Maggie's bounce-o-rama pt 2

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Kelly Howard

Kelly Howard

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Time for a new thread. Old: http://www.felinediabetes.com/FDMB/threads/maggies-bounce-o-rama.165952/

Well, we are only at +11 but take a look at today's numbers. Think this is still a bounce? She didn't go super low, and the drop rate this morning seemed good. Then she just shot up at the end of the day. If it was the dose wearing off, would it be that dramatic or is that indicative of a bounce?

On sheet 2 I've created some charts of the days I have been able to get mid-cycle numbers. Actually, the only time she didn't shoot up at the end of the day was when she was still on 3u. Maybe it is just the dose wearing off?

ETA: I went ahead and gave her shot early. We were an hour late with our schedule today anyway, since I slept in a bit. This will get us back on track for tomorrow.
 
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Well, I like the slow drop and the mid cycle numbers. I think the preshot is a bounce. If you want to proceed on that premise, I think I'd hold this dose awhile. Those greens on 10/1 on 2.5 were nice, and 2.5 might end up being the right dose for right now, but I'd take it slow getting back there. If she is bouncing, she'll bounce on either dose. And maybe less on the lower dose.

Check out Kris and Teasel and Steph's threads. They are dealing with the exact same patterns you are.
 
Hi Kelly and welcome with Maggie!
I have seen your threads pop up, but haven't had the time to reply! Happy others already did and you've gotten so much great advice. :joyful:

Kelly Howard said:
On sheet 2 I've created some charts of the days I have been able to get mid-cycle numbers. Actually, the only time she didn't shoot up at the end of the day was when she was still on 3u. Maybe it is just the dose wearing off?
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I wanted to comment on this, because that isn't true. It doesn't matter what the dose is, this can be .50U or up to 7U but the dose works the same. If the dose is smaller it doesn't mean it shouldn't work for at least 12 hours, does that make sense?

I like what you did on sheet 2! The only thing is right now, it's hard to find a pattern since Maggie is just starting out with Prozinc. Her tiny body needs to get used to the insulin so don't panic or get frustrated if you don't see a pattern just yet. Prozinc is known for the fact that it takes time... :)
We've all been there ;)

Hopefully you'll get some nice numbers soon and the bouncing will stop!
 
Do you think with her high numbers it's too risky to do a restart? I feel like if we could just get her to have one flat cycle then we can increase from there and she won't start bouncing again. It seems like she's just stuck in this pattern.
 
Kelly Howard said:
Do you think with her high numbers it's too risky to do a restart? I feel like if we could just get her to have one flat cycle then we can increase from there and she won't start bouncing again. It seems like she's just stuck in this pattern.
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No guarantees about not bouncing - some cats will, some cats won't.
 
Ruby&Baco said:
It doesn't matter what the dose is, this can be .50U or up to 7U but the dose works the same. If the dose is smaller it doesn't mean it shouldn't work for at least 12 hours, does that make sense?
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I see what you're saying... bigger doses don't last longer. Is that because of the type of insulin Prozinc is? I still don't totally understand this depot vs in & out thing.
 
Kelly Howard said:
Do you think with her high numbers it's too risky to do a restart? I feel like if we could just get her to have one flat cycle then we can increase from there and she won't start bouncing again. It seems like she's just stuck in this pattern.
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I personally don't think it matters if you restart or continue. The body has to adjust to the insulin and some cats do that rather faster than others...

Kelly Howard said:
I see what you're saying... bigger doses don't last longer. Is that because of the type of insulin Prozinc is? I still don't totally understand this depot vs in & out thing.
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No this is the same for other insulines (as far as I know) because it's just something that works that way.
You can see it as you need a painkiller for yourself, on the package it also says how long it works and when you can take a new one. But if you take 1 pain killer instead of 2 it doesn't mean it will wear of quicker. It only means (just like an insulin dose) that if you take more it will work harder, so less pain (or in the case of diabetes the numbers will drop)
Does that make sense?

About the depot, I can't really explain that either because i've used only prozinc.
 
Kelly Howard said:
Do you think with her high numbers it's too risky to do a restart? I feel like if we could just get her to have one flat cycle then we can increase from there and she won't start bouncing again. It seems like she's just stuck in this pattern.
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I am uncomfortable with a restart when she is already getting 2.25 units and she has dropped into some nice ranges. I would guess she needs something near the 2.25/2.5 dose right now. It is definitely harder to guess how much to reduce, rather than slowly make your way up. But, at this point, I think I would stick with this dose and see what her numbers look like for the next few cycles
 
I'll stick with the dose then. I'm probably driving you guys crazy analyzing every number. I work in software development, so in my world, everything has a cause and effect. There are no true mysteries, only answers you haven't found yet. So trying to deal with all these variables and unknowns is really screwing with my head :D I just want predictable results... I'm starting to realize that may be a pipe dream!
 
No, we don't mind the questions at all. Everyone who answers your thread is paying it forward for hours others spent answering their questions. Some day you can do the same thing for other people.

I think the hardest part of this disease is exactly that. There is no real control and often no real logic. Someone compared FD to a sugar dance, where you and the cat are dancing, but she is the only one who hears the music. :D
The whole process is variable because the insulin is a hormone and it reacts differently in every cat's body (think of menopause and how differently it is in some women than others). You control the food and the insulin, but you can't do anything but try to react to the changes you see. Data helps you see patterns in those changes, and you can use those patterns, but then the pattern can change. The good news is that almost every cat I've seen on the board eventually becomes regulated and lots go into remission. In some cats that is a pretty short process and in some cats, it can take years. In my experience, the process is usually 3-9 months. The longest I have seen on ProZinc is two years, after bouncing almost every day to OTJ.
 
Sue and Oliver (GA) said:
No, we don't mind the questions at all. Everyone who answers your thread is paying it forward for hours others spent answering their questions. Some day you can do the same thing for other people.
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I agree with Sue on that! We all are very grateful for the help we've received, and would like to pass that forward!

And btw I also work with a lot of data, so I had the same 'issue' haha trying to find an answer for every number my kitty was giving me, but unfortunately there isn't.
It takes some time to let that go and just 'go with it' but you will get there :bighug:
 
Hey Kelly ! And keep asking questions as that is how we all learned. To answer you question about depot vs in/ out insulin, in the simplest form, a depot insulin injection does not get used all at once that means that you don't see the full effect of a dose until the depot is stable at that dose. When you first start, only a little of each shot starts to work...the rest goes "into the depot" and slowly releases back into the body...but until the depot has a chance to build and stabilize, you won't see how well each dose is working.

With an in/out insulin like ProZinc, the dose is all used within the 12 hour cycle with some exceptions of some doses lasting longer than the typical 12 hour cycle. With both insulin bouncing can occur and that bouncing can take up to 6 cycles or 3 days to clear. That is one of the reasons I like to see a dose held for 3 days after a lower number than Maggie is used to seeing so the bounce can clear before a larger dose is given to set the bounce up all over again. And that said, it is hard to do when you see some black numbers like you have recently. On 10/1 you got those nice green and then 5 cycles later you reduce the dose to 2.5. I understand that your thinking was that lower the dose and lower the chance of bouncing but it doesn't work like that. Maggie did come down some but still not enough. I agree with Sue about the dose probably being somewhere between 2.25 and 2.5. I think if Maggie was my kitty I would hold the 2.25 dose through tonight's cycle and if she hasn't hit some lower blue numbers, I would increase to 2.5 on a cycle that you could monitor.

You are doing some good testing and good note taking in your comment section which is really helpful to get a bigger picture. And as Sue said, this dance has no exact science and absolutes and the kitties are clearly the only ones hearing the music. :eek:
 
Hey Kelly, I failed to ask last night about ketone testing. I hope that you are testing her while she is in these higher numbers. A good idea would be to test when she is running over 300.

Also, an observation: looking over your comment section you mentioned you got all the Science Diet dry out of the house but saw on 10/1 you gave some kibble after the test. Unless you are giving zero carb dry like Young Again, the kibble can really spike the BG and make it high. It's amazing what just a mouth full can do. Also, if you have multiple cats in your house hold it will be important to feed them all at the same time and monitor them if you are giving higher carb food to the other cats. I made the switch to only low carb FF food for both my cats. When Bubba develop some IBD issues and I had to change him to a novel protein, I give the same to my other cat. It just makes it easier to not have contraband that Bubba can get into around. Just an idea.

I like that she hit 254 at +4 last night and possibly went lower. :)
 
Hi Bobbie, thanks for giving your take on our situation :) The info about the insulin types is really interesting. I can see how a depot insulin might be frustrating for the human at first but it seems like in the long run it's a better design. Oh well -- no reason for us to try to switch now. I'm sure she can do just fine on Prozinc.

I got some ketone strips earlier this week but I haven't been able to catch her in the act yet. I had the litter box in the living room all day on Wednesday when I was home, and she managed to wait until I went into the kitchen to get my daughter some food and THEN used the box. By the time I came back out it was all soaked in. Sneaky kitty. I think I am just going to order the meter that can do it on a blood test. There's no way I can reliably test her with a urine sample.

I should put some more info in the spreadsheet about the kibble. Right now the cats are all eating EVO cat & kitten which we introduced last Saturday. I plan to order some YA food soon, just haven't gotten to it yet since I figured we were ok for now with the EVO.

She was up high again this morning, though not too different from her typical mornings. I wish I could get mid cycle numbers more often. I'm thinking it is time to try 2.5 again -- I did last night, just because she seems to run high at night. I was happy to see that +4 number too!
 
I hope this weekend you can get a curve. If you want to see how the higher dose (2.5) works, I'd give it and curve. You can always steer with food if needed, but better to increase while watching her carefully.
 
I can only do a partial... we have a wedding to go to on Sat and will be at my sister's in the afternoon on Sun. So both days I am only going to be home until about +6/+7 :(
 
Get what you can. The first few hours should let you see if it will be an "active" cycle with lower numbers. Any numbers in that 5-7 range help a lot.

It sounds like a fun weekend!
 
Kelly Howard said:
Hi Bobbie, thanks for giving your take on our situation :) The info about the insulin types is really interesting. I can see how a depot insulin might be frustrating for the human at first but it seems like in the long run it's a better design. Oh well -- no reason for us to try to switch now. I'm sure she can do just fine on Prozinc.

I got some ketone strips earlier this week but I haven't been able to catch her in the act yet. I had the litter box in the living room all day on Wednesday when I was home, and she managed to wait until I went into the kitchen to get my daughter some food and THEN used the box. By the time I came back out it was all soaked in. Sneaky kitty. I think I am just going to order the meter that can do it on a blood test. There's no way I can reliably test her with a urine sample.

I should put some more info in the spreadsheet about the kibble. Right now the cats are all eating EVO cat & kitten which we introduced last Saturday. I plan to order some YA food soon, just haven't gotten to it yet since I figured we were ok for now with the EVO.

She was up high again this morning, though not too different from her typical mornings. I wish I could get mid cycle numbers more often. I'm thinking it is time to try 2.5 again -- I did last night, just because she seems to run high at night. I was happy to see that +4 number too!
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Good that it is EVO dry, that is another lower kibble one.

And yes, sneaky kitty waiting until the bean was out of sight. That was what always happened to me and why I went with the ketone meter. So much easier. :)
 
I think we've given 2.25 a fair shake. I will be able to monitor her through her typical nadir time tomorrow, so I'm feeling comfortable with 2.5.

I've been reading through old threads tonight. One phrase I saw was "a cat will bounce until they don't"... I liked that a lot. I've been trying to figure out what we can possibly do to stop the bounces if the lower doses aren't helping. Reading that helped me understand that a cat's body will get used to the lower numbers and eventually stop bouncing. But then, this makes me wonder what was happening for the 3 weeks she was getting 3u while I wasn't testing. Surely she was bouncing then too, maybe even more severely... I guess I am thinking... wouldn't her body be used to it by now? It's been exactly a month today since that dose increase.

If you couldn't tell, I haven't ordered those patience pants yet! :D
 
Can you guys take a look at her PM cycles? Not much there, I know, but it seems like she starts trending back up after only a few hours. I thought tonight looked good at first, but then I ended up staying up late and got a +6 reading just now. She's over 100 pts higher than she was 2 hours ago. She hardly has anything under 300 in the smattering of night tests I've gotten. It's no wonder her AMPS are so high with nights like this.
 
Hey Kelly, I was asleep all ready when you tagged me. I use the Abbott Precision Xtra Meter for ketone testing. You should be able to find it for around 30 dollars on line. The strips are pricey though and I get them from Universal Pharmacy in Canada; that was the best price I found when I was looking around.

I see that you increased to 2.5 last night. Good call.

Kelly Howard said:
but it seems like she starts trending back up after only a few hours. I thought
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Usually a nadir with ProZinc is anywhere between +4 - +7 so she could have nadired last night around that +4. It's been a few days since she's been that low so she could be bouncing again. Yes, get those patience pants out. LOL It does get frustrating but like you read, "they stop bouncing when they do" and some kitties bounce all the way into remission. One thing to consider too is what is your feeding schedule? If you are feeding after nadir, that could influence the numbers popping higher too. Play around with the feeding times and keep track of the meal times as well. That will help you too. All data is good data.

Just as an FYI, if you look at my SS you will see that I recorded meals through out the day. Bubba has 6 equal part meals through out but I can do it that way with him as he is a late nadir cat and sometimes doesn't nadir until the beginning and the end of the cycle. Know thy cat, another thing we say around here becaue ECID Every Cat is Different.
 
Bobbie And Bubba said:
One thing to consider too is what is your feeding schedule? If you are feeding after nadir, that could influence the numbers popping higher too. Play around with the feeding times and keep track of the meal times as well. That will help you too. All data is good data.
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Well, that is a big variable. I've been giving Maggie a serving of wet food before each shot. There is dry food out (EVO) all day because of the other cats. However we've been giving them all half the recommended amount in the morning, and half in the evening, to mitigate what is available for Maggie to eat mid cycle.

Since we got the EVO, Maggie has been pretty uninterested in the wet food. I think she just really likes the EVO (kibble addict!) and would rather wait for that. I still put the wet food out, but now she just licks it a couple times and leaves and one of the other cats ends up eating it. Today, I had the idea to sprinkle a couple of kibbles into the bowl and that actually got her to eat about 3/4 of it. So hopefully that strategy continues to work.

That's the thing though, I don't know how early in the day they finish off that first half serving. It could be that she is eating at +10 or +11 and screwing up her numbers. Most days I'm not home then so it's hard to say. I know the EVO is low, so what kind of an impact does that have on her numbers? Any food at all will bring the BG up, right? Even if it was zero carb?
 
Kelly Howard said:
Today, I had the idea to sprinkle a couple of kibbles into the bowl and that actually got her to eat about 3/4 of it. So hopefully that strategy continues to work.
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Good, I was going to suggest that, you could even crush a little kibble and sprinkle it on top as they get addicted to the animal enzymes the companies spray on the kibble to make them get addicted. :banghead:

Kelly Howard said:
It could be that she is eating at +10 or +11 and screwing up her numbers.
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Is there any way you could pick up the dry food and make it not available the last 3 hours of the AM cycle? Looks like your home during the day and that should be doable. And the PM cycle maybe pick it up after the last test at +6. 6 hours with out eating isn't going to kill any of the kitties. And you will be able to get some more accurate reading of what is happening. Just an idea.
 
I'm only home weekends and Wednesdays (work from home day). Today we are leaving the house about 3:30pm to go to a wedding, which will be +8, so I can pick it up before I leave. These cats are definitely grazers. Although they all seem to like this food quite a bit so maybe it is getting eaten up sooner.
 
Looking like a high and flat cycle today. This would be a first (that I have data on). I'm glad she isn't bouncing, but it's too soon to up the dose again, isn't it? Maybe decide after tomorrow's tests?

I'm really starting to wonder if we just need a new bottle of insulin. This one is about 6 weeks old now, probably 2/3 empty, and it did get left out one night. Would a shorter effective period (9 or 10 hrs vs 12) be indicative of that?
 
I like to see beans wait 6 cycles, but you hold the syringe and get to decide. Be sure it is a cycle you can monitor if you increase.

Does the insulin still look the same? We think it is old when you see flakes inside, rather than it mixing up well when you roll it before the shot.
 
Oh boy, busy weekend. Toddler at the wedding was not fun... spent the whole time chasing her around, and managed to lose my phone in the process! Thankfully, the wedding venue shares a parking lot with a public library and I was able to get my phone's location, looks like someone found it and turned it in to the library. They are closed today for a holiday, but fingers crossed I hear from them tomorrow that they have it!

Saw a little improvement yesterday with the higher dose. She got into some nice low blues, though her PMPS was still awful. AMPS was in the red, haven't seen that for about a week. I hope we are on the right track now. Time will tell.

The insulin still looks ok, though it's hard to see much through the label. I can't really see the top layer easily. Do people typically replace their vials before they're empty? I found our original paperwork from the vet and there's a recommendation in one of the printouts to replace it after 6-8 weeks.
 
Some do...the insulin can last a lot longer than that, though. People will sometimes replace insulin early if they suddenly see numbers shoot up when they've been in good numbers for awhile. I used every last drop of mine. How long have you had this bottle?
 
Rachel said:
Some do...the insulin can last a lot longer than that, though. People will sometimes replace insulin early if they suddenly see numbers shoot up when they've been in good numbers for awhile. I used every last drop of mine. How long have you had this bottle?
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She was diagnosed 8/31, so just shy of 6 weeks ago. She hasn't been in good numbers, really, but it just doesn't seem to be lasting the whole 12 hours. I've only been testing for a couple of weeks though so it's hard to say if this is normal for her or if it was better when the bottle was new.
 
Back in the red this morning but I was about 45 min late getting her AMPS reading. My human baby needed a little extra attention this morning and I lost track of time. I'm choosing to believe that she was still pink at her normal AMPS time and I just missed it ;)

Today I work from home so looking forward to seeing how this cycle looks. So far, pretty good. 200pt drop in 3 hours. We should see blue today -- maybe even green...
 
Yeah, she's really listening to me... she must be subscribed to this thread :p Should have been more specific... high greens! High!

She's surfing on some nice blue ocean right now though. Really interested to see what the end of the cycle looks like.
 
Well, 3 more hours to go right?
I'm going to bet on a yellow preshot number!
I will see it tomorrow morning as it is 1AM here right now, but i'm curious!
 
Oh, Maggie. You always have the last laugh! 419 PMPS. It was looking like a nice slow rise, and then... bam! 200pt jump.

I got a new vial of insulin today. Should I give a lower dose the first time I use it?
 
But she waited till +12! Her numbers were lovely. I think I'd lower a little with the new vial. It probably won't be a big difference, but her green today was pretty low. After a few days, you can raise it again. Maybe 2.5?
 
Thanks! That's about what I was thinking. Maybe I'll wait til Saturday so I can be here for the nadir.

Yeah, that 79 shocked me. I was glad to see her come back up quickly though!

Here's her curve for today; more of a smirk than a smile, but I like these numbers!
Screenshot_2016-10-12-20-08-30-1.png
 
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Just when I think I'm starting to figure her out... blue AMPS! I guess she just really didn't want a shot today!

I've seen this on a lot of other spreadsheets; high numbers, and suddenly a preshot number in blue or green. Any idea why it happens?

Also, does temperature have any effect on BG? Normally her ears are warm enough that I don't even need the rice sock anymore. Today they were cold and her back was too. The weather is starting to shift here.
 
Great! Well you want to have 2 shootable numbers so it would be wise to decrease her dose a little...
 
Yup, that makes sense. This was just so out of the blue (hehe). I guess her PMPS will be very high, and then I have no idea what to expect tomorrow morning. Wish I could be here to monitor today.
 
Out of the blue :rolleyes::cool: hahaha yes indeed!
Well her PMPS can be high but maybe not, we will just have to wait and see!
But you can give (if you are comfortable doing that) 2.50U as off tonight. Are you using u40 syringes btw ? Because when these kind of numbers pop up and you need to decrease it is better to decrease just a little bit, so instead of 2.75 you can go to 2.65 or 2.60. So the dose isn't really a big difference (what can cause bouncing).
Btw if you are not using u100 syringes you can consider buying them, you would need a convert sheet though to use it as u40 1unit is not 1 unit in the u100 syringes.
 
Kelly Howard said:
Just when I think I'm starting to figure her out... blue AMPS! I guess she just really didn't want a shot today!

I've seen this on a lot of other spreadsheets; high numbers, and suddenly a preshot number in blue or green. Any idea why it happens?

Also, does temperature have any effect on BG? Normally her ears are warm enough that I don't even need the rice sock anymore. Today they were cold and her back was too. The weather is starting to shift here.
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Physiological systems are complex, Kelly, hence their quirkiness and unpredictability. Who knows? Maybe Maggie's pancreas woke up for 5 minutes then went back to sleep; maybe there was a tiny bit better insulin absorption last night. I could go on speculating.

U100 syringes with the conversion chart would widen your range of dosing options because you can do 0.2, 0.4, o.6 and 0.8 fractions and, if need be, eyeball between those.

Not sure about the temperature factor. I do think Teasel is feeling better now that our weather has cooled after a very hot, humid summer. I didn't need the rice sock then but I do now.
 
They are complex indeed! This is why I work in software and not hardware :D

Yes, I think it's time to get the U100's. I was comfortable eyeballing the 2.5 dose; the .25 adjustments have been iffy.
 
The u100s are pretty helpful. When you get them, I'd print the conversion chart off and post it on the fridge or someplace so you don't have to look for it. That helped me a lot. :)
 
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