Bølle - is he bouncing???

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Nina & Bølle Denmark

Nina & Bølle Denmark

Member Since 2012
Hi
This morning amps was 173.
Has been to work and just checked him at +9: 338
Just talked to Charlotte, who advised me to ask here.
Is he bouncing - shall I reduce his dose or should I continue .25u
 
What was his pmPS?

I think I would hold the dose a few more days as there is still a little improvement each day isn't there? As long as you are seeing even slight improvement or settling of the numbers, I would hold the dose until you can do another curve. (unless, of course, there are very ow numbers, then you reduce the next shot).
 
Thanks for your concern and good wishes.
I wish the same for your Munchie :-)
Bølle's recent numbers:
Last night at +4,5: 297
This morning amps: 401
I hold the dose at .25u and will make another curve friday or saturday.
This sunday Denmark is changing time 1 hour forward. How shall I manage that?

Nina & Bølle
 
Can you or Charlotte post his excel SS again? I think he isn't getting enough insulin since his numbers are all slowly climbing. That looks like a slow depletion of the circulating insulin (the insulin that is bound to albumin in the blood that gives lev its "time release" attribute).

Since the US just changed the time ahead a few weeks ago, we were discussing it here:

http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=65768

My suggestion (how I handle it) is this:

I handle it with two dose decreases. Lets say you shoot at 8a/8p:
Saturday night shoot at 8p (current, OLD time) but reduce the dose by 15-20% or so.
Sunday am shoot at 8a (NEW time - so an 11 hr cycle), but reduced dose by 15-20%
Done.

At the time Jeddie was on .75u, so I shot .6u for both shots. If you still have Bolle at .25u, you could do .2u for both shots. If you are going to raise after the curve on Sat. you could shoot .25u for both shots and then increase with the Sunday evening shot to whatever you decide to increase to.
 
Good, I would have said hold the dose. Well, he is still settling on .25u. I just wonder why he hit such a high number this morning. Something is still causing a big reaction - and yes, it looks like a bounce now. Maybe he will need a dose reduction after all.

Let's see what he does over the next few days.

Thanks for linking his SS. :-D
 
Thanks Sheila for your answer.
This morning amps is 421. He's feeling alright - eats well - and his urine production has not raised despite the higher numbers.
He's very tricky to figure out, but my experience in this field is not very long :-)
I'll hold the dose until further advice.
Now I've managed to create a spreadsheet - attached below
 
Oh, what a beautiful SS! And bless you for converting the numbers for us.

Well, he seems to have decided to stay in the 400s today - and climbed from last night's PS. It's clear as mud to me that he either a) is still rebounding, or b) he needs more insulin :roll:

The thing that makes me think it might be rebound is that he is getting some pretty good action from the insulin. He dropped over 200 pts yesterday from am to pm PS. It is entirely possible that since diagnosis and a diet change (I am assuming he is on all low carb now) he doesn't need much, or any, insulin any more. He was started on too high a dose of caninsulin and raised too fast on it and that could have just set in all kinds of rebound responses. This can also cause insulin resistance, so there is a possibility that is going on instead - except for that response he got yesterday. Maybe that means he is breaking the resistance.

I know it's hard to be patient because you want him well NOW, but it is early days since the change to lev.
 
Thanks so much for your answer
I will be patient, I promise, but you are so right, I just want him to get well again.
It's so disappointing to see those 400's
If he suffers from resistance, will he ever turn around and benefit from insulin?
I do regret I listened to the vet, but I didn't know better. She said it would take up to 6 months to get him stabil.
He's only eating low carb not more than 5% in the last month, and he is clearly in better shape with Levemir than Caninsulin.
I hold the dose for now - think I will be able to do a curve hopefully on Friday otherwise on Saturday.
I will check him tonight at +5 before bedtime in Denmark.
 
Don't feel bad. I listen to my vet too (who I love). She gave me two rescue kittens 4 years ago and spayed them for free, call Beau "the miracle kitty" and diagnosed his cardiomyopathy just from my description of his symptoms [confirmed by xray and ultrasound by a specialist. But at the time she didn't now enough about FD and nothing about home testing etc. Between her and another vet, Beau got up to 7u of caninsulin and I was told "don't change the diet until he is regulated". When I keep asking about that, they wanted to sell me Hills dry diabetes food. Everything I learned about managing FD, I learned her and by experience. And it made my vet a better FD vet too, I think.

If Bolle had insulin resistance (IR) on caninsulin changing the insulin probably helped. IR can also happen from glucose toxicity (chronic high glucose levels) but if it does you can steadily raise the dose until you "break through" the resistance. Often the dose can be lowered significantly after that.

Here is more about IR, if you want to read up on it:
http://petdiabetes.wikia.com/wiki/Insulin_resistance
 
It's so true about the diet. First time I saw a response in Bølle's numbers was when changing his diet.
Bølle and I will keep on.
Just checked him +5: 290
 
Hi
This morning amps: 472
Looks like Bølle is slowly rising his numbers the last days except for the pmps tuesday the 20.
Maybe I shall increase the dose?
Or still wait a few more days?
 
Hi Nina,

It would be better to wait until you can get more mid-cycle BGs for him before deciding which way to go with dose. He appears to have a good reaction to .25U because the 173 at preshot on the 20th is excellent. But it is unadvisable to raise dose based on preshot values alone.

The answer to your question "is he bouncing" should be revealed by a curve. Based on his diet he could very well need even less insulin. I know it is difficult to see their BG levels so high. Do you know how to test for ketones? You should get some test strips and do that every few days. He's probably fine if he's eating well, but it is a caution we always give when kitties are unregulated.
 
Thanks Vicky
I have been testing him, and there is no ketones so far.
He's eating well - actually he is rather hungry, perhaps due the higher numbers the last days.
When I think about it, he ate less tuesday when he was low in numbers. I don't know why, as he is as content as always - but begging for food.
I feed him 4 times with 75g low carb wet. He's getting a little bite 15g 3% carb wet +8,5 both afternoon and night.
Should I adjust his diet?
He has lost 200g the last week - weight 7.2kg
 
Is Bølle a big cat? Currently he weighs 15.8 lbs and lost 7 ozs last week. You are feeding him 2.6 oz four times a day and .5u twice a day - a total of about 11.5 ozs. (I put all that down for us westerners :-D )

An average male cat weighs 12-14 lbs. A small one maybe 10 lb, and a large one maybe 16 - unless he is a Maine Coon, or other larger breed (or mix of one), then 16-18 or even more could be a normal weight.

All that said, I fed both my guys "unlimited" food until they were regulated and stopped eating everything in site. I'd say Beau was eating close to the amount you are feeding Bølle now. He is/was a smaller cat then Bølle - around 10 lbs then (now he is even smaller and I can't get him to gain weight). I just leave food down all the time and my four cats eat a total of 26 ozs (740g) a day. I think Jeddie probably eats about 8 ozs (226g) and he is a smallish Maine Coon mix. He weighs about 11.5lbs (5.2kg) now [up from 9 (4kg) when I got him].

If Bølle needs to loose weight then maybe feed a bit more so he isn't loosing so much a week. Has he been losing like that since diagnosis or just this week since he has been on the lower dose? If he doesn't need to loose weight then you need to feed enough more to stop the weight loss.
 
Hi Sheila
Bølle is a big cat - long legs - long body - he is bigger than many of the popular small dogs.
Nevertheless he has been too fat and needed to loose weight. In his younger days he was 13,2 lbs.
Befor FD I think his weight was 19.8 lbs, when he was diagnosed it was 18,5 lbs
I managed to stabilize him at 16,3 lbs for the last month, and he has lost the 7 ozs the last on the low dose.
Perhaps I should go back to 3,2 ozs 4 times and a little bite in between
 
He is no longer bouncing which is good but he's also not getting much reaction to the dose. An increase is due because he's been on .25U long enough. If you can manage to draw a .3U dose that's probably safest at this point, although I think you should consider .4U. Although Tilly protocol would call for at least a .25U increase, I would be afraid that much increase might sending him bouncing again.

Good luck!
 
Thanks Vicky
We go for .3u - no reason to force anything.
Thanks to all of you for your support. I'm so glad there is people, who wants to help across the world :-)
We do appreciate that.

Nina & Bølle
 
Thanks Vicky
We go for .3u - no reason to force anything.
Thanks to all of you for your support. I'm so glad there is people, who wants to help across the world :-)
We do appreciate that.

Nina & Bølle
 
Bølles pmps was 367 and nina gave him .3u. At +5 he was at 193, the first blue number in a few days. So there is a reaction eventhough the dfference from .25-.3 is very small.
 
Good to see a response. So also a good idea to let it settle. If his numbers are still dropping on Sunday maybe let .3u settle for a few more days. Some cats are just so sensitive to insulin. Beau was. I reduced him by .1u amounts and then he got .05u for a week or so before I started skipping shots and then he went OTJ.

Yep, there is a difference in that small amount. That is why we suggest small changes at such low doses. The increase from .25u to .3u is 20%.
 
Because of the blue number at +5 I have been testing him 2 times throughout the night.
+8: 131 +11: 148
Is it really OK to continue? I know Levemir works differently than Caninsulin, nevertheless I get worried.
 
Sorry - I know you already shot him for the morning.

Yes, it's ok to continue. With such a small increase he shouldn't plummet even from the mid 100s. Now if he was lower than that 148 by much I would say either shoot .3u but be prepared to get some tests or drop him back down to .25u if you are worried. However, lev is meant to keep them in lower numbers for as much of the cycle as possible. So you "shoot low to stay low".

I remember how hard it was to "erase" my caninsulin thinking and not be afraid of those low PS number. I would not have given caninsulin on a 148, or would have greatly reduced the dose. Eventually, you learn how he will react to a full dose on a low PS (that's where the data gathering really comes in handy) and will feel more comfortable with it.

Also, lev is gentle and especially on these small doses won't drop them like a rock the way cansinsulin will. And even if he dose drop as low as 40 he probably wont have symptoms and will just need to be fed and retested until he is clearly rising again. Both of my boys have been below 40 and I think I have one reading below 30 for Beau. That did kinda freak me out, but I fed him food mixed with a few drops of Karo syrup and he was fine. The only problem is that low numbers usually cause a rebound response.

BTW, I shot Jeddie at 100 tonight and 81 two days ago. Although I did dial back the dose just a bit (he is getting .7u).
 
Thanks Sheila
Amps was 257, and I have given him the shot although I was half an hour late ind doing so this morning.
I will do my best not to worry too much :-)
 
OK. Good. At least you know he is responding to the new dose and that dose increases probably need to be very small with him. Going from 148 to 267 in 90 mins might be an indication of a little rebound from the lower numbers - NOT because they were too low, just because he hasn't had them in a while.
 
As you can see on his ss, his numbers has been rising through the day.
I fear he is in the red's again at pmps, but I guess I shall continue .3u.
Then I need to reduce the pm dose to .25u due to summertime despite his numbers? Or should I give .3u and see how the numbers are sunday morning?
 
Like I said, it could be a response to the first 100s in a while. Just hang in there.

I would take a chance and shoot .3u tonight and see where he is tomorrow. If he is lower than 150 maybe reduce, otherwise shoot .3u in the morning also especially if he is high. Just be prepared for that to cause (perhaps) a little more bobbles. Others may disagree with not reducing the dose, but I think given his numbers in the past few days you will be ok.
 
I have already given the shot .25u considering summertime. Could not wait due to the clock ticking. Sometimes difficult to communicate across time zones :-)
If he is high tomorrow morning I'll give him .3u
Thanks for your advice - I wish you a good saturday -here in Copenhagen is it dark already 7.45 pm, and Bølle is taking a nap after dinner.
 
Yep, the time difference makes things difficult. It was 12:43, my time, when you last posted - so you are 7 hours ahead of me. Your shot times must be about 6:30 am/pm, right?

Well, have a nice Sunday - even if it is an hour shorter. Another reason I like the fall - they give us our hour back!
 
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