10/29 Jetta PMPS 328 +2 339

[Jacspets]

Yesterday Jetta 10/28
Happy Caturday!!! Jetta had a lovely blue surf last night, 196 at PM +2 and 124 at +5, but this morning I guess she's bouncing again. AND sometime between +5 and this morning she puked and never ate anything. Though she's eating fine now. It's rainy and dreary here in usually sunny FL, so I think this will be a great catch up day for naps, paperwork, and studying, or anything else that involves a blanket and the couch ;-)

Momma Feral is doing good, ate well overnight and is much more coherent today. But she's laying accross the side of the litter box, basically on her incision. I don't like that. I stuffed a medicated concoction of Tramadaol and antibiotics in her cage, so hopefully she'll benefit from the pain relief.

I have a few Questions on bouncing. I understand the boilogical process behind it, but I'm confused about how if affects our kitties. It seesm to me Jetta spends more time in bad numbers, labeled as bounces, than she does in good. Eventually will her liver stop causing them, or do we need to do something different, or need a different insulin, or what? I'm just confused on how upping Jetta's dose to get better numbers is really quantified since she's still as high (or higher) with bounces after being blue or green for a short time. I hope my questions make sense. I hate bounces!!!!

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

I have a few Questions on bouncing. I understand the boilogical process behind it, but I'm confused about how if affects our kitties. It seesm to me Jetta spends more time in bad numbers, labeled as bounces, than she does in good. Eventually will her liver stop causing them, or do we need to do something different, or need a different insulin, or what? I'm just confused on how upping Jetta's dose to get better numbers is really quantified since she's still as high (or higher) with bounces after being blue or green for a short time. I hope my questions make sense. I hate bounces!!!!

everyone hates bounces! :mrgreen:

eventually jetta's body will become used to being in lower numbers. the bounces will become shorter... and then they'll go away. one of the ways i've been able to eliminate bounces when i'm able to monitor closely is to pretty much shoot every 12 hours. a lower preshot number gives you an opportunity to pull the entire range down. however becoming data ready, knowing how "your" cat responds to insulin, and the ability to monitor closely are essential to shooting low to stay low.

this whole sugar dance is a gradual process and every kitty responds in their own time frame... often adding to our frustration.

hope this helps... have a good caturday!

 

[Linda for Weezer]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

No answers from me, but I will be interested to hear. It does seem like all the bouncing must be uncomfortable.

A glance out my window says your gray weather may be headed our way.

 

[Michelle & Jetson]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

Hi Jaclyn,

Thanks for asking the bounce question - I was wondering the same thing myself.

Glad to see Jetta is spending more time in blues and greens :smile:
Hope you enjoy your day!

 

[Jacspets]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

one of the ways i've been able to eliminate bounces when i'm able to monitor closely is to pretty much shoot every 12 hours. a lower preshot number gives you an opportunity to pull the entire range down. however becoming data ready, knowing how "your" cat responds to insulin, and the ability to monitor closely are essential to shooting low to stay low.

OK- so this brings me to another question. Jetta is famous for her fast HUGE drops. I know if I shoot her at 250 and she drops like a stone I can bring her up with gravy/Karo. But, can it still be managed the same way if I shoot at 100 and she dives? Basically I'm wondering if there's ever a point where you can't manage the numbers with food/sugar, as in is there a point where you can't counteract the insulin?

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

OK- so this brings me to another question. Jetta is famous for her fast HUGE drops. I know if I shoot her at 250 and she drops like a stone I can bring her up with gravy/Karo. But, can it still be managed the same way if I shoot at 100 and she dives? Basically I'm wondering if there's ever a point where you can't manage the numbers with food/suger, as in is there a point where you can't counteract the insulin?

you won't see the same drop when you shoot a low preshot number as you'll see when you shoot a high preshot number. we probably don't say that often enough... and should.

the key is to stay ahead of the numbers. anticipate where kitty is going. don't let the cat get ahead of you. if you monitor often (especially when shooting low ps numbers the first few times), you'll remain in control.



edited to add:
look at alex's 2009 ss. i purposely tested her a lot more than necessary to illustrate what to expect when shooting low to stay low.

 

[Eva & Butters]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

Good Morning, Jaclyn and Everyone ~

You've asked some very good questions, ones that many of us have been wondering about, too. Thanks for bringing those questions about bounces up for discussion. Our cat Butters is a diver and a bouncer the way Jetta is, so we're learning a lot from your spreadsheet, Jaclyn. We've gone down the dosing ladder, and we're heading back up now the way you are with Jetta. I do need to get Butters' spreadsheet up soon.

I've wondered sometimes if we're dealing with a lack of duration of the Lantus instead of bounces. Is there any way to tell the difference?

Enjoy the weekend,
Eva

 

[Anne & Zener GA]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

Thanks for asking about bounces, Jaclyn. We think that Zener's bounces are getting shorter. They used to be the full 6 cycles and are now 1 to 3 cycles. He doesn't seem to go as high as much but maybe we are just being optimistic about that.

Glad to hear the update on the mama kitty and that she's doing better today. Momma, please don't lie in the litter box! Enjoy your rainy Saturday.
Liz

 

[Jacspets]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

you won't see the same drop when you shoot a low preshot number as you'll see when you shoot a high preshot number. we probably don't say that often enough... and should. the key is to stay ahead of the numbers. anticipate where kitty is going. don't let the cat get ahead of you. if you monitor often (especially when shooting low ps numbers the first few times), you'll remain in control.

I'm really glad I stirred this pot this mornning!!! It's all Very Interesting. I don't know if I hadn't heard that before re: drops from lower numbers or if it was lost on me. That's a bit of a game changer. Of course, we've only had maybe 3 occassions to shoot low enough to scare me, so it may be a while before I get to test my faith in that statement :lol: :lol:

And I was actually wondering the same thing as Eva and Butters, especially given your comment Jill, of staying ahead of the cat. I've often wondered if any studies have been done on more frequent dosing? It seems that most cats here jump drastically from +9 to +12. I'd be interested in data about shooting every 10 versus 12. What would happen? I know an early shoot is like an increase, but is it really if the insulin is only acting on their numbers for 8 or 9 or 10 hours??

And I think like Liz, Jetta's bouces are clearing in about a day, my problem is she's bouncing every day, and high.

And one more Q Jill. Looking at Jetta's SS how much more often should I test? I feel like I test a lot, but lookig at your 09 SS (every hour!) is there specific gaps in Jetta's I should try to fill or just all around test more frequently?

ETA--- What about inconsistent kitties? Somedays (well nights mostly) Jetta jumps down, some days she doesn't. Today is a good example. History would've told me Jetta's +3 today should have been a lot higher than it was- not complaining about blue!!! - but it was a surprise. So wht about inconsistent kitties, or is the theory that she'll become more consistent with time?

 

[mybuddybinks]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

I used to panic about binks taking a plunge from a low number,
until one day it dawned on me that it just doesn't happen that way...
their little bodies are very much in control!

(probably took a lot longer to blossom in my swiss cheese brain than most others) :lol:

 

[julie & punkin (ga)]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

good questions here - i saw a discussion in the Think Tank some time ago about dosing Lantus 3x/day instead of 2x - but i think the outcome was that 2x is best. the action is likely longer than you think, probably depending on the size of the shed. i've skipped punkin's shots and not seen much difference in his numbers because of the size of the shed. obviously he's on a much higher dose than the non-acro kitty, but the point remains.

i thought the same thing you are thinking - if they drop 100 points at 250 preshot, then what if i shoot 150? the lower the number that you shoot the flatter the curve is. it's not the same game at all - and that's part of the benefit of lantus and part of the process. that's why people joke that you have to put on your BOS (B**** of steel) and shoot low. of course, then you have to test as well to see where that shot takes jetta.

 

[Marje and Gracie]

Re: 10/29 Jetta AMPS 392 +3 159 +5 249 ??s re: bounces

Great questions today, Jaclyn and glad Jill gave you her wonderful experience in the answers.

The question about inconsistency is a tough one. ECID. While Gracie was on lantus, she had alot of inconsistencies but we actually got to where we could see a pattern in them. One thing that helped her alot with the dives was getting on a feeding schedule where we loaded her up on her food early in the cycle and fed through onset. She still occasionally dove but not like before and not as fast. That's why testing is important for you and Jetta. The more data you get, the more you should be able to see her patterns and the less she should surprise you....altho it won't eliminate the surprises ;-) ;-) She very well might become more consistent....many cats have. oh that crystal ball!!

When Gracie was on lantus, Sienne recommended to us that we always get a +2 and we did so religiously as we could see a pattern develop in her. It would have been interesting to see what Jetta's +2 was today....if you could see her headed down, you could have fed a little to slow her down. Any time we get a 50 mg/dl drop from one hour to the next in Gracie, we try to slow her down a little bit. If she's already low, we might switch from 4% to 8%; if she's high, we might just give her a little extra 4% or some 6%. I prefer slowing her down a bit as opposed to having to fight to get her up with karo. Sometimes we over control it but ..lessons learned.

One other quick thing....on a kitty that dives, as Jill said, they obviously don't have as big a drop at lower numbers as at higher numbers. So a kitty might drop 80 or 100 mg/dl/hour if she was at 300 but she won't do that at lower numbers. BUT....if your cat is at 90 and only drops 35 or 50 mg/dl/hour.....you still need to be on your toes. So don't think that just because they are below 100, they will only drop 10 mg/dl an hour. KWIM??

One thing I see on Jetta's SS is that you are not monitoring at night when she gets into green past her onset. On 10/24, you gave her FF Gravy Lovers at +2.75. You got a food spike and two rising numbers. But she very likely may have come down after the HC ran out. I don't trust food spike numbers and always get back up and get another test or two AFTER 2-3 hours because I know if the HC wears off, you will get numbers coming down. ECID...but until you know for sure with Jetta, it's worth the loss of sleep. Definitely on 10/27, I would have gotten more tests....she was still dropping when you quit testing.

All a learning process and you are asking great questions and thinking about it so you're doing super.

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 +3 159 +5 249 ??s re: bounces

jaclyn, i have to go offline to take care of the kitty crew and do the whole dinner thing, but i'll be back later to to take a stab at your questions.

 

[Jacspets]

Re: 10/29 Jetta AMPS 392 +3 159 +5 249 ??s re: bounces

Thanks Marje for your reply and insight. On the testing- I Haven't been super inclined to test past +4 ish at night because of Jetta's nadir being typically here and gone by +4. Once she starts to rise (food or otherwise) I've never seen her come back down. But, I will heed your advice and do more night testing.

As for feeding, Jetta has food accessible almost 24 hours a day. She's a nibbler. Even when she's eating well, she only eats about 1/2 an ounce then comes back 30 minutes or so later for more. I'm not really sure I can do much with her feedings since she eats when she feels like eating and can't really be convinced to eat in different amounts or at different times than she wants to.

Anyway, I guess I'm just sharing more insight into Jetta and the bottom line remains that I need to test more so I will.

 

[Sienne and Gabby (GA)]

Re: 10/29 Jetta AMPS 392 +3 159 +5 249 ??s re: bounces

The question you asked about duration is complicated. One way to look at this is like an early shot and you need to remember that an early shot acts like a dose increase. There are times when shooting early makes sense. If numbers are consistently running high, an early shot may help to bring numbers down. Or, if you've stalled and are off schedule and by the next cycle or two, there's a bounce into high numbers, shooting early may help to offset the effect of the bounce and allow you to get back on schedule.

However, shooting early every cycle if this is an issue of duration is a strategy that can be challenging. On the one hand, there have been beans whose cats do not seem to get the duration from Lantus that most other cats do. Often, they are on a three time a day (every 8 hour) shot schedule. This is challenging for most people and their schedules. It's also not something to be undertaken until you are absolutely certain that your cat isn't getting the necessary duration.

Shooting early routinely (e.g., every 10 hours) is exhausting for the bean. It functionally means that you would need to be shooting around the clock. Again, this has been done but you have to have maximum flexibility with your schedule. It also means that you run the risk of too much overlap between cycles. This would be like using the shooting early = dose increase every cycle to the point where you might risk an overdose.

Jill has had a great deal more experience with these issues than I have. I hope she will be able to stop back and clarify (or correct) my post based on her experience.

 

[Marje and Gracie]

Re: 10/29 Jetta PMPS 328

Jaclyn: Thanks for clarifying Jetta's nadir. You do know her best. I just want to be sure you also know that nadirs can shift. Not saying Jetta's does or will but just that they "can".

I wonder IF a cat that doesn't seem to have enough duration and nadirs early is not getting enough insulin and needs a higher dose. That's a question for either Jill, Libby, or Sienne.

 

[Melissa & Tarragon]

Re: 10/29 Jetta PMPS 328

Good evening! Wow what great questions and answers today! Thank you all for the info. Even though we have been at this for 9 months or so, there is still so much to learn.

Have a wonderful weekend!!

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

I've wondered sometimes if we're dealing with a lack of duration of the Lantus instead of bounces.

bounces and a lack of duration are very different.

a bounce is what happens when a cat drops into lower numbers than it's body is used to. a cat can bounce from greens, blues, or even yellows if the cat has been running in higher numbers. think of a bounce as a reaction.

lack of duration is when the insulin peters out at around the same time in each cycle on a given dose.

once you get butters' spreadsheet up we can talk specifics...

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

And I was actually wondering the same thing as Eva and Butters, especially given your comment Jill, of staying ahead of the cat. I've often wondered if any studies have been done on more frequent dosing? It seems that most cats here jump drastically from +9 to +12. I'd be interested in data about shooting every 10 versus 12. What would happen? I know an early shoot is like an increase, but is it really if the insulin is only acting on their numbers for 8 or 9 or 10 hours??

as far as i know, there haven't been any studies done on dosing any more than twice a day.

it's rare that a cat has to be shot more than twice a day with lantus or levemir because of their long-lasting properties. however, there are exceptions to every rule. occasionally, we'll spot a kitty who we think would benefit from shooting TID (every 8 hours). we never jump right in and suggest shooting TID until we can see with utmost certainty that shooting twice a day just isn't working. a TID schedule is hard work... you could even say grueling. shooting TID does not fit in with most people's lifestyles.

the problem with shooting every 10 hours is because of the cumulative nature of lantus and levemir which can result in too much overlap. i mean, overlap is great, but too much overlap can put you in a bind when you're least expecting it. i've been working with lantus and lev for the last 5+ years and i have to say even i would not shoot every 10 hours. i work from home and i still couldn't be chained to my cat that many hours of the day & night in order to catch an unexpected drop to keep her safe.

And I think like Liz, Jetta's bouces are clearing in about a day, my problem is she's bouncing every day, and high.

from my perspective... the problem is you're equating bouncing as a problem.
until a cat is tightly/well regulated bouncing is normal. thank g_d kitty bounces! that means his body is doing exactly what it's supposed to be doing... Mr. Liver is on the job and working! this is a good thing. once Mr. Liver gets used to what it feels like to be in lower numbers he'll start relaxing a little. he won't become panicked when seeing those lower numbers. eventually, Mr. Liver relaxes enough to say,"hey, this isn't so bad. i kind of like feeling what it used to be like... before diabetes." that's when you'll see a lot less bouncing and eventually flat cycles.

And one more Q Jill. Looking at Jetta's SS how much more often should I test? I feel like I test a lot, but lookig at your 09 SS (every hour!) is there specific gaps in Jetta's I should try to fill or just all around test more frequently?

when alex went back on insulin in 2009 after almost three years at the Falls, i wanted to create a spreadsheet which could be used as a teaching tool to illustrate what happens when you shoot on low preshot numbers. that is the ONLY reason she was tested so often. i think you're doing an exemplary job of testing jetta. some +10s or +11s go a long way in providing information about where your preshot number is coming from.

ETA--- What about inconsistent kitties? Somedays (well nights mostly) Jetta jumps down, some days she doesn't. Today is a good example. History would've told me Jetta's +3 today should have been a lot higher than it was- not complaining about blue!!! - but it was a surprise. So wht about inconsistent kitties, or is the theory that she'll become more consistent with time?

most kitties become more consistent over time.


hope this helps...

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

I used to panic about binks taking a plunge from a low number,
until one day it dawned on me that it just doesn't happen that way...
their little bodies are very much in control!

i've always been more on guard to the possibility of a big drop from a higher number. the drops from a lower preshot number don't concern me as much.

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 ????s re: bounces

good questions here - i saw a discussion in the Think Tank some time ago about dosing Lantus 3x/day instead of 2x - but i think the outcome was that 2x is best. the action is likely longer than you think, probably depending on the size of the shed. i've skipped punkin's shots and not seen much difference in his numbers because of the size of the shed. obviously he's on a much higher dose than the non-acro kitty, but the point remains.

shooting twice a day is usually all that's necessary for most kitties. shooting TID is simply another option for caregivers if shooting BID isn't working due to a lack of duration.

i thought the same thing you are thinking - if they drop 100 points at 250 preshot, then what if i shoot 150? the lower the number that you shoot the flatter the curve is. it's not the same game at all - and that's part of the benefit of lantus and part of the process. that's why people joke that you have to put on your BOS (B**** of steel) and shoot low. of course, then you have to test as well to see where that shot takes jetta.

yes, we can't compare the drops when shooting high ps numbers versus shooting low ps numbers.
it's a difficult concept to grasp...

 

[Jacspets]

Thank you Jill- all VERY helpful.

And you hit the bounce nail perfectly on the head. I have been thinking of bounces as bad, I guess because of the numbers they create. But the way you explained makes sense. And, I will get some 10s and 11s now that I know they're also important. I'm glad to hear my testing so far has been good otherwise. Tonight is a perfect example of the inconsistency I meant. I NEVER expected Jetta to be running higher at +2 that at PS. I'm wondering if this will be like the few daytime cycles this week where she rose initially then came down late in the cycle. Weird, totally weird. So, I'm going to go to bed and when my bladder wakes me I'll test but I don't see a need for an alarm since she's so high now.

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 +3 159 +5 249 ??s re: bounces

The question about inconsistency is a tough one. ECID. While Gracie was on lantus, she had alot of inconsistencies but we actually got to where we could see a pattern in them. One thing that helped her alot with the dives was getting on a feeding schedule where we loaded her up on her food early in the cycle and fed through onset. She still occasionally dove but not like before and not as fast. That's why testing is important for you and Jetta. The more data you get, the more you should be able to see her patterns and the less she should surprise you....altho it won't eliminate the surprises ;-) ;-) She very well might become more consistent....many cats have. oh that crystal ball!!

good point, marje! eventually one does see patterns in cats who appear to be very inconsistent!

When Gracie was on lantus, Sienne recommended to us that we always get a +2 and we did so religiously as we could see a pattern develop in her. It would have been interesting to see what Jetta's +2 was today....if you could see her headed down, you could have fed a little to slow her down. Any time we get a 50 mg/dl drop from one hour to the next in Gracie, we try to slow her down a little bit. If she's already low, we might switch from 4% to 8%; if she's high, we might just give her a little extra 4% or some 6%. I prefer slowing her down a bit as opposed to having to fight to get her up with karo. Sometimes we over control it but ..lessons learned.

One other quick thing....on a kitty that dives, as Jill said, they obviously don't have as big a drop at lower numbers as at higher numbers. So a kitty might drop 80 or 100 mg/dl/hour if she was at 300 but she won't do that at lower numbers. BUT....if your cat is at 90 and only drops 35 or 50 mg/dl/hour.....you still need to be on your toes. So don't think that just because they are below 100, they will only drop 10 mg/dl an hour. KWIM??

i understand what you're saying marje (and agree), but i have a problem with thinking in terms of dropping "x" amount of points per hour. reason being... a kitty *can* drop "x" amount of points in one hour and then only drop 3 points over the next hour. sometimes you'll see a major drop and then a surf. in any case, it's a good idea to pay attention to any fast drop.

One thing I see on Jetta's SS is that you are not monitoring at night when she gets into green past her onset. On 10/24, you gave her FF Gravy Lovers at +2.75. You got a food spike and two rising numbers. But she very likely may have come down after the HC ran out. I don't trust food spike numbers and always get back up and get another test or two AFTER 2-3 hours because I know if the HC wears off, you will get numbers coming down. ECID...but until you know for sure with Jetta, it's worth the loss of sleep. Definitely on 10/27, I would have gotten more tests....she was still dropping when you quit testing.

all good points!

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 +3 159 +5 249 ??s re: bounces

As for feeding, Jetta has food accessible almost 24 hours a day. She's a nibbler. Even when she's eating well, she only eats about 1/2 an ounce then comes back 30 minutes or so later for more. I'm not really sure I can do much with her feedings since she eats when she feels like eating and can't really be convinced to eat in different amounts or at different times than she wants to.

free feeding is fine! i have a civvie who's a nibbler and in five years time i have not been able to get him on alex's feeding schedule.
it just is what it is...

 

[Jill & Alex (GA)]

Re: 10/29 Jetta AMPS 392 +3 159 +5 249 ??s re: bounces

Jill has had a great deal more experience with these issues than I have. I hope she will be able to stop back and clarify (or correct) my post based on her experience.

well, i'm back... and i've probably confused rather than clarified. :lol:
hope not...

 

[Jill & Alex (GA)]

Re: 10/29 Jetta PMPS 328

I wonder IF a cat that doesn't seem to have enough duration and nadirs early is not getting enough insulin and needs a higher dose. That's a question for either Jill, Libby, or Sienne.

i can't answer that without a spreadsheet in hand because sometimes an early drop is a clue that kitty will be looking for a reduction soon.
whenever i'm trying to figure out what's going on with any individual kitty i don't isolate the action seen in a particular cycle. a single cycle doesn't mean much to me at all. instead i look at what's happened... what has lead up to what is happening now. i look at what i call "waves of action". those waves of action tell me more than anything else...

 

[Jill & Alex (GA)]

Thank you Jill- all VERY helpful.

And you hit the bounce nail perfectly on the head. I have been thinking of bounces as bad, I guess because of the numbers they create. But the way you explained makes sense. And, I will get some 10s and 11s now that I know they're also important. I'm glad to hear my testing so far has been good otherwise. Tonight is a perfect example of the inconsistency I meant. I NEVER expected Jetta to be running higher at +2 that at PS. I'm wondering if this will be like the few daytime cycles this week where she rose initially then came down late in the cycle. Weird, totally weird. So, I'm going to go to bed and when my bladder wakes me I'll test but I don't see a need for an alarm since she's so high now.

happy to have helped!
ni-ni!



ps - sorry for cluttering up your condo today. just wanted to try to get all the questions covered...

 

[Jacspets]

Oh my goodness Jill! Did you really apologize for clutter?!??? I can't thank you enough. I was actually considering sticking a link to today's condo in my signature. So many good questions and thoughts from so many people (thank you Marje, Julie, Eva, Sienne) and so many things I will want to re-read again and again!

 

[mybuddybinks]

:lol: :lol: :lol: :lol: Oh, that Jill and her darned clutter!!!

BOOKMARKING THIS CONDO!

and deep appreciation to all of you for the info!

 

[Maresydotes]

I'm sorry that Jetta bounced, but that was one of the most interesting condos I have read! Great info......
Hope Jetta clears the bounce quickly!

 

[Anyname]

So, a cat could have high numbers for a while with dose increases achieving nothing but more high numbers? Is that possible? Could it take longer than 5 days to achieve results from an increase if bouncing is an issue?

 

[lovey11]

I am new to Lantus but I think that really could be the case if you are on a fast track and increasing after 6 cycles with a bouncy cat. If you keep increasing during the bounces, do you know if the dose was effective?