4/1/19 Jasper AMPS 362 / +5 309 / +8 375

[Jasper Blue and Jay]

I know it sounds weird to be happy about a 362 amps...but I am. Because it has now gone back DOWN to what was typical before we started insulin.

So I feel confident he is now out of the bounce, or at least out of it enough.

So we went with a .25 decrease this am to try to prevent another hypo/bounce situation.
Which also makes me feel safer about trying out a nighttime shot depending on his numbers today.

He was happy and playful last night and this am, back to like before we started the insulin which makes him just sit there staring into space wide-eyed like he's having hallucinations, or like he's stoned.

Now that I realize his nadir might be even later than the +7, cause we always feed him after that and it only goes up a little bit for +8/+9... I want to try to see if I can wait til after +8 to feed him today, to see what that number really is without food.

I'm thinking if he has a late nadir... that means the insulin is taking longer to clear his system... which makes me even gladder I stopped giving him insulin at night and going to sleep . Especially after reading that many cats go even lower at night than during the day.

Anyway... that's the plan. I'm sticking to it. I've put a lot of research, thought, and effort into this plan, so please don't try to convince me to increase the dosage, I really don't have the energy right now to keep explaining our health/schedule situation or why we need to start low and go slow, but that's what is right for us right now and that is what we're doing. I'll see what effect this has on him after a couple days before deciding if he needs more insulin.

Thanks again to every single one of you who have taken the time out of your own busy/stressful day to offer support and advice, I'd be a sobbing heap in the corner if it weren't for you all. It means the world to me that you care about Jasper and have given us so much support.

 

[Jasper Blue and Jay]

Ugh... he's stalking around looking for food at +6.25 and he ate not that long ago... wanted to hold out to +7 and +8 if those numbers were good to get a true +8 cause he always eats after +7 ...


I'm going to have to check him again...

 

[Jasper Blue and Jay]

So, the .25 or "drop" doesn't seem to be doing anything at all. Will still give a dose tonight and then depending on amps will probably do .5 in the am... I'll just have to keep testing his poor little ears around his nadir and NOT freak out and overdo honey/gravy food if he hits 53ish again... and just give him his regular food and test again first.




If he's as high at tomorrow's amps as he was today... going back up to .5 will make sense. Because a bounce/rebound/whatever will have had enough time to wear off.

If he's lower...lower enough to think that maybe a cumulative effect or longer duration than 12 hours happens with him and upping the dose might bring him too low again...I will do .25 again in the am.

I'm not sure yet what that magic number will be but we have a whole other cycle tonight to look at before then so we'll see.



Again, thanks for listening to me ramble... it helps me process it all if i write it out.


It's a marathon not a sprint... saw that on here... that's my mantra right now..

 

[Bellasmom]

Again you have to be consistent with the dosing, he needs .5 am and pm, please, he needs to get out of those pink numbers, I believe either around 200 or 250 it’s not doing as much harm to his body, @Marje and Gracie please verify and see if you agree with dosage I recommended, he needs insulin every 12 hrs

 

[Jasper Blue and Jay]

Bleh, I don't know if this is still the bounce or the lower dose or both... but these numbers make me sad.

Going to do the .25 tonight... so that will be the first time he's had a back to back dose of any dose since what I'm dramatically dubbing "the incident" when my partner and i discuss it lol

I don't think it will do much... though I practiced with used syringes and colored water to get a "fat .25" and think if numbers really do go lower at night...and I do manage a slightly bigger .25... maybe that will be something...

And then in the am he will have gotten two doses in a row... and the bounce will have to be gone by then...so we'll know better what we're dealing with in the am.

I don't know what to hope for in the am... I always hope he gets good safe numbers but at the same time... if he's "too low" for my neurotic brain I don't want to panic and give him only .25 again. I don't think I will... because today sucked and I don't want a repeat. But I'm getting ahead of myself... we'll see how he does tonight.

 

[Bellasmom]

Bleh, I don't know if this is still the bounce or the lower dose or both... but these numbers make me sad.

Going to do the .25 tonight... so that will be the first time he's had a back to back dose of any dose since what I'm dramatically dubbing "the incident" when my partner and i discuss it lol

I don't think it will do much... though I practiced with used syringes and colored water to get a "fat .25" and think if numbers really do go lower at night...and I do manage a slightly bigger .25... maybe that will be something...

And then in the am he will have gotten two doses in a row... and the bounce will have to be gone by then...so we'll know better what we're dealing with in the am.

I don't know what to hope for in the am... I always hope he gets good safe numbers but at the same time... if he's "too low" for my neurotic brain I don't want to panic and give him only .25 again. I don't think I will... because today sucked and I don't want a repeat. But I'm getting ahead of myself... we'll see how he does tonight.

It takes patience, not gonna happen over night, stay on dose for a bit before changing, bouncing sometimes doesn’t go away in 1 cycle, patience, we all are told we have to wear our,patient pants, before increasing or decreasing as the forum these guys are great, and I’m sooooooo happy your gonna give 2 shots a day cause ur not getting the full effect of the insulin by skipping unless the numbers are to low to shoot and he’s not near that

 

[Marje and Gracie]

I’m sorry I didn’t get a chance to further explain bouncing in the post I did today on yesterday’s thread. I was out running errands and just wanted to get some info to you.

Bouncing can occur when the BG drops quickly or goes lower than the cat’s liver is used to. That means a BG does not have to be in a hypoglycemic range to initiate a bounce. As an example, if the BG drops from 400 at AMPS to 200 by +2, it’s most likely going to trigger a bounce. In my years here and reading hundreds of SSs as well as my own kitty, it seems to me that harder bounces occur from those big dives. The second scenario is when the BG is lower than the body is used to. In this example, let’s say he always stayed above 400 for his BG and then one cycle, with a better dose, over the course of the cycle, he gradually drops to 200. That can trigger a bounce the same as if he’d dropped to 90.

A bounce is just a response by the liver and pancreas to bring the BG up quickly and it does this by releasing counterregulatory hormones and glucagon into the bloodstream driving the BG back up. As you’ve read, it can take six cycles to clear the bounce but I have see some cats who truly were overdosed and it took almost ten cycles.

While bouncing is quite normal and happens to cats where the dose might not yet be where it needs to be, it certainly can occur if the cat is overdosed because the lower numbers are foreign to the cat’s body. Because bouncing is so common, if we can tell that the cat is truly not overdosed, then we will recommend you try and ignore the bouncing and focus on the numbers when the bounce clears.

I’d like to show you two examples of real cats who were obviously overdosed:
Tucker: Tucker’s vet started him at a whopping 6u. While we rarely do “rebound checks” here, when a cat is started at 6u of insulin, we typically know that’s too much. The dose was reduced to 1u, but he dropped to 24 the cycle of the reduction and then he bounced really hard for eight cycles. At that time, since Chris wanted to switch to Lantus, we thought he should start at a “normal” dose but it became clear pretty fast that Tucker was done with insulin.

Teronto: started at 10u of Lantus!! This was one of the other times where the normal starting dose and the actual starting dose were so far apart that it screamed rebound hyperglycemia. Insulin was restarted at 1u and even that was too much for him and, like Tucker, he quickly went off the insulin but he bounced almost all the way.

These are just two extreme examples and they both involved overdoses from the beginning. I do want to stress that when the dose is started close to what a normal starting dose would be, and it’s raised slowly, it’s extremely unlikely the cat will be overdosed. Rebound checks are unnecessary. And some cats will bounce for years with great nadirs in between the bounces. We even had one Lantus cat who bounced horribly for over two years and then her liver just “snapped” and seemed to “get it”. She was off the juice in three weeks and remains there 8 years later.

I don’t want to try and convince you of anything but I do want to educate you so you can make the correct decisions or at least consider it before you decide.

I'm thinking if he has a late nadir... that means the insulin is taking longer to clear his system... which makes me even gladder I stopped giving him insulin at night and going to sleep . Especially after reading that many cats go even lower at night than during the day.

Some cats are just late nadir cats just as some are early nadir cats. We used to have one cat here on Lantus who always had his lowest BG at PS and his caregiver had to learn to shoot those lower numbers. That does indicate that he was getting decent duration out of his shots but, because he shot up after his shot, he wasn’t getting longer than the 12 hours Lantus can give. Jasper might be getting decent duration but you are stopping it cold in its tracks by feeding him so late in the cycle. I don’t know how many carbs you are giving him but when the numbers shoot up like they did on 3/29, 3/30, and 3/31, it’s a sign he’s lost duration. If you had given insulin in those evenings, you might have seen him come right back down into some decent numbers.

That means I don’t necessarily believe he was really doing that much bouncing; it looks mostly to me like loss of duration with a titch of bounce, potentially. You see that when he was getting 0.5u, he was coming back down after he onset. Also remember that PZ is not a depot insulin like Lantus or Levemir so without a shot, you are going to get very little residual action in the next cycle. As you have observed, the 0.25u just isn’t enough to get him where he needs to be.

Today looks like not enough insulin to me. It does not look like a bounce. High and flat is often indicative of not enough juice.

Lastly, because insulin syringes are so inaccurate and absorption can vary up to 50% from shot to shot, you can potentially get quite a bit of variation in dosing. While it is not required by any means at all, I did find, as have many others, that using calipers can at least take half of that (changes in absorption) out of the equation by giving more consistent dosing.

 

[Rachel]

I know the numbers aren't fun to see when they're high. Give it some time...consistency is key and over time, the numbers will get better. I know that 53 was low and scary...I would have felt the same way! But remember that insulin needs also change over time. Sometimes a cat will get into a lower number once on a dose, but that doesn't mean that dose will NEVER be right for them. You're testing more than enough to keep Jasper safe, and you're doing a great job taking care of him. Give it a bit of time, and we can help you get him into better numbers.