? Rebound, Dawn Effect or just unregulated and needs time?

[ErinKitty]

Hi All

Firstly, I look at this forum approximately 299773 times a day and have found it extremely helpful for these first few months when everything is hard and overwhelming, so a huge thank you to the creators and contributors of this community. Some key info before my question:
- We are in Australia
- Kitty is 13yo and 6.5kg
- I use a Contour Next human meter for BG (mmol)
- Diagnosed in early Nov 2025 and started insulin treatment on the 19th Nov
- Insulin is Lantus (I was given a vet pen / Optisulin SoloStar which has increments of 1 unit only)
- Currently on 3 units at 7:30am/pm (just increased from 2 units on 30th December)
- Food is Fancy Feast Pate 1.5 tins per meal (not enough for her weight but vet wants her to lose some)
- Kitty lost 1 kg between September and November when diagnosed which was a symptom of something not right
- When she was first diagnosed we had a hypo incident before I even started insulin as I switched her to wet food from an all dry food kibble pretty much overnight (lesson earnt)

Question:
We are having trouble with Kitty's numbers being very high in the morning and generally unregulated. Her AMPS are 20+ mmol consistently, then decreasing throughout the day, sometimes getting too low for a PMPS to be done. Today for example she was 20.6 at 7:30am for AMPS and then 5.1 @+11.75 and 5.3 @+12.75. I did not give insulin tonight due to this.

Due to her all over the place numbers, the vet increased from 2 units which we were on for about 4ish weeks and have been on 3 units now for 1 week. I feel like there may be some improvement as she has only had one AMPS at 20.1 since the increase, and the rest have been 15-17. In saying this, her PMPS are not consistent and I'm always a little worried about them being very low overnight.

We did a curve at the vet and a curve at home, and both were pretty unhelpful as no real trend emerged from the other data we have and didn't explain any of the highs or lows.

Home BG Curve on 20th December was:
AMPS 16.9
+3 10.5
+5 11.1
+7 12.0
+9 12.3
+10.75 16.3
PMPS 15.7

Her AMPS the next day was 19.5

My working theory is one of two things (or a combo of both):
1. The dose is too high and she is dropping too low into Hypo overnight creating a rebound in the AM
2. Her hunger cues in the AM are causing a BG spike - she wakes me up in the morning for food when the sun comes up (around 5:30am here in Aus at the moment) but is not fed until 7:30ish AM

I would love to hear anyone's thoughts, opinions or suggestions for a hard to regulate cat like Kitty?

I've linked my spreadsheet. It is not the one supplied as I found this forum after creating but it works for me and my vet. Screen shot of her trends since 1st Dec included as well.

Worth noting that overall she is still happy and her usual lazy, chubby, hungry self. She has no symptoms since her 1st Hypo scare.

Thank you very much
Erin

 

[ErinKitty]

Have since updated my spreadsheet to the FDMB version so easy to see US numbers

 

[Robo & B]

Hi Erin

Sorry you're having trouble getting your cat regulated but glad you've found this forum.

Good work on getting your spreadsheet updated to the one used here. You'll get much more help that way.

For your lantus pen, I'm fairly certain other members here use insulin syringes into the cartridge itself to get the insulin, which allows finer control of the dose. You're definitely going to want to be able to give dose changes in increment smaller than one unit.

For the before insulin food change hypo, how do you know that was a hypo? Were you testing bs already? I've never heard of that happening before, I'm still new here though so me not having heard of that before doesn't mean anything. Must have been scary for you anyway, I'm glad your kitty is back to her normal self.

Going to tag a couple of more knowledgeable members
@squeem3
@Wendy&Neko
@Sienne and Gabby (GA)

 

[ErinKitty]

Thanks the the reply @Robo & B!

I had not even considered a syringe into the cartridge, I’ll definitely mention it to my vet if she wants to do another increase or decrease.

RE the hypo, I’m not certain but she had all the typical symptoms about 4 days after I switched food. She was walking like she was drunk, couldn’t sit down without falling to one side and she wasn’t really interested in food so I had to hand feed her. This went on for about 24 hours before I realised what was going on and so we held off starting insulin until she came good. The only thing that had changed was her food.

Once she realised there was other food she refused to eat her regular kibble and we went straight to wet food in less than 2 days, so I assumed the big change in carb and water content sent her hypo.

I thought for a moment that this might mean we could get her diet regulated but alas not the case so far.

Ive been trialling a later feed/snack just before I go to bed around +3 to see if this changes her AM readings, and this morning she tested at 6.1 @ +11 which has been unheard of so far!

 

[Robo & B]

Thanks the the reply @Robo & B!

I had not even considered a syringe into the cartridge, I’ll definitely mention it to my vet if she wants to do another increase or decrease.

RE the hypo, I’m not certain but she had all the typical symptoms about 4 days after I switched food. She was walking like she was drunk, couldn’t sit down without falling to one side and she wasn’t really interested in food so I had to hand feed her. This went on for about 24 hours before I realised what was going on and so we held off starting insulin until she came good. The only thing that had changed was her food.

Once she realised there was other food she refused to eat her regular kibble and we went straight to wet food in less than 2 days, so I assumed the big change in carb and water content sent her hypo.

I thought for a moment that this might mean we could get her diet regulated but alas not the case so far.

Ive been trialling a later feed/snack just before I go to bed around +3 to see if this changes her AM readings, and this morning she tested at 6.1 @ +11 which has been unheard of so far!

Ok I asked because there is a reasonable amount of overlap between DKA and hypo symptoms. I would have thought in this situation (mild) DKA was more likely for an untreated diabetic but someone more experienced may say differently. Either way your cat's doing better now.

It would probably still be a good idea to get some urine ketone test strips. The standard human ones are fine. Just to double check. If she is showing as having ketones you don't want to restrict calories right now.

Smaller more regularly meals can make getting regulated much easier. You do want to make sure she eats with her shot but it doesn't need to be half her food for the day. I feed my cat snacks at +2,+4,+6 and sometimes+8 and have found letting him get too hungry seems to stress him out so much it raises his bs (but he does have a condition that makes him more hungry). Experimenting with when you feed and how much can be helpful.

You've already read about bouncing from low numbers and that also could be happening, so spreading that food out could really help

Lantus is a U100 syringe, so you will want u100 syringes with half unit markings.

 

[Robo & B]

You had a nadir if 54 at AM+6 on the 3rd? If your cats not used to those numbers she could definitely be bouncing. Also cats often dip lower at night do you have any overnight nadir readings? Sorry I know it'll mean setting an alarm, but I'm wondering if she's dropping a bit low some nights.

 

[Wendy&Neko]

Hello and welcome to you and sweet Drama (gotta see a picture with that name!)

Some reference material for you. The staggering does sound like possible hypo.

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

This food list may help if you are looking for alternatives: AUSTRALIA - LOW CARB CANNED AND AIR/FREEZE DRIED CAT FOOD We are looking for food that is 10% and under in carbs.

What day did you switch the food, and from what? It'd be really helpful to add things to the Remarks column of the spreadsheet that might impact blood sugars. Such as food changes.

Most of us use syringes to take the insulin out of the vial/pen/cartridges. Some people have bought half unit marked syringes on line. Another alternative, if you use the BD Microfine syringes is a paper ruler you can compare to. And yet another alternative is to buy a digital caliper and use it to measure out the insulin in the syringes. If you get syringes and are interested in trying any of these options, let me know and I can get you more detail. Though I'm not sure on the current on line options.

As far as "numbers all over the place" - it is the most common phrase we hear from new people. I think there are a couple of factors contributing to that. First, I think 3 units is too high a dose. If you are following SLGS for dosing per your signature, you reduce the dose if they go below 90, which she did yesterday. We change the dose based on how low it takes the cat, and 3.0 units is taking her too low. If you had syringes, we'd suggest a 2.25 units dose, as 2.0 units did take her to 92, which is as low as you really want her on a dose.

The second factor impacting her numbers, is that she is likely doing what we call bouncing, totally normal (but annoying to us). Here is the description:

• 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)

Last points for now, we strongly recommend testing before every shot, to make sure it is safe to shoot. If she was low at shot time, you wouldn't want to shoot. Second recommendation on testing is to get more tests at night. Many cats go lower at night, and we use those lows to determine how to change the dose. A test right before you go to bed at night can be really helpful in telling us if she's going low at night, then bouncing to those higher numbers.

 

[ErinKitty]

Thank you all this has been really helpful!

Previous food was Hills Science Diet Light kibble - she has been on and off prescription dry kibble for the whole time I’ve had her due to her weight.

Her current dose of 3 units was due to the vets concern about her consistent high numbers in the 400s and no real sign of a downward trend after 3 weeks at 2 units. I agree it could be too high and will be hesitant to do a further increase even if vet suggests.

Regarding SLGS, I may have misunderstood as I thought that referred to gradually increasing the dose until regulated? I also read that Lantus can’t be reduced based on the pre-shot number and you have to give the same dose if you are going to shoot? Please correct me if wrong!

Thank you

 

[Wendy&Neko]

SLGS (start low go slow) does mean gradually increasing the dose, and starting low. If a cat is on dry food, the starting dose is 1.0 units, if on wet food, the dose starts at 0.5 units. Increases are by 0.25 units at a time (not 1.0 units!) and you stick with the dose for a week before changing it, unless kitty goes under 90.

You are right. With Lantus, we base dosing on how low the dose takes the cat. That is typically somewhere in the middle of the cycle, but can occasionally be at shot time. With SLGS, you do not shoot if the preshot is below 90.

Funny story about so called "diet" dry foods. I worked part time/volunteered at the local shelter. They had a bunch of fat cats and decided to put them all in the same room on so called prescription diet food. They all gained weight over a few months, and got put back in with the general population. The one I eventually adopted gained 2 pounds but gradually lost 4 pounds when he came home with me on low carb wet food.

Another good page to read is the "how is started" page on catinfo.org - she is now a feline nutrition vet: The Origin of CatInfo.org

 

[ErinKitty]

You had a nadir if 54 at AM+6 on the 3rd? If your cats not used to those numbers she could definitely be bouncing. Also cats often dip lower at night do you have any overnight nadir readings? Sorry I know it'll mean setting an alarm, but I'm wondering if she's dropping a bit low some nights.

Yes she has been quite low in the +5 and +6 when I have been occasionally able to check. Same just now, her AMPS was 113 and at +6 she has hit 54 again.

Overnight lows are something the vet and I have been chatting about and she had a Libre installed for 3 nights before eventually knocking it off so we could check these - but I will do a couple of nights with an alarm to check and see what's happening there.

 

[ErinKitty]

SLGS (start low go slow) does mean gradually increasing the dose, and starting low. If a cat is on dry food, the starting dose is 1.0 units, if on wet food, the dose starts at 0.5 units. Increases are by 0.25 units at a time (not 1.0 units!) and you stick with the dose for a week before changing it, unless kitty goes under 90.

You are right. With Lantus, we base dosing on how low the dose takes the cat. That is typically somewhere in the middle of the cycle, but can occasionally be at shot time. With SLGS, you do not shoot if the preshot is below 90.

Funny story about so called "diet" dry foods. I worked part time/volunteered at the local shelter. They had a bunch of fat cats and decided to put them all in the same room on so called prescription diet food. They all gained weight over a few months, and got put back in with the general population. The one I eventually adopted gained 2 pounds but gradually lost 4 pounds when he came home with me on low carb wet food.

Another good page to read is the "how is started" page on catinfo.org - she is now a feline nutrition vet: The Origin of CatInfo.org

Ah right, understood! How many times do they have to drop below 90 before you should reduce? So far she's done it twice on the 3 units.

So interesting regarding the food! She never actually gained weight on the diet but never lost any either. I kept putting it down to her age and that she was comfortable and happy so I didn't want to really restrict her. She was only meant to be eating 1/2 cup per day of kibble and always was asking for more or trying to steal my food. She seems to be a bit more satisfied now we've switched to Fancy Feast (it must taste a billion times better than the diet kibble too).

I have learned from this forum that a lot of cat foods are unfortunately labeled with the buzz words to get us to buy thinking we are doing the right thing. My vet kept suggesting getting the expensive diabetic wet food but when we compared composition & ingredients the Fancy Feast pate actually came out with more protein and less carbs.

 

[Wendy&Neko]

With SLGS, you drop the dose immediately (the first time) they go below 90.

I think a lot of us had our eyes opened on food that is supposed to be good for cats once we got here.