3/28 Rusty #2 AMPS 589; +3 662; +7 519; +9 556; PMPS 487

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I haven't visited you guys before - welcome, Rusty #2!!! It's definitely possible that he bounced. You may have answered this before - are you able to get at least one nighttime test? One right before you turn in? Evening tests will definitely help fill in the gap in information, since a lot can happen during the overnight hours.

Have a great day, guys!
 
Amy&TrixieCat said:
I haven't visited you guys before - welcome, Rusty #2!!! It's definitely possible that he bounced. You may have answered this before - are you able to get at least one nighttime test? One right before you turn in? Evening tests will definitely help fill in the gap in information, since a lot can happen during the overnight hours.

Have a great day, guys!
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Hello and thank you! :) I updated my AMPS number because I accidentally typed a 4 instead of the horrid 5. Normally I'm not really able to do any more PM tests because I leave shortly after giving him his PM shot (he's a shelter cat where I work). However, I'm truly thinking about setting up camp in his enclosure for at least part of an evening. I just don't want to do that during a bounce. Last nights PMPS made me think he was coming out of his current bounce and might have been a good night to do that.

I'm envisioning a reclining camping chair, a blanket, and Netflix on my phone, lol.
 
Hi Mandi,
I hope someone with more experience with ketones, DKA, etc. will take a look at Rusty #2's spreadsheet. It can take up to 72 hours (6 cycles) to clear a bounce. By my count you are now on cycle 5 at this dose (bouncing since the low numbers on March 25th). Let's see what happens after the evening cycle tonight. If he is still high tomorrow morning, you might go back up to 5 units, but I would like it if one of the experienced dosing advisors confirms this (@Wendy&Neko, @Sienne and Gabby (GA) , @Marje and Gracie , @Tricia Cinco(GA) & Harvey . One thing to remember about Lantus is that it is a "depot" insulin. It can take up to a week to build the depot when Lantus is first begun. Every time you change the dose, the depot has to re-calibrate so that it corresponds to the amount of insulin you are giving. This recalibration can take a couple of cycles.
Are you sure that your AT meter and strips are properly coordinated? Perhaps you should get another meter for confirmation (a human meter with much less costly strips, such as the Walmart Relion Confirm is a good choice; at ADW the Arkray Glucocard 01 meter kit is a good buy (free kit + 100 strips). Relion Confirm is Walmart's branding of the Arkray Glucocard 01 meter. The meter and strips are the same. ) If the shelter knows how much cheaper strips are for human meters, they probably wouldn't mind switching from the AT. Just a thought. The AT reads higher than human meters, so you would have to take this into consideration when looking at Rusty's numbers.

I admire your dedication to Rusty. I hope you find a good lounge chair!

Hang in there!
Ella & Rusty
 
I have been silently following Rusty's progress. You have already received some wonderful information and help. The only thing I wanted to add in was whether it would be possible to somehow get a mid cycle test in the evening. This would tell whether the high numbers today are from a need for more insulin OR whether Rusty dropped into much lower numbers during the night and is bouncing.

If you look at March 23 his AMPS was 342 but his nadir went down to 89, which caused much higher numbers the next day. Whether this is what is happening today or not is impossible to say without the evening nadir. I know that your situation is much different than most CGs but if there is some way to get mid cycle evening tests that could give a clearer picture.

:bighug: :bighug: :bighug:
 
Ugh on the numbers today. :( It does look like a bounce day today, though it's hard to tell cause he has the dry food. Any different food last night/today than the day before? If you do give fluids today, I'd give it several hours before the PM shot. It's also possible fluids made him came down last night. Today is cycle 6 after the 62, so he should be coming off the bounce from that by now.

Paws crossed he slides down the rest of the day.
 
Ella & Rusty & Stu(GA) said:
Hi Mandi,
I hope someone with more experience with ketones, DKA, etc. will take a look at Rusty #2's spreadsheet. It can take up to 72 hours (6 cycles) to clear a bounce. By my count you are now on cycle 5 at this dose (bouncing since the low numbers on March 25th). Let's see what happens after the evening cycle tonight. If he is still high tomorrow morning, you might go back up to 5 units, but I would like it if one of the experienced dosing advisors confirms this (@Wendy&Neko, @Sienne and Gabby (GA) , @Marje and Gracie , @Tricia Cinco(GA) & Harvey . One thing to remember about Lantus is that it is a "depot" insulin. It can take up to a week to build the depot when Lantus is first begun. Every time you change the dose, the depot has to re-calibrate so that it corresponds to the amount of insulin you are giving. This recalibration can take a couple of cycles.
Are you sure that your AT meter and strips are properly coordinated? Perhaps you should get another meter for confirmation (a human meter with much less costly strips, such as the Walmart Relion Confirm is a good choice; at ADW the Arkray Glucocard 01 meter kit is a good buy (free kit + 100 strips). Relion Confirm is Walmart's branding of the Arkray Glucocard 01 meter. The meter and strips are the same. ) If the shelter knows how much cheaper strips are for human meters, they probably wouldn't mind switching from the AT. Just a thought. The AT reads higher than human meters, so you would have to take this into consideration when looking at Rusty's numbers.

I admire your dedication to Rusty. I hope you find a good lounge chair!

Hang in there!
Ella & Rusty
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Thanks Ella :) The strips are coordinated and also tested using the control solution. Fortunately, we get a shelter discount straight from Zoetis to where we get a pretty good discount on the test strips ($30 a bottle).

Tuxedo Mom said:
I have been silently following Rusty's progress. You have already received some wonderful information and help. The only thing I wanted to add in was whether it would be possible to somehow get a mid cycle test in the evening. This would tell whether the high numbers today are from a need for more insulin OR whether Rusty dropped into much lower numbers during the night and is bouncing.

If you look at March 23 his AMPS was 342 but his nadir went down to 89, which caused much higher numbers the next day. Whether this is what is happening today or not is impossible to say without the evening nadir. I know that your situation is much different than most CGs but if there is some way to get mid cycle evening tests that could give a clearer picture.

:bighug: :bighug: :bighug:
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Something is telling me he went low last night and we are now on cycle one of a new bounce. I thought the same thing you mentioned...about his previous 342 putting him into the greens and I have a feeling that's what happened last night. He might have dropped even lower due to the fluids. This is so frustrating! :( Ketones were negative this morning and he's acting normal. I'll get another ketone test today and although he's still high, his current number is lower than his AMPS and +3, so that's something I guess. I'm willing to have a partial slumber party with him (staying at the shelter until 11pm or so) but I want to make it count and make sure I'm not doing it while he's still bouncing. I guess I'll do it when his PMPS becomes lower than usual.

Wendy&Neko said:
Ugh on the numbers today. :( It does look like a bounce day today, though it's hard to tell cause he has the dry food. Any different food last night/today than the day before? If you do give fluids today, I'd give it several hours before the PM shot. It's also possible fluids made him came down last night. Today is cycle 6 after the 62, so he should be coming off the bounce from that by now.

Paws crossed he slides down the rest of the day.
Click to expand...

Same food. What do you think of my hypothesis above? Being back into the 600's feels like a fresh bounce, as his numbers yesterday had fallen to consistent 400's. Does one bounce change in severity as it's waning or does it constantly go up and down?
 
SantaCruzSPCA said:
Thanks Ella :) The strips are coordinated and also tested using the control solution. Fortunately, we get a shelter discount straight from Zoetis to where we get a pretty good discount on the test strips ($30 a bottle).



Something is telling me he went low last night and we are now on cycle one of a new bounce. I thought the same thing you mentioned...about his previous 342 putting him into the greens and I have a feeling that's what happened last night. He might have dropped even lower due to the fluids. This is so frustrating! :( Ketones were negative this morning and he's acting normal. I'll get another ketone test today and although he's still high, his current number is lower than his AMPS and +3, so that's something I guess. I'm willing to have a partial slumber party with him (staying at the shelter until 11pm or so) but I want to make it count and make sure I'm not doing it while he's still bouncing. I guess I'll do it when his PMPS becomes lower than usual.



Same food. What do you think of my hypothesis above? Being back into the 600's feels like a fresh bounce, as his numbers yesterday had fallen to consistent 400's. Does one bounce change in severity as it's waning or does it constantly go up and down?
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I think he's still feeling the reverberations from the lime green a few days ago. That low can leave him extra sensitive to insulin and the dose was lowered only a small amount, essentially giving 4.5 u (with the residual 5 u depot still in play to some extent) to an "overly responsive" cat. That could have set up the extreme bouncing cycles.
 
Kris & Teasel said:
I think he's still feeling the reverberations from the lime green a few days ago. That low can leave him extra sensitive to insulin and the dose was lowered only a small amount, essentially giving 4.5 u (with the residual 5 u depot still in play to some extent) to an "overly responsive" cat. That could have set up the extreme bouncing cycles.
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I'm at a loss of what to do. :(
 
SantaCruzSPCA said:
I'm at a loss of what to do. :(
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I know exactly how you feel. My guy is very bouncy and there's not much I can do to control it. You've just completed the 6th cycle at 4.5 u and 5 of those look like bounce cycles. They often come down after 6 cycles or so but that's not carved in stone. If you could stay late one evening soon to get a BG at +3 or+4 it might give you some useful data.

My opinion is that bouncy cats will bounce as high and as long as they choose. They're erratic in their responses to begin with and very sensitive to change - eg. that lime green. All the interventions that help less bouncy cats like steering with food, etc. are less effective in bouncers.

The best we can do with a bouncer is monitor for urine ketones, watch their clinical signs, work toward whatever seems to be the good dose at that point in time and let go of trying to control it. You need to step back a little and allow ...
 
Kris & Teasel said:
I know exactly how you feel. My guy is very bouncy and there's not much I can do to control it. You've just completed the 6th cycle at 4.5 u and 5 of those look like bounce cycles. They often come down after 6 cycles or so but that's not carved in stone. If you could stay late one evening soon to get a BG at +3 or+4 it might give you some useful data.

My opinion is that bouncy cats will bounce as high and as long as they choose. They're erratic in their responses to begin with and very sensitive to change - eg. that lime green. All the interventions that help less bouncy cats like steering with food, etc. are less effective in bouncers.

The best we can do with a bouncer is monitor for urine ketones, watch their clinical signs, work toward whatever seems to be the good dose at that point in time and let go of trying to control it. You need to step back a little and allow ...
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Thanks for that. I know I need to chill out on him. My husband is like "what is up with this sudden cat obsession." I just know that we absolutely cannot afford another DKA and I would hate to have to be forced to euthanize him after all of this. :( But you're right, all we can do is all we can do. I think as soon as I start to see his sugars come down, I'll plan to get some evening numbers and go from there.
 
How far do you live from the shelter? If it's not too far, just going back there to get a +4 or +5 might work. Or you could go back for a +3 with your chair and phone and stay to get another couple of tests. I also am all admiration for all you are doing for Rusty. What a blessed cat he is to have you in his corner. :bighug:
 
Phoebes said:
I second that God bless you and your dedication!!
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I am thirding this. God Bless you for all you are doing for Rusty. I admire you, and I want you to have good Karma, and get Rusty regulated and into a good loving home. :cat:
Maybe keeping the chair, a blankie and pillow, and something to good to read in your car is a good idea.. I hope your husband is very understanding and supportive :bighug:
 
SantaCruzSPCA said:
My husband is like "what is up with this sudden cat obsession."
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Welcome to the world of fellow crazy cat ladies and guys. :)

It's possible today was a bit of a bounce. Note that cats can also go low from dropping faster, as well as going lower than they are used to. Fluids might be doing that to him. Are you doing fluids on one side and shot on the other? Both yesterday and today fluids seem to be bringing him down. Or it's coincidence. :cat:
 
Wendy&Neko said:
Welcome to the world of fellow crazy cat ladies and guys. :)

It's possible today was a bit of a bounce. Note that cats can also go low from dropping faster, as well as going lower than they are used to. Fluids might be doing that to him. Are you doing fluids on one side and shot on the other? Both yesterday and today fluids seem to be bringing him down. Or it's coincidence. :cat:
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Thanks, I'm new to that world! I've always considered myself a dog person and have actually never owned a cat! And even with dogs I don't obsess quite this much. However, I do find animal medicine very interesting and I love learning about it.

It does seem like the fluids are dropping him. Since I only get a +1 or +2 reading after fluids I'm never certain how low they are taking him. I am doing fluids on one side and the shot on the other. Last night I did the insulin shot like you suggested, behind the opposite shoulder and down a little. I'm wondering if tonight's the night I try to come back at +3 and hopefully get a +4 and +5? I also don't want the numbers I'm going off of to be fluid influenced. I hadn't been able to do a ketone test since early this morning so I did the fluids before I knew his evening test would be neg. Maybe I'll hold off on fluids anymore unless his ketone level starts to rise.

Also, he's a little more unsteady on his feet than normal, especially when jumping from level to level. I'm wondering if a little nueropathy isn't kicking in. That can be common with sustained high numbers right?
 
I also wonder if giving fluids mid day might be a better option, so it's effects are in and out by shot time. Not sure, just worth an experiment.

If you do come back at +3, you may not need to stay, unless he's dropped a lot at that time.

As for neuropathy, not all cats get it. Neko was in sustained high numbers since she had high dose conditions and it took a while to get up to to a good dose. Zobaline is a solution people suggest.
 
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