Hold the dose through bouncing?

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Stacym20

Stacym20

Member Since 2014
I'm finally getting some better numbers with Bud, but if you look at his spreadsheet, it looks as if he's got some major bouncing going on. Despite the higher pre-shots, I should hold the dose though correct?

And I have no idea what that 169 AMPS yesterday morning was all about... odd.
 
I've never used ProZinc, but I've always found better results by holding the dose longer when Mikey is bouncing and waiting till he settles down and flattens out a little bit before increasing again. You're getting some very lovely mid-cycle numbers right now, so hopefully Bud flattens out and those pre-shots drop a little lower for you.
 
Yes those 300 point drops in 3 hours concern me, I guess that's why I was *hoping* it was bouncing going on and that his preshots would settle down. I realize I don't have any data to tell me what's happening at +6 through +12. I plan on getting a curve Saturday or Monday. Bud has a dental appointment on the 22nd so I was thinking of holding out on ProZinc at least until then and a bit after to see if his numbers improve after the dental. If there's no improvement, I will talk to the vet about switching insulin. @Larry and Kitties Should I hold the 1.4 dose or should I cut back a little so he doesn't have those wild swings? It's all a catch 22 and I'm so confused.
 
You make dosing decisions based upon how low the dose takes the cat - so I wouldn't reduce a dose unless the dose takes the cat too low. Does that make sense? If your goal is remission you want to get him into normal numbers as much as possible (50-120 on a human glucometer.) The 1.4 got him to 79 a couple of nights ago - that's pretty great.
 
One of the longer-lasting insulins (Levemir & Lantus) would help smooth out the high numbers, but ProZinc is a great insulin too. Some people shoot more often than every 12 hours in order to get a little better coverage.

I'm seeing you've been using the ProZinc since September. At the point where you're out of insulin and going to buy new anyway, you might want to consider switching. Don't misunderstand - ProZinc is good and lots of cats do well on it. It's just a thought to consider.
 
Bud was diagnosed in September but we didn't start insulin until November. I unfortunately listened to my vet who advised to try a diet change alone for one month then yet another. I finally said I wanted Bud to start insulin. If I had listened to her, by the time they ordered the ProZinc in, it might have been almost December before Bud started insulin. I actually just bought and opened a new ProZinc recently because I was questioning the potency of my first vial. ProZinc would really work best for me because I like the flexibility of it. Plus I'm a wreck trying to figure out this in and out insulin stuff. I can't imagine how messed up I'd be with a depot insulin lol. So I'm definitely giving it at least another couple weeks and then I'll go from there.
 
I actually find the depot insulins easier to understand because you don't really have to worry about pre-shot numbers for the dose and you hold each dose a minimum of 3 days before changing so that gives you 3 days to figure out what your next dose might be (up, down, the same).

With Levemir, I've noticed it's much more forgiving with early or late shots than Lantus, so there might be a bit of flexibility there for Bud that you could test out. Mikey personally can have a shot up to an hour or two off schedule either way and it doesn't throw his numbers off. I don't do this more than once in a week if I can help it, but it's really made a difference for me because now I can stay late at work or go in early (yeah, right), if need be.

Plus, with Levemir's (usually) later nadir, it means I can go to bed at a reasonable time and get some sleep before he starts dropping low. This does make for some early mornings if he drops too low, but at least I've rested a bit first. I also can usually be home from work around his nadir (+7-14).
 
So Bud threw me a 250 tonight. Haaaaaaa. I don't know what to do with that.... Lol dosed at 0.8 and will monitor closely.
 
You can shoot through the bounce.

Take some time to look over how much he has dropped at various pre-shots with various doses over the past week or so (ie recent data). This can give you some ideas for a sliding scale, where a lower pre-shot gets a lower dose and a higher pre-shot gets a higher dose.

For example, on 2/8 with a pre-shot of 382, you gave 1.4 units and dropped to a 79 at +4, then it started going up. That is a drop of 303 mg/dL and likely provoked bouncing due to the rate of drop.
It also shows you how much Bud can drop on 1.4 units, though it won't always be the exact same amount.
You can estimate that if you wanted him to drop 150 mg/dL, 0.7 units might do it.
If you needed him to drop 100 mg/dL, you might test 0.4 units (roughly 2/3 of 0.7 units).
And if you needed him to drop 50 mg/dL, 0.2 units might be in the ballpark (roughly 1/3 of 0.7 units).
So just guesstimating, every 0.2 units might drop him about 50 mg/dL. That will need some refinement, of course, but its a start.
 
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It looks like lately 1.4 units will drop him about 300 points, so about 214 points per unit. 214 x 0.8 is 171 take that away from 250 and you get 79. So, in theory, he could drop to about 79 tonight. Maybe a bit aggressive but I want to be aggressive right now to see those lower numbers!
 
Hi Stacy,
What is Bud's feeding schedule?
Because his blood glucose can drop fast quite early on in the cycle, I wonder if a snack/mini-meal maybe an hour or hour and a half after the shot would slow that drop down a tad (if you're out then a timed feeder may help).
As BJ said the rate of drop can also trigger bounce; it's not only lower numbers that trigger it.

I've been staring at Bud's chart for a while now (am almost cross-eyed now! :confused:) and am not totally sure that this is all bouncing that we're seeing. Bouncing certainly could account for those highs and lows. But I also wonder if some of it is caused by this insulin having an early onset in Bud's system, and then a fairly short duration; almost as though he's metabolising it faster than normal, if that makes sense...? If I didn't know what insulin you're using, and saw your SS, I'd think you were using Caninsulin/Vetsulin rather than Prozinc; Bud's numbers remind me of Caninsulin/Vetsulin 'patterns' at the moment. (Just thinking out loud here....)

.
 
Thank you @Elizabeth and Bertie for staring at his spreadsheet! :) I'm quite confused. With a preshot of 250 last night, the 0.8 units did nothing for his numbers as he was 303 at +3 and 398 at +5. He was 313 this morning and I dosed at 1.2 so we'll see if that budges his numbers any.

I put down 4 cans of food for 6 cats at 7am/7pm. They don't eat everything right away and continue to graze on it for hours. Especially with the way that Buds numbers have been dropping, I have been making sure there is food out to get him past nadir at least.

I know what you mean about the Caninsulin/Vetsulin. I've the thought that same thing. It was just at the new dose of 1.4 that his numbers started dropping like that, so I was hoping he would level out on it after a while. Then he had to throw me a couple lower preshots that I didn't know what to do with not allowing me to hold the 1.4 of course.

I know getting some numbers from +6 to +12 might help put some of this puzzle together do I plan on doing that over the next few days.
 
If you feed the curve, ie slow down the drop by giving mini-meals in the first half of the cycle, that may help a bit with any bouncing.

Another option is to use a touch less insulin, aiming for 100-150 mg/dL, rather than 50-100 mg/dL (on a human glucometer).

Keep in mind that it may take a bounce several days to clear, so you need to be patient when there was a bounce somewhere in the previous 3 days.
 
I'm so glad it's helped! It really does look like we are having the same issues. How did the 0.4 go for you last night? I definitely think I need to start dosing on a sliding scale.
 
Stacym20 said:
I'm so glad it's helped! It really does look like we are having the same issues. How did the 0.4 go for you last night? I definitely think I need to start dosing on a sliding scale.
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Yes, there are definitely similarities, here. I often feel like Hannah is the only one confusing her bean, so it's helpful to know that other kitties are doing the same... especially when their beans know how to ask questions and get answers. I have been trying to dose on a sliding scale, but am still having issues figuring out just how much to dose. And what works one time doesn't work the next. Sigh! :banghead: It also confuses me as to whether I shoot the pre-shot number (which could be a bounce) or shoot the nadir. I need to collect more numbers during the night, but I'm not the best at waking up fast, then trying to get back to sleep. Grrrrr! :mad: Plus, poor Hannah's ears look like two little pincushions, already, and sometimes I just think, "Enough is enough, already!"

Last night didn't turn out as I had hoped. Still, I'm grateful for the advice received. Guess I should have had a little more fortitude and gone with the 0.6U, but I'm usually conservative to a fault, especially when my baby doesn't want to eat. Hannah's AMPS was 503. And she's still not dropping much for this day. However, she's acting really good, so we're thankful for that.

Keep asking those questions!!
 
The ears do have a tendency to look pretty terrible the first month or so of testing but it should clear up soon. Just make sure you apply pressure after every poke to reduce bruising and stem the bleeding.

Blamethecats and Hannah said:
Last night didn't turn out as I had hoped. Still, I'm grateful for the advice received. Guess I should have had a little more fortitude and gone with the 0.6U, but I'm usually conservative to a fault, especially when my baby doesn't want to eat. Hannah's AMPS was 503. And she's still not dropping much for this day.
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You did just fine last night. We have a saying around here: "you hold the syringe so it's you who has to feel comfortable shooting the dose." Sure, you found out later that she would have probably been just fine with .6u, but hindsight is always 20/20. What matters is that going forward, you now have data on what happens if she does this again and it helps build that fortitude in you so you'll be able to give .6u next time.
 
Also, we were estimating what might work based on some limited data. When using an estimate that way, you want to be cautious ... or be up monitoring all night, ready with the high carb to steer the numbers as needed. I know which I prefer, given that I have a sleep disorder!
 
BJM said:
Also, we were estimating what might work based on some limited data. When using an estimate that way, you want to be cautious ... or be up monitoring all night, ready with the high carb to steer the numbers as needed. I know which I prefer, given that I have a sleep disorder!
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Agreed!
 
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