10/3 Atlas AMPs 365

[Beth & Atlas]

Good and Happy Sunday morning...

Two pot coffee morning here and I'm still pouring for anyone who would like a cup!

Yesterdays Condo: viewtopic.php?f=9&t=26492


Everyone fed and all three snuggled down into pillows and bankies this morning. Rain & 49F and no heat on in the house yet...

Atlas still a bit high and most likely still in rebound from two days of hypos. I finally had the courage though to up him to what should have been his correct dose reduction. It looks to me he is still insulin sensitive and is even bouncing from yellow numbers.

SS is highlighted and counting down the rebound hours.

Question:

I am sort of feeling like the terms Rebound and Bounce are not quite interchangeable.

Bounce: generally describing a panicky liver as defined in the Tilly protocol resulting in no dose change.

VS.

Rebound: which is what I feel like I'm really dealing with from true hypo numbers, generally last more than 24 hours or even longer than 72 hours. And result in a dose reduction.

 

[Sienne and Gabby (GA)]

I have a couple of thoughts...

First, I went back to your condo from 9/29 and 9/30. You didn't note that Atlas had any symptoms of hypo. It's not uncommon for kitties on Lantus to have low numbers and be asymptomatic for "hypo." Unless there are symptoms present, it's not really hypo. There are actually some OTJ kitties whose numbers run in the 30s and 40s without any insulin. At this point, there's no way of knowing if Atlas is one of those kitties. Not that I'd encourage having him surf in that range, my point is just that providing he's not experiencing symptoms of hypo, then it's just low numbers.

From my way of thinking, I don't see the distinction between a bounce and rebound. The only reason that numbers will relatively rapidly rise back up is because the liver is reacting by releasing glycogen (stored glucose) and counterregulatory hormones. A bounce or rebound do not initiate a dose change. It's the drop into lower numbers that triggers a dose reduction. In fact, we do not increase doses until any bounce/rebound clears. Also, keep in mind that any drop in numbers can cause BG to skyrocket. It all depends on what range your cat is used to spending time in and how fast a drop may occur. A cat can bounce on numbers that drop into the blues or even the yellows if this is a big change from where the cat's pre-diagnosis levels have been. (I hope I haven't confused you!)

 

[Beth & Atlas]

I have a couple of thoughts...

First, I went back to your condo from 9/29 and 9/30. You didn't note that Atlas had any symptoms of hypo. It's not uncommon for kitties on Lantus to have low numbers and be asymptomatic for "hypo." Unless there are symptoms present, it's not really hypo. (I hope I haven't confused you!)

Sienne, not to totally disagree with you, but Atlas is infamous for symptomless hypos even when he was on Humilin N. The first time he "hypo'd" on me for Humilin N, he had absolutely no symptoms. I discussed this with the Vet at the time it happened. He said since Atlas is such a laid back kind of cat...it isn't unusual for no symptoms until he'd be seizuring out and dead. That's your criteria for my Atlas? I can't accept that or the example you give and then so eloquently take back. My manual for my meter states that a LO reading is below 20...since he didn't have outward symptoms...that is not a "true hypo?"

Atlas is not a cat off insulin, he is a cat that is insulin dependent and the example you give is a false and misleading assumption.

Second, even the HYPO stickie describes this symptomless type event near the end.

Just because a cat doesn't show symptoms doesn't mean they are not hypo. They just can't talk to tell you...hey I'm dizzy, hey I'm not feeling so good right now, hey I think I'm dropping too fast! They could very well be like my Atlas and just lay down and sleep.

Saying that, is like saying just because a cat doesn't yowl in pain means it's not in pain.

C'mon Sienne I know and trust your advice vastly better than what I just read.

PS edit: if you read the condo from the LO day...he did actually get aggressive with me. You wanted a symptom.

 

[Sienne and Gabby (GA)]

You're right -- ECID. My only point was that many cats will run in lower numbers and be asymptomatic. You're there with your cat and know his behavior first hand. All I can go by is the info in your condo or on your SS. There was some possibility raised that the LO reading may have been a meter error -- either way he was in lower ranges and didn't need to be in those ranges.

In general, and this may not apply to Atlas, I think it's helpful to distinguish between a hypo event and low numbers. For some cats, being in the 40s may involve symptoms and be considered "hypo" and I'm pretty sure we had a recent FD who was initially experiencing lethargy if his numbers were in the 70s or 80s. This doesn't apply to all cats, though. A different cat may need to be in the 30s or the 20s to have the same symptoms -- or not. By definition, from Wikipedia, since the brain effects of hypoglycemia, termed neuroglycopenia, determine whether a given low glucose is a "problem," most doctors use the term hypoglycemia only when a moderately low glucose level is accompanied by symptoms or brain effects. (I would also be remiss if I didn't point out that the article is focusing on hypoglycemia as a stand alone condition vs. concentrating on it as a factor in diabetes management.)

My primary point in response to your initial post was in differentiating between bouncing and rebound.

 

[Beth & Atlas]

In those treated for diabetes a diagnosis of hypoglycemia can be made based on the presence of a low blood sugar alone.[4] Otherwise Whipple's triad is required which include symptoms consistent with hypoglycemia, a low blood sugar, and resolution of these symptoms once the blood sugar improves.[4]