Let's talk about the "bounce"

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Zach Pool

Zach Pool

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My 15 year old snowshoe has been tightly regulated with lantus for several years now. Usually ranges between 160-170amps to 100-120 in the middle of his curve. He began having trouble eating this year and had a dental procedure done, now everything has changed. Blood glucose levels are all over the place requiring higher doses of insulin. There are also instances where I have reduced the dose of insulin and noted smaller discrepancies in blood glucose fluctuation. There is no consistency to be provided in listing numbers for a curve. I am more curious in discussing the potential in getting higher glucose levels from using more insulin than necessary. Has anyone else experienced this? Is it possible that a cat can continually release glucagon into their bloodstream day after day to combat and excess of lantus? I have noted that upon increasing the amount of insulin administered you can most certainly get elevated blood glucose levels. I am curious if this trend can be continued day after day.
 
Doubt anybody will give you opinions until you set up a signature and spreadsheet. We are very data oriented here. Please read the stickies at the top of this forum on posting guidelines as well as the sticky I know you have on what is needed for us to really help you.
 
Yeah I've noticed that. It's unfortunate that politics supercede relevance. Data is only important when there is an ability to directly correlate the aforementioned data to a control. ( In this case a particular amount of lantus to bg levels )There is no ability to do that in this situation.
 
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You’re welcome. Some other food for thought. Generally speaking, when one lowers a dose to prevent bouncing, what ends up happening is the cat just stays flat but in higher numbers. So while no bouncing, the risks in staying in prolonged high numbers would include more demand on the organs, like kidneys which have to work harder to remove sugars which get dumped in the urine. Extra sugars in urine can lead to increased risk of UTIs. The cat just gets used to being in higher numbers, so glucose toxicity sets in, and then takes more increases to break the glucose toxicity and get the cat back to better numbers again.
 
We just got back from the vet and his lab work looks good with no ketones in the urine or glucose. His bg was 224 mg/dl at the vet but I would imagine that was stress related because he was 147mg/dl at 8:30 a.m this morning. His pre shot number was 182 at 3:48 a.m. What I'm used to is .25 units BID producing a result of 160 amps +2 160-170 +4 110-100 +6 120 etc. This year has been wild. It's unrealistic how inexperienced veterinary doctors are in dealing with this. I was told today that testing him as often as I have is stressing him out creating higher BG values. I think he has concurrent pancreatitis or IBD as well. There are so many factors that play into it that it's unreal. I've been fortunate that he's been as easily regulated as he has been for such a long time. I reduced his dose the other day from .5 units to slightly less (maybe .25 it's hard to tell because the marks on syringes vary AT LEAST .25 units, which is a whole problem within itself) and the reduced dose resulted in an immediate flat response with a lower nadir and a lower amps number. I thought "oh great, I'm just giving him too much insulin". So I gave him another dose of the same reduced amount and ended up with a pre shot number of 259 mg/dl. There is literally NO consistency. It's unlike any of the results I've received over the last four years. I'm exhausted. Now I have good labs as well so the confusion continues. He's recently had dental work as well and cannot get used to the feel of having lost a tooth so he gets pissed off while eating and I get to deal with the same problem I had with him not wanting to eat as I did prior to his dental.
 
He does end up finishing all of his food it just takes him longer than normal...I assume that might be your next question.
 
It sounds like you are doing a great job; always good to get positive lab results :). I would say it’s common to hear from the vets or techs that the home testing causes stress, I heard that too when Maverick was diagnosed. Just ignore that, home testing keeps your cat safe. As you have noticed there are a lot of variables, and given that you are on such a small dose, it’s hard to say (without a SS ;)) whether the higher AMPS was due to the reduced dose. Sometimes too any source of inflammation can cause higher BG, as can bouts of pancreatitis.
 
Did the vet take X-rays after the tooth removal to make sure there wasn’t any piece(s) of the tooth left behind? If he’s grumpy while eating I wonder if he has some pain still there? When was the dental?
 
I can totally fill out a spreadsheet. Where are they? Also the dental was Sept....I think September 7. They did not do an x ray, although that is a good idea. I was concerned that his BUN levels went from 31 to 46 in the course of three months but the doctor was NOT. That reality is now starting to set in as well.
 
Here you go, Zach, this should get ya going > https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/ & https://www.felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/
@Bandit's Mom typically helps people with the spreadsheet if they need any template changes.

Here's info on the signature too > https://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

I'm just pulling these all from sticky posts at the top of the "Lantus / Levemir / Biosimilars" section.
 
Hi Zach :). Here is a link to setting up your spreadsheet, if you have maybe about 2 week’s worth of data you can add that.

How to Create a Spreadsheet

As for the elevated BUN, that may be a little higher than normal, depending on the lab’s reference ranges, but sometimes BUN can be a little higher because of dehydration, or stress, or if the creatinine is normal, from eating a higher protein diet.

I would say it also needs to be read in conjunction with urinalysis (the urine specific gravity) and the SDMA if your vet ran that test. That’s likely why your vet wasn’t concerned, maybe those other values were fine.
 
Zach Pool said:
I was concerned that his BUN levels went from 31 to 46 in the course of three months but the doctor was NOT. That reality is now starting to set in as well.
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Funny, the BUN is like the main item I look at from the labs. I always bring it up as it increases and they always are never too concerned. My vet always says, she's only concerned when she see the BUN going up along with creatine and I think the specific gravity.

Does your lab tests do the renal tech? They do that one every time and it comes up positive. https://www.antechdiagnostics.com/renaltech/

So I constantly ask what can I do on the prevention side, the only thing I was told was a high quality omega3 as there have been some studies of actually preventing CKD, but also lower phosphorus foods can help reduce stress on the kidney? I don't know.... I've been using the Weruva Wx Phos focused foods for while now. Not sure if I'm doing anything, but here are some of Kona's BUN.
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Yes she did say he seemed dehydrated and compared to some other values in his labs, she wasn't concerned. She said that his urine wasn't diluted so that contributed to her lack of concern regarding elevated BUN. I have the labs in my truck. I can post those as well. He's been lethargic but I think he just needs to get his bg back down. Essentially to "break the glucose toxicity"....I'm usually really good at following this German regulation method I found online. I believe you guys may use the same one. I always get ultra paranoid with increasing his doses because I'm a single dad and run my own business so I'm insanely busy. I need to just bite the bullet and raise the dose to what it needs to be. I also tend to panic and feed him if I get anything under 80mg/dl. I got a 79 earlier this week and panicked...then fed him and had concurrently higher pre meal **** levels in the evening. You know how this goes...it can make you a basket case.
 
Jason - Kona's Dad said:
Funny, the BUN is like the main item I look at from the labs. I always bring it up as it increases and they always are never too concerned. My vet always says, she's only concerned when she see the BUN going up along with creatine and I think the specific gravity.

Does your lab tests do the renal tech? They do that one every time and it comes up positive. https://www.antechdiagnostics.com/renaltech/

So I constantly ask what can I do on the prevention side, the only thing I was told was a high quality omega3 as there have been some studies of actually preventing CKD, but also lower phosphorus foods can help reduce stress on the kidney? I don't know.... I've been using the Weruva Wx Phos focused foods for while now. Not sure if I'm doing anything, but here are some of Kona's BUN.
View attachment 71515
Click to expand...

I'm not sure....I will post some pictures of his labs before too long. He eats fancy feast classic pate. He doesn't much like anything else.
 
Jason - Kona's Dad said:
My vet always says, she's only concerned when she see the BUN going up along with creatine and I think the specific gravity.
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Exactly, and the SDMA is a good “early warning” test that helps to detect CKD at an earlier stage than is possible when measuring creatinine and BUN. The USG is helpful because it shows how well the cat is able to concentrate urine which is also a good measurement in addition to the other aspects noted above. The point being you cannot look at one thing in isolation of the other results.
 
Zach Pool said:
...I'm usually really good at following this German regulation method I found online. I believe you guys may use the same one. I always get ultra paranoid with increasing his doses because I'm a single dad and run my own business so I'm insanely busy. I need to just bite the bullet and raise the dose to what it needs to be. I also tend to panic and feed him if I get anything under 80mg/dl.
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Yes, our Tight Regulation method is a slightly modified version. Here is a link to our dosing methods

Understandable to want to take action around that BG level since you are using a pet meter. I’d be happy to offer some of my thoughts when you get up and running with the SS :)
 
I'm using a human meter. Increased our dose this morning and definitely got a bounce. Amps was 240, and now our +2 is 337. God I hate this. I can tell he does too.
 
I'm about to embark on a house full of laundry and a $15k paint job as well, so I don't see where within my life of owning 3 cats, and being the single father of an 8 year old, is going to afford me the time to comprise a ss.
 
Zach Pool said:
Yeah I've noticed that. It's unfortunate that politics supercede relevance. Data is only important when there is an ability to directly correlate the aforementioned data to a control. ( In this case a particular amount of lantus to bg levels )There is no ability to do that in this situation.
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There are no politics here. We are data driven exactly because the amount of Lantus you give your cat does affect its BG and the SS allows us to see the patterns and help you adjust the dose so the BG improves.

The tight regulation protocol was developed by a scientist and a veterinarian using data from the German forum members. As a scientist myself, having treated my own cat for 5.5+ years here and having helped hundreds of other members with their cats, I can also attest to the validity of collecting the BG data and putting it on a SS.

Zach Pool said:
I'm using a human meter. Increased our dose this morning and definitely got a bounce. Amps was 240, and now our +2 is 337. God I hate this. I can tell he does too.
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You did not get a bounce from increasing the dose. That doesn’t happen and it isn’t why bounces occur. Without seeing data, it’s hard to say whether he needed an increase or whether he dropped low last night and is bouncing today. Often within 24 hours of a dose increase, numbers can temporarily rise but that won’t happen within two hours of a dose increase.

Many members come here having to deal with several life stresses at once including their diabetic cat but they still manage to do a SS and enter the data. If you need help with it, please PM me.

Lastly, if “Pool” is your last name, you might want to change your username for added account security.
 
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Sounds like I will definitely need help with a spreadsheet then. And I would literally bet the entirety of my next $8,000 paycheck on the fact that the amount of insulin I gave him this morning directly resulted in drastic elevated glucose levels.
 
Well...not that I am a betting gal, but I've seen a few hundred spreadsheets over my time on the board, whereas Marje has seen thousands ;) as have a few other longer-term members. I suspect when you get your data set up, you may regret your bet ;)
 
I'm going to be gone most of the day today so I won't be able to give him a curve. I won't be able to do that until tonight.
 
Zach reached out to me in a PM with questions about the SS. He also asked how to do a curve. For transparency, my response was:

If you are doing Start Low Go Slow method, the curve is done once a week. Curves are done every two hours for one cycle.

If you are doing tight regulation, we don’t usually do curves but test randomly for a few cycles so perhaps AMPS, +2, +5, +8, PMPS, +3, +6 and then do different times the next day but always a preshot test. Of course, if you want to do a curve, you can.
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