Hershey bouncing?

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Judy and Hershey

Judy and Hershey

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Hi everyone, this past week, I increased Hershey's insulin dose to 1.25 x 2. He has come in quite low at different times, which makes it hard to regulate. I don't feel comfortable shooting 1.25 for instance like tonight when he was 167 at his PM test. I guess what I need to know is, is it ok to give him different amounts of insulin at his am and pm shots? Thanks!
 
To be honest Judy, I cannot tell what is a good dose without seeing what his mid-cycle numbers (nadir) are. I am assuming that he is going lower somewhere in his cycle but unless I know that number, I cannot provide any advice. If you can get a +5 - +7 test and maybe a before bedtime test, that would help.
 
Cindi is right. More data always helps. :-)

To answer your question - yes, it is ok to give different doses AM and PM. You can give less on a lower preshot if you are comfortable shooting on a lower number. The question is "how much less?". That's where the mid-cycle data comes in handy.
 
Me three. The pm tests look like the am dose is working. I like your shooting the pmps number, as long as it stays in shootable range. But it does look like he could be dropping low at night and bouncing. If I were you, I'd get some tests overnight and see if he is dipping low enough to bounce.

Once you have the data, you have a couple options. You can shoot a different dose am/pm or you can shoot an 11/13 schedule, if the amps is consistently higher than the pmps. So catch the am number as it starts to rise at +11 and then wait an hour in the pm to give that number time to rise, at +13. But first, more data would help you decide which makes sense and how to dose.
 
Since I was up late tonight, actually fell asleep on the couch, I decided to do a mid-cycle with Hershey at +6. I as shocked he went down to 74, he had eaten after his PM shot at 6:20 pm (gave 1.25 tonight) reading of 260 (see ss) and then he ate again around 8:00 pm. and disappeared after that and went for his usual nap. Hershey as stated somewhere before is a grazer, he never eats a lot at any time, I usually give them another serving before I go to bed. So before bed tonight, I fed my ravenous shelter cat Jezzy and thought good time to get a test for him. Hence his 74! I have fed him a nice bit of low carb food and gave him some regular cat treats, my daughter and I tested him again in 40 min at almost +6.5 and he is at 106. Will do more testing as I have 4 days off for Thanksgiving. Keep an eye out for more posts. Anyway, I know you all will be busy with your Thanksgiving celebrations, but any advice appreciated. I saw all the expert's advice above and still don't even understand completely what bouncing is, but I am hopefully that he is on his way to remission down the road. Happy Thanksgiving, I may as well stay up now and get my turkey on!
 
Since you're staying up....

This post by Dr. Lisa may help you understanding "bouncing" (although she refers to it as 2 types of "rebound".)
One type is " unwarranted rebound"- when a cat sees numbers that are lower than what he's used to, but still safe and not really low numbers.
The other she calls "warranted rebound". That's when the number is actually low, and indicates a reduction in dose is probably needed.

The other really important thing she discusses is what she calls a " downward slant". Where the BG just seems to drop for twelve hours and gives you a much lower reading than the previous preshot number.

I think that point is even more important than the part about rebound. I have seen quite a few cats on PZI experience that in the past couple of weeks since I stared posting here again. And in just about every case, caregivers and advisors seem to think that this means that the dose was too high, and the cycle ran too long.

I could not possibly disagree more with that thinking. Neither does Dr. Lisa if you read her comments. Attempting to reduce a dose to prevent this from happening, and instead trying to get a "smile curve with two shootable numbers" causes a loss of momentum, and causes a cat to spend more hours per day in hyperglycemic numbers. It undoes "progress". IMHO, there is nothing more encouraging than seeing a cycle that lasts more than 12 hours, and that doesn't cause a climb back to a preshot number that matches the last preshot number. I think the " smile curve" is grossly overrated.

I'll climb off my soapbox now :-)

But do read what Dr. Lisa has to say about rebound!

http://www.felinediabetes.com/FDMB/threads/new-day-after-yesterdays-hypo.58953/#post-642503
 
What a lovely number, Judy! Glad you were able to grab that one.

In MY opinion, you do want 2 shootable preshots...and a smile curve. I personally would not be comfortable shooting if my cat was still going down at +12...but Carl and I have already agreed to disagree.

In the end, you have to do what you feel is right. I am glad you are able to see differing opinions on the board and then take the info you are given and make a decision.

I'll be around on and off today...and this weekend. :) Have a great Thanksgiving!
 
Rachel
I may not have said it right...
I agree you want 2 shootable numbers. When you get a lower preshot than expected, smile or not, you shoot at it. Just with a lower dose. That's where "gut feeling" comes into play...how much lower?
If your AMPS is 350, and your PMPS is 200, shooting less on the 200 is better than wishing it was a 350 with a 200 nadir at +6. And you're not really "shooting at the 200". You're shooting at the number 2 or 3 hours away after the food does its thing and the dose reaches onset.
What good is a smiley 350? It leaves you right where you started. Much of the time you might see a symmetrical smile. But on the cycles where it looks like the insulin lasted longer, IMHO, you take advantage of it.
 
So now I'm really confused. Being the lay person that I am. Hershey's AM preshots have always been shootable. Although I note know his AM is coming into the mid-200's. The PM shot has been lower, which puts him at risk for hypo if I shoot the same at night if a lower preshot presents. So what about just reducing both to 1.0 instead of both at 1.25? Still waiting on our turkey.
 
You could try that. I'd really like to see you get a couple more mid cycle numbers...that way we can see how a particular dose affects a particular number.

Hope your turkey is coming out soon! All our food is safely in the oven...
 
Hershey's AM preshots have always been shootable. Although I note know his AM is coming into the mid-200's. The PM shot has been lower, which puts him at risk for hypo if I shoot the same at night if a lower preshot presents. So what about just reducing both to 1.0 instead of both at 1.25?
Click to expand...

My opinion only...
Yesterday the AM dose worked really well. The result was a lower PMPS, which is what you want to see.
Last night, the 1.25u dose worked perfectly. 74 was not too low, and you saw that feeding him a little low carb stopped the drop.
Today's AMPS was great! You'll see at PMPS what the reduced dose did for him. If you see another 250ish preshot, then yes, reducing to 1u might work well.

If you can get mid-cycle tests in either the AM or the PM cycle, then that is the cycle you can afford to dose more aggressively than if you can't get mid-cycle tests. I'm not saying do a curve, just a test at +4 or +5 to see if the number is ok, or to see if a snack is needed to slow things down. Because as long as you have a meter in your hand, you can control his numbers if and when you need to.

If you can't test mid-cycle, then err on the side of caution. As long as you have data, the number that you consider "shootable" can be lower, and you can lower the dose accordingly as the preshot numbers continue to improve.
 
Thanks Carl. I guess I have never seen a low number like that, but then I'm not testing him every hour either. He always seems sleepy after his morning feed, and shot. Is that what insulin does? He seems most awake after his breakfast, but before his shot. Oh dear, I have no idea... anyway, today's readings were horrible. Gonna try and get a test in before bed, and see if he has dropped... Thank you for your advice, it means a lot. :)
 
It is like hitting a moving target, Judy, but you are doing great. I posted this on another thread this am - someone once said that in this sugar dance, not only is the cat leading, but he is the only one who can hear the music. :p
 
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