http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=121584
What the heck?? He did ok yesterday. Major bounce?? Wowee!!
What the heck?? He did ok yesterday. Major bounce?? Wowee!!
07/11. Jake's AMPS 401@5:30am!
- Thread starter Jakesmama
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Hi Cory!
I don't think I've had a chance to post to you yet and welcome you and Jake to Lantus Land.
A couple things can happen with bounces. First, they can be delayed. On the night of 7/9, Jake was headed down. Sometimes they can pick up a little steam during the cycle and drop faster. It's hard for us to know if the 117 at AMPS was his lowest number or if he had already hit his lowest number and was on his way back up. If I have a number that is dropping during a cycle, I will always get another test around mid cycle to see if she's still dropping. And that includes at night. The other good method is to get a +10 and that will usually tell you if he's dropping going into his PS or is on the way back up. So, back to the first sentence....if the 117 was his nadir, he could be having a delayed bounce now. I've seen it happen many times where you don't see the bounce really kick in for 24 hours because the liver release some of the counterregulatory hormones and the pancreas can then later release others.
What I actually suspect might be the cause of that 401 is a phenomenon known as "high before the break". This is where the kitty will bounce (as Jake did yesterday) and then right before they start to clear the bounce, they have a really high BG. I'm not seeing a pattern of highs before the break with Jake but my Gracie does not always do it....sometimes she just clears the bounce without going up higher first. Because there isn't yet a lot of data on jake, we will just have to see whether this is the case with him or not.
I've read back through the last several days and you've gotten some great info. One thing I want to clarify is that, as Julie said, it's best to feed all foods prior to nadir, if possible, and just supplement with a LC (e.g. Boiled chicken breast) snack after if absolutely necessary because you want the insulin to keep working for it's full duration. Chris mentioned that I feed Gracie right up until the next preshot. That isn't correct and she might have misunderstood a post I made. I'll try to clarify here just so you have the info.
When new members come on the board, we suggest they not feed after +10 until PS because we don't want them to shoot a lower number (above 50) that might be food influenced. When the insulin has started to wane late in the cycle, feeding even really LC food can push the BG up. So let's say Jake was at 75 and you fed him at +11 and then when you checked him for his PS, he was 120. You would think, "he's going up, it's a very safe number to shoot". So you do and then at +2, you find he is at 60. It is "possible" that he was headed down at the 75, you shot a food spike, and then once the effects of that wore off and the next shot was onsetting, it dropped him much lower. We just suggest new members don't feed the two hours before PS until they understand their kitty's patterns inc onset, nadir, duration; how they respond to food at different times in the cycle; do they get a food spike and how much; how to bring low numbers up, etc.
With Gracie, routinely she is fed so her last meals are long before nadir so I get the duration levemir is known for. I don't feed up until PS. BUT I know if I need to, I can because I'm not worried if I shoot a food spike. I know how to deal with it. if I want to go out to dinner at +10, I know I can give her a little food to bring her up and keep her safe for two hours and if I shoot a food spike, it's not a big deal because I have a ton of data and understand what I'm doing as do many, many of the experienced members here.
It seems very rigid when we first get here and there is a reason why.....because ECID and you have to build the data to learn about your cat (and patterns do change). Once a member understands how the insulins work, how it works for their kitty, their kitty's patterns, response to food, etc, then there is more flexibility so you can meld treating FD with having a life
I don't think I've had a chance to post to you yet and welcome you and Jake to Lantus Land.
A couple things can happen with bounces. First, they can be delayed. On the night of 7/9, Jake was headed down. Sometimes they can pick up a little steam during the cycle and drop faster. It's hard for us to know if the 117 at AMPS was his lowest number or if he had already hit his lowest number and was on his way back up. If I have a number that is dropping during a cycle, I will always get another test around mid cycle to see if she's still dropping. And that includes at night. The other good method is to get a +10 and that will usually tell you if he's dropping going into his PS or is on the way back up. So, back to the first sentence....if the 117 was his nadir, he could be having a delayed bounce now. I've seen it happen many times where you don't see the bounce really kick in for 24 hours because the liver release some of the counterregulatory hormones and the pancreas can then later release others.
What I actually suspect might be the cause of that 401 is a phenomenon known as "high before the break". This is where the kitty will bounce (as Jake did yesterday) and then right before they start to clear the bounce, they have a really high BG. I'm not seeing a pattern of highs before the break with Jake but my Gracie does not always do it....sometimes she just clears the bounce without going up higher first. Because there isn't yet a lot of data on jake, we will just have to see whether this is the case with him or not.
I've read back through the last several days and you've gotten some great info. One thing I want to clarify is that, as Julie said, it's best to feed all foods prior to nadir, if possible, and just supplement with a LC (e.g. Boiled chicken breast) snack after if absolutely necessary because you want the insulin to keep working for it's full duration. Chris mentioned that I feed Gracie right up until the next preshot. That isn't correct and she might have misunderstood a post I made. I'll try to clarify here just so you have the info.
When new members come on the board, we suggest they not feed after +10 until PS because we don't want them to shoot a lower number (above 50) that might be food influenced. When the insulin has started to wane late in the cycle, feeding even really LC food can push the BG up. So let's say Jake was at 75 and you fed him at +11 and then when you checked him for his PS, he was 120. You would think, "he's going up, it's a very safe number to shoot". So you do and then at +2, you find he is at 60. It is "possible" that he was headed down at the 75, you shot a food spike, and then once the effects of that wore off and the next shot was onsetting, it dropped him much lower. We just suggest new members don't feed the two hours before PS until they understand their kitty's patterns inc onset, nadir, duration; how they respond to food at different times in the cycle; do they get a food spike and how much; how to bring low numbers up, etc.
With Gracie, routinely she is fed so her last meals are long before nadir so I get the duration levemir is known for. I don't feed up until PS. BUT I know if I need to, I can because I'm not worried if I shoot a food spike. I know how to deal with it. if I want to go out to dinner at +10, I know I can give her a little food to bring her up and keep her safe for two hours and if I shoot a food spike, it's not a big deal because I have a ton of data and understand what I'm doing as do many, many of the experienced members here.
It seems very rigid when we first get here and there is a reason why.....because ECID and you have to build the data to learn about your cat (and patterns do change). Once a member understands how the insulins work, how it works for their kitty, their kitty's patterns, response to food, etc, then there is more flexibility so you can meld treating FD with having a life
julie & punkin (ga)
Member Since 2011
Hi Cory!
just checking in on you and Jake today. I wanted to add 2cents worth about counting cycles, just to flag it for you. We count cycles to decide what to do about the dose. So each time there is a dose change, we count 6 shots and then re-evaluate the dose to decide if it should be held longer or increased. we know to decrease with a newly diagnosed cat whenever their numbers go below 50.
Your cycle count reset with the switch from 2.5 to 2.0, so the night of 7/9 would be 1 as you start to recount. with blue numbers, we wait 10 cycles when a blue first appears to see if the cat will settle in and the numbers will come down. let's look at Jake's numbers again before the evening shot tomorrow (7/12) and see if he needs an increase or to be held longer.
you're doing a great job getting tests in - i know you don't have a lot of supplies. have you found a source for the insulin yet?
and about feeding, i wrote something day before yesterday as a plan for you to try, if you'd like.
just checking in on you and Jake today. I wanted to add 2cents worth about counting cycles, just to flag it for you. We count cycles to decide what to do about the dose. So each time there is a dose change, we count 6 shots and then re-evaluate the dose to decide if it should be held longer or increased. we know to decrease with a newly diagnosed cat whenever their numbers go below 50.
Your cycle count reset with the switch from 2.5 to 2.0, so the night of 7/9 would be 1 as you start to recount. with blue numbers, we wait 10 cycles when a blue first appears to see if the cat will settle in and the numbers will come down. let's look at Jake's numbers again before the evening shot tomorrow (7/12) and see if he needs an increase or to be held longer.
you're doing a great job getting tests in - i know you don't have a lot of supplies. have you found a source for the insulin yet?
and about feeding, i wrote something day before yesterday as a plan for you to try, if you'd like.
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