Bouncing, Underdosed, or Overdosed?

[Mistryst]

Khaleesi started Glargine November 2023. It started off very promising nice flat green cycles, and low preshots.

Took reductions when necessary. Until reductions no longer brought greens.

Fast-forward to today, I've been on a somewhat modified SLGS/TR,

I still can get green curves but am almost always met with high red preshots.

1.5u Brings her into the greens the most consistent with occasional blue curves.

Lower doses can occasionally bring her to the greens but usually end up with higher yellow cycles.

I am at a crossroads which would help ease my mind with the advice of more experienced members.

Please review my chart since November 2023, to today.

One of these things is happening but I can't quite pinpoint it...

1. Khaleesi is just a bouncy a cat and I'm doing an okay job with the sugar dance.

2. The dose is too strong and causing spikes and high preshots.

3.The dose is too low and high preshots are due to low Depot.

I would like to stop these spikes and high preshots, while also providing Khaleesi with healing numbers.

Please advise.

 

[Bandit's Mom]

Hi and welcome to the LBL forum!

Does she get multiple small meals - especially in the first part of the cycle? Food can help flatten the curve. She does seem to dive which in turn can aggravate bouncing.

What is the dosing method you are following? You are changing doses too often for a depot insulin. Dosing isn't based on preshots or highs but on nadirs.
Is there a reason you aren't following TR? You are testing enough for it! And it looks like you are feeding her only LC canned food and no dry?

Previous post:
https://www.felinediabetes.com/FDMB/threads/amps-317-bouncing-stopped.275904/

 

[Mistryst]

As for meals the cat was previously on Vetsulin for almost 8 months. The feeding regimen is a throwback from those days, As Khaleesi and I both have grown accustomed to that schedule, we have not changed it.

1 Full 3oz Can at 6 am,
1/4 3oz Can between 9-11am
1 Full 3oz Can at 6 pm,
1/4 3oz Can between 9-11pm

All cans are low carb 3 percent fancy feast pate. No dry food, occasional freeze dried treats.

The dosing method is essentially the SLGS, but instead of taking a reduction at under 90, I take a reduction under 60.

Once I've Settled at 1.5 I would only reduce or give a token dose when preshots were lower than normal, due to fear of a potential hypo episode, and some conflicting data.

Conflicting data being that when the bounce/spike is broken, lower doses tend bring her to the greens. Other times her nadir seems to move to +9 negating the +3-+6 number trend.

An example being on 1.2.2024 Evening cyle took a low turn at +3, @58 after two cycles prior @ 1.25units barely moved her numbers.

Another example is 2.16.2024. +5 was 341 then +9 is 72

I would like to get her on tight regulation but her nadirs are technically falling into range, for TR regulation, so switching really wouldn't look much different, right?

I'm open to any suggestions to better regulate my lil girl.

 

[Bandit's Mom]

1 Full 3oz Can at 6 am,
1/4 3oz Can between 9-11am
1 Full 3oz Can at 6 pm,
1/4 3oz Can between 9-11pm

You want to feed some of the food you feed with the shot at +2. Here's more info on how to use Food to Manipulate the Curve
Feeding after the nadir can reduce the duration of insulin and lead to higher preshots/contribute to bouncing.

Once I've Settled at 1.5 I would only reduce or give a token dose when preshots were lower than normal, due to fear of a potential hypo episode, and some conflicting data.

You want to pick a dose and stick to it. Too many changes disrupts the depot and you don't know which dose is working for her. With SLGS you can shoot any number over 90 and with TR any number over 50 - especially if you can monitor. Lantus gives very flat cycles when you shoot low. You've seen that she can go from 394 to 76, so a preshot is not an indication of how a cycle will play out. You got lovely cycles when you shot the full dose with blue preshots on the nights on 2/17 and 2/18.

Conflicting data being that when the bounce/spike is broken, lower doses tend bring her to the greens. Other times her nadir seems to move to +9 negating the +3-+6 number trend.

Bounce breaking cycles have more downward momentum and later nadirs. You want to feed after each test when you see her numbers trending lower. That will slow the drop.

I would like to get her on tight regulation but her nadirs are technically falling into range, for TR regulation, so switching really wouldn't look much different, right?

With a reduction point of 60, you are pretty much following TR where reductions are taken at 50. You want to try "feeding the curve" and sticking to a dose and shooting the full dose at lower preshots.

 

[Mistryst]

As per your response, I have maintained same dose and have been seeing more consistent greens and lower preshoots.

Might actually earn a reduction soon and current dose brings her close to 50s but not under yet.

I see she still is a bouncer with that 500, but like you said I need to be consistent with her dosing.

Thank You Bhooma

 

[Bandit's Mom]

Hi. The aim is not to earn reductions, but to spend as much time in normal numbers as possible. It's good you held the dose, but you want to add some snacks at +1 and +2 to slow the dive. Bouncing can also be triggered by steep dives like you saw tonight and on the night of 2/25. Does she get food after every test?

 

[Mistryst]

Eating at 2+ typically too much food too soon and causes both diabetic and regular cat to barf.

I could split the food meals up into smaller portions, To get a feeding at +2 instead of +3.

She does get a low carb freeze dried snack after every test.

 

[Bandit's Mom]

Yes, you could feed a part of her PS meal at +2 and +3. So smaller meals spread out will help flatten the curve which in turn will reduce bouncing.