Martini 03/27 - Exasperated with bounces

[SMM]

Last post
Dancing the sugar dance now close to a year and a half...
What does it mean to 'ignore the bounce'? Does it mean not to count/include those cycles on the dose? Just to skip them and only count the cycles when not bouncing? Or?
I think we are in glucose toxicity? Is the answer to increase .25 now to get out of it? Since Martini 'follows all the rules', we will go thru NDW again and then bounces to maybe get even higher numbers?
I always feed the curves, have tried small increases to lessen bounces, tried TR/SLGS and probably have held numbers way too long. (Please don't beat me up for not always following rules, I am trying everything I can)
I'm just not getting consistently good results. Does anyone have any advice for me please??

Thank you in advance.

 

[Sienne and Gabby (GA)]

First, Martini's numbers are by no means "awful." I can appreciate your wanting to flatten out the curve, though. Having been the CG for a bouncy cat, I'll try to offer some insights.

I would encourage you to stick with dose changes in 0.25u amounts. I'm not sure that making micro-dose adjustments is helping at this point. When you want to use a fat or skinny dose, it's typically because your kitty is consistently in a good range and you're zeroing in on what is a good dose. I don't think Martini is quite there and you've tried making tiny dose adjustments and I don't think you're getting the results you are looking for. Similarly, I'd pick a dosing method and stick with it. I'd follow the approach closely for well more than a week or two (think in terms of months) and see if you do get a better looking curve. If, in the past, you did hold a dose overly long, then you know what the results were and you can use that information to guide you now. The other factor to keep in mind is that trying to get a cat back into remission is harder than getting the cat there the first time post-diagnosis.

I'd also keep in mind that small dose adjustments don't prevent bouncing. Frankly, almost anything that we would consider that might "logically" prevent a bounce doesn't seem to work. I suspect this is because bouncing is normal. The kitty just isn't quite used to spending time in normal numbers and reacts with bounces. It's hugely frustrating to us but it's part of the process. There are also some kitties who will bounce wildly. If you can track down Dyana/JD's spreadsheet, JD was one of those cats who bounced his way along the entire time he was here. Gabby did the same, although not to the degree that JD did.

What I learned from Gabby was that it was important to try to maximize the amount of insulin that I was giving her and use food to steer the curve and to prevent a dose reduction. At some point, Gabby would let me know that she was getting too much insulin and I needed to reduce her dose. However, getting as much insulin into her as I safely could, keeping an eye on her numbers so I could catch her notorious dives, and hoping to get her to a point where she was seeing mostly greens in the middle of the cycle and in blues around pre-shot was the goal that I set. Overall, I also wanted to keep her below renal threshold since after a couple of years, it was unlikely that she would achieve remission.

 

[SMM]

Sienne, sincere thank you for your thoughts as always. I'm not even hoping for remission, just keeping her below the renal threshold. I'll try to find the spreadsheets you mentioned. You are so right about the logically, been there, didn't work. I do try to feed for curves, sometimes she eats, other times not.
I gather what you are saying is keep upping the juice as long as she's safe basically.
Glucose toxicity?
'Ignore the bounce'?

 

[Jill & Alex (GA)]

Excellent advice from Sienne.
Forgive me for being so short, but I have grandchildren demanding my attention. My advice is to go back to following the TR guidelines and treat Martini as a long term diabetic. It won't prevent bounces, but hopefully it'll make them shorter. It'll also help to prevent glucose toxicity from setting in again.

 

[SMM]

Thank you so much Jill. Sienne has been an amazing source of info for me. I hate going thru NDW and the bounces all over again, but I will try.

 

[Stacy & Asia]

Great advice from Sienne. I agree, those micro adjustments aren't the way to go at this point. You were making some excellent progress near the end of February. If I can point out what could have been done differently, it might help you for the next time:

You set the reduction point higher for Martini, I think it was 55? Which is fine, but same rules would apply, if it doesn't stick, you go right back up in dose, which you did. You called the failed reduction after 4 cycles and then went back to 2.25. The only problem there was you held that dose for way too long and then increased a tiny amount instead of the .25. If you don't see green in the 6 cycles, go ahead and increase .25 again. Sometimes you have to go even higher after a failed reduction to get back to where you were before.

I would increase to 3.25 the next cycle you can and just stick with TR. If you get confused or are uncertain about something, that's what this board is for.

As far as NDW goes, you know Martini best, and if NDW happens, you have a good read that it's happening and how many cycles it takes to work out. Ignoring the bounce only means if you aren't seeing greens and she bounced from say a low blue, it doesn't mean wait for the bouncing to end in case she might see green again several cycles later. You increase when it is needed, even if she is bouncing. Usually waiting out bounces is when you are likely at the magic dose and seeing a lot of green, you give some time to see if the green will come back, and even then, depends how low or high the green is and I would also consider if it was one green or a string of them. Martini has a habit of throwing a teaser one off green and then no dice. You can use her patterns and history to your advantage in these situations.

Martini is quite close to being a well regulated cat and I do think the bouncing will slow down when you get there, you already saw a preview of that in February.

 

[SMM]

Thank you too Stacy!! I shouldn't be uncertain, I've been here long enough for goodness sake! but I am always second guessing myself.
Tonight is 3.25. I am still confused on the increase when even bouncing and waiting out bounces when likely at the magic dose - how can you tell when she's bouncing? - seems opposite to me. I will keep rereading until I hopefully understand. I could only wish she is close to regulated...Again much thank you's for your input!!

 

[Stacy & Asia]

How I find bounces in other people's SS is I look for wacky/high numbers that don't fit in line with the rest. In Martini's case, I see occasional pinks. I follow a pink backwards until I find something that makes sense of it.

Today's pinks are somewhat of a mystery. My best guess would be Martini went lower than the 126 last night (the 121 and 126 there are about the same number, so she was surfing...meaning she wasn't coming back up yet, which means she could have gone down more. Your most recent late pm cycle data gives clues that it isn't unheard of for Martini to go lower then: 3/6, 3/10, 3/12). The ones in the pm cycle on the 26th are a bit more obvious, follow them back and they lead to the greens the night before. She got those greens from clearing a bounce (the inverted yellow am cycle on 3/25).

Bouncing doesn't always look like a blast off to the moon, sometimes it's wobbly and bobbly. How I tell on my own cat is when her numbers are doing something that isn't typical for her. Example, her am all blue cycle yesterday. She started up, went down a tiny bit and came back up, nothing very dramatic there, but it is a bobble like bounce because it makes no sense with the rest of her cycles. She's been on this dose for a long time, her AMPS was in line with the others, yet she played a different tune and she should have got to green. Sure enough, she cleared the bobble and threw me a bunch of lime greens last night and today's cycle is a more obvious, "traditional" bounce.

 

[Jill & Alex (GA)]

Today's pinks are somewhat of a mystery.

See how the rest of the cycle plays out. If the numbers continue to trend downwards, it means we're seeing a high before the bounce from the 80 (3/25 PM cycle) breaks. That bounce was caused by a relatively quick drop (for Martini).

If it's not a bounce breaking, I'd chalk it up to any number of things... poor absorption, another cat entered the yard and Martini didn't like it, tummy hurt today, too hot, too cold... you get the idea. It could be any number of reasons. Personally, I wouldn't over-think it.

 

[SMM]

You are a treasure of info Stacy! Thank you.. I should have been more clear on my 'how can you tell when she's bouncing'? comment. I meant how can you tell you have hit the magic dose when she is bouncing all the time ? Does that make more sense??
Your Asia is truly a wonder and I can see what you are saying about her, cannot believe she is 21. Love the 'traditional' bounce!

 

[SMM]

I upped Jill, as per Sienne's, Stacy's and your advice I thought. I hope it doesn't 'hurt' her. I think that's one of my biggest problems Jill - I overthink everything about Martini cause I love her so very much. So we're gonna try TR again! - started already 3.25. Thank you once more!!