12/31 Furball AMPS=353 PMPS=340 Dose Question

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Re: 12/31 Furball AMPS=353

Morning guys sorry about the stinky pinky this morning! Patient pants are in order here lol. Hope you see some nice numbers soon! Have a great NYE
 
Re: 12/31 Furball AMPS=353

Morning Carla, sorry about the pink :sad:
Hope Furball comes down nicely, and yes, I've also heard something about patience pants :oops:

Have a great day & NYE.
 
Re: 12/31 Furball AMPS=353

Good morning! Well I'm sure Furball will find her way out of this bounce for you soon. It's great that she's feeling good and frisky :-D Hope things smooth out to the blues again for the New Year.
 
Re: 12/31 Furball AMPS=353

Morning Carla! We're right there with you on the stinky ol pinky this morning. BLECH! YUCK DARN!! Come on back down sweetie, please grab ollie on your way. It's good to hear she's happy and playing.. she's the happiest, purringest cat!! Happy New Years Eve. hugs and scritches to you xoxo mary and oliver
 
Re: 12/31 Furball AMPS=353

It looks to me like the reduction didn't hold. When that happens, you want to bring the dose back up to your last good dose as soon as you think the reduction didn't hold.
 
Re: 12/31 Furball AMPS=353 Bounce Question

How long can a bounce last? I thought I read somewhere that a bounce can last up to 72 hours, but that seems like a long time.

ETA: Sienne I don't feel like I have seen evidence the reduction didn't take yet. Looking at her SS, I realize it has only been 2 days since she gave me a low blue. I am trying to figure out if she is still bouncing now.
 
Re: 12/31 Furball AMPS=353 Bounce Question

Carla & Furball said:
ETA: Sienne I don't feel like I have seen evidence the reduction didn't take yet. Looking at her SS, I realize it has only been 2 days since she gave me a low blue. I am trying to figure out if she is still bouncing now.
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You have a week since the reduction with no green numbers and minimal blue. To my eyes, that's data that suggests the reduction didn't hold.

Even with SLGS, you really need to evaluate your doses sooner than your are. The downside of holding a dose as long as you have been holding some of your doses (e.g., over 35 cycles) is that it allows glucose toxicity to develop. This makes it much harder for the insulin to bring the numbers down and encourages bouncing since your cat's body adjusts to higher BG levels. When levels drop into even high blues, the result is bouncing. Looking at Furball's SS, you've seen green numbers on 10/30 and then the next time was 12/23. Most of the time, Furball is in at least yellow ranges. You want to try to keep him under renal threshold, which is somewhere in the low 200s.
 
Re: 12/31 Furball AMPS=353 Bounce Question

Morning Carla and Happy New Year's Eve. Sorry about the icky pink this morning and I hope that Furball comes down for you today. I hate those pinks!!!! We've had 2 days of those plus some high reds while Scratchie bounced. I'm hoping his has finally cleared. Good that Furball is happy and purring - Scratchie is more lethargic when he's in those numbers - sometimes not, but he does sleep a lot.

Good luck my dear and hope you have a nice New Year's Eve.

Jo
 
Re: 12/31 Furball AMPS=353 Bounce Question

I guess I am confused about when to make a dose change. I thought I was following the SLGS protocol by waiting a week between each curve or test that gave me a reduction. The 127 Furball had Saturday morning is within the range to hold the current dose for another week.

Also, I’m not sure I can tell the difference between a bounce and a dose reduction not holding. In looking back at Furball’s SS, it seems to take her about 3 days to clear a bounce.

It doesn’t really matter what dose I shot tonight because I smelled insulin. I’m sure I gave her a fur shot. I don’t know whether to increase tomorrow morning or not. I’m really confused right now.
 
Hi Carla, I can so understand your confusion... I feel that way too, quite often in fact. When I think I finally have something figured out, it seems that I was wrong ;-)

I am sorry about the fur shot, I hate it when I do that! It will be better in the morning. I can't give dosing advice, just wanted to send along some support. Hang in there. Hugs,
Kathie
 
Carla

It can be confusing and especially trying to read the SS and whether is is a bounce or a failed reduction.

From the SLGS protocol:

After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve (blood glucose tests every 2 hours, starting at shot time and continuing until the next shot). Follow the cat’s normal feeding schedule during the curve. The curve should be evaluated by someone experienced at interpreting feline blood glucose curves, in order to check for signs of rebound and other possible problems. If no rebound is present, follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):

a) If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
b) If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
c) If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.

Repeat the cycle of curving and waiting 1-2 weeks. As your cat’s blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don’t increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don’t be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat’s blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose

Once you can no longer increase the dose without the cat dropping below 90 mg/dl (5.0 mmol/L) at the lowest point, evaluate the duration of the insulin’s action. If your cat’s preshot blood glucose values are still consistently above 350 mg/dl (19.3 mmol/L), or if your cat’s blood glucose usually returns to preshot values more than an hour before the next shot is due, ask your vet about longer-duration insulins or possible adjustments to your cat’s food or feeding schedule.
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I agree with Sienne that you held the 1.25u dose too long. I think with Furball, it might be a good idea to just wait one week at a given dose before evaluating the dose because she is spending too much time above the renal threshold. As far as the current dose goes, you had a NS on the morning of 12/28 so you should start counting cycles over again starting with the PM cycle of 12/28 UNLESS you gave a fur shot tonight. If you actually did, you'll need to start the cycle count again. Whenever she misses a shot, the depot is drained. If you didn't give a fur shot tonight, I'd reevaluate her dose the evening of 1/3 and see where her nadirs are when she's clearing the bounces. If she continues her current pattern, I'd raise the dose because her nadirs are generally above 149 although she's had two that were between 90 and 149.

You should be doing a dose reevaluation every seven days regardless of whether she earns a reduction or not. That's why I think you held the 1.25u dose too long....you were waiting for a reduction but the SLGS protocol doesn't state that reevaluations should only be made after reductions.

It is sometimes hard to tell a bounce from a failed reduction. For those of us doing TR, if the bounce clears and kitty doesn't come back down into green, it's a failed reduction. I think for Furball, if the bounce clears and she doesn't come back down into the 90-149 range, you should consider it to be a failed reduction.

I hope that helps. Please let us know if you have questions or I've just caused more confusion.
 
Marje your information does help. I realize I held the 1.25 dose too long at the end of Nov. into Dec. But with the last increase I gave her, the next day she gave me the 43 and earned a reduction. That's confusing.

As far as counting cycles goes, I can't do a curve during the week because I work. That makes it difficult if I have to start over in the middle of a week. That's why I wait until the weekend to get extra readings in. I think this is causing a problem with me determining if Furball needs a dose increase because most of the time she seems to be bouncing on the weekends. I don't know what else I can do because I don't live close enough to work to get a mid day test and if I get off on my sleep I am really out of it at work for the rest of the week.

Just to be clear, if I gave a fur shot this evening, does that mean I should hold the dose in the morning?
 
I think what you were seeing when you increased her and then she gave you a 43 was she was clearing a bounce and then had a little extra insulin on board. Gracie does that to me and I typically don't reduce her (see 12/26 cycle). Kitties can clear bounces with a little extra enthusiasm ;-)

I understand about the curves and the weekend. So maybe leave her on one dose just a little longer to get you to a weekend and then every weekend, you can reevaluate her dose with a curve.

When I went back and looked through everything on SLGS, it doesn't talk about counting cycles nor does it talk about consecutive cycles like TR does. It makes sense to me that if you drain the depot, you should start the cycle count over.

However.....and I'm going to do a reversal here ;-) ....when I look at her SS overall at this dose, she's just doing so so. If you are off work the rest of the week, maybe take her up tomorrow and monitor and see what she does. If you have to work and you are worried about it, you could increase her Friday night and see how she does. We want to keep her safe in consideration of your work schedule. If you decide to hold off, I'd put a note on the SS that you want to do a dose increase but want to get her on a weekend so you can start doing curves on the weekends.
 
Rats on the fur shot. I find the dosing confusing, too, trying to evaluate when something is a bounce and when I should reduce or not. I can't advise, but it's good to read the conversations in your condo today about it. Good luck with whatever you decide, and Happy New Year!
 
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