Numbers going high for days after going low - rebound?

It seems that whenever Napoleon gets low numbers, his system fights back with high numbers for days after. I don't know what to think - is this rebound? Or just his liver fighting cause it is used to high numbers. If it is not too much to ask could someone take a peak at his spreadsheet linked below and give some insight. I don't know what to do, should I try lowering his dose, should I talk to the vet and have his dose increased? When he goes low he goes pretty low so I am afraid to up his dose for those days when he dips cause I am afraid it will make him crash. This is so very frustrating. He never gets a decent curve 2 days in a row.

 

All,
Please see the specific areas that I saw that need covered here:
http://www.felinediabetes.com/FDMB/view ... 82#p145482

She needs to know about no shoot levels and what to do under no shoot conditions. And more. Please help her as I cannot right now.

Hopefully too, Nimcewan will find a U40 insulin to give which would make things easier. BCP will send a "sample" I need to call them if they would send a U40 sample and not a U100 sample. I'm sure Nimcewan can call to see if she can get a free sample of U40???

 

The wild fluctuations that you're getting are most likely because your dose is too high. The usual starting no dose is 200 and then once you've stabilized you can work down from there. That 52 you got at nadir was too low which means you should back off on the dose.

Some general rules of thumb that we've seen:

1) Pick your no shot # and stick with it until you are getting consistent data - a good starting point is 200
2) You can start adjusting that no shot when your PS's start becoming consistent to each other. Ex: Morning PS 300, Night PS 320 (within a good range of each other)
3) Unless you are completely regulated and know your cats #'s and reactions well, if you get a super low # (I'd start at anything under 60) lower the dose immediately. Do not wait. The dose is too high and will have overlap which will be compounded by continuing with that dose. Then you'll probably end up with some whacked out rebound #'s that throw off all sense of logic and can have you raising your dose when you shouldn't be.
4) Really rapid drops may cause wonky #'s regardless. The body tries to protect itself.

For Napolean - I'd say jump back to 2.5 for a bit and then reevaluate.

 

Thank you. I started him back at 2.5 this morning. As soon as I saw that super low nadir I knew raising the dose would be the last thing I want to do.

 

IMO - I think you're seeing overlap that is causing all the wacky numbers, but I could be wrong. You may want to try and shoot at +10 or +11 if you start seeing the raise, but only if you can test PM +2 +4 +6. Have you thought about going to TID? Just curious. One of the most important thing to remember is to be consistent. ie: food, shot time, etc until you have a better idea how the insulin is working. Hang in there. :smile: Sending you good vibes!

 

Oh! Forgot to add - for ProZinc, really small changes do go a long way. If that 2.5 isn't quite enough, try 2.6 or 2.8 and work around there. Also, because you just dealt with rebound, you are going to get wonky #'s for a bit. You may see a high PS# tonight. Don't panic. Shoot the 2.5 (unless you get another super low # at nadir, then I'd go 2.2-2.3). Let his body get back on all 4 feet. Going low can cause major wonkiness but it usually clears out in a few cycles.

 

can someone fill me in here becuase ALL i'm seeing is MAJOR rebound. why shoot 3u into a 140...and after watching that go UP why shoot 2.5.
Unless i'm missing something this kitty is being way overdosed....and i do know about the ketones but that won't be resolved by overshooting.

 

Lori - we're trying to get her to lower the dose and set a no shot #.

Everyone agrees 3 units was way high. 2.5 was the last dose that gave her somewhat decent curves, so a return to that was what we were looking for. If she hits low greens with 2.5, then obviously another reduction will be needed, but she also has some overlap that's going to skew the #'s for a bit and probably some rebound #'s that are going to have to be dealt with.

 

it looks to me like she will never get those low #'s with those shots. (look at me the last of the high shooters talking) but i would say 1u for a few cycles would tell the story. and if a 140 amps is not a clue to lower the dose or not shoot....what # is?
when a # goes up after the shot...the next thing you'll see eventually is a hypo.
the #'s only go up after a shot becuase the body sense's a hypo coming.

 

I agree with you Lori. My only concern about going too low on the shot too fast is that she's got 14 cycles of 3 units preceeding which has thrown poor Napoleon out of whack. She's got glucose from the liver going in with all the rebound so his #'s are quite elevated. A .5 unit reduction for ProZinc is pretty significant and the 2.5 he was on before wasn't perfect, but it might be a good place to start. We don't have enough data on Napoleon to know how he reacts. I also think his dose is going to end up being lower, but since it's been a while since he's had steady #'s.

You and I both know the next few cycles are going to be whacked out, so I think getting down to 2.5, checking the nadir and seeing where it is and then reducing for the next cycle if needed is a good start. She may be reducing his dose a lot in the next few days and I think the lot of us will be keeping a better eye on Napoleons spreadsheet.

Nimcewan - It's best to make a new post with your date and your cat . Ex: 5/14 Napoleon. That will make sure people are keeping an eye on your #'s and give you a chance to let us know what's going on with him and what problems/successes (hopefully more successes) you are seeing. If you're not posting, usually everyone thinks everything is all good. I would take what Lori is saying into consideration. I also think that 2.5 may be too much, but I'd like to see some data.

ETA - Lori, I about snorted when I saw your "last of the high shooters" comment. Wasn't that you with a .2 this morning!! I was about shocked to see that on his SS!

 

Thanks so much for all of your input. I will continue with the 2.5 and see where that gets us. Im waiting on stupid test strips- only 6 left! Hopefully I will get them tomorrow, so I can start with a curve again. I am just holding onto the 6 I have for pre-shot numbers and nadirs. I am going to go with the 2.5 for now as you suggested Hope because at 2u he has had ketone issues. What would you say is a good number of cycles to let this go for before I go ahead and lower the dose?

 

Hi Hope and Napolean's mom (sorry don't yet know your name)
I agree that it's nice to set your sights on a dose and stick with it---however you have to also consider your amps and pmps when shooting and not just stick to dose.
nadir is the second factor to consider here, especially for napolean at this point.
IMHO, i think this is some dangerous shooting. I do not think it's always necessary to go down in dosing slowly as it is to go up in dosing slowly.
Just my 2 cents.

 

Thanks Lori. I'm Nicole :smile:

First let me say that I am forever grateful to have found the support and advice of the members here. Especially on this thread, it may have saved Napoleon's life and that is immeasurable to me.

I have already begun to see a difference in Napoleon having changed his dose for just one cycle. He has been alert, playing, looking more himself. I have been on the brink of tears for a lot of the day knowing I put him in a dangerous situation with just sticking to the norm and the vet's instruction and dosing the 3 units. I know better now and I hope I have not caused any damage to his system. He has finally gone under 300. I am getting a curve again after PMPS. God willing my test strips will come tomorrow. If they don't I will bite it and just pay full price for them at CVS of Walmart. He has never been below 2 units on this BCP insulin, he was started at 2, but that did not seem to do the trick. Maybe I was missing something. Is it safe to follow through with the 2.5 for the next few cycles and follow accordingly with lowering the dose? Will I be hurting him doing this? I will never allow him to be at 3 units again, at least we know the ceiling now and can lower it from there. Again thank you so much for all of your replies. I have learned so much.

 

Hi Napolean's mom, IMHO, I feel like you need to at least go to 2.4 or less since he's been at 2.5 before. Definitely don't go up unless you have enough test strip too. On 5/10 you wrote on your SS that he may have re3ceived less than 3. since he pulled away. That has me thinking that you definitely want to go lower. My gut says 1.25U am and 1.25 pm. and stick it out for a few days.

Will check back later on you guys. Hang in there!

 

Hi Nicole, and i really hope i did'nt come off as too impatient. oh how i remember my early days!
i think your starting dose was high for sure. and every cat takes a few days to settle with the insulin and it is not at all unusual for the 1st 2 or 3 days to actually see a rise.
if napolean were my boy, knowing what i know, i would go with the lowest dose you can allow yourself...as if you were starting over. my choice would be 1unit. my tom was dx'd 3 years ago at 525 and i started him on one unit. he lowered on food change before he lowered on insulin (i know this becuase i changed his diet 4 days before the insulin arrived)
there is much greater danger in dosing high than dosing low.
if you want to go to 1.25 or 1.5 go ahead. don't expect big drops right away.
if you get a 200 or abouts amps or pmps than go to 1u.
you CANNOT shoot too little
you CAN shoot too much.
and i'll be checking on you often.
start a new thread each day with your name and amps ok?
lori
and tomtom too!

 

After some much needed guidance from Lori, we are starting over tomorrow with 1 unit. I will not shoot anything below 140. This has truly been an awakening and quite possibly the beginning of healing for my Napoleon. Lori, you are an angel! Thank you to everyone on here also for their support and guidance. I will keep you all posted! My hope was regained tonight with this situation. :YMHUG: