Re: 8/4 Charlie AMPS 434 +4 389
Good morning, Jill!
Here's
your Bounce-Question condo as well. Normally we try not to open more than one condo per dat per cat because that way info can get lost and some important things can fall through the cracks, ok? (If you're happy to do so, you can always still delete that condo, especially if no one has yet replied in it. I have reposted you questions from it here. You can add "Need Bounce Info" to your subject line and add a question mark icon, to make sure it gets noticed. Otherwise, just keep the 1 condo/cat/day basis in mind for the future, k?)
Jill's Question regarding BOUNCES:
What's the rule of thumb for deciding if a cat is continually bouncing? Or if they just need more insulin?
My kitty is still on antibiotics through tomorrow, but she has had a day with green numbers just 2 days ago. Still, lots of red over the past week.
Guess we need to wait it out a bit, but is there any general rule for this?
You're asking about "continual bouncing". I wonder whether you might mean a phenomenon called 'Somogyi Rebound' (chronic/continual rebound)? There are mentions of and discussions about it around FDMB and beyond. It's a controversial issue because, as Sienne pointed out in a previous thread I cam across, since the original research into this 'phenomenon' (which was done in the 1930s) there has not been any scientific data to replicate those early findings or prove that it exists. A couple of links are the one on
Wikipedia about Chronic Somogyi Rebound and the one on
Pet Diabetes on Wikia about Somogyi Rebound that you can read for starters if you like.
Remember that Charlie was only diagnosed at the end of June, a little over a month ago, and has only been on Lantus since late July. This is early days. Seeing high numbers and seeing bounces is frustrating and worrying for the bean, especially one that's new to the sugardance, we all know and understand that. And it's good that you're venting and letting people know you're frustrated. But try, try, try to be patient. The ABs (antibiotics) Charlie is still on may well be affecting how her SS is looking - meds can and often do affect BGs. It's good she'll be done with them so soon, so that ABs will fall away as a factor.You yourself have put your finger on one thing that jumps out from your SS: the day in green numbers she had just a few cycles ago. It's the lowest she'd gone on Lantus since the 27th of July, and it makes sense for a kitty with a liver that's still a bit "panicky" (not used to healthy green BGs) to bounce and take a little while to clear the bounce-related glucagon and hormones out of her system.
Just as it is with dose reductions, there are certain SS-trends and situations that will (normally) dictate a dose increase. Still, things here work along
guidelines rather than hard-and-fast rules, because ECID - every cay *and* every caregiver is different. Even within one and the same cat, the "rules" and needed reactions/decisions can change depending on specific circumstances! That's why it's important to be patient and take the time to assess a cat's progress carefully and critically, and keep on and keep on collecting data and poring over spreadsheets to make decisions. In the
TR Protocol Sticky, you'll remember, the guidelines advise:
"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles). Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...). Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Now, I'd encourage you to
go back to your SS, with these guidelines fresh in your mind. Think about them when you look at the numbers you see. Look at some other newbie-spreadsheets, even, if you feel up to it. Starting dose (with the exceptiojn of very first shot of Lantus) for Charlie was 0.5u. After only three days (once the shed had begun to build the way it ought to), you saw green! Even green close to a drop-below-50... So, after the guideline-given "Hold initial dose for 5-7 days", Charlie's numbers showed, yes, a readiness to bounce, but ALSO, and this is just as important, repeated ventures into healthy numbers. Even now, to me, her SS does not show stagnation (when progress halts and a dosecrease becomes a likely option). As you say, just 2 days ago, you saw green.
To me, her SS says that Charlie needs some liver-training to help her not to panic and bounce off healthy numbers. But she IS getting those healthy numbers. Look at your SS, Please. Do you see what I mean? Does it make sense? Look at other newbie-SS, to get a sense of the way (dosing) decisions are made and in what kinds of situations.
This is my take on it. I know others will come and weigh in. Overall, remember: You're doing very well. You're a wonderful bean. You're doing the right things by reaching out, asking for feedback, expressing rather than bottling up frustration. You will keep seeing progress, I'm sure, if Charlie continues as she is and even improves. We're here for you.
I hope this helps.
Hugs!
Jane
