Anxious and frustrated newbie here

[Vanda Kay]

Hello,
It's been a week since my 17.75 year old girl, Landa (aka Landypants) was diagnosed and 2 days since she was fitted with a Freestyle Libre sensor so I can monitor her glucose levels at home. The vet put her on 1 unit of Lantus, administered via pen (I bought the 8mm 31g pen needles) every 12 hours. So far, the insulin is barely making a dent in her high glucose levels (in the high 300s or out of range (ie above 400) and I'm so demoralized. Yesterday, she was briefly in the normal range for a few hours, then climbed steeply back up to out of range. Today, she's barely been below 300 and her evening insulin shot has had zero effect on her curve. Am I doing something wrong? She has been on a wet food only diet since I adopted her from a shelter 5 and a half years ago, although I failed to stop her going up to 11.5lbs. She's now 9lbs. Can anyone help? My anxiety and feelings of failure are through the roof. I have been reading everything I can since the diagnosis, but there's only so much an anxious brain can absorb in that short time. Thank you!

 

[Barb 4 Angus]

hi ,
i'm new here too , and it is overwhelming at first ! Your anxiety and feelings of failure are something we have all felt , I'm sure. My cat was diagnosed in early Feb and at first I was really lost, not sure if I would be able to do home blood glucose tests . The first week my guy was on insulin his BG readings were all over the place too !
There is a huge support team here and they can guide you through what you need to do for your kitty . What you probably need to do is to set up a spreadsheet to track Landa's blood glucose , meds she gets and other details you can provide . There is loads of info on feeding , best types of foods, lots of info on different types of insulin ... you name it you're sure to find it here!
I dont know enough about linking info and threads etc , but if you go to the main Forum page there is info on how to set up your spreadsheet (SS).
and if you look below my comments here you will see a link to Angus' spreadsheet. Don't dispair or be hard on yourself , you made it here and soon you will feel more able to do it all.

 

[squeem3]

Are the canned foods you are feeding low carb? If not, that might be an issue. Canned food is great but only the low carb ones are suitable for diabetics. Most people use the chart here to find under 10% carb foods: https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf Whatever brand your cat likes and you can afford is good. Give low carb treats, too. Freeze dried meat treats are best. PureBites is one brand and there are many others. Plain cooked chicken is good too.

Don't use the Lantus pen the way it was intended for Human diabetics. The pen only doses in whole units. Cats often need half unit and even quarter unit doses which is not possible to measure with the pen. I think that sometimes it's hard to tell if the insulin actually gets into the cat using the pen. You can use an insulin syringe to draw the insulin out of the pen, like you would with a bottle of insulin. The ideal syringes to use are 3/10cc with half unit markings. There's info here on how to use an insulin syringe with a pen and info: https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

A week isn't much time to see improvement in blood glucose levels. It may take awhile with dose adjustments and figuring out how your cat responds to the insulin and food to find what works best. Have patience

@Bron and Sheba (GA) @Sienne and Gabby (GA) @Wendy&Neko

 

[Wendy&Neko]

Hello and welcome, overwhelmed and anxious is a very common feeling to start.. We've all been there, which is why we stick around to help new people.

As squeem3 says, you don't want to use the pen needles, but rather U-100 3/10cc syringes with half unit markings. There can be a number of technical issues with using the pen needles. If you don't prime the pen properly you can end up giving a smaller dose, you have to keep the pen needle in the cat for 5-10 seconds or you could be giving a reduced dose (my cat wouldn't stand for that!), and you can't keep the pen in the fridge once you start using it, otherwise the pen mechanism might not work. Fine for humans, but out of the fridge lasts only 30 days, which means a lot of wasted insulin for cats.

Having only two days of test data won't tell you much - you need longer than that. Many cats do what we call bouncing, and testing at the wrong time means you only see the high numbers. Here is a definition:
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).

Let's see what the next day of numbers tell you (and us).

There is some basic information we like people to tell us, by including in your signature - details here:
New? How You Can Help Us Help You!

 

[Vanda Kay]

Thank you so much for the newbie support! I don't know how I'd have managed without the wealth of information, experience and goodwill on here. My vet is a relief vet I can only reach 2 days a week. They sent me home with a 2-page fact sheet that doesn't address most of the Landa-specific questions I have. Two days after my first post, Landa's BG is really quite low today, in the low 100s. I guess I may not have been administering the full dose with the pen before. I've got the hang of it now. But now I'm paranoid about the hypo. My main questions are about how to avoid hypo with a cat who sometimes vomits (she threw up 3 hours after her morning dose today) and who can't eat a large serving of food in one go. How do I parse out the daily food intake to accommodate this? How long before the Lantus should I feed her? What do I do if she throws up? Can I space out her meals as I've always done throughout the day? I haven't yet got an understanding of how to make the insulin work for her without making her go hypo. I have no rainy day funds for an emergency vet! I know I need to do a spreadsheet for her. I'll take a look at the instructions.

 

[squeem3]

With Lantus it doesn't matter when your cat eats as long as you know your cat will eat. Lantus typically kicks in about 2 hours after injection so as long as your cat eats something within that time frame, it's good. Small meals work best for diabetic cats. Most people use a programmable timed feeder to give their cats snacks throughout during the day. Unregulated diabetic cats are usually always hungry so just feed as much food as your cat will eat in a day, portioning it out into a timed feeder if you won't be home.

Hypo info to have printed out so you're not frantically looking for it if it happens:

https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
https://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/

Always, always test the blood glucose level before giving insulin. That's the only way you know what your cat's level is and if it's at a safe enough number for any insulin to be given. It's generally recommended not to give insulin if the level is at 150 mg/dl or less. Some cats may need a token dose of insulin with a level lower than 150 but that depends on a variety of different factors (ketone prone, etc). If the level is borderline 150, maybe wait half an hour and retest and then decide if you can give insulin or not. Track all the blood glucose levels. A shareable online spreadsheet is helpful. Paper and pencil works in a pinch.

And always test if you see hypo symptoms or even if the cat just seems "off" somehow or you have a weird feeling. I once tested my previous diabetic cat because I felt that he was off somehow even though his morning pre insulin level taken about 3 hours earlier was over 300. His level had plummeted to 38 My cat was totally fine and had no hypo symptoms. I got high carb food into him and called the vet who didn't have any advice other than to decrease the insulin dose (Humulin N). I switched to a new vet not long afterwards and got my cat onto Lantus.

Dose changes are done slowly and no more than half a unit at a time. Insulin can pack a punch so increasing slowly a little bit at a time can sometimes avoid a hypo.

Cats vomit Vomiting doesn't affect blood glucose levels. Do you know what triggers your cat to vomit? Hairballs can be treated with diabetic-safe remedies like powdered egg yolk. Elevating the food bowl may also help. Food gobblers might benefit from a slow feeder or a few small meals spaced throughout the day.

Read the stickies over on the Lantus board: https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/ There's lots of good info.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
I've just looked at your spreadsheet and can't see any data on there yet.
Are you able to add what you already have? We rely on data to be able to help you with dosing questions.
Diabetic cats benefit from snacks throughout the day and evening. So give the 2 main meals and then 2 or 3 snacks during the first half of both cycles. A snack is a teaspoon or 2 of low carb food.

 

[Vanda Kay]

Apologies! I'm new to spreadsheets (musician, sorry). I have filled in all the data I have, but haven't yet created extra columns to reflect more accurate times of testing. I will do that tomorrow when I've caught up on some sleep. I have also filled in Landa's recent labs.

 

[Bron and Sheba (GA)]

Apologies! I'm new to spreadsheets (musician, sorry). I have filled in all the data I have, but haven't yet created extra columns to reflect more accurate times of testing. I will do that tomorrow when I've caught up on some sleep. I have also filled in Landa's recent labs.

It looks great. You don’t need to make extra columns. If you took the test at say 2.45 pm and it was 175 and that was 4 and 3/4 hours after the dose, for arguments sake, you would put it in the +4 column and write 175@+4.75

With the current BG numbers you are getting you need to stay with the 1 unit dose

 

[squeem3]

It looks great. You don’t need to make extra columns. If you took the test at say 2.45 pm and it was 175 and that was 4 and 3/4 hours after the dose, for arguments sake, you would put it in the +4 column and write 175@+4.75

You lose the auto coloring if you add non-numerical values into the cell. You can manually add in the color but someone who may not be familiar with spreadsheets may know how to do that. It's just easier to add a new column and label it as +4.5 or whatever so the cells will have the auto color.

Just me being a little OCD Feel free to set up your spreadsheet the way you want It's totally customizable for your needs. If you test at an odd time like +8.35, just enter the bg level at +8 or +8.5 and add in a note in the comments if you feel the need.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

One of the "quirks" regarding Lantus is that it is very different from most other insulin. Lantus is a depot type of insulin. In other words, every time you give a shot, the insulin forms micro-crystals that are deposited in the fat tissue. Those crystals dissolve slowly over the course of the 12 hour cycle. However, they all don't dissolve which gives you carryover into the next cycle. It also forms a bit of storage that ideally keeps the numbers in a flat, good range. What it also means is that it can take up to a week for the depot to be fully formed and stabilized so you often don't see an immediate response to Lantus. In addition, any time you increase or decrease the dose, the depot has to catch up to the change.

If you want to read more about how Lantus works, dosing methods, etc., you can look over the sticky notes at the top of the Lantus forum.

 

[Vanda Kay]

Welcome to FDMB!

One of the "quirks" regarding Lantus is that it is very different from most other insulin. Lantus is a depot type of insulin. In other words, every time you give a shot, the insulin forms micro-crystals that are deposited in the fat tissue. Those crystals dissolve slowly over the course of the 12 hour cycle. However, they all don't dissolve which gives you carryover into the next cycle. It also forms a bit of storage that ideally keeps the numbers in a flat, good range. What it also means is that it can take up to a week for the depot to be fully formed and stabilized so you often don't see an immediate response to Lantus. In addition, any time you increase or decrease the dose, the depot has to catch up to the change.

If you want to read more about how Lantus works, dosing methods, etc., you can look over the sticky notes at the top of the Lantus forum.

Welcome to FDMB!

One of the "quirks" regarding Lantus is that it is very different from most other insulin. Lantus is a depot type of insulin. In other words, every time you give a shot, the insulin forms micro-crystals that are deposited in the fat tissue. Those crystals dissolve slowly over the course of the 12 hour cycle. However, they all don't dissolve which gives you carryover into the next cycle. It also forms a bit of storage that ideally keeps the numbers in a flat, good range. What it also means is that it can take up to a week for the depot to be fully formed and stabilized so you often don't see an immediate response to Lantus. In addition, any time you increase or decrease the dose, the depot has to catch up to the change.

If you want to read more about how Lantus works, dosing methods, etc., you can look over the sticky notes at the top of the Lantus forum.

Many thanks. I am really struggling to understand how Lantus works. It's a lot of information to absorb on not much sleep over the last week. Today's BG went all the way down to 82 this morning from over 400 PS like a sheer cliff drop on the graph. It really scared me, because I didn't do anything differently. I may not have been injecting her properly before or maybe her body is just adjusting. She also vomited a little during the night and then again at +3 this morning. What if I give the shot and she vomits again? I don't know how you all cope with the anxiety! I live alone, I don't have a car or a big emergency fund and so I'll be awake all night worrying.

 

[Bron and Sheba (GA)]

Many thanks. I am really struggling to understand how Lantus works. It's a lot of information to absorb on not much sleep over the last week. Today's BG went all the way down to 82 this morning from over 400 PS like a sheer cliff drop on the graph. It really scared me, because I didn't do anything differently. I may not have been injecting her properly before or maybe her body is just adjusting. She also vomited a little during the night and then again at +3 this morning. What if I give the shot and she vomits again? I don't know how you all cope with the anxiety! I live alone, I don't have a car or a big emergency fund and so I'll be awake all night worrying.

It can be scary in the beginning until you get used to the way Landa manages the Lantus.
He is doing well for a newly diagnosed kitty.
Lovely to see that green 82!
I can’t see it on the SS yet.i don’t think you have updated it. Try and always update before you ask for advice as we rely on the SS for information.
As you are doing SLGS and he dropped to 82, he has earned a reduction in dose down to 0.75 unit at the next dose.
Congratulations.
So moving forward you are to give 0.75 units.
Are you giving him snacks during the cycles.?
Do you have an automatic timed feeder.? You could give him a couple of snacks during the night whi”e you sleep with the feeder.
Do you have a hypo kit? Remember if you are testing the BGs you are in control.

 

[Vanda Kay]

It can be scary in the beginning until you get used to the way Landa manages the Lantus.
He is doing well for a newly diagnosed kitty.
Lovely to see that green 82!
I can’t see it on the SS yet.i don’t think you have updated it. Try and always update before you ask for advice as we rely on the SS for information.
As you are doing SLGS and he dropped to 82, he has earned a reduction in dose down to 0.75 unit at the next dose.
Congratulations.
So moving forward you are to give 0.75 units.
Are you giving him snacks during the cycles.?
Do you have an automatic timed feeder.? You could give him a couple of snacks during the night whi”e you sleep with the feeder.
Do you have a hypo kit? Remember if you are testing the BGs you are in control.

Thank you. Sorry about not updating - I have a lot going on and very little sleep. Landa (she) was diagnosed 10 days ago and has been on the Libre 2 for a week. I freaked out when I saw 82 with a downward pointing arrow and thought she was headed for a hypo, so I gave her food. Is 82 a good number? I don't think I know what regime she is on. I just wrote SLGS on the spreadsheet as a guess. The vet put her on 1 unit and will review after 2 weeks. She has been bouncing all over the place in the last few days. I do give snacks, depending on the numbers, but not 2 hours before AMPS or PMPS readings. I will enter the data when I finish teaching later tonight. I don't have an automatic feeder - she is on LC wet food only and I am at home during the day, only out a couple of nights a week teaching and the rest of the time wfh. I do have a hypo kit now, thanks to this lovely forum! Thank you so much!!

 

[Bron and Sheba (GA)]

Apologies for calling Landa a he not a she
No problem with the updating. It’s just for future reference.
I will give you the link to the 2 dosing methods for Lantus below. Have a look and see which one suits you. As you are wfh you might like to do TR. it’s more agressive but gets results quicker. Up to you and your comfort zone.
82 is a normal number for a cat. 50-120 is what a normal cats BGs are.
You did well to give her some food. Just normal low carb food unless under 50 in which case you would give high carb or honey/karo. Always test after 20 minutes if you see a lower than normal number to check the number is going up not down.
Keep posting and asking questions.

 

[Bron and Sheba (GA)]

Lantus dosing methods

 

[Vanda Kay]

Apologies for calling Landa a he not a she
No problem with the updating. It’s just for future reference.
I will give you the link to the 2 dosing methods for Lantus below. Have a look and see which one suits you. As you are wfh you might like to do TR. it’s more agressive but gets results quicker. Up to you and your comfort zone.
82 is a normal number for a cat. 50-120 is what a normal cats BGs are.
You did well to give her some food. Just normal low carb food unless under 50 in which case you would give high carb or honey/karo. Always test after 20 minutes if you see a lower than normal number to check the number is going up not down.
Keep posting and asking questions.

Thank you so much. Landa's Freestyle has just malfunctioned and terminated after just a week. I have no way now of monitoring her BG. Nobody at the vet's told me or showed me how to do it manually. I don't have a clue. I've got to get through a whole night now without knowing and I don't know how soon the vet will be able to attach a new one.

 

[squeem3]

Hometesting tips with a blood glucose meter (pet or Human): https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Most people get a drop of blood from the edge of the cat's ear. It might be hard for you because your cat has black ears. Some people use a flashlight (strap on a small headlamp or hold a small one in your mouth) or a bright lamp to better see where the ear vein is on dark colored ears. Warming the ear up first helps to get the blood flowing. Offer low carb treats so your cat associates you messing with the ear with a reward.

Getting blood from a paw pad is also an option but not all cats will allow that.

 

[Sienne and Gabby (GA)]

The Libre company should replace the sensor. Just don't tell them it's for a cat! You can also replace the sensor yourself. There is a Facebook group that has tons of information about using the Libre with your pet including how to apply the sensor. The Libre has its pros and cons. The biggest "con" is that they sometimes do not last the 2 weeks that they are supposed to. The other "con" is that at lower numbers (e.g., below 100), they are not wholly accurate. They tend to give a lower than actual reading. It is among the reasons that we encourage members to also have a hand held glucometer so that you can test if numbers are running low and have a more accurate blood glucose number. (Your vet may not know that they give a false low reading.) You can use any human glucometer. Many people here use the Walmart Relion brand because strips are inexpensive but if a Walmart isn't close, you can get a glucometer at any pharmacy. The link that Squeem3 provided has lots of information as well as videos of how to home test. You'll need to get a glucometer, extra strips, lancets (get ones that are around 26 gauge), and cotton balls or pads. If you don't already have low carb treats, I'd get some of those as well. Landa gets treats any time you try to test. You want to reward her for putting up with your poking her ear.

FWIW, I managed my cat's diabetes and like you, it was only me who was caring for her. In the beginning, it was overwhelming -- and I'm very familiar with most things medical. It will take a few weeks but you will develop a pattern and much of the, "I don't know what I'm doing and could harm my cat." will begin to dissipate. The other thing to remember is that while your vet has office hours, we don't. There is usually someone online here pretty close to 24/7. For example, Bron is in Australia so she tends to be here late into what is our night. @Wendy&Neko is one of the moderators and she's a bit of a night owl.

 

[Wendy&Neko]

she's a bit of a night owl.

I am two hours west of you, but 4 mornings a week I get up at 4:30AM for a workout, so let's just say I'm not consistent as to when I'm on. . We do have people from around the work, and all sorts of different sleep patterns. There is almost always someone around to help. Just make sure you have items on hand from the Hypo Tool Box that was linked in post #6.

 

[Rae's Family]

Many thanks. I am really struggling to understand how Lantus works. It's a lot of information to absorb on not much sleep over the last week. Today's BG went all the way down to 82 this morning from over 400 PS like a sheer cliff drop on the graph. It really scared me, because I didn't do anything differently. I may not have been injecting her properly before or maybe her body is just adjusting. She also vomited a little during the night and then again at +3 this morning. What if I give the shot and she vomits again? I don't know how you all cope with the anxiety! I live alone, I don't have a car or a big emergency fund and so I'll be awake all night worrying.

I just want to say that I was exactly where you are 2 months ago.

Read that again -- 2 months ago.

I'm just here to tell you that it does get easier, you're never going to be less anxious but you will be better equipped to handle it, and it won't always be like this.

I was in a really low spot right after Rae got diagnosed because I felt like I wouldn't have a life (or sleep) until she got under control. Truth is, she's still not under control, but her mood and behavior improved SO MUCH in such a short time. Once she started acting like she felt better, it was a lot easier to take a deep breath and get some sleep.

It feels like an eternity, but I swear to you it will not be as long as it feels

 

[Vanda Kay]

I just want to say that I was exactly where you are 2 months ago.

Read that again -- 2 months ago.

I'm just here to tell you that it does get easier, you're never going to be less anxious but you will be better equipped to handle it, and it won't always be like this.

I was in a really low spot right after Rae got diagnosed because I felt like I wouldn't have a life (or sleep) until she got under control. Truth is, she's still not under control, but her mood and behavior improved SO MUCH in such a short time. Once she started acting like she felt better, it was a lot easier to take a deep breath and get some sleep.

It feels like an eternity, but I swear to you it will not be as long as it feels

Thank you so much! I've been teetering on the edge of a nervous breakdown this last week and have been in survival mode. I got the Libre replaced with a new one at the vet's and everything was going pretty well until last night. Her levels yesterday morning were in the green zone and I was so happy! Then, after her 6pm shot, her BG levels did not go down at all and stayed "HI". Same again after her 6am shot this morning. My vet told me to take her to the emergency vet to check her ketones and I did that. Her BG was 388 in reality (but saying over 400 on the Libre) and ketones were 0.4. The emergency vet said to increase her dose of Lantus to 1.5. Is that good advice? 2 days ago her BG (as measured by the Libre) slipped down to 67 because she hadn't eaten as much as usual. Her appetite now seems very good. Should I increase her dose to 1.5? Or 1.25? WHY would the Lantus have no effect at all the last 2 times?? I definitely did not do a fur shot. The needle went in and so did the insulin. I don't know what to do!

 

[Wendy&Neko]

Nope, it's horrible advice. We determine how to dose Lantus based on how low the dose takes the cat. You don't want her any lower, so definitely no increase. It'd really help us if you could put some data for the last week in the spreadsheet. Again, mostly interested in preshot numbers and the lowest point you see between the shots. But if you are seeing a 67, that means the dose is too high and you actually need to lower it to 0.75 units. If you have 1/2 unit marked syringes, we eyeball between the 0.5 and 1.0 unit lines.

You actually didn't need to take Lanta to the emerg vet. She is doing what we call bouncing (extremely common), definition here:
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).

Being able to test ketones at home is a good idea. Here are some tips how to do it: Tips to catch and test a urine sample

 

[Vanda Kay]

Nope, it's horrible advice. We determine how to dose Lantus based on how low the dose takes the cat. You don't want her any lower, so definitely no increase. It'd really help us if you could put some data for the last week in the spreadsheet. Again, mostly interested in preshot numbers and the lowest point you see between the shots. But if you are seeing a 67, that means the dose is too high and you actually need to lower it to 0.75 units. If you have 1/2 unit marked syringes, we eyeball between the 0.5 and 1.0 unit lines.

You actually didn't need to take Lanta to the emerg vet. She is doing what we call bouncing (extremely common), definition here:
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).

Being able to test ketones at home is a good idea. Here are some tips how to do it: Tips to catch and test a urine sample

Thank you. It's very difficult to manage when one cannot rely on advice from the vet. Is this normal??

 

[Vanda Kay]

Nope, it's horrible advice. We determine how to dose Lantus based on how low the dose takes the cat. You don't want her any lower, so definitely no increase. It'd really help us if you could put some data for the last week in the spreadsheet. Again, mostly interested in preshot numbers and the lowest point you see between the shots. But if you are seeing a 67, that means the dose is too high and you actually need to lower it to 0.75 units. If you have 1/2 unit marked syringes, we eyeball between the 0.5 and 1.0 unit lines.

You actually didn't need to take Lanta to the emerg vet. She is doing what we call bouncing (extremely common), definition here:
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).

Being able to test ketones at home is a good idea. Here are some tips how to do it: Tips to catch and test a urine sample

I'm going to enter the data for the last week on the spreadsheet in a minute. It's been a week and things were good right up until last night. Is there a reason why her BG would not drop at all after 2 doses of 1 unit? Is that part of bouncing?

 

[Wendy&Neko]

It's very difficult to manage when one cannot rely on advice from the vet. Is this normal??

Unfortunately not uncommon. Vets treat many conditions in many different animals. The amount of diabetes training for dogs and cats is less than 1 day. And things change, so hard if they haven't kept up with the latest. We live diabetes 24x7.