9/13 Lucky AMPS 203

[Luckyducky]

Hi again everyone! Lucky's numbers really seem to be bouncing up and down the last 2 weeks, and I thought I should ask for some advice on addressing it. Here's a link to Lucky's Spreadsheet, and his numbers for yesterday to today:

Readings for 9/12~9/13
AMPS 283
+9 145
PMPS 150
+3 91
+9 98
AMPS 203
+4 351

Looking at his SS, he seems to have been jumping up and down in two-day periods for the past couple weeks, and I'm wondering if I should decrease the dose or wait it out. I've heard that constant bouncing can be a sign that the dose is too high, so I was thinking of dropping the dose from 2u bid to 1.5u bid and seeing what happens. I also wanted to mention that when Lucky was at 2.5u bid (about 2 weeks ago) he dropped as low as 26, which was alarming and also makes me think his dose may still be too high at 2u bid. Any advice and insight is, as always, very greatly appreciated.

 

[Angela & Blackie & 3 Others]

Re: 9/13 Lucky AMPS 203 Bouncing Advice?

Hi, please wait for an experienced person to help you with your dosing question. Also, please put "Question" in the beginning of your subject line, as well as click on the "?" so that they can find your condo quickly. All I can tell you about bouncing is that it does clear up, however, some cats may take longer than others to clear a bounce. ECID = every cat is different. I wish I could help you.

 

[Marje and Gracie]

Re: 9/13 Lucky AMPS 203 Bouncing Advice?

Hi Joe

I wouldn't decrease him unless he earns the reduction. Lucky just appears to be a bouncy kitty and he's likely bouncing off the greens last night. It would have been nice to see how low he actually went between those two 90s. One suggestion I'll make is if he is coming down, try to set your alarm and get up to test him to ensure you get two rising numbers. That way you can catch any low numbers.

I've heard that constant bouncing can be a sign that the dose is too high

Bouncing is caused by the release of counterregulatory hormones and glucagon by the liver in response to either rapid drops in BG or numbers that are lower than which the liver is accustomed. They don't have to be really low numbers...just lower. Some cats are very bouncy. Others get over it quickly. ECID and, basically, they bounce until they don't.

What you are talking about doing by decreasing the dose because you think the bouncing is caused by an overdose, is called a rebound check. However, there is no evidence that a cat who has systematically been taken up and down in dose per the TR protocol (as you have done with Lucky) can get overdosed. By reducing the dose prematurely (which is your prerogative), you risk leaving him at higher numbers and developing insulin resistance and possibly glucose toxicity.

Here is a Recent Condo with a super discussion on the above. While there are a lot of great comments, I urge you to scroll down and read Jill/Alex's lengthy and very informative post.

 

[Luckyducky]

Re: 9/13 Lucky AMPS 203 Bouncing Advice?

Thank you for pointing out the edits I should make to the op post Angela, and thank you also for the reply Marje, it was very informative and helpful, esp. the reference to the conversation in the other thread. I guess if rebound checks haven't worked so well for others, it might be better for me not to do it. Still, I feel like I'm in dosing limbo, because even up till now Lucky still looks to be bouncing.

I'm guessing I should stay at 2u bid until the bounce fully clears or I catch a low point below 50 then. Would that be the recommended route right now? I've been at 2u bid for almost 9 days now, and I'm starting to get anxious with the constant bouncing.

I also thought I should mention Lucky's feeding schedule, since it might be related. Every cycle I take his reading, feed him 1/4 can of Fancy Feast half an hour before his shot, give him another 1/2 can while he's getting his shot, and then another 3/4 can at +6 (for a total of 1 1/2 cans per cycle, or 3 cans a day). The reason I give him 1/4 can half an hour before his shot is just for safety, to make sure his numbers don't drop without food in his system. The reason I give him 3/4 can at +6 is because he doesn't handle eating a lot of food at once very well --- he'll either leave a lot of food in his bowl or throw up if I encourage him to eat as much as he can. Even in the instances where I managed to get him to eat the 1 1/2 cans over the course of the first 4 hours of a cycle, he'd beg for food towards the end of the cycle (waking me up early in the morning and leaving me exhausted), which I figured was a sign that the feeding schedule wasn't working well for him.

 

[Marje and Gracie]

Re: Question: 9/13 Lucky AMPS 203 Bouncing Advice?

Joe

It's best if you have follow up questions to start a new condo. I know it's a pain but we typically do one condo per cat per day. I know you don't post every day. At any rate, I'm looking at his SS. BRB, ok?

 

[rhiannon and shadow (GA)]

Re: Question: 9/13 Lucky AMPS 203 Bouncing Advice?

Hello.
I haven't posted to you before.
I can't address the dosing but I can tell you what I've been told about feeding.

I think the half hour before shot feeding is skewing what your real shot number would be if you didn't feed then.
Most of us get some increase from the food, especially after half an hour. So you might have a much lower number at shot time if you weren't
doing that.
I was told to try to not feed after +6 to get the best outcome in numbers at shottime.
My cat doesn't quite want to stretch it 6 hrs so I usually cut her off between her +7 or 7.5 until shot time.
She also gets fed 1/4 3oz can at shot times , and usually around the +4 and then a slightly smaller portion at +7 or 7.5.
She does get her testing snacks and sometimes wakes me up where I give her 4 or 5 pieces of freezedried turkey which keeps her happy
until shot time.

My other observation from your ss is it's been a while since you did a full curve.
I think you could really benefit from doing at least a mini curve in the pm cycle. I know how hard it is to give up sleep but
that seems to be the sacrifice we all have to make with FD. You could set the alarm every 3 hrs.
I think by doing that you will get a much better idea of how the dose is working. Even if you change the dose soon.
Just my two cents.

 

[Marje and Gracie]

Re: Question: 9/13 Lucky AMPS 203 Bouncing Advice?

I'm glad you clarified his feeding schedule. We highly recommend that you absolutely do not feed between +10 and +12. Why....because it can spike his PS number; if he's high, it's not such a problem but you don't want to be shooting a food spike. I also wouldn't feed him at or after his nadir because you are now working against the insulin.

Think of it like this: you are driving a car and coming up to a stop sign (analogy is you've given insulin and are approaching nadir). You stomp on the brakes as you approach the stop sign and you come to an immediate halt (analogy is you feed around nadir thus putting the brakes on the insulin). However, if, as you approach the stop sign, you just take your foot off the gas while you are a way out, then you glide up to the sign and gently stop. So you want to let the insulin take it's full action for the entire cycle by not putting the brakes on it with food (of course, unless he is really low and then it depends where in the cycle that he is low).

A better solution if he has to have something to eat at +6 is to give him some boiled chicken breast which is extremely LC and will have minimal impact on his BG. But I strongly urge you to quit feeding him between +10 and +12. His numbers do not indicate that he needs it.

Here's my thought about Lucky and his dose. First, he is a bouncy kitty but bouncing is normal!!! There is nothing wrong with it....it's a good thing because it tells you his liver is working like it should. You have to teach yourself to ignore the bounce numbers because they do not figure into his dose. You want to focus on his numbers when he clears the bounce. IMHO, you shouldn't have reduced him from the 2.25u because he didn't earn the reduction.

I think you have two options:
1. leave him here at this dose and see if he will come down more the longer he's at the dose OR
2. I actually think you have room to take him back up to 2.25u but I think you will need to get a few more nighttime tests when he dips into green. Typically, we say you should not stop testing for the night until you have two rising, non food influenced numbers. Most of us sleep/test. I never stay up all night but I do get up to test until I know Gracie is coming up into safe numbers and I dont' have to worry about her going back down.

Please let me know if you have questions.

 

[Luckyducky]

Re: Question: 9/13 Lucky AMPS 203 Bouncing Advice?

Rihannon and Marje, thank you both so much for your insight, explanations and guidance. I guess I mistakenly went about the feeding schedule from my own mis-interpretation of some advice I'd read some time ago, and maybe I also mis-remembered reading somewhere that people feed their cats a little before a shot to make sure there's food in the system before getting more insulin. Anyways, I've decided to change around his feeding schedule a bit --- I'm going to try feeding 3/4 can at the shot, and another 3/4 can an hour after the shot. I don't know if he'll be able to eat all of the second 3/4 can though, so I may split it to 1/2 can if he doesn't eat it all, and give the remaining 1/4 can at noon.

As for the dosing, I guess I'll stick to the 2u bid for now and see how the change to the feeding schedule affects his numbers. It's hard to tell atm what his non-bounce numbers are because the bounces seem to be one right after the other, so I'm hoping the feeding change will help.

It's true that it's been a while since his last curve, so I'll try to get one done this coming weekend.

The dedication you all have for your cats is really amazing. You all must be exhausted every day, and yet still go that extra mile for more night-time measurements. I'm going to do as best I can to catch the low point in the greens if he dips down in the night again next time, so hopefully I can get a better gauge of how low Lucky's been dropping.

Thank you both again for your help, it's very much so appreciated by both me and Lucky. :smile: Here's to hoping the changes work out.

 

[Vyktors Mum]

Another option is free feeding but taking the food away after +10 Unless you find you need to steer the cycle with feeding at particular times this can work well, especially for cats that don't like to eat a lot all at one time (Vyktor was free fed before FD and so I continued it). Of course it won't work at all if you have other critters that might get into the food!