How to tell if BSL are bouncing or just high?

[Teresa & Cricket]

Hello,
I am new here and am seeing all the info about SLGS, and frequent testing, but I didn't have that info before.

How do I know if her dose is too high and she is bouncing because of it, or if her BSL is just high and she needs to keep incrementally increasing her dose?

And then, if it is determined to be a bounce effect, do I lower it by half units each week with testing?

284 is the lowest nadir I have seen, but my testing has been a bit random and I wasn't instructed to test for the first couple of weeks.

(I know I need to do a full curve, but am currently low on strips, just ordered some)

Any advice would be great-- I asked some of this in the health forum, but it was further down a thread and I felt it better to come over here.

Thanks

 

[Bobbie And Bubba]

Hi Teresa and welcome to L, B, & L forum. So glad you are here as there is a lot of good information here.

To answer your question as to whether Cricket is just high or bouncing, we would need to see some more data. And I want to impress upon you that you should always get a pre shot number so that you know it is safe to give insulin. Without that knowledge, you could potentially be shooting a number that is too low and she could get into some serious hypo trouble. Although Lantus is based on how low a kitty goes on the dose, consideration to the pre shot is important too.

I would suggest that you run a curve which would be to start at Pre shot AM or PM and test every 2 hours for 12 hours. That information will help to see what the current dose is doing.

Once you have more data, you will be able to know whether she is just high or bouncing from a lower number that she is not used to . Here is a little bit about bouncing:

Why bouncing occurs

1. Going too low (below 68 on the AT) 50 on a human meter
   2. Dropping too much, too fast
   3. Dropping to a number their body isn't used to being at anymore (or any mix of all 3 reasons)

When that happens, the liver responds by dumping stored sugar and hormones into the bloodstream to bring them back up quickly....they "bounce" up

It's normal, especially for newly diagnosed cats and there's nothing you can do about it but wait for it to clear (up to 3 days)

So, start getting more test. Always a pre shot test, and a test at +2 . This is one of my favorite test because if the +2 is lower than the pre shot number, it is going to be an active cycle and more testing is necessary. Another test anywhere from +4 - +7 as that is the typical times most kitties will nadir. And at night time, pre shot, +2 ( to give you a heads up on the way the cycle could head ) and then another one before you go to bed.

Think of the SS as a puzzle and you want to fill in some missing pieces to have a picture of what is going on.

Keep posting and asking questions as that is how we all learned.

 

[Teresa & Cricket]

Thank you Bobbie, that was very helpful and clear.
I'm currently concerned that she has been too high for too long and am tempted to do my vet's suggestion to increase by even a half unit.
I can't do a curve until next weekend because I am getting strips on Wed.

I'm nervous about the idea of changing the dose before I get some more strips though.

(BTW, your Bubba is so adorable!)

Hi Teresa and welcome to L, B, & L forum. So glad you are here as there is a lot of good information here.

To answer your question as to whether Cricket is just high or bouncing, we would need to see some more data. And I want to impress upon you that you should always get a pre shot number so that you know it is safe to give insulin. Without that knowledge, you could potentially be shooting a number that is too low and she could get into some serious hypo trouble. Although Lantus is based on how low a kitty goes on the dose, consideration to the pre shot is important too.

I would suggest that you run a curve which would be to start at Pre shot AM or PM and test every 2 hours for 12 hours. That information will help to see what the current dose is doing.

Once you have more data, you will be able to know whether she is just high or bouncing from a lower number that she is not used to . Here is a little bit about bouncing:

Why bouncing occurs

1. Going too low (below 68 on the AT) 50 on a human meter
   2. Dropping too much, too fast
   3. Dropping to a number their body isn't used to being at anymore (or any mix of all 3 reasons)

When that happens, the liver responds by dumping stored sugar and hormones into the bloodstream to bring them back up quickly....they "bounce" up

It's normal, especially for newly diagnosed cats and there's nothing you can do about it but wait for it to clear (up to 3 days)

So, start getting more test. Always a pre shot test, and a test at +2 . This is one of my favorite test because if the +2 is lower than the pre shot number, it is going to be an active cycle and more testing is necessary. Another test anywhere from +4 - +7 as that is the typical times most kitties will nadir. And at night time, pre shot, +2 ( to give you a heads up on the way the cycle could head ) and then another one before you go to bed.

Think of the SS as a puzzle and you want to fill in some missing pieces to have a picture of what is going on.

Keep posting and asking questions as that is how we all learned.

 

[Sienne and Gabby (GA)]

At the moment, I would ignore your vet. Let me explain why.

Lantus dosing is based on the lowest number in a 12-hour cycle (i.e., the nadir). You need to get a pre-test shot to make sure it's save to give a shot but whether you increase or decrease the dose is based on the nadir. If you are getting only random tests, you could easily be missing low numbers. As an example, my kitty was a bit of a drama queen and could start a cycle in the 400s, drop into the 40s, and bounce back into the 400s by the next shot time. If I wasn't a testaholic, I could have easily missed giving her a dose reduction and instead, raised her dose.

The other factor is that even with the more aggressive of the dosing methods that we use, the Tight Regulation Protocol, doses are typically raised by 0.25u and only raised by 0.5u if the nadirs are consistently above 300. With the less aggressive method, Start Low Go Slow, doses are raised by 0.25u. In Cricket's case, your vet was instructing you to raise the dose by 1.0u. When a dose is raised that aggressively, you don't know if you've missed what could be a "good" dose. This is particularly the case if you have limited data. Unfortunately, giving too much insulin can look very much like not giving enough insulin which is why we urge people to raise the dose in a systematic manner.

Unless you are able to consistently get pre-shot tests every cycle and get at minimum, one test per cycle, it may not be safe to raise Cricket's dose. I know it's hard to see high numbers. We all hate them. However, safety is a much bigger factor and we all would rather err on the side of keeping a kitty safe.

Also, if you are concerned about Cricket's numbers, I would encourage you to routinely test for ketones. This is a bit of prevention that is good to do until you can get your kitty in better numbers. You can purchase Ketostix at any pharmacy. You just dip the stick in your cat's urine and get a reading based on the instructions on the box.

 

[Teresa & Cricket]

@Sienne and Gabby (GA)
So you feel it is better for me to keep her on the same dose until I can do a full curve? (which might not be until next weekend)


I'll look into the ketone strips-- but I'm a bit overwhelmed financially (Very close to not having rent and bills this month-- 80% of my income already goes to rent, I have no savings and no credit card)

There's no way I could possibly check preshots and nadirs every day--I work and live alone. And at night, I am asleep at that time.
I can do it on the weekend.

 

[Wendy&Neko]

Even a +2 test at night or whatever is your before bed time, will fill in some of the picture to give us an idea what is happening.

If cost is an issue for testing, you might want to invest in a human meter as a backup. The test strips are much cheaper and more easily available. A lot of us use them and our dosing methods were written using human meters.