? Jack 02/25 - AMPS 307, +3 412, +6 373, PMPS 328, +3 237, +6 258

AngelaMiao

AngelaMiao

Member Since 2019
Previous posts for context here and here

Is it normal for a bounce to last this long and is this really a bounce? He went down to 3.4 at +6 on February 23rd and his BG has been crap for the last 4 cycles - today he's up to 412 at +3 from a 307 pre-shot. I don't even know what to do with his dose anymore because I have no idea if the 3.4 was a fluke from something like him eating less without me noticing and it's becoming really hard to anticipate anything since he'll go from bouncing to a flat curve and back to bouncing. I can't tell if his dose is too much or too little because this is all so new to me that I just don't understand how certain things happen.

Also can't judge anything based on how he acts because today he was super energetic and social, like a new cat so I expected a good BG at +3, but nope, 412, highest reading in 5 days. He's usually in a good mood when he's under 200 or over 400, makes no sense.

Not sure how to proceed. Should I continue with 0.75 or go down to 0.50 to see if he'll bounce less? I was expecting to increase his dose but then his BG suddenly went down and now I know he's capable of achieving a 3.4 on 0.75 units. I feel like because he's bouncing for longer periods than he is in good numbers now his body is becoming accustomed to even higher numbers and making him even harder to control than it was at the beginning when we just started insulin.
 
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Hi there!

I'm fairly new here too, and definitely not going to give any dosing advice, but I do have a question....are you using calipers?
I assume being Canadian you're using BD syringes and, if so, they have a reputation for being poorly marked, and I can say that my experience has followed that. I found that the markings can be off by as much as almost 0.5 U! And *many* of the BD syringes are mismarked.

With a cat getting such a tiny dose as Jack, this could be causing a very significant variation in each of his doses. As an example, if you using a syringe that has the markings off by 0.25 U and you are drawing up to the 0.5 U mark, then Jack could actually be getting a dose of either 0.25 U or 0.75 U. And since some syringes are marked correctly, some are slightly off, and some are widely off, calipers are the only way to ensure a consistent dose with every shot which is really important with a depot insulin like Lantus.

This may not be the cause of the variation in Jack's numbers, but if you're drawing to the lines with BD syringes it certainly isn't helping :) If you don't have calipers, you can find a correctly marked syringe and draw to dose with colored water (some use tea!) and compare your drawn dose to that one to help get a more consistent dose.

Hth, with love, Nikki
 
AngelaMiao said:
Previous posts for context here and here

Is it normal for a bounce to last this long and is this really a bounce? He went down to 3.4 at +6 on February 23rd and his BG has been crap for the last 4 cycles - today he's up to 412 at +3 from a 307 pre-shot. I don't even know what to do with his dose anymore because I have no idea if the 3.4 was a fluke from something like him eating less without me noticing and it's becoming really hard to anticipate anything since he'll go from bouncing to a flat curve and back to bouncing. I can't tell if his dose is too much or too little because this is all so new to me that I just don't understand how certain things happen.

Also can't judge anything based on how he acts because today he was super energetic and social, like a new cat so I expected a good BG at +3, but nope, 412, highest reading in 5 days. He's usually in a good mood when he's under 200 or over 400, makes no sense.

Not sure how to proceed. Should I continue with 0.75 or go down to 0.50 to see if he'll bounce less? I was expecting to increase his dose but then his BG suddenly went down and now I know he's capable of achieving a 3.4 on 0.75 units. I feel like because he's bouncing for longer periods than he is in good numbers now his body is becoming accustomed to even higher numbers and making him even harder to control than it was at the beginning when we just started insulin.
Click to expand...
As is often said here, a bounce can often last up to 6 cycles. You're on cycle 4 since that green so give it time. In my experience a bounce can last longer than 6 cycles but 6 cycles is generally a reasonable time to wait it out. If there's no improvement the TR rules are clear:

General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
 
nslade001 said:
Hi there!

I'm fairly new here too, and definitely not going to give any dosing advice, but I do have a question....are you using calipers?
I assume being Canadian you're using BD syringes and, if so, they have a reputation for being poorly marked, and I can say that my experience has followed that. I found that the markings can be off by as much as almost 0.5 U! And *many* of the BD syringes are mismarked.

With a cat getting such a tiny dose as Jack, this could be causing a very significant variation in each of his doses. As an example, if you using a syringe that has the markings off by 0.25 U and you are drawing up to the 0.5 U mark, then Jack could actually be getting a dose of either 0.25 U or 0.75 U. And since some syringes are marked correctly, some are slightly off, and some are widely off, calipers are the only way to ensure a consistent dose with every shot which is really important with a depot insulin like Lantus.

This may not be the cause of the variation in Jack's numbers, but if you're drawing to the lines with BD syringes it certainly isn't helping :) If you don't have calipers, you can find a correctly marked syringe and draw to dose with colored water (some use tea!) and compare your drawn dose to that one to help get a more consistent dose.

Hth, with love, Nikki
Click to expand...

Not using calipers. The syringes I'm using are SureComfort syringes that I ordered from the USA (cheaper than buying them here). How do calipers work? I looked into it a bit but got confused and gave up pretty quickly. Do the calipers know how thick the syringe is and how much plastic there is? I did use BD syringes for the first 10 doses and I noticed the syringes are a bit wider than the SureComfort and the plastic is thinner too, so the measurements are a bit further apart on the SureComfort since each mm of syringe fits less insulin (I don't know if that makes sense).
 
Kris & Teasel said:
As is often said here, a bounce can often last up to 6 cycles. You're on cycle 4 since that green so give it time. In my experience a bounce can last longer than 6 cycles but 6 cycles is generally a reasonable time to wait it out. If there's no improvement the TR rules are clear:

General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Click to expand...
I'm just discouraged because everytime a bounce clears, he just ends up bouncing again just as quickly or even more quickly since the bounces seem to be bringing him into higher numbers and getting his body used to those.

Before starting insulin, we did 3 weeks of testing after switching him to wet food and he averaged between 250 and 300 (down from 400 at the vet) I got maybe 2 readings between 300 and 350 and the rest were all below 300. Now he's constantly above 350, has managed to exceed the 400 that he was at when he was still on cheap dry food, and even more lethargic and inactive than he was before starting insulin.
 
AngelaMiao said:
I'm just discouraged because everytime a bounce clears, he just ends up bouncing again just as quickly or even more quickly since the bounces seem to be bringing him into higher numbers and getting his body used to those.

Before starting insulin, we did 3 weeks of testing after switching him to wet food and he averaged between 250 and 300 (down from 400 at the vet) I got maybe 2 readings between 300 and 350 and the rest were all below 300. Now he's constantly above 350, has managed to exceed the 400 that he was at when he was still on cheap dry food, and even more lethargic and inactive than he was before starting insulin.
Click to expand...
I truly understand how you feel. My cat is an Olympic level bouncer and it's taken a very, very long time to get him somewhat settled. After more than three years and three different insulins his SS is still quite colourful. His clinical signs are great though so I focus on that.
 
Bouncy cat here too.

Overtime I’ve noticed the bounces clear faster and the bouncing numbers became lower for my cat. Ming’s been on Lantus for almost 6 months. I know from looking at other’s SS that some cats took just a few months to be regulated and some took a year+. Every cat is different.

I had also noticed in the beginning, Ming would act very uncomfortable when he hit lower numbers because he wasn’t used to it. And then when he went back to high numbers, he’d be running around and doing his thing. The opposite is true now. I can tell now when he’s lower because he’ll act more like a kitten. But he’ll also act off when his numbers dive too low. It’s a very delicate thing.

It’s discouraging and frustrating and we all understand how that feels.

But remind yourself, you’re doing your best. Keep doing what you’re doing: follow the protocols and ask for advice here. Be patient and make sure kitty is comfortable and happy. I had to learn that our cats are more than their numbers and that FD is a marathon.
 
The Unit markings on each brand of syringe should correspond to the manufacturer's measurement of a "real" (i.e., exact) Unit. Otherwise there would be more chaos than usual (!). So if you hold your Sure Comforts next to your BDs you will see that the markings do not occur at the same places on the barrel (some barrels are thicker than others, etc., as you have noted). That said, virtually all brands of syringes are not very accurate within themselves: the "zero line" often does not line up with the stop disk, as it should do. This is where calipers can help you get a more accurate measuring of your dose. Here is the link to Marje's excellent study of "Dosing with Calipers": http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

With regard to bounces, weird numbers, etc. etc. This is to be expected when beginning Lantus. Lantus needs time to get "established". It needs to build a depot (reserve supply) of itself in the cat's body. It can take a week to 10 days to build the initial depot, and every time you change the dose, the depot needs to recalibrate itself. That's why we don't jump around in dose. If you skip a dose or give a "fur shot" you have to start over again counting cycles. Remember that dosing with Lantus is based on the lowest number in the cycle, not on the pre-shot number. It can take up to 72 hours (6 cycles) to clear a bounce, and if you make changes in dose within those 72 hours, you are setting yourself up for more bounces and/or weird readings. Jack is bouncing from the 62 he had two days ago.
It's not clear to me why you went from 0.25U to 0.75U. Protocol would raise the dose by 1/4 Unit (to 0.50U). Are you following the TR protocol, or the Start Low Go Slow (SLGS) dosing method? Please post this information in your signature. That would be a big help to people who are trying to help you.

The best thing to remember is that "Rome was not built in a day" . It can be frustrating when things don't work the way they should, but just do your best. You are helping Jack and he is feeling good. This is what matters. It will all fall into place as you go forward and Every Cat Is Different (ECID), so some cats just take longer to get there.

:bighug::bighug:
 
I was originally doing the SLGS but it wasn't working out, especially since it says to go down 0.25 anytime he goes below 90, I ended up getting down to 0.25 and it wasn't doing much so I switched to TR and went back to 0.75 since he would have never earned a reduction had I been doing TR from the beginning. Being a noob, I probably should have gone back to 0.50 rather than 0.75 but by the time it was pointed out I had already been back at 0.75 for a few days (I kinda panicked at him going over 400 and it was probably not the best judgement).

I just noticed that the Special Kitty pate he's been eating has wheat gluten and carrageenan. I wonder if that's affecting anything. Originally I was alternating between Fancy Feast and the Special Kitty and ran out of Fancy Feast. I wonder if maybe that's why he had more good numbers when he was having a mix of both versus only the Special Kitty. They're both supposed to have about the same amount of carbs.
 
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AngelaMiao said:
Not using calipers. The syringes I'm using are SureComfort syringes that I ordered from the USA (cheaper than buying them here). How do calipers work? I looked into it a bit but got confused and gave up pretty quickly. Do the calipers know how thick the syringe is and how much plastic there is? I did use BD syringes for the first 10 doses and I noticed the syringes are a bit wider than the SureComfort and the plastic is thinner too, so the measurements are a bit further apart on the SureComfort since each mm of syringe fits less insulin (I don't know if that makes sense).
Click to expand...

The plastic or the barrel doesn't make any difference. It's the lines that are important. When using calipers you set them to the units you want to give (math calculation involved). Once that is figured out you set the calipers (assuming there is a lock on them) and it's good UNTIL you change dose or brand of syringes. Then you have to reset calipers.
 
AngelaMiao said:
I just noticed that the Special Kitty pate he's been eating has wheat gluten and carrageenan. I wonder if that's affecting anything. Originally I was alternating between Fancy Feast and the Special Kitty and ran out of Fancy Feast. I wonder if maybe that's why he had more good numbers when he was having a mix of both versus only the Special Kitty. They're both supposed to have about the same amount of carbs.
Click to expand...

Carrageenan is a thickener that is made from seaweed. Wheat gluten, however, is not part of a low-carb diet. I don't know offhand the carb content of Special Kitty, but in general, the low-carb foods are grain-free. I would shift him from that to either Fancy Feast or Friskies classic pates. Feeding a high-carb food (such as I assume Special Kitty is) is going to cause his numbers to go up and make it hard to regulate.


ETA: There has actually been some discussion on this board about Special Kitty: http://www.felinediabetes.com/FDMB/threads/special-kitty-wet-food-info.177825/

According to this, it appears that it may actually be acceptable as far as carb content. However, it was the subject of a recall a few years back, and the formula/manufacturer may have changed since this info was published. The fact that it contains wheat gluten gives me pause, though - it's definitely not grain-free. If it's not an affordability issue, I would stick with Fancy Feast or Friskies simply because the actual contents are known and known to be low carb.
 
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AngelaMiao said:
Not sure how to proceed. Should I continue with 0.75 or go down to 0.50 to see if he'll bounce less?
Click to expand...
On TR we base the dose on how low the dose is taking kitty, and we largely ignore the bounces. This dose has got your kitty down to 62, and now she is bouncing, so we need to wait and see what she does when she clears the bounce, will she return to the 60s or not.
Bouncing is frustrating, but taking the dose down will not help, it will only waste time.
I would look to here clearing the bounce tonight or tomorrow morning, if she is yellow at PS tonight or tomorrow am, that would be your signal to pay attention.
She's been on this dose for 10 cycles already, reassess the dose once the bounce has cleared, if she doesn't make it back into low green then it may be time to take the dose up. Have someone look at the numbers for you if you are unsure.
I can't find any info on the actual carb content of Special kitty, but with wheat being listed in its ingredients, like Erin and Scott, it makes me suspicious that it may be higher in carbs than one might think. I would experiment, cut it out of her diet and see what happens. Even if its were not high in carbs on paper, it is worth noting that it's not unusual for gluten to upsets GI system. FWIW The HC food I fed george had gluten in it and it used to upset his tummy every time I used it.

From the TR protocol
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
 
Erin & Scott said:
Carrageenan is a thickener that is made from seaweed. Wheat gluten, however, is not part of a low-carb diet. I don't know offhand the carb content of Special Kitty, but in general, the low-carb foods are grain-free. I would shift him from that to either Fancy Feast or Friskies classic pates. Feeding a high-carb food (such as I assume Special Kitty is) is going to cause his numbers to go up and make it hard to regulate.


ETA: There has actually been some discussion on this board about Special Kitty: http://www.felinediabetes.com/FDMB/threads/special-kitty-wet-food-info.177825/

According to this, it appears that it may actually be acceptable as far as carb content. However, it was the subject of a recall a few years back, and the formula/manufacturer may have changed since this info was published. The fact that it contains wheat gluten gives me pause, though - it's definitely not grain-free. If it's not an affordability issue, I would stick with Fancy Feast or Friskies simply because the actual contents are known and known to be low carb.
Click to expand...
I'm going to just switch him back to FF. Already bought a bunch today and gave the rest of the Special Kitty to my parents for my other two cats that still live with them

Friskies pate also has grains in it (rice), so I think I'm gonna avoid that one too. He eats Friskies pate when we visit my mom and his cat brothers and his BG always spikes.
 
Thank you everyone! Will wait for the bounce to clear and see how it goes. Hopefully this crappy food was part of the problem and will resolve itself soon.
 
AngelaMiao said:
Thank you everyone! Will wait for the bounce to clear and see how it goes. Hopefully this crappy food was part of the problem and will resolve itself soon.
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make a note on the ss about the concerns about the food and when you are swapping back to an all FF diet. As it's important to consider all factors when making a decision about the dose.
 
Bounces are probably the one consistent thing that frustrate caregivers the most. What I would also encourage you to do is look at the whole cat -- not just Jack's numbers. In fact, you noted,
...today he was super energetic and social, like a new cat
Click to expand...
. This tells you a great deal about how Jack is feeling.

The beginning of this adventure is confusing. We'll do our best to help you navigate Jack's spreadsheet. Typically, bounces begin to slow down and cats begin to clear the high numbers more rapidly. Ultimately, the cycles will flatten out. Keep in mind, Jack has been diagnosed a little over a month. That's not long in diabetes time when it comes to seeing any changes. If there is nothing else Lantus and feline diabetes will teach you, it's patience.

 
Update!

So it looked like his bounce was starting to clear last night, he finally went into yellow numbers post PM shot and now he seems to be bouncing again.

Starting to notice a pattern where he becomes super energetic and social during a bounce, as if his liver is screaming THANK YOU. :(
 
Update!

So it looked like his bounce was starting to clear last night, he finally went into yellow numbers post PM shot and now he seems to be bouncing again.

Starting to notice a pattern where he becomes super energetic and social during a bounce, as if his liver is screaming THANK YOU. :(
 
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