? 12/20 Max AMPS 353 +4 367 PMPS 338

[Rick Max’s dad]

Hi, I just have a question. My cat Max's dose started at 2 and went to 2.5 then he had a couple low nadir's which brought him back to 2. Last week I put him back up to 2.25 and he has been extremely flat for several weeks. In the next day or so I will have to increase back to 2.5 if he continues. I'm just wondering if it's normal for them to have such a flat curve and do they normally bounce around on the dose like that. I was hopeful the way he was going he might end up in remission. He's been on insulin about two months now.

Thanks for your help.

 

[Wendy&Neko]

Flat and high numbers is not a good thing. That typically means "not enough insulin". You want to get him regulated in flat but mostly blue and greens. Regulation is a prerequisite to remission, so focus on that target first. Today is day 7 on this dose. Any chance of a curve soon? It's also be a really good idea to get into the habit of getting a before bed test every night. Cats like going lower at night. My cat once spend months going low at night and earning reductions, and bouncing during the day. If I hadn't tested at night, I would have though she needed increases instead of reductions. Plus it's quote common that cats insulin needs change and you have to play around with dosing up and down.

Got snow in your part of town? It's coming down thickly here.

The link to your last post here, for continuity: https://felinediabetes.com/FDMB/threads/11-29-max-amps-464-4-365-8-265-pmps-356-10-398.239347/

 

[Rick Max’s dad]

Thanks for the reply yes we got a fair bit, had some big branches come down in the front yard. Been busy the last few days but I updated his spreadsheet. I've increased his dose and updated his spreadsheet for the last few days. The first day after the increase he looked good now he's going really high again. I just switch vials of insulin. The first vial I got from the vet ran out and now I'm starting a new vial from the pharmacy near me. Is there any chance of variation between vials? I'll do another full curve in a few days.

 

[Wendy&Neko]

Is there any chance of variation between vials?

Absolutely possible. We recommend not getting vials from the vet. Besides being more costly from the vet, it could be older depending on how often they sell vials.

Are you familiar with term bouncing? From the New to the Group Sticky Note:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

I think what you are seeing with those higher numbers yesterday and today is bouncing. Which begs the question, when did he go lower to cause the bounce. I see no tests after PMPS on the 24th and his bounce really started on the 25th. So I suspect he went lower on the night of the 24th. Many cats go lower at night, which is why we strongly recommend getting before bed tests. Plus you had started a new vial that morning, and if it was stronger than the old one, he might have caused lower numbers on the 24th. The good news is tht higher numbers from bounces will go away an hopefully by or before the day after tomorrow if you count six cycles from the possible low the night of the 24th.

Also, did you give insulin this morning? There is nothing in the units column for the AM. Missing a dose will also cause higher numbers.