You can see that he saw green in the morning cycle and by the evening cycle he was in high yellow by +7 and stayed there , even though I shot the same dose, he remained high, was pink at amps the next morning but by +6 he was in low yellow, note this wasn't his nadir, he continues to drop Al the way into pmps, we are not seeing a curve, just a downward slide, giving me a blue pmps t, this was him' clearing the bounce' his liver has stopped releasing glucose and the hormones, his BG is stabilising. I shoot blue and he returns to creen, we have a cycle with s clear nadir, he has stopped bouncing in the pmps of 16/12/2015. His drop into green triggers another bounce, which starts towards the end of the pm cycle of 16/12/2015, he is punk at amps of 17/12 and stays in yellow bobbling about in that cycle on this occasion he starts to clear the bounce mid cycle in the pm cycle of 17/12.

Note how he spends time high inspire if being given insulin, and how in his bounce cycles he hasn't got a defined curved.

He wasn't a very bouncy cat, he cleared his bounces quickly, and his bouncy 'period' didn't last long, he gave up bouncing quite quickly.

Hope that helps with the explanation

If you look at Mia's numbers you see she has clear defined curved, even on caniinsulin, albeit steep curves, the problem with caninsulin was that she didn't get duration, her insulin r
'run out' and her BG shot up, only to come back down sharply when she received her next shot and she onset. It doesn't look like her liver was responsible for it.

Moving to lantus has worked for her in that it's a 'gentler' slower acting insulin which typically gives better duration in cats, helped by the insulin deposit.

That's why you are not seeing her shoot up like crazy at PS. She still has some insulin helping her BG levels remain more stable.
 
MonicaT said:
@Gill & George oh ok, that's a new perspective to me. I am just going by what I have been told on the forum in my previous threads. Which was that her high numbers after having lime green numbers were due to her bouncing because of the liver going into panic mode like you said.
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Well if you look at her spreadsheet while she was on Caninsulin, when she went into lime green then green then yellow by the end of the cycle that’s not because of a bounce. It’s just that the short-acting (in a cat) Caninsulin wore off — there just wasn’t any more insulin available to her. So if she were bouncing, you would see those yellows continue into the next cycle and perhaps even climb into pink (or higher,) but in Mia’s case, when she got her next insulin shot her numbers went back down again and frequently went into lime green again. That shows that she was not bouncing because if it was a true bounce the insulin would have had little effect (BG not really going down and certainly not way down into low green and lime green.) Does this make sense? So when we see higher numbers toward the end of a cycle but then the next shot is given and the numbers go down again, we call that loss of duration (meaning the previous shot wore off.)
 
Mia just had diahrrea when she used her litter. Should I be worried? She was fine all yesterday and ate normally. And got in a ketone test during the day which was negative.

Should I take her to the vet in the morning? She is still acting normal, purring etc.
 
Gill & George said:
Have you introduced new food?
How liquid is it,?

George used to get diarrhea (very soft poop)after I fed him high carb food and when he had a lime green event
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@Gill & George No new food, she has been eating the same low carb food since we switched her diet weeks ago. Apart from the one meal she had 4 days ago with the new food that made her BG jump. She got some of her old dreamies treats 2 days ago when she dropped into lime green numbers, but nothing after that.

It was liquid with some parts that were firm in it.

In her meal this morning with her shot I mixed in fortiflora to see if it helps.
 
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What are the vets opening hours today? Is it half day today?
Do you have a vet available on Sunday if you were to need it?

From what you are saying she seems ok and is not showing any signs of pOn/discomfort, other than the poop she seems herself.
Do you have s good relationship with your vet? Will they talk to you if you phone and ask for advice?

Has she had pancreatitis in the past? Or periodic problems with diarrhea?
 
Gill & George said:
What are the vets opening hours today? Is it half day today?
Do you have a vet available on Sunday if you were to need it?

From what you are saying she seems ok and is not showing any signs of pOn/discomfort, other than the poop she seems herself.
Do you have s good relationship with your vet? Will they talk to you if you phone and ask for advice?

Has she had pancreatitis in the past? Or periodic problems with diarrhea?
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Yes they have half day today and closed tomorrow. But there is an emergency vet available.

She seems ok other than the one round of diarrhea last night. She ate like normal this morning so her appetite seems fine, she was purring and running around too.

I do have my vets phone number on Whatsapp so I can message 24/7.

She does not have a history of pancreatitis or diarrhea
 
It might be just a one off event. I know some of mine occasionally do that for no reason I can figure out.
Is she an indoor cat?

Given she seems ok is eating and behaving normally in your position I'd probably speak to your usual vet for advice, and watch for any signs of pain/discomfort, and monitor her ketones, and see of her next poop is normal or still problematic.
Any signs of her not eating or of lethargy, would set alarm bells going for me.

My worry with what I've said above is your access to care if you need it, for me here in Spain we have the same hours, and the nearest out of hours vet is an hour's drive away, so that often influences my decision on whether to take them or just observe when they get sick on a Friday night.
 
Gill & George said:
It might be just a one off event. I know some of mine occasionally do that for no reason I can figure out.
Is she an indoor cat?

Given she seems ok is eating and behaving normally in your position I'd probably speak to your usual vet for advice, and watch for any signs of pain/discomfort, and monitor her ketones, and see of her next poop is normal or still problematic.
Any signs of her not eating or of lethargy, would set alarm bells going for me.

My worry with what I've said above is your access to care if you need it, for me here in Spain we have the same hours, and the nearest out of hours vet is an hour's drive away, so that often influences my decision on whether to take them or just observe when they get sick on a Friday night.
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@Gill & George yes definitely hoping it was just a random one time thing. She is strictly indoors, but has access to a balcony, so bugs, dust etc.

Will keep an eye on how she is feeling today or if she continues to act normal and eat normally. And will check after she visits the litter as well as try to get in another ketones test.

Regarding care later today or tomorrow if needed, luckily nothing is anymore than 30min drive here in Malta. There is an emergency vet on call at all times, they just vary which vet office it is. But if needed we always have a vet we can bring her in to for tests etc. From what I have googled so far, pancreatitis and IBD would be the two most common things to check/test for if we do take her in
 
MonicaT said:
Regarding care later today or tomorrow if needed, luckily nothing is anymore than 30min drive here in Malta.
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LOL yes I know Malta is pretty 'compact' I'm from Gibraltar originally, though I live in Spain, we visited Malta on a youth exchange trip. My Great Grandmother was Maltese, Gib has always had close. links to Malta.:)

Keep us posted of you're worried about anything.

I see she's gently heading down this morning sorry o stepped out, took 5 cats and two dogs for their vaccinations this morning.
 
Morning Monica,
How is Mia?

Just looking at her SS, which broadly looks good, her Nadir's, seem to have crept up and she appears to be sending less time in green. I'm feeling that thissy be a 'failed' reduction.

With TR, we are looking for her to have most of her Nadir's to be that of a healthy cat (between 50-80).

I might give her a couple more cycles to see if she can bring her BG down, but in your shoes I would be looking to take her dose up in an attempt to get her seeing more green, if she continues to creep up.
 
Gill & George said:
LOL yes I know Malta is pretty 'compact' I'm from Gibraltar originally, though I live in Spain, we visited Malta on a youth exchange trip. My Great Grandmother was Maltese, Gib has always had close. links to Malta.:)

Keep us posted of you're worried about anything.

I see she's gently heading down this morning sorry o stepped out, took 5 cats and two dogs for their vaccinations this morning.
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@Gill & George Oh, love that you have maltese blood in you! Have yet to visit Gibraltar myself :)

Mia has been doing good over the weekend, Saturday she didn't have any poop for me to check in the litter, but yesterday I checked after she had been and there is still some diarrhoea in between the normal looking poop. So I am not sure if maybe she had some "leftovers" that still needed to come out and is back to normal now, or if she is still having abnormal BM. Will keep on checking the litter after she has gone. Managed to test for ketones again yesterday and was negative so that's good.

Apart from that she is eating like normal, playful, purring etc. so I haven't seen any other changes apart from the bit of diarrhoea we still saw yesterday.

Yesterday evening she had a bit of a weird cycle were we didn't see her numbers going down until +6, which has been unusual for her. Both her morning/afternoon cycle yesterday and Saturday got her into green numbers at +4 and +6. So not sure why she doesn't go into green in the evening/night cycles :(

Will follow your suggestion and give it a couple of more cycles until making any changes to her dose

Took a photo of her BM yesterday evening, which was a strange mix of normal looking poop with liquid in between. https://drive.google.com/file/d/10ULDo1Rn1DRLXFJAq0BPfRirR_ciz4CO/view?usp=sharing
 
MonicaT said:
Will follow your suggestion and give it a couple of more cycles until making any changes to her dose
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Before you take her up check with us, I'm going to the UK for a conference today, so I may not be around very much, Tuesday and Wednesday. I'm back Wednesday afternoon.

MonicaT said:
Yesterday evening she had a bit of a weird cycle were we didn't see her numbers going down until +6, which has been unusual for her. Both her
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She had a pretty flat cycle last night, sometimes a flat blue cycle precedes a very active cycle. So let's see if she's playing games with us.

MonicaT said:
@Gill & George Oh, love that you have maltese blood in you! Have yet to visit Gibraltar myself :)
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LOL. A lot of families are descendants of malteses families, if you looked in the phone book you'd recognise a lot of surnames.
 
@Gill & George
Gill & George said:
Before you take her up check with us, I'm going to the UK for a conference today, so I may not be around very much, Tuesday and Wednesday. I'm back Wednesday afternoon.


She had a pretty flat cycle last night, sometimes a flat blue cycle precedes a very active cycle. So let's see if she's playing games with us.


LOL. A lot of families are descendants of malteses families, if you looked in the phone book you'd recognise a lot of surnames.
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Of course, not doing anything at all until I check in with you guys on here! :) Just did her +2 check, and it has gone down from 8.6 to 6.2, so definitely already more active than last night!

Haha and yes, us Maltese are definitely everywhere! Just always get surprised just the same seeing Maltese surnames etc from this tiny little island o_O
 
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Suzanne & Darcy said:
Well if you look at her spreadsheet while she was on Caninsulin, when she went into lime green then green then yellow by the end of the cycle that’s not because of a bounce. It’s just that the short-acting (in a cat) Caninsulin wore off — there just wasn’t any more insulin available to her. So if she were bouncing, you would see those yellows continue into the next cycle and perhaps even climb into pink (or higher,) but in Mia’s case, when she got her next insulin shot her numbers went back down again and frequently went into lime green again. That shows that she was not bouncing because if it was a true bounce the insulin would have had little effect (BG not really going down and certainly not way down into low green and lime green.) Does this make sense? So when we see higher numbers toward the end of a cycle but then the next shot is given and the numbers go down again, we call that loss of duration (meaning the previous shot wore off.)
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Sorry for the lack of reply here @Suzanne & Darcy! Took a little "break" from it all over the weekend (apart from testing and insulin of course). But yes your explanation of her low numbers while on caninsulin definitely makes sense in regards to it being a short-acting insulin. So for it to be a bounce, it will result in longer lasting higher numbers and not actually just "bouncing" from low to high during a cycle.
 
How is she doing? I saw you had negative ketones :). I think you should got ahead and take her back up to 0.1 units. She’s been in too much blue and we’ve lost the greens. Even when she did go green it was not for long. What do you think? Do you want to wait until tomorrow morning?
 
Suzanne & Darcy said:
How is she doing? I saw you had negative ketones :). I think you should got ahead and take her back up to 0.1 units. She’s been in too much blue and we’ve lost the greens. Even when she did go green it was not for long. What do you think? Do you want to wait until tomorrow morning?
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Yes managed to get in another ketones test, and was negative luckily! Haven't been able to check her poop today, so not sure what the update is on that yet. But have been adding probiotics (fortiflora) to her food twice a day so could be that has done the trick.

She has already gotten her dose for this evening/night where we stuck to a drop dose. But seeing that she has been in blue numbers for the past 5 cycles now, I would have to agree that it seems like she needs an increase to 0.1u again. Will be getting a caliper tomorrow hopefully, which should make consistent measuring a lot more easier. I have had a slight feeling the last couple of days that she went into lime green numbers because of wrong measurement of the 0.1u dose as I have recently noticed the markings on syringes have varied slightly. So I have a theory that the newest syringes have their markings slightly lower down on the syringe itself. Have you ever experienced this?

Got any tips on how to use a caliper in order to measure the 0.1u on our syringes?
 
Suzanne & Darcy said:
Unfortunately, I have never had the need to use calipers, but other people on this Board have.
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@Suzaune Oh ok! It seems like it could be a great tool to get these tiny measurements correct and the same every single time. I spoke with Stefania too and she said she has also seen the same thing with the syringes we are getting here in Malta. That the lines can be a little off. Will have a look on the forum to see what I find about using a caliper and how it works :nailbiting:

I have given Mia her morning shot now and increased it back to 0.1u. So we'll see how her numbers will do on this cycle
 
I understand your anxiety. The 50s are good numbers (2.9/52) is safe. We have cats on the Board who hang in the 50-80 range for long periods of time. It does take some time to become accustomed to that. In Mia’s case, it looks like she went up to 74 within an hour. After that, I can’t tell what happened. We would like her to spend time in dark green.
 
Suzanne & Darcy said:
I understand your anxiety. The 50s are good numbers (2.9/52) is safe. We have cats on the Board who hang in the 50-80 range for long periods of time. It does take some time to become accustomed to that. In Mia’s case, it looks like she went up to 74 within an hour. After that, I can’t tell what happened. We would like her to spend time in dark green.
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Yes of course very happy to see those green numbers again! Just found it to be quite a big drop from her pre shot number. Her +6 is coming up now in 30min, so will update the SS then.
 
Heather82372 said:
Actually my last post about calipers was me asking about it because it was so confusing to me. Honestly, life has been too busy for me to even figure it out yet. Sorry I can't help.
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Didn’t someone post a video about how to use them? I haven’t been able to find it yet.
 
MonicaT said:
Yes of course very happy to see those green numbers again! Just found it to be quite a big drop from her pre shot number. Her +6 is coming up now in 30min, so will update the SS then.
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When her preshot numbers start to come down and you are “shooting low to stay low” then the cycles will smooth out and be much flatter.
 
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