07/06 Zorro AMPS 547 +8 355 Please help

Zorro's mom

Zorro's mom

Member Since 2019
I am becoming so worried about our darling Zorro's numbers and don't know which way to adjust things for him.

The period on his SS that I'm referring to is the past 11 days from June 26, 2019 onwards when I started 12/12 BID dosing as described on this board (the earlier data is from my chopping and changing with a different form of TR so please ignore - except it can be helpful to see what doses had him better regulated).

The thoughts running through my head are:

1. He has been spending soooo many hours in black, red and pink numbers this past week and I'm so concerned about damage to his little system. It's taking all my will power to not dose earlier at +10, like I'm more used to. Will this really get better (because I do think he is particularly bounce'y) or do some cats simply metabolize insulin quicker and require say, at least +11 dosing? After all, ECID?

2. I'm afraid he's building up glucose toxicity during the times spent in these high numbers.

3. Should I increase his dose with 0.5 this PM since it's been 6 cycles now on 3.5 units with no good results? My partner feels we should give the current dose more time but see my point 2 above.

4. On the other hand, simultaneously I'm wondering whether his current dose is too high, considering he seems to have done much better on 3 units. Perhaps I should have given 3 units a longer time to settle things? Further to this point I'm also considering that he recently underwent a big dental where 6 extractions were done and abcesses were treated (which we never even suspected) so surely that could have increased his earlier bg and now he needs less insulin? My starting TR on 3 units was based on an average from all of his previous data but perhaps I started too high?

5. He had a huge drop on 07/03 from the PMPS to +3 but can the bounce still be this severe during the 5th cycle thereafter?

6. If experienced Levemir users think my point 4 above warrant testing, is it safe to do so for say, 6 cycles, considering his current high numbers?

Sorry for all the contradicting questions but I really don't know how to untangle this and Zorro's numbers is all I can think of these days. I need fresh, unemotional eyes to look at his data and please advise.
 
First, big breath.

You have a comment on your spreadsheet about noticing blood in Zorro's urine. There is a reasonable likelihood that Zorro has a UTI. Antibiotics from his dental may have helped but it would be even better if you talked to your vet about this. Any infection can cause a rise in BG numbers.

What you are seeing is that Zorro's numbers are bouncing. This is normal although it's highly irritating to us! Starting on 6/24 when Zorro dropped to 47, you see his numbers spike up, he dropped into the blues,and then up again into reds and blacks. You see similar patterns when he drops into the blues. Bounces occur if:
  • your cat drops into low (i.e., dose reduction territory, especially with TR) numbers
  • your cat drops into lower numbers than he's used to spending time in or
  • your cat's numbers drop fast
Some cats do metabolize insulin more quickly than what we typically see. You don't have enough data accumulated at this point to know if this is the case. Levemir is very different than Caninsulin and none of the same rules apply. Caninsulin has nowhere near the duration that Lev has. In other words, be patient.

Your dose is not too high. This is a common misconception that people, including vets who are not familiar with depot-type of insulin draw. Stick with the TR protocol and keep systematically raising the dose. Be patient.

Glucose toxicity is the result of holding an ineffective dose for too long so that your cat starts treating the high numbers as his new "normal." You've been seeing numbers in the blues in greens. You're seeing bouncing not glucose toxicity. Be patient.

Bounces can last up to 6 cycles and for some cats, they can last a bit longer. Be patient.

You mentioned his dental. Did the vet do post-procedure x-rays? If not, there's always a possibility that a tooth fragment was left behind. Please make sure that x-rays were done and if not, ask the vet to get a set. (The post-procedure films should have been included in the cost of the procedure.)

So, if it's not completely transparent, we all understand your worries. You are asking reasonable questions especially for someone who has used a different, non-depot type of insulin. The one thing Lev and Lantus teach us all is patience. Welcome to the club!!
 
Thank you for the reply, Sienne.

My comment about blood in Zorro's urine was actually that his urine tested negative for heamoglobin the last time that I did a ketone strip test. Our vet also did a urine strip test very recently and she was not concerned about anything on it. However she did say we can do a full urinalysis about 10 days after he finished his post-dental course of antibiotics so I guess it can be done any day now. I'll look into that shortly.

I don't think any x-rays were done before or after Zorro's dental but I'll definitely find out. I think things are done a bit differently in South Africa!

I do understand when bounces can occur (too low drop, too fast drop, lower than what used to) but I've never experienced such a long run of solid black, red and pink numbers before. That's why I'm concerned that glucose toxicity is currently busy building up because we're in the 6th day since his last blue number.

If I interpret TR correctly, then I can increase his dose by 0.25 or 0.5 (since he's seeing high numbers and nadirs) this evening ie. after 6 cycles, correct?
Perhaps I'll play it safe and wait for tomorrow day time, just in case his bounce also finally breaks this evening.
 
Sienne gave you the BEST advice "Patience!" It's only been 10 days since you started TR.
Our animals feel our emotions. Take several deep breaths & try to be calm as possible when you're with Zorro. How old is he? (you should add that to his info)

It's possible he has an infection brewing,which will raise his bg. Stress will also raise it. I understand what you mean about X rays. I've been going to my vet for years & assumed he took dental Xrays. I recently found out he doesn't! He doesn't have a Dental X rays machine.

If I have to have any extractions done in the future I'll need to find a clinic that does dental X rays.

You might want to make a copy of the Directions for TR method. Even if you read it, it's good to keep it on hand to read it again. Remember you are not increasing the dose based on the pre shot number. Lantus is Slow working. You are looking at the Nadir, the Lowest number in the cycle.

Think of his SS like a puzzle. The more boxes you fill in ,the more information you have to see what the insulin is doing at different times. This will help you to make decisions in the future about his dose.

My cat Ravan was in High BG for a long time. It's very frustrating! But eventually his body got accustomed to the insulin & he finally start coming down. ( i've been here for 17 months) (you can go on his SpreadSheet & see what I mean)

I still don't give dosing advice. I leave that to the "Experts" here that have been doing it for years!

Keep asking questions! The more you know about how Lantus insulin works the easier it will be to help Zorro! :)

3 Cheers to you for rescuing all your Kitties & dogs! We need more people in this world like you with a compassionate heart for animals! :bighug:


Good Luck to you & kitty Zorro!
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Thank you for all of that, Joy :bighug:

I've updated my signature as suggested.

Yes, I will print out the TR guidelines and I will try my best to hold a dose for at least 5 days before increasing.
It is just so hard to see them in high numbers, not looking their best and knowing it is harming their bodies while you just have to wait it out. I am not good at waiting for results. Fortunately my partner is more steady than me and this time he is working hard at keeping me on track and seeing this TR method through.

I am simultaneously so happy for your dear Ravan and his beautiful blue 'n green SS yet also pretty envious! Right now getting where you are seems like an almost impossible task ahead. Well done, he is so lucky to have you as his human mama.

Thank you again for the encouragement.
 
Thank You for your kind words! :)
It's wonderful you have a partner to keep you on Track. It sounds to me like you're off to a great start. If you follow the advice of the Knowledgeable people here (the ones that have Years of experience) you will do just fine!
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Hi and welcome to the L,L & B Forum.

You are doing a great job of testing and collecting data. It looks like Zorro could use more insulin if you don’t see a green number by the end of this cycle. Since you got 263 on the AM Cycle on July 4th, I would only raise the dose by .25 of a unit the next cycle where you can monitor, making the new dose 3.75. With TR you would raise the dose every 3 days if needed not 5 days at this stage in the game.

When did you switch to Levemir? If you could put that date in your Signature , it would be helpful.


You are doing a great job!
 
Thank you @Bobbie And Bubba :bighug:

Noted about the dose increase.
However I've just checked Zorro's +3 and he has done a good drop for so early on in the cycle. I even fed him a 2oz mixed canned/raw meal at +1.5 and he still dropped so well. I hope it's not too fast, as it was for the PM shot on 07/03 and which actually led to the long bounce he seems to have finally cleared. I don't want a repeat bounce just yet! :facepalm:
It's a bit premature to predict, but if he bounces hard from this dose again, perhaps I should rather reduce it by 0.25 tomorrow?
 
Zorro's mom said:
Thank you @Bobbie And Bubba :bighug:

Noted about the dose increase.
However I've just checked Zorro's +3 and he has done a good drop for so early on in the cycle. I even fed him a 2oz mixed canned/raw meal at +1.5 and he still dropped so well. I hope it's not too fast, as it was for the PM shot on 07/03 and which actually led to the long bounce he seems to have finally cleared. I don't want a repeat bounce just yet! :facepalm:
It's a bit premature to predict, but if he bounces hard from this dose again, perhaps I should rather reduce it by 0.25 tomorrow?
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That was a nice drop. But here’s the thing about bouncing, Lowering the dose does not stop the bouncing. It is the opposite. Until you can get them in lower numbers more often, their bodies are responding to that low by spilling counter hormones into the blood system to bring their numbers back up. It’s a self perseverance thing. So , by increasing according to the protocol and getting them into better numbers is what will help bouncing stop.

So, unless Zorro ( love the name!) can get into a green number above 50 , I would increase. We have to get him out of these blacks and reds. Make sense?

ETA: and he still might bounce from the big drop tonight but unless he hits a green tonight , he needs more insulin.

Oh, and when was Levemir started?
 
Okay it makes sense the way you've put it, thank you Bobbie.

So no green tonight = increase tomorrow, Zorro!

Sorry, I forgot to mention in my previous reply (and my signature won't allow enough further text): I changed to Levemir about 2.5 months ago, around April 18.
So the shorter +10 and +11 cycles on Zorro's SS was already with Levemir but I was still following a different form of TR.
I started this board's method of TR on June 26.
 
Zorro's mom said:
Okay it makes sense the way you've put it, thank you Bobbie.

So no green tonight = increase tomorrow, Zorro!

Sorry, I forgot to mention in my previous reply (and my signature won't allow enough further text): I changed to Levemir about 2.5 months ago, around April 18.
So the shorter +10 and +11 cycles on Zorro's SS was already with Levemir but I was still following a different form of TR.
I started this board's method of TR on June 26.
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How about since your signature won’t allow for additional info if you could indicate it on your SS . What a lot of us do is add a colored line above the date and say Levemir started.
 
I just want to say Zorro is absolutely adorable.

My Alice bounced a lot at first on Lantus and I used a non-depot insulin before that too, so for awhile I felt like I had less control! But as you get used to it and collect more data, you will feel more empowered to handle all the surprises sugar kitties like to throw our way!
Alice doesn’t bounce anymore and she’s doing okay.
Someone on here once told me, feline diabetes is a marathon, not a sprint. As much as we would like it to be...!
 
I want to add a bit on bouncing since I suspect that Bobbie didn't quite catch some of her autocorrected text.

Fundamentally, a bounce occurs when the liver and pancreas release a stored form of glucose along with counterregulatory hormones. It is a self-protective mechanism that may prevent your kitty from spending too much time in low numbers. (Do not, however, become complacent about low numbers!) While this is a normal function, it's hugely annoying for us because we hate seeing those high numbers. There's really no way to prevent a bounce. Generally, as your cat becomes more accustomed to lower numbers, the bounces take less time to clear.

While many vets will talk about Somogyi rebound and lowering the insulin dose, this doesn't work. Not only does lowering the dose not work, it causes your cat to sit in higher numbers overall (and then glucose toxicity enters the equation), there's a relatively recent research paper that debunks Somogyi.

The raw food that you're giving Zorro, is a a complete diet (i.e., does it have all of the necessary nutrients such as taurine, etc.) or are you adding plain raw food to his diet? My only concern is that the canned food you're using is at the high end of the low carb food range (we consider low carb as less than 10%). If Zorro is very carb sensitive, he may benefit from a lower carb option.

With TR, if the majority of the nadirs over 6 cycles (3 days) are above 300, then you can increase the dose by 0.5u. If nadirs are mostly in normal range (50 - 120), hold the dose for 5 days. If numbers are largely between 100 - 299, hold the dose for 3 days before increasing.
 
Sienne and Gabby (GA) said:
I want to add a bit on bouncing since I suspect that Bobbie didn't quite catch some of her autocorrected text.

Fundamentally, a bounce occurs when the liver and pancreas release a stored form of glucose along with counterregulatory hormones. It is a self-protective mechanism that may prevent your kitty from spending too much time in low numbers. (Do not, however, become complacent about low numbers!) While this is a normal function, it's hugely annoying for us because we hate seeing those high numbers. There's really no way to prevent a bounce. Generally, as your cat becomes more accustomed to lower numbers, the bounces take less time to clear.

While many vets will talk about Somogyi rebound and lowering the insulin dose, this doesn't work. Not only does lowering the dose not work, it causes your cat to sit in higher numbers overall (and then glucose toxicity enters the equation), there's a relatively recent research paper that debunks Somogyi.

The raw food that you're giving Zorro, is a a complete diet (i.e., does it have all of the necessary nutrients such as taurine, etc.) or are you adding plain raw food to his diet? My only concern is that the canned food you're using is at the high end of the low carb food range (we consider low carb as less than 10%). If Zorro is very carb sensitive, he may benefit from a lower carb option.

With TR, if the majority of the nadirs over 6 cycles (3 days) are above 300, then you can increase the dose by 0.5u. If nadirs are mostly in normal range (50 - 120), hold the dose for 5 days. If numbers are largely between 100 - 299, hold the dose for 3 days before increasing.
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Thanks Sienne, “counter”
 
Thank you so much for all the info and encouragement. Sorry for the late reply. I saw everone's posts when I woke up for Zorro's +6 check last night/this morning and was too sleepy to respond. Then today we had family over for lunch so I had to prepare for that.

@Bobbie And Bubba thanks for the tip about adding a line onto Zorro's SS. You'll notice how far I managed to get with it :oops: I'm not very Excell literate and the SS does not seem to give the same Excell options as an Excell doc on my pc. How does one clear the columns from that line so that one can insert text?

@AliceMeowliss&Cassandra thank you for saying hello :bighug: I have been following your darling Alice's progress and you are both doing so well. She seems like a sweetheart and her little face and fighting spirit reminds me so much of our own Alice'y (one of our other kitties).
Yay to you for no more bouncing! We hope to get there too!

@Sienne and Gabby (GA) thank you for the additional info. For now I've just scanned the article you linked but will read it properly later tonight. What I could gather so far is that the article basically says that a true Somogyi effect is very rare with a depot insulin.
My understanding then is that what we call bouncing is a normal occurrence (and not Somogyi as our vets might refer to it) that does not require bg to go truly low before it occurs and does not require reduction of a dose (unlike true cases of Somogyi).
I am just a bit puzzled by the effects of the PM shots on 07/03 and 07/06 (last night) on Zorro's SS. Both times the insulin kicked in very strong very early in the cycle, but then his body seemed to kick into defence mode early too. Nadirs (if you can even call it that in those cycles) were high numbers with the rises starting very early again. Are those instances where one just has to stay on top of it, test early and try to slow the drop down with food whilst keeping the same dose? Ie, were those not examples of a too high dose?

I buy Zorro's raw food from a supposedly reputable raw pet food company and they make fresh batches to order. The packaging says that it does contain "supplements including taurine". However I recently noticed that constipation is an issue for Zorro so now I add in either a bit of pumpkin or sometimes 1/2 tsp olive oil. I was also advised that a little bit of carbs might be a good idea so now I've added the Petley's to his diet. However for most meals I would give 1oz raw plus .5oz Petley's to keep the carbs low. It is tough to find reasonably priced low carb canned food in SA. Purina FF wasn't too bad but the company who used to import it has stopped importing any Purina products. I still have a large stash of the Classic Salmon Feast (the only flavour from the Classic range that we used to get) but I use it very sparingly since I found out that the phosphorous content is very high. The search for low carb canned is always ongoing, though! :)
 
He really zoomed upwards between +11.5 and +12. However I still had an "eeek" moment when I gave the new dose of 3.75u :nailbiting:

Yup, I'm one of those who's terrified of the insulin (and yet I chastise myself when I'm a wuss and my boy sits in high numbers because I didn't increase a dose as suggested.)
 
If it's at all reassuring, my Gabby was capable of starting a cycle in the 400s, dropping into the 40s, and then zooming back to the 400s by PMPS.

It may help to keep in mind that there is a 20% variance around any test number. Zorro's numbers are dropping but it looks like he's bouncing and then clearing the bounce within a cycle or two. Hopefully, his pancreas will start to get used to those yellow numbers soon.
 
Zorro's mom said:
He really zoomed upwards between +11.5 and +12. However I still had an "eeek" moment when I gave the new dose of 3.75u :nailbiting:

Yup, I'm one of those who's terrified of the insulin (and yet I chastise myself when I'm a wuss and my boy sits in high numbers because I didn't increase a dose as suggested.)
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We have all been there with those feelings ! As you do this dance longer, you will get more and more comfortable after you start to see Zorro’s patterns.
 
@Zorro's mom ,
If you ever need SS help go here- it’s the tech support type forum. Someone there will be able to help you with the spreadsheet and other issues! :)

I wonder what shipping to SA would be like.... I mean for you to get other cat food options.... until FDMB I never realized how difficult cat food choices can be in other countries...... all I know is shipping between US and Oz is like..... absolutely insane. Back in my days when I had money though, I’d probably have gone and ordered a ton of cans of stuff and shipped them to you, anyway! I miss those days. Lol.

You’re doing great. I am loving the questions you are asking. :) congrats on that blue!!!!!
 
Okay , so since that blue number is the lowest number since 6/30 , he is likely to bounce. The bounce can take 6 cycles or 3 days to clear. Keep that in mind.
 
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