12/29 - Leo - High Bounces?

[Susan Shropshire]

I am seeing some great numbers overnight at this new dose but then it seems a really high bounce the next morning. The last 2 nights we had lower blues and even a green but then low 400s the next mornings.

Is this bounces from the lower overnight numbers? Could this dose be too high?

I saw a mid-blue the last day of the 8.5 dose but went ahead and increased since I've been told I hold doses too long. That was 12 cycles at the 8.5 due to the holidays and not wanting to increase on Christmas. He has been at the 9 unit dose for 6 cycles now. I am seeing great numbers at night but after that high number at the AMPS he stays kind've high during the day.
@Wendy&Neko

 

[Katherine&Ruby]

Hi Susan, hopefully someone else will come around to confirm but I would increase to 9.5 tomorrow if you don't see any greens today. The idea is to increase 6 cycles after the last green to be certain that you're not jumping the gun.

 

[tiffmaxee]

He is bouncing from blue or green but I don’t think his dose is too high.

 

[tiffmaxee]

Hi Susan, hopefully someone else will come around to confirm but I would increase to 9.5 tomorrow if you don't see any greens today. The idea is to increase 6 cycles after the last green to be certain that you're not jumping the gun.

With the first green on this dose I would wait 10 cycles before an increase.

 

[Susan Shropshire]

With the first green on this dose I would wait 10 cycles before an increase.

I agree, I definitely don't want to increase at this point. Today will be 8 cycles, if I am still seeing low blues would you continue to hold passed 10 cycles? I am using an AlphaTrak 2 meter so my #s will be a little bit higher. I am planning on transitioning to the ReLion Premier at the first of the year. I though that would be a good time to transition at the start of a new spreadsheet.

Also, is it 10 cycles from the cycle that had the green OR 10 cycles from the start of the new dose? So 10 cycles from the new dose would be 12/31 but 10 cycles from the green would be 1/1/2022.

I have found with Leo in the past, it takes a couple of days for him to adjust to a new dose. He usually goes higher the first 2 days and then comes down a little. I was shocked at the low numbers and even a green on the first night at the new dose.

I am just glad that we are finally starting to see those low numbers!!! YEA!!! @Wendy&Neko

 

[tiffmaxee]

I might hold even longer as you are seeing nice numbers. I’d see how he looks after 10 cycles and evaluate. I also noted you are using an AT. Let’s see what Wendy thinks. I’m glad you will switch meters as it makes things easier plus a lot cheaper unless you have pet insurance paying.

 

[Susan Shropshire]

I might hold even longer as you are seeing nice numbers. I’d see how he looks after 10 cycles and evaluate. I also noted you are using an AT. Let’s see what Wendy thinks. I’m glad you will switch meters as it makes things easier plus a lot cheaper unless you have pet insurance paying.

I am so happy we are finally seeing low numbers. That is what I have been waiting on to switch meters as well. I read up a little and I was seeing at higher numbers the Relion wasn’t as reliable but at the lower numbers it was much better. I am going to keep Alphatrak strips to do checks if needed and hopefully we will keep these low numbers.

 

[Wendy&Neko]

It's great that you finally saw Leo's first green number in a long time. We hold doses with green nadirs for 10 cycles. Which means an increase on the 31st.

I would caution against holding a dose too long, just because you see one high number under 100. Leo has some type of insulin resistance going on, because his dose is as high as it is. We don't know whether it's acromegaly or insulin auto antibodies. My Neko had both. She saw her first green at 3.5 units, but the resistance mean that greens kept going away. I nicknamed it "the dose going stale". So I'd have to keep increasing for another brief glimpse of green. Sometimes it would take a couple increases to see it again. That's the nature of resistance. Eventually she's start putting a few hours in a row of greens. It wasn't until 8.75 units that she finally earned a reduction.

As for the bounces, they don't tell you anything about the dose. All they tell you is that his body is not used to greens, or even low blues. They are annoying to you, not so much to him. It's a very normal part of the process.

 

[Susan Shropshire]

It's great that you finally saw Leo's first green number in a long time. We hold doses with green nadirs for 10 cycles. Which means an increase on the 31st.

I would caution against holding a dose too long, just because you see one high number under 100. Leo has some type of insulin resistance going on, because his dose is as high as it is. We don't know whether it's acromegaly or insulin auto antibodies. My Neko had both. She saw her first green at 3.5 units, but the resistance mean that greens kept going away. I nicknamed it "the dose going stale". So I'd have to keep increasing for another brief glimpse of green. Sometimes it would take a couple increases to see it again. That's the nature of resistance. Eventually she's start putting a few hours in a row of greens. It wasn't until 8.75 units that she finally earned a reduction.

As for the bounces, they don't tell you anything about the dose. All they tell you is that his body is not used to greens, or even low blues. They are annoying to you, not so much to him. It's a very normal part of the process.

With the insulin auto antibodies, if I remember from previous post on the forum, is something that at a point can be overcome, is that correct? That at a point the dose will overcome it and then after a bit at the lower numbers, his numbers would start to fall and I would start to reduce his dose.

 

[Wendy&Neko]

The antibodies are supposed to self limiting, around a year time frame. For Neko it was about 9 months and corresponded with her SRT. It is good to know if you are dealing with antibodies (we have a few cats with just that), as we'd tweak our dosing suggestions a bit. Meaning slightly on the aggressive side on increases and more cautious on doing decreases if the timing is right.

 

[Susan Shropshire]

The antibodies are supposed to self limiting, around a year time frame. For Neko it was about 9 months and corresponded with her SRT. It is good to know if you are dealing with antibodies (we have a few cats with just that), as we'd tweak our dosing suggestions a bit. Meaning slightly on the aggressive side on increases and more cautious on doing decreases if the timing is right.

Is that one year from diagnosis? I’m not sure what SRT is?

 

[Wendy&Neko]

Is that one year from diagnosis?

Bit of a complicated answer. Theoretically a year from when the antibodies begin. They are a reaction to injected insulin so yes a year from starting insulin therapy. But the antibodies don't always start right away. No one really understands how this works, been very little research on them. An example of a complicated case is Oberon, who was on insulin, went OTJ, then fell out of remission in July 2020. He had the IAA diagnosis in October 2020. So that's over a year from that diagnosis, and two years from his original diabetes diagnosis. We had another cat Doodles, who was well on his way to remission, tiny doses and all green. Then he got a heart condition and somewhere in there the IAA started up and he ended up in double digits insulin doses.

I’m not sure what SRT is?

Stereotactic radiation therapy - a treatment for acromegaly. We have two cats here who had SRT recently, Max and Eddie.

 

[Susan Shropshire]

Bit of a complicated answer. Theoretically a year from when the antibodies begin. They are a reaction to injected insulin so yes a year from starting insulin therapy. But the antibodies don't always start right away. No one really understands how this works, been very little research on them. An example of a complicated case is Oberon, who was on insulin, went OTJ, then fell out of remission in July 2020. He had the IAA diagnosis in October 2020. So that's over a year from that diagnosis, and two years from his original diabetes diagnosis. We had another cat Doodles, who was well on his way to remission, tiny doses and all green. Then he got a heart condition and somewhere in there the IAA started up and he ended up in double digits insulin doses.

Stereotactic radiation therapy - a treatment for acromegaly. We have two cats here who had SRT recently, Max and Eddie.

Thank you for the info. I’m just really glad I am seeing blues and that one green. I would love to start seeing yellows, blues and and a few greens. No more reds and pinks!