5/15, Tux, PMPS=284 +3=333???

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Julie & Tux

Julie & Tux

Member Since 2014
Tux's +3 is higher than most of the other readings I have taken. He is only his 5th cycle of insulin. Should I be concerned or is this a normal adjustment?
 
Hi Julie,

I'm glad to see you've made your way over here! Here's the link to your post on the Main board: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=118817. We try to link to our previous posts so that people have an easy way to click back to see what was discussed the previous day/post.

What you're seeing with that +3 is what is called "bouncing." When a cat gets into numbers he hasn't seen for a while (like the blues yesterday), the liver panics and releases extra glucose. That keeps the numbers high. Bounces can take up to 6 cycles to clear (72 hours). During that time, we just have to wait it out.

EDITED TO ADD:

One of our members - another "Julie" - wrote this about bouncing. I thought it might be helpful for you!

BOUNCING

Here is an example of a bounce from someone's recent condo:

you can spot a bounce this way (this only took me 6 months to learn and a bunch of people explaining it! i'm a slow learner!)

yesterday morning you had a 215 - then it went 235, 271, 270, and then 308 this morning - basically straight up. no curve. and then look backwards in the ss and the night before was that sweet little 148 12 hours earlier.

if you imagine that night-time cycle, starting at 148, kitty probably went down in a nice little curve, hitting something under 100 mid-cycle. that lower-than-usual number would've shocked her body. they get accustomed to whatever range they're in, and any sudden dip lower can set this off.

"HELLO WE"VE GOT A 911 HERE- KITTY'S GOING DOWN!" yells Mr. Liver. Fortunately, mr liver has a storehouse of counter-regulatory hormones and stored sugar (in case kitty needs a little nommy sweets in the middle of the night) and when Kitty gets into a range of numbers lower than usual, Mr. Liver lets loose with the sugar and the hormones and sends Kitty on a rocket to the moon. this is the cat's body's protective mechanism to keep the cat from becoming hypoglycemic. unfortunately, mr liver doesn't seem to know that anything above 40ish isn't a crisis and it will do this regardless of the range of numbers, even at 200 if the cat has become accustomed to 400.

A second cause of a bounce is if a cat drops very quickly. 100 points in an hour, for example, regardless of the range the BG number is in, can cause a bounce as well.

So, what to do now? don't increase the dose because of these higher numbers. once this bounce clears, which can take up to 3 days of high numbers if mr liver is super-active, then if you had increased the dose, it would be too high. you are entering the phase of treatment that we say requires "Patience Pants." when you think you're seeing a bounce, you have to wait it out, then you can see what the dose really does. You will know the bounce has cleared when you start seeing numbers you were seeing before - like that 148 again.
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Hi Julie and Tux

Welcome to Lantus Land! We're glad you found us and you've done a great job with hometesting and getting that spreadsheet going.

Before I make too many comments, I was wondering what Tuxs ideal weight is? Is he underweight now and if so, how much does he weigh? I'm assuming because he's a Norwegian Forest Cat, that he's uh "sizeable" :lol: I'd just want to be sure his starting dose is appropriate because sometimes vets start the dose a little higher then we would in using a tight regulation protocol.

I would encourage you to read all the Stickys at the top of this forum and to ask questions. We are a warm family group and everyone is anxious to help out. You can usually find someone online most hours of the day and night.
 
Welcome to Lantus Land Julie and extra sweet Tux!

You're in the best place you never wanted to be here and will find lots of others here that can help guide you in learning the steps of the "sugardance"

I agree with Shelly too. This looks like a bounce to me too. Bounces are frustrating, but all part of the dance and all we can do is wait them out. They can take up to 72 hours to clear.

I agree with Marje too! We usually start at 1 unit twice a day and go up slowly until we find the "best dose" for each cat, but this is also based on their ideal weight. Those Norwegian Forest cats can be on the "hefty" side....LOL

If you can give us what Tux's "ideal" weight is, we'd know better if the 2 units was the best starting dose for him

Again, welcome to the family! Ask all the questions you can think of and we'll be happy to do our best to answer them!
 
Thanks all! I looked around at other spreadsheets last night to see if others had experienced this with their cats and what the numbers looked like afterwards. "Bouncing" makes sense. Tux is currently underweight at 11lbs 2 oz. Ideally he would be 13-14lbs. I read the stickies at the top, a ton of great info! From what I read and if my memory isn't off, he would have been started with 1.5 units based on the ideal weight measurement.
 
Hi, Julie and welcome to Lantus Land.

My civvie, Gizmo is a Wegie, too. Aren't they a wonderful breed? Gizmo is a bit younger than Tux and a true character!!

Chris & China said:
I agree with Marje too! We usually start at 1 unit twice a day and go up slowly until we find the "best dose" for each cat, but this is also based on their ideal weight.
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Actually, for a cat just starting on insulin, we base initial dose on a formula that was developed by Jacqui Rand, DVM -- one of the authors of the Tight Regulation Protocol. (Initial dose = 0.25 x ideal weight in kilograms). "We" don't usually start cats at 1.0u unless that's what the formula dictates. Whether your kitty is underweight of if you're switching from a different insulin can effect the usual starting dose. Marje was asking about Tux's weight so we could see how close your vet started the initial dose to the dose recommended based on the TR protocol.

I noticed that Deb/Wink suggested a raw food diet. If that's something you're interested in investigating, Dr. Lisa's recipe is great. When I was feeding raw, I used a pre-mix so I didn't have to track down all of the ingredients. TC Feline is what I used. There is a link to US retailers in the "shop online" section of their webpage.
 
If he's underweight, we would want to dose based on that, so we'd start probably at 1.25

From the protocol:

Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
the formula is 0.25 unit per kg of the cat's ideal weight

if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight

So 11.2lbs = 5.1kg x .25 = 1.25 units

I think it would be perfectly fine for you to drop back to 1 unit and work your way up too. It's always safer to start low and go up slowly... letting the numbers guide you when to increase.

Since he's new to Lantus, he's still "filling the depot" (which takes about 5-7 days) and then you'll start to see how the dose really does on Tux. Dose is always based on the nadir (the lowest point in the cycle) and since he's been on the low carb food, even his pre-shots are looking much better, so I think it'd be a good idea to drop back to 1 or 1.25 and see how he does.

You can always go up if it's not enough once the depot is full

Hopefully some of the other most experienced eyes will come along soon to give their opinion too.
 
I'm glad you suggested the pre-mix and appreciate the link. When reading over the recipe yesterday I noticed there were a few "random" ingredients I'd have to track down.
 
Hi! I'm the "other" julie! Welcome to Lantus/Lev Land!

What do the numbers in Tux's spreadsheet in the notes column mean? The ones that say "BG@1731?" Is that the time of day the blood test was taken?

You've done a super job of getting going with the low carb food, hometesting, spreadsheet going, etc. And now you've found the spot to get advice. We'll be glad to help you learn how to interpret the blood sugar numbers and how to make decisions on dosing safely to get Tux back into as good of health as possible. Newly diagnosed cats do have a good chance at remission if they get tightly regulated as soon as safely possible.

I think the 2.0u is an ok dose to start with. Weight-based it's a little bit high, but if he's been diabetic since March his body has had time to get used to high numbers. It often takes a little bit more insulin to overcome the Glucose Toxicity that develops when they've gotten used to that high range. It's not something to get worried about - it's common - it just helps you understand why it's important to try to get them back into normal non-diabetic cat blood sugar ranges (50-120) as quickly as is safe. The protocol is designed to do that.

Everyone giving insulin should have a hypo kit available - do you have some kind of high carbs - Karo, maple syrup, honey, or gravy from a high carb cat food (not sure about the grain issue with that) available? Most people keep a container of 50 strips set aside in reserve for the time the cat gets low numbers and it's at night, stores are closed, and your regular supply of strips is low. You don't want to only have 2 strips left when you're faced with low numbers! Here's one list Hypo Toolkit - we never suggest dry food anymore, so i don't think that's an essential. This post on Shooting and Handling Low Numbers has 3 sections - one on becoming "data ready" to be able to shoot lower numbers, another on how to make a decision when faced with a low preshot number, and a third section on how to treat low numbers. That is a long post, but we encourage people to print it out and have it handy, just in case you need it when the board is down or no one is online.

Not to overwhelm you with too much - i'll stop there! There are no dumb questions - we've all been in your shoes and we understand how overwhelming this can be. So please ask whatever you want and we'll give you ideas, tips or explanations on things that have worked for other kitties and their people.

Glad to have you here! julie
 
Yes, the notes column reflect when the BGs were taken. I have a Hypokit ready to go :) I've been trying to read everything and process it but there is so much!
 
There is a ton to learn! We joke that it's like taking a college crash course in Feline Diabetes and ya gotta learn it all fairly quickly. Fortunately, no one expects you to get it all right away and people will keep repeating themselves to help you learn what you need. So just keep asking. Even finding information can be difficult, although this board has most of it really well-organized.
 
"We" don't usually start cats at 1.0u unless that's what the formula dictates.
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Sienne beat me to it :lol: :lol: :lol: I do agree he "should" have been started at 1.25u but I also agree with Julie/Punkin that we should let this dose ride a bit.
 
:-D I had the lid open to make sure it dried and in he jumped! It was the perfect napping/stalking spot apparently LOL He is a very cheeky Wegie!
 
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