2/7 - Sami - PMBG 171; +12.25 147; +13 88 - SKIPPED

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Tina & Sammy

Tina & Sammy

Member Since 2010
Good morning all,

Yesterday's condo

@Wendy&Neko Thanks for the explanation about long term diabetic.

@Chris & China We both learned something

@Marje and Gracie So lets take Sami's action last night. She dropped from 402 to 266 in a matter of an hour after fluids. Then she pretty much stayed stable all through the night and into the morning, but now at +3.5 she has spiked again. I don't understand how she can stay stable that long and then all of a sudden spike up unless she went too low and her body is responding in kind. On the other hand on 2/6 where she was under 100 and then slowly rose over a 12 hour period that to me seems more like a legitimate bounce than going rom 203 to 327 this morning in about an hour an a half.

I am going to test again very shortly and probably give her the fluids early to hopefully slow down any additional climb.

Depending on how her numbers look later this afternoon and at PMPS I think I might want to reduce her to 1.75 or even 1.5 to see how she does. If she is going too low and spiking back up this is never going to get her regulated. At least if I back off I can always increase again if it appears that we need to do so.

I don't mean any disrespect to any of you who have given me advice to hold the dose, I am just trying to learn all the stuff and do what is best for us. And maybe we jumped up to 2 units too quickly.
 
Okay, I just took another reading and she was at 301. So right now it doesn't appear that she is on the climb like she was the night before. I will test again in an hour or so and see where she is.
 
I do not see any place where she had the time to go low and spike back up.

Quite often, a kitty will start a bounce, numbers will go up, they will wobble a bit, they might come down a tad and then flatten out in yellow (or sometimes blue) for several hours, then spike, then clear the bounce. The spike is called the high before the break. You will see a perfect example of this on Gracie's SS where she started a bounce in the 2/1 pm cycle and gave me a high before a break on 2/2 a.m. cycle and was in the 40s that night. The 301 for Sami tells me she might be starting to break the bounce.

By reducing the dose, you are doing what we call a rebound check. The only time I think a rebound check is worthwhile is when a vet has started a cat on way too high of a dose and/or increased by too much too fast. You followed the protocol and it's not possible to overdose a kitty if you follow the protocol. Doing a rebound check can put her in high, flat numbers again.

Having said all that, I respect the caregiver's decision on dosing. We are here to support you and the decisions you make. We aren't here to chastise you for doing what you think is best for your kitty.
 
I couldn't agree more with Marje. Bounces don't just occur due to dropping "too low." Low is a relative term. What kind of numbers is your cat used to spending time in. For a cat that's been sitting in red and black numbers, 300s could be "low" for that cat. Bounces can happen if your cat drops into below 50s or into a range that their body isn't accustomed to. A bounce can happen if there's a fast drop in numbers, as well.

In Sami's case, she's used to spending time in the 300s - 400s. The drop into blues or greens is likely to result in a bounce.

As Marje said, what we've seen here repeatedly, is when someone opts to reduce the dose as a means of avoiding a bounce usually results in the cat sitting in high numbers, losing time with regard to getting the numbers back into a better range, and the risk of developing glucose toxicity.

As Marje noted, it's your call.
 
Sorry I thought I posted this earlier.

@Marje and Gracie You don't think it is possible that Sami dropped close to 200 points from +2 to +3.5 today and then spiked back up? She has a tendency to drop big and quick. Plus, we did the fast track from 1.5 to 2.0 and I am just wondering if I should have stayed at 1.5 for two more cycles, or only gone up to 1.75 unit instead of jumping to 2.0. I do agree that she needed a bit of a kick start and the 2.0 units seem to have given her that. But I am still really concerned that she is dropping fast and quick and then spiking. I thought I was doing enough checks to make sure that wasn't happening. It is all so confusing.

Yes, the doctor thanks she is having a Somogyi affect, which is why she is encouraging me to lower the dose.

I guess the fact that I am on a time crunch is stressing me out, and I do understand that I can't make it happen I just have to follow the protocol. I guess the next time she start to drop into the GREEN I just need to monitor more closely and see if she drops below 50 to earn a decrease. And yes, I know she really wouldn't earn that decrease until she fell below 40, but I am not sure I am comfortable with that.
 
You don't think it is possible that Sami dropped close to 200 points from +2 to +3.5 today
Click to expand...

I think I am not understanding your question. She was 203 at +2 and 327 at +3.5. I don't see how she could have dropped 200 mg/dL anywhere in there or even from AMPS. Or from last night. I do see she dropped last night from 402 to 266 in an hour and that could trigger a bounce in a kitty.

As I said, most vets don't see the number of SSs that we do. Smogyi, in theory, occurs as a result of a chronic overdose. Not only do I not think Sami is experiencing Somogyi, I don't think it exists in cats. From Roomp/Rand's Management of Diabetic Cats with Long Acting Insulin:
Insulin-induced rebound hyperglycemia (Somogyi effect)

An evaluation of the prevalence of the Somogyi effect in a cohort of 55 cats undergoing intensive blood glucose control with glargine showed that blood glucose curves that were consistent with insulin-induced rebound hyperglycemia were very rare despite the frequent occurrence of biochemical hyperglycemia.
The fluctuations of blood glucose concentration that were commonly observed in the first weeks, and more rarely months, following the initiation of treatment with glargine, and which might be mistaken for the Somogyi effect, generally resolved with time using consistent dosing.
The dose of glargine or detemir should be reduced if the cat develops asymptomatic or clinical hypoglycemia but not when the blood glucose concentration is high and poorly responsive to insulin.
Click to expand...


The bold is mine.

Also, from Tilly's webpage on Tight Regulation with lantus or levemir for diabetic cats:
Be aware that experimental studies in human diabetics over the last 15-20 have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia.
Click to expand...
 
@Marje and Gracie Thank you so much for this information.

So even though Sami dropped 136 points in an hour last night, you don't think it is possible that she dropped into the danger zone between +2 and +3.5 this morning. If she dropped 136 points in an hour last night don't you think it would be possible for her to drop more than 136 points in an hour and a half? I do understand that the fluids last night might have been part of why she dropped so quickly last night.

I gave fluids at +7 this afternoon and she didn't experience the same dropping effect this afternoon. And why might she stay consistently in the YELLOW for 12 hours before she bounced? Where as on 2/5 she went into the GREEN, numbers she hasn't seen for awhile and then started climbing right afterwards. I am trying to understand why both of these are the same sort of reaction, but have different onsets.
 
PM shot is in about an hour, I still concerned that we might have increased too quickly from 1.5 to 2.o units, I know we followed the fast track protocol, but I am still wondering if it might be beneficial to Sami to drop back to 1.75 unit to see if perhaps she is getting too much insulin. Or if we should stay the course and stick with 2.0 units for now.
 
Cats don't react the exact same way to the exact same circumstances every time...If they did, they wouldn't be the wonderful, mysterious creatures we all know and love!

Right now, there's just not enough data on Sami (this time around) yet to be able to say "Yes, the fluids are effecting the numbers" or much of anything else for sure!

What you can see is that Sami dropped into blue on 2/4...then bounced to pink. The next cycle, she started in pink and only came down into yellow before going back to pink at PMPS ...she was still "bouncing" through that cycle and just didn't clear it very much. That night, you gave fluids and she dropped into greens....was it because of the fluids? Was it because she REALLY "cleared the bounce"?...was it a mix of both? Or was it just because she's a cat and they don't like to be predictable? We'll never really know.

From those greens, she "bounced" again...Her liver said "Wait a minute! I'm not used to living in these lower numbers!! I'd better panic and flood her body with stored sugar and hormones so I can be where I've been used to living!" (This can happen from going TOO low, dropping too fast, or just dropping into numbers the cats body isn't used to...there are several reasons for bouncing)

This time she bounced all the way to red!...and now, she's slowly working her way down again, but it can take up to 6 cycles for that bounce to fully clear. Just because they cleared a bounce in 2 cycles last time doesn't mean they'll do it again. You have to just hold the course and keep following the protocol.

The fact is she's still running higher than you want her, so if she were mine, I'd continue the 2 units, but if you choose to drop her back to 1.75, that's your decision. You hold the syringe and we'll support whatever decision you make.

The good news? Well...if 2 units got her into blues and greens once, hopefully it'll do it again!! And the more time she spends in those lower numbers, the more her body will get used to it...and the more likely she is to be able to go into remission again.
 
Tina

My number one priority for the cats here is safety. If I think a dose is too much or a caregiver is not able to monitor like they should, I wouldn't suggest the dose. If the numbers look like a reduction is needed or a good dose has been bypassed, I will gladly suggest a reduction.

Can I predict what she will do? I can't. Even as much as I know my own cat, she throws an occasional 3o something at me. But because I'm testing and I know how to bring up her numbers, I can keep her safe.

You've had several of us say we don't think she came down low and that we think you should hold the 2u. If you choose to shoot 1.75u, you don't have to convince us. She is your cat.
 
Sami took another nose dive, and I haven't even given her the PM shot yet. She dropped from 326 to 171 in two hours. I was pretty sure that I was going to drop to 1.75 units with tonights dose, but now I am wondering if I need to drop back to 1.5 unit.

I am going to stall for a bit to see if she is still dropping. I might take a BCS tonight and just go with the 1.5 unit and the see where she is in the morning, maybe then I can bump it back to 1.75 tomorrow morning. I really hate doing this because I am afraid that it might derail her progress, but I know I definitely want to pull back from the 2.0 units.
 
I'm betting the fluids is what's bringing his numbers down more than too much insulin, but if we're going to guess that's what's going on, then it could be an active night

Of course there's no way to know for sure what's going to happen (Isn't this fun?) but no matter what, as long as you're able to test and have the supplies you need, you're going to be in control

I can understand why you'd want to reduce, but she was getting fluids when she was on 1.5 too wasn't she?

If you choose to reduce tonight, I wouldn't go to 1.5...I'd try the 1.75 and see how it goes
 
I am still stalling, I was thinking about moving her shot time up a bit anyway so this is a great reason to stall and move the shot time. I have not given her food yet.

Oh yeah, so fun. LOL! One of these nights I will get some sleep.
 
That was my point....if she was getting fluids when she was on 1.5 and was still pink, 1.5 doesn't look like it's going to be enough
 
I know this might not be the right decision, but I think I am going to skip the shot tonight. If I see that she is on the rise by +4 I might give her a bit more fluids to see if that will stabilize her for the night and then see where she is in the morning. If nothing else it will empty her depot a bit.
 
Lantus & Lev work best at lower numbers. Just a quick read for you about shooting a dropping number, written by Libby, one of our moderators and most ezperienced members.

Scroll down and look at post #6 there. If she were mine, I'd go for it with the full dose and celebrate the opportunity to lower her whole range of blood sugar.
 
I just saw your last post, Tina, about skipping. One thing that we see over and over here by folks that are new is that when the cat finally starts getting better blood sugar tests, the CGs back away from the dose. Remember - the goal of tight regulation is having all of the blood sugar tests between 50-120. Not having them dip their toe in there once a week, but 24/7 staying under 120. Like the others, i respect your decision but am thinking you might not have enough information, so wanted to add this in.

Good luck!

And in case it's helpful, here's another explanation about shooting low. Scroll down to post #16.
 
@julie & punkin (ga) Yes, I do realize that it is important to get her back under 100 on a regular basis before stopping insulin and more than likely I will give Sami insulin tomorrow morning. I will test her again in another hour after she has eaten and she experiences the spike due to food. I just felt like I had to try this to see what happens. I know it could possibly be the totally wrong thing to do, but for my own piece of mine I needed to try.
 
i totally get that! sometimes you just have to try out things and see what happens.

In the meantime, I hope you'll read the links I gave you. Once you've had a low preshot happen, chances are very high that you'll have another opportunity before long.

Since she's still dropping, I'd continue testing tonight. Did you go ahead and feed her? There's no reason not to since you've made the decision to skip.
 
@julie & punkin (ga) Yes, I did feed her right after the reading of 88. I will continue to test her tonight. I will probably try to get a test at about 2 hours after she ate to see how much she is spiking up. Then I will set the feeder for some small meals throughout the night and test again at the new normal shot time to see if she is going to need insulin.

I have already read the links, and will probably need to read them again just to be sure that I understand everything. I know that no two cats are alike in how the respond to insulin but at least it gives us a jumping off point.

Thanks again for all the advice. I really don't know where I would be if I didn't have the help and support of everyone here. @Marje and Gracie , @Wendy&Neko , @Chris & China , @Sienne and Gabby
 
it takes a while to learn all of this. And when i say "a while" i mean a long time, LOL. I know a lot more now than I did when punkin was alive, and he lived 2.5 years with his acro/diabetes. i thought i knew plenty then, but it seems like there's always more to learn.

it'll get easier!
 
Hi Tina - quite the day for you and Sami. :bighug:I was away all day and just seeing how your day all played out now. I know each cat is different, but a couple things from my own personal experience. Cats can bounce differently from a rapid drop than they do in a reaction to a number lower than they are used to. Neko will often have a cycle of flattish blue after an event that triggers a bounce, similarly to the way Sami surfed low yellows last night, then she's start the "real" bounce a cycle later. Neko's highest numbers of a bounce are often three cycles after the event that caused the event. It took me the longest time to figure that out and it was very confusing at first. We've also noticed that a lot of kitties coming back out of remission react differently that they did the first time on insulin. So not only is ECID, but the same cat can be different a second time. :rolleyes:

I see progress in Sami at this dose - that green today (probably partly because her supper was delayed), means that she's getting faster at getting over bounces, at least the one's due to fast drops.

Good luck with whatever you decide to do tomorrow morning.
 
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