1/31 Tonka AMPS 25.2 mmol (454) - rebound or "New Dose Wonkiness"?

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jmalasiuk

jmalasiuk

Member Since 2014
Yesterday's post: http://www.felinediabetes.com/FDMB/threads/update-on-and-up-and-up.132325/#post-1362555

So, Tonka was doing quite nicely on his increase to 2.5 units yesterday. Had come down from 22.7 mmol (408) in the morning before his shot to 10.7 mmol (192 by +11). He was likely lower at nadir, since he was on his way up by his pm shot, but he tends to drop again at +10 or +11 on his "normal curve" days, so I'm not positive of that. The evening curve that I did showed that he was down to 8.8 mmol (158) by +4 and on his way up a bit to 10.0 mmol (180) by +6. But overall, he was in the upper "blues" for a nice continuous period yesterday, so I was hoping that he wouldn't be rebounding.

Now this morning, he'd spiked back up to 25.2 mmol (454). As noted, this doesn't look like a rebound scenario to me since he was at close to the same level for such an extended period yesterday. Unless he dropped again at +10 or +11 and I didn't catch that. I'll hold the 2.5 units for a few days and see what happens. Just wondering if anyone has any ideas about why he does this? (he was good and perky this morning, not excessively hungry and drinking very little, so if it weren't for the ridiculously high reading, you'd think that he was perfectly fine)
 
Today's number are a "bounce"

Tonka's body got used to living at high numbers, so even getting into mid-blues is "low" for him! The more time he spends in "good numbers", the more his body will get used to them again and the less he'll react.

It can take up to 72 hours to "clear the bounce", but as he spends more and more time in those good numbers, the bounces won't be as high and will clear faster

You want to keep holding the 2.5 until we're sure he's cleared the bounce before you increase again (it's not time to increase yet anyway). This is where it just takes experience to know when the bounce is breaking. If you increase because you see high "bounce" numbers and during that cycle he ends up clearing the bounce, they can come crashing down pretty fast....which just sets them up to bounce again

Bounces are caused by several things.....A number that's too low (Even China still bounces if she drops too low and she's tightly regulated), Numbers that are lower than the body is used to being at (this is Tonka) and Fast drops (Like dropping from 400 to 250 in 2 hours)

The good news is he's getting into pretty blue numbers on this dose!! Very nice to see after all that red and pink!
 
Good to see him with less high numbers, definitely. Just can't figure out why it's taking more than twice the amount of insulin to get him there than it was a few weeks ago with no other changes. Still waiting to hear back from the vet on getting a dental scheduled.
 
He's really not taking twice the insulin to get him in the same place

You have to just keep increasing until you get the numbers you're shooting for routinely...2 weeks ago he might have gotten into blue once or twice, but he was still mostly in reds, pinks and yellows

The goal is to find the best dose that keeps him in good numbers the majority of the time...whatever dose that might be
 
I see improvement over a couple of weeks ago. Yesterday hit hit blue in both cycles, did a really quick bounce and he's back in blues already today. A couple of weeks ago he was barely dipping his toes in blue and bouncing longer. I'd get a +6 today, he seems in a hurry to go down.
 
I actually just got a reading on him a few minutes ago before seeing your post: he's down to 7.1 (128) at +6.5. That'd be his first "almost perfect" reading, if he were a human. Of course, it was taken on a human meter, so he's probably still a touch above the ideal, but certainly better today.

I heard back from the vet a few minutes ago as well. She's really happy with the levels he's hitting at 2.5 units (sent her his spreadsheet this morning as more info to go with his blood work) and wants to keep him at that dose for a while, unless his levels go way up or starts dropping significantly. So we won't be chasing the greens just yet. To be honest, since I'm home so little during the day, and he can be so variable from day to day, I'd be nervous about trying to get him into those significantly lower numbers until he's a bit more stable.

From what you were all telling me a couple weeks ago, I understand that he'll probably stop dipping quite so strongly when he's starting from lower numbers, so the higher dose should be safe even if his pre-shot levels are closer to normal as well. If that's the case, I might get braver and nudge him down a bit more. Of course, we still have to get there :rolleyes:
 
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jmalasiuk said:
he'll probably stop dipping quite so strongly when he's starting from lower numbers, so the higher dose should be safe even if his pre-shot levels are closer to normal as well.
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True!! When they start in the 400's, there's a long way to fall, but when they start lower, like the 100's, they generally just go down a little

We do recommend that the first time you shoot a Pre-shot under 150, you have someone here watching out for you. As you get more and more confident and see how Tonka responds to both food and insulin, you'll gradually work down to where you'll shoot anything above 50 (but that's only after collecting more data)

If you do get a Pre-shot of 150, best thing to do is "stall", don't feed, and post for help. Have someone here that's able to watch out for Tonka throughout the cycle. We all make a "promise" that if we agree to watch out for someone, we don't leave them until it's absolutely safe....Or if we have to leave, we find someone else to take over so you're never alone

Looking good Tonka! That yellow PS is much nicer than that icky red one this morning!
 
Sadly, he's decided that he missed the bright red colours. Back up to 22.6 (407) only 3 hours after his evening shot, and didn't even eat as much as usual. Also noticed that the litter boxes are full today, in spite of the fact that he and Teeger seem to be back to drinking their usual shared cup of water a day right now. Not sure where that all came from. Better add some more water to his food, I guess. Sigh. Oh well, a couple days and he should be coming back down, if he's following his usual pattern.
 
Those blue numbers are still very new to Mr. Liver, so I'm not shocked that he's bouncing tonight

As he spends more time there, he'll bounce less high and clear them faster...and he cleared this morning's bounce nicely, so hopefully he'll continue!

The nice thing about a bounce at PM+3?.....Permission to SLEEP!
 
jmalasiuk said:
I heard back from the vet a few minutes ago as well. She's really happy with the levels he's hitting at 2.5 units (sent her his spreadsheet this morning as more info to go with his blood work) and wants to keep him at that dose for a while, unless his levels go way up or starts dropping significantly. So we won't be chasing the greens just yet. To be honest, since I'm home so little during the day, and he can be so variable from day to day, I'd be nervous about trying to get him into those significantly lower numbers until he's a bit more stable.
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Most vets aren't comfortable with green nadirs, as they aren't used to having clients who home test. My vet thought we'd found our magic does at mid blue. It does depend on what your goal is with Tonka, regulation or remission. Either is fine here and we'll support what you want to do. If you are interested in the possibility of remission, you may have to up again by .25U, but not until after we've seen what Tonka can do for 8-10 cycles at this dose. A bit more insulin also helps reduce how much they bounce. For now sleep, and paws crossed he comes back to blues again tomorrow.
 
I'd love to get him into remission, but I'd settle for better regulation. It'll depend on how quickly it could happen. If he's still requiring insulin come spring when I have to start being away from home for extended periods for field work, it'll be safer to have him in the blues since his sitter is only here twice a day and isn't comfortable with testing him.
 
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