Best way to handle rebound?

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Lisa and Jack

Member Since 2012
It looks like Jack was rebounding yesterday. I gave him 1 unit last night when his PMPS was "Hi." This morning his AMPS was down to 268 so I reduced the dose to scant .75. Right thing to do?
Thanks for you thoughts.
Lisa
 
Welcome, Lisa!

It looks like this is your first Lantus post (other than the AlphaTrack thread). Here's the link to your post on Health.

Jack looks like he's having a good response to Lantus. I'd really encourage you to read the Tight Regulation Protocol sticky since I can't quite figure out your strategy for dose changes. An important point to keep in mind is that because the AlphaTrack is calibrated differently than human meters, a dose reduction is taken when numbers drop below 80 (vs. a human meter where numbers need to drop below 50) in a newly diagnosed cat. (I have to admit, I nearly had a panic attack when I saw the 38 on your SS. It took me a few seconds to see you had switched to a Relion meter.)

If your question is whether you should have reduced Jack's dose, yes, you did the right thing. The 38 absolutely warrants a dose reduction. You could have "shot through the bounce," though. What this means is that you could have kept your dose at PMPS (vs. reducing) as a way of helping Jack to get through those high numbers.

You may also want to take a look at this post on handling low numbers. We encourage people to test a bit more frequently if numbers drop until you know that your cat's numbers have stabilized in a safe range.

I also want to point out that Lantus likes consistency. It looks like you've had to move your shot times around. Because Lantus is a long acting insulin, an early shot acts like a dose increase and a late shot acts like a dose reduction. You'll get better results if you can shoot twice a day and as close to a 12 hour schedule as possible.
 
welcome to LL, Lisa and Jack!

Will you be able to get some spot checks today? It looks like Jack is already clearing his bounce. Since the 268 is quite a bit lower than the HI last night, you'll want to get a spot check fairly early today (maybe +2, if that hasn't already passed) to see if he is still dropping that fast.

It looks like Jack is doing well. You're definitely on the right track. The 38 earned Jack a reduction to 0.75, and it also made him bounce high to the 500s. As you saw this morning, those highs usually clear out on their own. Reducing was the right thing to do, but the fact that you gave 1u last night while he was bouncing is probably what helped him clear out the high numbers so quickly (lots of cats stay high for days after a lower number, so the fact that he only stayed up there for one cycle is very encouraging).

It looks like you have been having to stall shots often because the numbers were lower than you were comfortable shooting. Hopefully the dose reduction is just what Jack needs to keep him just a little bit higher so you don't see 50s at preshot. You're doing a good job of collecting data, so if he does keep hitting 50s at shot time, we can help you figure out what to do.

Because Jack cleared this bounce so quickly, it might be that you don't need to "shoot through the bounce." If he drops too low or too fast today, then make a mental note the next time he drops low and bounces that you should reduce his dose right away rather than waiting for the bounce to clear. Today's cycle will give us a good idea of whether that is the case.

Good job!
 
Thanks for your response. I dropped his dose from 1.25 to 1 b/c his BGs at +12 were so low I was having to shoot at +14 or +15 and even +17. Yesterday, his AMPS was 216 so I gave 1 unit but that caused his +3 BG to drop to 38. Since his BG number last night was "Hi" I went ahead and shot 1; then reduced it to .75 this am b/c his AMPS was 268. His +3 this morning was 323. Not sure what that means w/ respect to his dosage but I think I'll hold at .75 for a bit and see how that goes. Anything I should have done differently? Thanks!
 
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