How to proceed during/after bounce?

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fearlessmom

fearlessmom

Member Since 2017
I feel like I have wasted the last 3 wks. Started Fearless @ 2U of Lantus per vet. Even though vet agreed we would follow SLGS, starting dose according to this forum should have been .5U (or no more than .75U if we were following TR protocol as Fearless was underweight to start, at 6.5 lbs). Under vet's advice, after 5 days (first 4 not tested) switched to 1U, another no-no according to this forum. We then shot between .5 and 1.5 for a couple days until settled on 1U for 5 days. We were flatlined in the 300s and 400s so increased to 1.5U. Stayed there and thought we were doing OK until couldn't get out of the 400s and 500s, so under vet advice increased to 2U. Trying to be consistent I overdosed him this morning and now bouncing into 400s. Before I pull out what's left of my hair, I have a few specific questions:
1. Even though we had pretty good numbers yesterday, was the 116 (on pet meter) too low to give full 2U last night, even though +3 pm count was 139? If the 156 at +1 am today was a food spike, could the 139 last night have also been a food spike?
2. According to the sticky note, after a week at a specific dose (for us that was 1.5U from 4/6 to 4/12), we should have done a 12 hour curve (which we didn't, but the nadir was still >150) and increased by .25U. If this is true, once Fearless is over his current bounce, should we reduce to 1.75U and follow SLGS rules (e.g., NOT shoot if he is <68 on pet meter)?
3. That brings up another question: Because we know today's numbers are a bounce, should I not shoot at all tonight? If not, what are the rules for how much insulin to give during/after a bounce? How do I even know when the bounce is over?
4. Alternatively, should I start from the beginning again at a much lower dose?
I guess my main concern is that I have yet to see a pattern in Fearless's counts and thus I am unsure how to proceed after this latest bounce.

BTW, here's link to previous thread on Fearless:
http://www.felinediabetes.com/FDMB/...nd-his-spiking-bg-levels.175753/#post-1940549
 
When is your shot time? Hopefully someone will be able to help with dose advice before then...
 
It looks like they recommended 1.75u this morning. I would wait just a few more minutes to see if someone who knows Lantus shows up. If not, you can probably go with that, and then just make sure to grab a test in a few hours.
 
Fearless is in at 526 at PMPS please go ahead and shoot the reduced dose of 1.75. Remember, earlier on today's thread I said that he will probably bounce higher and to ignore the higher numbers and shoot the reduced dose. He could be higher (bouncing ) for 6 cycles. Go ahead and get the insulin in him.
 
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@Djamila I wouldn't say I am an expert as there are many many more here that know lots more than me. But, I will say, that I care deeply for all the kitties here and their beans and I always try to do my best. And glad you were lurking over in Lantus/ Levemir land!
 
Feed the PM meal as you would normally feed. When they are in higher numbers, don't withhold food from them, it is tempting but don't. LOL
 
He already got some food (about half his normal amt) 2-1/2 hrs ago at last test, so just fed the other half after shot. Will wait a couple hrs and test again. What should I look for? Will lower count mean insulin is working in spite of the bounce, or am I just testing to get a read on what he does with the 1.75U? If he's still bouncing, what's the point of testing? I thought I read somewhere that the one silver lining of a bounce is it gives kitty and person a break from testing. I've been testing an average of every 3 hours during am cycle since we began. If counts continue to be high with 1.75U, how do I know when the bounce is over?
 
fearlessmom said:
He already got some food (about half his normal amt) 2-1/2 hrs ago at last test, so just fed the other half after shot. Will wait a couple hrs and test again. What should I look for? Will lower count mean insulin is working in spite of the bounce, or am I just testing to get a read on what he does with the 1.75U? If he's still bouncing, what's the point of testing? I thought I read somewhere that the one silver lining of a bounce is it gives kitty and person a break from testing. I've been testing an average of every 3 hours during am cycle since we began. If counts continue to be high with 1.75U, how do I know when the bounce is over?
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Bounces usually last 6 cycles or 3 days. Since he is in the 500's you can stop testing for tonight. Tomorrow's test will be telling if he is starting to clear the bounce yet. Remember, it can take up to 6 cycle to clear. Keep posting and peeps here will help you know whether it was a failed reduction or not. It is sometimes hard to discern whether it is a failed reduction or still a bounce. Keep asking questions.
 
Sometimes the lower they drop the higher they bounce, Some kitties (especially one of mine) are much more prone to the dreaded "bounce". A bounce can take up to 3 days to completely clear the system and it is just a matter of patience and waiting it out. As Bobbie said when they are bouncing high like tonight, it is okay to take a break from constant testing and it is a good time to relax and get a good night's sleep. :bighug::bighug:
 
And what affect does the amount of food have in all of this? He typically gets about three 3 oz cans of FF spread out over the entire day (in 5 or 6 smaller feedings). Today because of the odd timing of tests, he's gotten about 2-1/2, with the last 1/4 can about 30 min ago. Should I still leave him 1/2 can overnight as I usually do or will it skew what I'm looking for tomorrow morning?
 
If he is due for another 1/4 can of food, I would give it to him when you normally do. Maybe give it before the mid cycle as that is the lowest part of the cycle and then the BG's go up from there. Another words, if you give the food after the nadir and the numbers are starting to rise, it is like you are putting the foot heavier on the brakes for the insulin to stop working .
 
Well, his nadir is typically +6 to 6-1/2 hours, at least in am cycle (don't usually stay awake until +6 after his evening shot, which would be 1 am), so anytime before then? That works. I'll give him his last 1/2 can of the day within the hour. Thanks, and good night to all.
 
Hi, I wanted to add a little on to the explanation about bouncing. When a cat is really used to high numbers, each time they hit normal numbers they bounce and it might last up to 3 days or so.

It looks to me like Fearless is getting into normal numbers regularly on the 2u. He's had green numbers 3 days in a row now, so I would definitely not assume that he'll be high for 3 days. He's clearing the bounces very quickly, within a day. I wouldn't be surprised if he had the bounce cleared by morning, but you never know. That 67 AT was pretty low and it might make him bounce longer than he's been doing.

Trying to answer your other questions - when Fearless is in a bounce you feed and dose as normal. Lantus dosing is based upon how low the dose can make the cat's blood sugar go, so highs don't usually change the dose. You simply wait for the bounce to clear, assess how low the dose is making him go, and make dosing decisions from there.

You were ok shooting last night. An experienced person following SLGS will shoot pretty much everything over 90, as long as they can monitor afterwards and the cat isn't ill or not eating. The idea is to work up (or down) to shooting lower range numbers. You're basically already there since you've shot that 116. Here is the link to the sticky for SLGS, which includes what to do if your preshot number is lower than you've typically been shooting. I think it helps to think of it as phases - in the beginning people don't shoot under 200, then 150, then gradually lower the preshot number as they have experience to see what happens when they do shoot lower numbers.

I don't think your vet's dosing changes were so terrible. I wouldn't be angry about it - you're in the ballpark on dose now. Yes they were higher than we start here, but it's not uncommon for vets to start cats at 2u. The SLGS doing guidelines that you're following were developed by experienced people here, but there are other dosing methods for using Lantus. Since you are testing at home you'll be able to keep Fearless safe. The one change I would encourage you strongly to make is to get a test before you go to bed every night. Cats often have their lowest numbers in the pm cycle, and because Lantus dosing is based upon the low numbers it can be very helpful to see what's going on at night. At this point, I'd encourage just 1 test right before bed.

This link "Where Can I Find?" might be helpful to you in finding information that we commonly refer to in this group. Lots of information here and it's good to be able to find it!!

Hope that isn't too much information all at once! Please do ask questions if any of it is confusing. You're off to a good start and Fearless's making progress. If a cat's pancreas is able to heal, it does so when the cat's body is in normal numbers, so it's great that he's falling into that range already. Well done!
 
Here is the explanation on bouncing from the "Basics: New to the Group?" sticky:
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
The more the cat's body is in normal range, the more the bouncing will *usually* lessen, both in intensity and duration. So instead of bouncing to 526 (yikes) he might only bounce to 200. Instead of it lasting 3 days, it might only last a couple of hours.

Hope that helps.
 
Thanks for sharing your thoughts, Julie. I thought we were on the right track on 4/13 and 4/14 shooting 2U, but then I went and blew it by shooting that 67 yesterday. Ugh. When you say "An experienced person following SLGS will shoot pretty much everything over 90" do you mean 90 on a pet meter or human meter? I checked out Punkin's SS and noticed the low range is different than others I have seen.
On Fearless's bounce, he was 409 this morning so it hasn't cleared. What I'm confused about is the 139 bedtime count after shooting at 116. Do you think that was a food spike, as someone else suggested? If so, wouldn't all my bedtime counts be higher? If the bedtime counts are consistently higher than the pre-shot tests, should I be feeding less? If so, how much less? I guess only time (and consistent evening testing) will tell. I can definitely stay awake for one test just before bed, but I can't help but wonder when some folks sleep (based on their SSs that show tests far into the night). Is this common? Anyway, I am more encouraged after reading your comments. Thanks again.
 
Do you think that was a food spike, as someone else suggested? If so, wouldn't all my bedtime counts be higher
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Not necessarily. If your +2 reading is the same or lower than the pre shot number, it can indicate an active cycle. Otherwise, it is not unusual for the +2 number to be higher from a food spike. Lantus kicks in some time around +3 but if kittie is bouncing you might not see a lower number yet which might have been the case with the 139 the other night.

While you are still so new to using Lantus, as time goes on you will start to see a Fearless developing a pattern and as we say around here Know thy Cat.
 
You're wise to ask for clarification regarding the numbers. Most of the sticky notes are written for a human meter. The only direct correlation is between a 50 (human meter) and 68 on an AT. The "below 90" if following SLGS is based on a human meter. Beyond that, the numbers gradually become similar once you're in the higher ranges. Frankly, many of us who have been around for a while find it hard to offer a "rule" for when exactly to reduce the dose if you're using an AT meter and following SLGS. What I'd suggest for now, is that if you see "green" numbers, please post and ask for people to take a look at Fearless' spreadsheet.

Julie's Punkin's SS may not offer you the best example of what to do. Punkin was diagnosed with acromegaly and was a high dose cat. While Julie primarily followed Tight Regulation, the dosing strategy changes if a cat's dose is above 6u and especially changes if there's a diagnosed high dose condition. Julie also used a human meter. You're welcome to look at Gabby's SS but I used a human meter, as well.

The 116 and 139 are essentially the same number. There is an allowable 20% measurement error inherent in the meter. So if you add approximately 20 points +/- to either number, you'll see that they overlap. What you were seeing is a small bump due to you're having given Fearless his dinner. the real question is where were his numbers closer to nadir? Given the 67 at AMPS, there's a very good chance that his numbers dropped overnight or that you had a "bad" AMPS test. (I would generally re-test if I got an unexpectedly high or low number.)

I am going to say this again. You need to get a "before bed" test each and every night. It doesn't matter that the cycle started out high. Gabby was a kitty who could start a cycle in the 400s, drop into the 40s, and be back in the 400s by the next pre-shot (see 11-2-2009). If I wasn't testing, I would have been increasing her dose rather than reducing. Testing is the best and only way to keep your cat safe.

 
The 139 was a bedtime test. Before that, shot at 116. Should the reduction have been taken there? When you say "doesn't matter that the cycle started out high" are you referring to that same day? Yes, it started at 359 but had only been at 2U for a day so had no intention of increasing the dose. The dark green on AT is 68-99, so anything under 99 should raise a red flag?
 
I think so, but at this point I'm not 100% positive of anything. Everyone else here seems to think I am, but because I am using a pet meter, the sticky on SLGS is not as helpful for me as for those using a human meter (apparently it was written using human meter numbers). If I simply look at the 3 wks of data I have and compare AMPS #s to that of today, my inclination is to wait, test again in an hour and see which way the numbers are moving. But I'd like some confirmation on that.
 
He could have been clearing a bounce it is hard to know with out any night time numbers . Yes, give him some food now to slow him down. I would give MC food and retest in 30 minutes.
 
It's best if you start a new thread so others can keep an eye on you and help out. I'm running out the door shortly. My gut says he might be looking for another reduction soon but you're doing a great job!
 
@julie & punkin (ga) are you going to be around for a bit that you could keep an eye on Fearless? He started off 167 this AMBG and shot 1.75 u and is dropping. I need to run a few errands before I get my mom up. If not, I will stay here with them.
 
I would continue with the MC and retest again in 30 minutes. Since it is early in the cycle he could continue to drop as onset starts, so keep testing and giving food according to the number you get.
 
He isn't out of the woods until he has two test in a row where he stays above 68 without any food influence. I need to run out for about 1 hour. If you get into trouble, change your title to a 911 so other eyes will be on you. I will check back in about 1 hour.

ETA: if his next test is appreciably higher, you could switch back to LC food for any subsequent meals or steering.
 
I'm back, and see that he dropped again. yes, keep doing what you are doing.

Congrats on the reduction, I forgot to say that earlier.....so tonight's dose will be 1.50. I had a feeling too it wasn't going to be too long before he earned another reduction . :cat:

Start a new thread tonight with the date and PMBG as that is what we do here in L & L otherwise the thread gets too long like this one. And please get a +2 tonight no matter what the PMBG starts off with because Fearless is living up to his name and clearing bounces with a vengeance. Also, get a test in before you hit the sack because kitties go lower usually in the PM cycle and it's important to see what he is doing so we can alter the dosing correctly. I will keep popping in on you to see how things are going but, just wanted to say the above so I wouldn't forget and I might not be around for his PM cycle.


You and Fearless are doing great!!!!!
 
fearlessmom said:
I think so, but at this point I'm not 100% positive of anything. Everyone else here seems to think I am, but because I am using a pet meter, the sticky on SLGS is not as helpful for me as for those using a human meter (apparently it was written using human meter numbers).
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Hi there and welcome to the group!

Just wanted to clear this up...
I'm afraid there was some confusion surrounding the information you received about the guidelines in the SLGS protocol. It doesn't matter that you're using a pet-specific meter. Use the numbers in SLGS at face value.

In other words, Fearless earns a reduction when dropping below 90 mg/dL. When Julie said most experienced users will shoot anything 90 mg/dL or over... that means most experienced users will shoot a 90 mg/dL or higher on whichever meter they're using when following SLGS. Matter of fact, oftentimes experienced caregivers following SLGS eventually find themselves lowering that number if they have data accumulated to support their decision. Make sense?

It looks like Fearless cleared his bounce last night. A before bed BG test probably would have given you a clue that he'd be dropping. If at all possible, try to get a before bed test done every night. It'll usually clue you in as to what may happen.

You and Fearless are doing great!
Good luck! :)

 
Just popping in and I see where he really jumped up for you. Probably a combo of bouncing and all the HC gravy you gave to bring back up his numbers. If you haven't all ready done so, it's a good idea to record what food you gave to steer with so you can look back and see what worked. If you take a look on Bubba's last year SS you can see how I stacked the numbers and the carb food I gave and how much ( ie. 1 tsp MC , 2 tsp gravy, 1 tbsp MC etc) so I can see how that brought him up. It will help you the next time he starts to drop ( an there will be an next time )

Typically, we want to give enough high carb food to bring them up about 20 points but, as you saw today, Fearless was clearing the bounce today and kept you on your toes for a few hours. Again you did great. :cat:
 
He hasn't had any food since noon and he (might be?) leveling off. We'll see what the next hour brings. I keep a paper food chart and added the MC food to Comments in SS, but can't figure out how to add it to individual cells without losing color coding.
 
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