Bouncy Alfie - Week 8

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Jen and Alfie

Jen and Alfie

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Another new week and another new trick from Alfie!

Since his mini hypo last week, I've been 3u in the morning and 2.75u in the evenings. He's had some pretty good evening numbers (though not as good as when he was on 3u PM) and some of his morning nadirs have been yellows, which means we're making some progress.

Then this morning, his AM preshot was 24.5, not particularly unusual so I gave his normal shot. Then did my usual +2 test as I was running out the door to work and he was at 14.8, which is very unusual. So after fretting all the way to work I fortunately managed to grab some stuff and come back to work from home for the day. Got back just before +4 and he's at 3.4!! :eek:

He's had a small snack of high carb food and is back at 4.5 after 20mins so he'll be fine. It's just scary he's being so unpredictable at the minute. I was thinking about increasing his morning shot slightly but now I'm not so sure!

The vet has suggested only changing one shot at a time, rather than both PM and AM at once, which makes sense, but I'm not sure where to go next with his dosing. I'm thinking we should just stick with what we're doing for now for a few more days and see how it plays out.

All suggestions gratefully received, I'm wrung out! :blackeye:
 
WOAH Alfie! You've got great instincts Jen. :)

It's hard to really know what's going on. Looks to me like he had a pretty low number PM cycle of the 15th, then had a really beautiful cycle AM of the 16th (not as low as we want, but it actually got him into really nice numbers without dropping so low from those blacks), which may have sent him into that higher flat cycle that night. Then this morning...well he decided to recover by allowing that insulin to drop him back down!

I honestly don't know what to tell you! You could maybe try dropping to 2.75 for a bit both cycles to see if that helps him have gentler curves. I know you'e done that and it didn't really work in the past...but maybe it would now?

I'm torn on that one. It might work, but it might backfire...yet clearly 3 units is too much if it drops him that low at +4.

I guess think about it some and let's see what others say too. I'm usually more decisive than this, but dang Alfie is trying to confuse us!
 
My goodness! I think Alfie is bouncier than my kitty - and that's saying something! :eek: You could try playing with fat/skinny doses. A skinny 3 u would be insulin drawn to the 3 u mark (wherever you normally set it), then release a drop so you're just inside that mark. You can either call it a skinny 3 u or a fat 2.75 u.

Looking ahead: there might be a point at which your vet can make a case under the rules you have in the UK to try Lantus. Teasel is still bouncy but less so on Lantus. You can also give full doses on lower BGs with Lantus. Just something to think about for later. :)
 
And to add one more idea to your list of dosing options: This completely depends on how much you're able to monitor over the next few days, and how your nerves are feeling, but I think I'd be inclined to hold the dose and see if he does it again. I know that is risky and will require some monitoring, so please only try that if you are around to monitor and feel like you can manage that emotionally.

My reasoning is that the lower doses weren't enough. This dose is getting better responses on the 15th and 16th, as Rachel noted. That low earlier today may be an over-reaction for Alfie, and a couple of days at this level, he may settle down. Or not. He could go lime green again. That's the tricky part. If he does it again you would definitely need to reduce, but holding might get him to settle down and keep him in better numbers too.

And I agree with Rachel - you have good instincts about this, so use that as you consider your next steps. If this sounds nutty, don't do it.
 
Thank you everyone. It's really tricky. I won't be around to monitor for the next couple of days, but have a few days holiday coming up so will be home from Thursday for five days.

I'm assuming he's still bouncing around because he's still getting used to being in the blues and greens? He's only been experiencing fairly regular blue number for about three weeks, which isn't long compared to how long he's had high numbers. He isn't generally bouncing as high, or quite as frequently, which is obviously a good thing.

I'll give him 2.75u tonight (he's already back in the high 30's) and see what his AMPS is tomorrow before making a call on it. I'm tempted to just push through it at these doses and see if he settles down a bit as @Djamila has suggested. But I won't be around to monitor so can't really risk it. I can pop back at +6 if I drive to work but that would have been too late today. So maybe reducing back to 2.75 is the way forward.

I've also just bought an automatic feeder so I'm hoping regulating his feeding times will help. At the minute he tends to get fed a few times during the day at weekends but only AM and PM during the week as we're out.
 
Jen and Alfie said:
Thank you everyone. It's really tricky. I won't be around to monitor for the next couple of days, but have a few days holiday coming up so will be home from Thursday for five days.

I'm assuming he's still bouncing around because he's still getting used to being in the blues and greens? He's only been experiencing fairly regular blue number for about three weeks, which isn't long compared to how long he's had high numbers. He isn't generally bouncing as high, or quite as frequently, which is obviously a good thing.

I'll give him 2.75u tonight (he's already back in the high 30's) and see what his AMPS is tomorrow before making a call on it. I'm tempted to just push through it at these doses and see if he settles down a bit as @Djamila has suggested. But I won't be around to monitor so can't really risk it. I can pop back at +6 if I drive to work but that would have been too late today. So maybe reducing back to 2.75 is the way forward.

I've also just bought an automatic feeder so I'm hoping regulating his feeding times will help. At the minute he tends to get fed a few times during the day at weekends but only AM and PM during the week as we're out.
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Sounds like a good plan, Jen. You're right about needing a margin of safety when you can't be around. Extremely bouncy cats are very challenging but they teach you a lot about seeing through bounce numbers to evaluate a dose, keeping your cool when they bottom out and making good dosing judgments. It's like anything else in life - hard teaches so much more than easy. :)
 
Kris & Teasel said:
Sounds like a good plan, Jen. You're right about needing a margin of safety when you can't be around. Extremely bouncy cats are very challenging but they teach you a lot about seeing through bounce numbers to evaluate a dose, keeping your cool when they bottom out and making good dosing judgments. It's like anything else in life - hard teaches so much more than easy. :)
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He definitely doesn't want to make it easy! I think he just likes all the drama really! ;)
 
Exiting day here yesterday with two perfect curves in one day. Well, I say perfect, his evening nadir wasn't low as I'd like but he dropped almost exactly 50% in both cycles. :cat:

But this morning, we're back to a super high AMPS. :rolleyes:

So, what do you think is happening here? My initial thought was that the duration just isn't long enough, but he does get the occasional ok preshot, so I guess that can't be right. Is he still just bouncing around?

I'm home for a few days now so can guarantee getting mid cycle tests, but he's responding so well I'm unsure about upping his dose and triggering major bounces again! His insulin is getting to a month old and we don't have too much left, so I'm going to pick up a new vial in case that's got anything to do with it. Though he's had nice cycles, so I doubt it.

He's getting auto timed feeds now, the same amount and times both AM and PM, to try and take out any variables! He's fed a big meal with his shot, then mini meals at +2, +4 and +6. I've no idea if that's a good schedule! But I read feeding after nadir isn't a good thing? So that's what I'm starting with.

Generally happy we've seen some nicer AM numbers but soooo want to get rid of all the super high preshots!
 
Jen and Alfie said:
Exiting day here yesterday with two perfect curves in one day. Well, I say perfect, his evening nadir wasn't low as I'd like but he dropped almost exactly 50% in both cycles. :cat:

But this morning, we're back to a super high AMPS. :rolleyes:

So, what do you think is happening here? My initial thought was that the duration just isn't long enough, but he does get the occasional ok preshot, so I guess that can't be right. Is he still just bouncing around?

I'm home for a few days now so can guarantee getting mid cycle tests, but he's responding so well I'm unsure about upping his dose and triggering major bounces again! His insulin is getting to a month old and we don't have too much left, so I'm going to pick up a new vial in case that's got anything to do with it. Though he's had nice cycles, so I doubt it.

He's getting auto timed feeds now, the same amount and times both AM and PM, to try and take out any variables! He's fed a big meal with his shot, then mini meals at +2, +4 and +6. I've no idea if that's a good schedule! But I read feeding after nadir isn't a good thing? So that's what I'm starting with.

Generally happy we've seen some nicer AM numbers but soooo want to get rid of all the super high preshots!
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Nice!! He'll be a hard kitty to flatten a lot, just like Teasel.

His vial should be good for longer than 28 days. You could get a new one now though if it's getting low. I always approach a fresh vial with caution and start in the AM on a day I can monitor.

Keep the dose for now. With a bouncy cat it's best to evaluate a dose more on the nadirs and less on the PSs. Those darn bounces make it harder to see what's happening though.

Yes, many people try to keep the majority of the food in the first half of a cycle. That can change later on when they're trying to fine tune the dose's action.
 
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Jen and Alfie said:
I don't want to jinx things but he's not had a totally flat, high bounce cycle for a little bit, so fattening up the 2.75 is probably a good plan. I'll keep it as is tonight and try that from tomorrow morning. :)
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See what a pro you've become, Jen? Think back to how it was only a few weeks ago ... :smuggrin:
 
Kris & Teasel said:
See what a pro you've become, Jen? Think back to how it was only a few weeks ago ... :smuggrin:
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Ha ha, I know, this sugar dance is a steep learning curve! Even you super knowledgable people were newbies once upon a time right? ;) That's why you keep paying it forward. I hope to do the same here one day :smuggrin:
 
Jen and Alfie said:
Ha ha, I know, this sugar dance is a steep learning curve! Even you super knowledgable people were newbies once upon a time right? ;) That's why you keep paying it forward. I hope to do the same here one day :smuggrin:
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I can't begin to tell you how completely in the dark I was about treating FD. :confused:
 
Jen and Alfie said:
Ha ha, I know, this sugar dance is a steep learning curve! Even you super knowledgable people were newbies once upon a time right? ;) That's why you keep paying it forward. I hope to do the same here one day :smuggrin:
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People who come here, learn, and pay it forward are how this board keeps going! When I first got here I insisted that my cat would never get off kibble and would never let me test him. Ever. Plus, my hands used to shake so bad when I tried to do a test that even when he was cooperating I could barely get the blood on the test strip. :smuggrin:
 
I wish you had seen me when I first arrived! I came home from sobbing (yes I broke down and sobbed in the vet's office while giving Gypsy "practice shots"...which by the way, she purred through) to post on here. I explained how I would never be able to test her or keep up with a SS...thank heavens for the folks that were here! They had their hands full with me!
 
I'm not having a great day today. Nothing I'm trying seems to be bringing any improvement.

I've gone back up to 3u tonight after three cycles at a fat 2.75u. Mainly out of desperation to try and get his numbers lower. He's had a few better morning cycles recently but now his evenings cycles, which had looked promising, are all over the place. :banghead:

I don't know what to try next. Not sure if I should keep adjusting dose or whether it's time to try switching to Lantus. Assuming our vet would even prescribe it. Alfie seems so sad all the time I can't stand it. And hubby and I are stressed to the max :arghh:

Guess I'll just have to see what the next few cycles bring.
 
Oh Jen, sorry to hear you're not having a good day and Alfie not seeming happy :bighug:. I know it's hard to be patient but be careful with the dose increases, more insulin is not the answer since we've seen him give lime greens on 3.0U twice. Kris is probably the best to give advice since Teasel is similar. Is there any alarming sad behaviour he's displaying? Have you gotten a ketone test this week?
 
Oh Jen, I'm so sorry that you and hubby are stressed. It does seem to wax and wane throughout this dance. There are times when I've thought this is no big deal and other times when I've sat and cried and thought I couldn't do it anymore. And I have an easy kitty!

I think increasing the dose is the right decision. Alfie's numbers are too high, and you and DH test enough, that I think it's worth the risk of an occasional low because you'll catch it and be able to steer if you need to. It's good to have a healthy caution for unmonitored or reckless lows, but you have the skill and sense to make sure that isn't what's happening. An occasional dip you can take care of with monitoring, and feeding if necessary. And keeping him in those high numbers out of fear of a low numbers has it's own risk. At the beginning of the journey, the fear of a hypo is big because the owner may not have the skill or sense to manage it well. But you are a pro now, so I think the danger is shifting towards extended time in higher numbers.

I also wonder if you would consider using a human glucometer? I think it might lower your stress level a little if your spreadsheet looked a little more like the other ones you see here. Maintaining your emotional health is important in this process, and seeing the flatter, nicer colors that you get on a human meter may help feel better about this process. It still gives you the data you need to take care of Alfie, but without the emotional hit of the AT2 numbers. It's kind of silly, but I think it could help. Take a look at @Kris & Teasel's spreadsheet from before when she was using the AT2 and now when she's using a human meter. There is a link on the spreadsheet to show where she transitioned. It really makes a big difference.
 
Please take heart, Jen. You WILL get Alfie to a better place. I truly understand the anxiety and frustration of having a very bouncy cat. I like Djamila's advice to try 3 u again because you know how to handle the odd low number, should it arise. I also agree that you might find the numbers that a human meter gives you to be psychologically uplifting. You'll still be able to keep Alfie safe and there's a lot to be said for seeing less extreme variations in numbers.

Finally, keep the idea of Lantus in the back of your mind in case you can't your boy calmer on ProZinc. It has certainly helped Teasel, human meter notwithstanding. :):bighug:
 
Djamila said:
I also wonder if you would consider using a human glucometer? I think it might lower your stress level a little if your spreadsheet looked a little more like the other ones you see here. Maintaining your emotional health is important in this process, and seeing the flatter, nicer colors that you get on a human meter may help feel better about this process. It still gives you the data you need to take care of Alfie, but without the emotional hit of the AT2 numbers. It's kind of silly, but I think it could help. Take a look at @Kris & Teasel's spreadsheet from before when she was using the AT2 and now when she's using a human meter. There is a link on the spreadsheet to show where she transitioned. It really makes a big difference.
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Ha, ha, I love the idea of seeing nicer numbers, but isn't that just cheating? I thought there were different spreadsheets for Alphatrak and human meters that are calibrated differently?

A sheet full of yellows and blues would be nice, But if I put them on the human meter sheet, they'd still be black an red right? It's the large amount of time he's spending on the high numbers, and the long term damage that could be doing, that's causing my stress.

And to answer @Yong - he's not displaying any extra sad behaviour. He's just down all the time since he was diagnosed. He just hangs out near the kitchen as he's always hungry. The only time he's really slept like he used to is after a hypo! I do keep testing for ketones. All ok so far.
 
The protocols on FDMB were all written for human meters, and that's what the majority of us use. Is it cheating? Sort of, in the sense that a 500 on the AT2 might read as a 380 on a human meter (I'm just making up those numbers - there's no way to calculate a difference). So is the cat really at 380? No. But 380 tells you that the cat is too high, and that's the only information you really need. How much too high doesn't matter all that much for our purposes. And now you have a pink instead of a black. Treatment is the same, but it's easier on your heart.

The difference between AT2 and a human meter is less at lower numbers, so the lower the numbers actually are, the closer together the two meters read. So when it starts to really matter, it's more accurate.

The spreadsheet ranges are identical except for the break between the lime/dark green. The human meter breaks at 50 and AT2 at 68. The rest of the ranges are the same.

Plus, it's a LOT cheaper.

Of course, what we really need, and what we are working toward, is getting Alfie into better numbers. The rest of that is just a strategy to keep your sanity while we do that.

And lowering your stress in that area might really help since dosing may end up raising your stress a bit. I think it would be good to be a bit more aggressive with your increases to try to pull his curve down. That's going to cause bouncing though which means you're going to end up with some random lows, and some unfortunate bounce-highs, and probably have to make some tough decisions about shooting on wonky PS numbers that will appear....it makes it harder, but the alternative is leaving him in these high numbers, which as you've noted, has it's own stress.

Lantus is definitely an option to consider if your vet will prescribe it. Many cats, and especially bouncy ones, find some calmer waters over there. One thing to note though is that they more or less *make* you use a human meter over there. The rules in Lantus are pretty strict, but they do get good results. You might take some time to read the Sticky threads on Lantus, and take a look at some of the threads to see what you think. For Sam, I haven't found the switch to be particularly helpful, but it also coincided with him getting sick, so we've had a rough start. Most people have found switching to make a positive difference.
 
Djamila said:
The rest of that is just a strategy to keep your sanity while we do that.
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Well said :smuggrin:
Djamila said:
For Sam, I haven't found the switch to be particularly helpful, but it also coincided with him getting sick, so we've had a rough start. Most people have found switching to make a positive difference.
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I think we both switched our kitties when they weren't feeling well :oops:. On the original note though, Maury's numbers have started showing gentler drops :)
 
Teasel's drops are gentler even though he's dramatic by nature. I've also been able to have nice runs of flat numbers occasionally - never happened with ProZinc.
 
Djamila said:
The spreadsheet ranges are identical except for the break between the lime/dark green. The human meter breaks at 50 and AT2 at 68. The rest of the ranges are the same
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That's good to know, I'd assumed the ranges would be different, a red would still be a red just at different numbers.

I'll look into human meters here in the UK. We're lucky at the minute as our pet insurance covers the cost of test strips but we get through so many that we're starting to get funny looks at the vets when we pick them up, so I don't mind switching!

I'll have look at the lantus stickies and forum so I can start to get an idea of what I'd be letting myself in for. And speak to our vet to see if it's an option.

For now I agree, we need to push his dosing a bit. We had some good cycles on 3u before so I'm hoping for similar this time.

Thanks as always for all of your kind and supportive advice everyone! :bighug:
 
Jen and Alfie said:
That's good to know, I'd assumed the ranges would be different, a red would still be a red just at different numbers.

I'll look into human meters here in the UK. We're lucky at the minute as our pet insurance covers the cost of test strips but we get through so many that we're starting to get funny looks at the vets when we pick them up, so I don't mind switching!

I'll have look at the lantus stickies and forum so I can start to get an idea of what I'd be letting myself in for. And speak to our vet to see if it's an option.

For now I agree, we need to push his dosing a bit. We had some good cycles on 3u before so I'm hoping for similar this time.

Thanks as always for all of your kind and supportive advice everyone! :bighug:
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Teasel's SS going all the way back to the beginning of this year is a good overview of how a very bouncy cat responds to ProZinc (January) versus Lantus (beginning early February), settles into Lantus and then the BG range change with a human meter.
 
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