Persistent Rebound

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DMUKCAT

Member Since 2014
Hi, I am a fairly new member who has been lurking for a while, though unfortunately I am not new to Feline Diabetes as I now have Cat No2 Mr. Mojo, (Previous kitty long gone and regulated easily on Insuvet PZI).

I have no spread sheets to offer, just a book of scruffy hand written numbers in UK terms using an Alfatrak (vet insisted so our numbers match the clinic) but wondered if anyone out though is able to give advice on the topic of persistent rebound?

I’m up to speed on recommended low carb high protein diets as well as insulin types generally (we’ve tried most) and I’m aware in terms of this forum most people do not advise to dose through rebound, but is there any protocol or recommended insulin type for cats who have high pre insulin BG and cannot be dosed high enough to bring numbers anywhere near normal levels without sudden rebound?

I’m aware that generally speaking this is an issue for many cats in the beginning until the liver adjusts, but we are two months in and it’s still happening so to my way of thinking, I need first to find an insulin and a dose which doesn’t drop him too rapidly so at least his numbers will be flatter even if still high, and then after a period of adjustment, make tiny increases until his liver gets used to each new lower level?

Does this make sense and if so, are there particular insulin types that are likely to achieve this better than others? I thinking perhaps short acting in a hospital setting and then home with an intermediate at low dose?

The rebounds are very severe, and he goes HI on the meter after dropping to midrange numbers (approx. 15 to 16) halfway through a 12hr cycle on Lente insulin, was all over the place on Glargine, and has spent most of the time on Hypurin PZI where duration wasn’t long enough for SID dosing (approx. 14hrs), but either due to misjudged overlaps or it just being the wrong insulin for him, he constantly rebounds on BID doses, or doses are just not high enough to achieve regulation when we do reduce.

These spikes are seriously taking their toll on his wellbeing and I’m really worried about him, to the extent that I’ve booked him into the Royal Veterinary College who use constant blood glucose monitors inserted under the cats skin for two days at a time to read a continuous BG, but even these human tools are not calibrated to read the extreme highs and lows and I stress that his case will be lost to some extent in a large study based institution.

HELP PLEASE!!

Any input appreciated because I cannot find any info on this type on rebound scenario despite having searched on the internet.

Thank you,

Angela.
 
Welcome Angela. Sounds like you have a pretty good understanding of feline diabetes and have just landed yourself a bouncy cat. One thing I notice is that it looks like you have tried 3 different insulins in a matter of 2 months. It is hard to hold out on an insulin when it is not working, but usually it will take a few weeks for any insulin to settle and to build up to a dose that is going to work well for a cat. Especially depot insulins like Glargine. Lente is a short acting insulin and would produce bouncing in a cat.

Is there are possibility he is getting into some high carb food? Some cats are very sensitive and will shoot up high with just a mouthful.

Any possibility you could get a spreadsheet set up? Sometimes seeing the numbers in that format help spot things that help understand what is going right and what is going wrong.

That study at the College sounds very interesting.
 
Hi Melanie and thank you, I’m desperate at this point.

Yes I agree my insulin record looks awful on paper, but Caninsulin has to be prescribed by law before decent insulin can be issued under the “cascade” in good old England, so quickly put on Glargine because my internal Meds Specialist was looking for remission, (Mojo’s a pancreatitis case BTW), but she didn’t like his erratic BG on that so switched him to Hypurin PZI after a couple of weeks. I’ve spent most of the time on PZI though trust me, I’m home testing, take pre-insulin readings, spot checks, and curves when they are required (did an hourly 12hr curve on Lente today as it happens) and his PZI numbers were as I said, absolutely awful, and I already know a lot of people have had difficulty with this particular PZI, as it’s much longer acting than the one used in the States (and the old Insuvet of yesteryear) so really hard to work with, but it’s the same scenario with all the insulin for him as it happens, meaning, doses that start getting into the normal ranges (or mid ranges, dependant on how high he is pre-insulin) just rebound because he can’t cope with the drops, then numbers are high and stubborn for two to three cycles, and then he just rebounds again, or stays stagnant when we lower the dose.

It’s on advice FROM the Royal Veterinary College that we’re now trying the Hypurin Lente, because they said in some cats, the longing acting insulin groups just don’t work for the very reasons I’ve described,( either not enough duration at SID or rebounding every two to three cycles on BID), though to be fair they also said perhaps revisit the Glargine as a “less potent” choice, and I’m pretty sure my vet had me overdosing at 2 units BID when I was already certain he was rebounding on less in the short time we were using it. I know how the Lente works, and notoriously bad in rebound situations because so spikey, but choice is limited, and I have to get the numbers down a bit flatter somehow, just no idea the best way to achieve this.

The bottom line is I’m not sure what anyone does in this scenario, or what IS best, and that’s essentially what I’m asking. Anyone else had this problem and got round it?

Not trying to be difficult on the SS but absolute technophobe here, wouldn’t have a clue, and even when I typed up my PZI history in an email it took me forever.

Not involved in any study at the college, he’ll be a paying guest I’m afraid, but they are the only place in England currently using these monitors as far as I know, and they are a reliable way of getting to grips with a hard to regulate cats BG for the important part of the cycle, so while you don’t get the Hypos and the Hypers (those still have to be done with blood sampling), you DO get a constant reading of the cats BG on a removable chip so you can see its exact response to insulin. My concern is it IS a large teaching institution, HUGE, so they have the facilities yes, but perhaps lacking on the TLC, all a bit clinical with students following the consultants around everywhere, so not exactly a stress free environment even if it is one of excellence.
 
Re: Persistent Rebound/Feeding schedule.

Oh and no on the food Melanie, (missed that bit, sorry).

We are feeding low carb high protein wet, and though he does have access to grain free 19% carb/high protein dry because he's been a dry freak for 13 years with a history of anorexia and hepatic lipidosis and therefore withholding what he WILL eat is not an option, he doesn't eat much of the grain free dry AND I've picked it up before now to see the affect on his curve and there isn't one - he has no food spikes, just gentle rise up and down after a small meal because he's a little and often grazer. It's the drops from on high in short periods of time that is his problem, today for example, pre-shot he was around 38, + 6 on Lente he was 16.5, and by + 8 up to 31 before going HI on the meter by +10.

PZI, sometimes his nadir doesn't occur until +12, really slow, during which time the numbers don't move much, but they either stay high and flat, or suddenly drop rapidly within the cycle and bounce up again. Absolute nightmare I'm having, hardly slept in two months for worry.
 
Re: Persistent Rebound/Feeding schedule.

DMUKCAT said:
... he does have access to grain free 19% carb/high protein dry because he's been a dry freak for 13 years with a history of anorexia and hepatic lipidosis and therefore withholding what he WILL eat is not an option, he doesn't eat much of the grain free dry AND I've picked it up before now to see the affect on his curve and there isn't one - he has no food spikes, just gentle rise up and down after a small meal because he's a little and often grazer. ...
Click to expand...

Maybe add a note in your signature about diet not changing.

Ever try baking the wet into a dry crunch version? Spread thinly on a jelly roll or other wide shallow pan. Bake at a temp like crackers. Possibly stir or turn over a few times. Cool and serve. Store estra in frig. And the house will smell like baked catfood ... yum (?)
 
Re: Persistent Rebound/Feeding schedule.

"Maybe add a note in your signature about diet not changing".

My Signature? Now you'll discover just have much of a techno twerp I actually am.

"Ever try baking the wet into a dry crunch version?"

I've never tried baking full stop, though I do make a make a mean roast potato on a Sunday so I'm told. Seriously, food not an issue here, no post nosh spikes, only post big drops in short period spikes on intermediates and/or BG falling into normal range on long acting insulin (anything below 10) rebounds. Much of a much really, his liver say NO, needs retraining, I just need some input on how to go about.
 
You can do this - techno and cat - just believe in yourself.

Copy or print the following.

In the upper left of the web page, there is a line which says User Control Panel. This is where you can adjust settings for how the board displays, your signature, get private messages, and so on.
Click on that.

A new page displays, with 6 tabs along the top edge. Take a look at each by clicking on the tab and notice the topics listed on the left under each one.
Click on the tab which says Profile. You'll see a list of 4 categories: Edit Profile, Edit Signature, Edit Avatar, Edit Account Settings.

You can click on Edit Profile to put in any details you want to share in the boxes given. When you are done, you click on Submit at the bottom of the boxes.

You can click on Edit Signature to put in some details you want to show up in each post you make. This is where you put your name, your cat's name, the insulin you are using, and any special notes such as diet limitations or other conditions which are present. You have only 255 characters, so be succinct! When you are done, you click on Submit at the bottom of the boxes.
 
Re: Persistent Rebound/BJM Tech Talk

OK thanks, I'll have to give it a whirl tomorrow at some point, as it's 4am here and I'm still mopping up after the latest BG bonanza, and I have to see a vet about a kitten later (what is now) today.

Just one quickie in the interim if you're about, are there any particular long standing members on the forum with an in depth knowledge of all things DM? I ask only because as a member donkey's years ago with another cat, there was a lady, Robin, and I'm not kidding when I say there wasn't anything she couldn't answer. Now perhaps I have my rose tinted specs on because as it turned out the cat regulated in a very predictable 1/2 unit at a time fashion, so of course I was eternally grateful, remember our brief encounter fondly, and what probably seemed like wizardry back then might be standard protocol these days....but I'm older and uglier now, with a ton of cat related health issues under my belt, so it isn't that I think I can't do the cat thing, (though appreciate your sentiment because it IS driving me potty) but more that I know I CAN do the cat thing (if not the tech thing) but the cat thing feels like it isn't doable right now, and may never be because insulin wise, there isn't much else to play with.

I'll be interested to know what the college have to say about rebound, but none of my cats ever seem to do 'text book' and I used to think it was unique to me and my weird Pedigrees, but now know there's an awful lot of cats out there who NEVER dance to the tune of the established protocols, they really ARE all different.

Anyway, sorry to waffle, it's the one thing I am good at.

Thanks for your input.

Night Night.
 
A way to mediate the bouncing (aka rebound) is to feed the curve. That is, intentionally time some mini-meals to slow the rate of drop and control how low he goes. Maybe he needs to stay at 10 for a nadir goal for a while before gradually aiming for 9, then 8, etc.
 
Hi Angela, it's nice to see you here :smile:
But I'm so sorry to hear that you're still having a tough time.

DMUKCAT said:
...his PZI numbers were as I said, absolutely awful, and I already know a lot of people have had difficulty with this particular PZI
Click to expand...
Could you possibly give me more information about this? I'd be very interested to know of people who've had problems (it would help with my knowledge base about this insulin). Most Hypurin cats I've known have actually done really well on it. The only issues I've known folks to have is learning to factor in overlap (which generally means reducing the dose).

Really hoping you can find an insulin and dosing method that work for your kitty...

Best wishes,

Eliz
 
Re: Persistent Rebound/BJM andEliz

Thanks all and yes Elizabeth, I'll happily share my PZI stuff with you, just give me some time as I'm snowed under cat wise at the moment, spending most of my time either researching on line, exchanging emails with my Specialist, or speaking with different consulting vets to get their input on what they do in these scenarios. I also have another neighbours cat who has been left behind to deal with, as well as my other 5 non diabetics, including a kitten!

My Specialist is very well respected locally by different vet practices, and as one vet said today, if she can't sort it out, the college really is your best bet as the next step up because there are a variety of conditions (including insulinoma) that may cause high blood glucose, coupled with a pancreas trying to fight that with an over sensitive glucogen secretion disorder, so we're getting into the weird, wonderful and rare here, potentially, though I'm not convinced it's not just a case of chronic overdose (and by that I mean his insulin requirements may be tiny), and his liver having just settled with higher numbers in the process. We shall see.

There is no feeding through the curve option here, as he already eats little and often throughout the curve, so what we are doing to tide us over until the RVC appointment now is, to try dosing Lente super low (in other words not high enough to rebound) and dose each 8hrs until the numbers flatten a little, though ultimately I may revisit Glargine because of the release mechanism (less potential for drops) at a lower starting point than we tried previously, because with hindsight I don't think we used it for long enough to know, and while he WAS rebounding on Glargine, it's the one insulin we didn't pursue at lower dose.

Will report back when I know more, and look at the signature thing when time permits.

Thanks again.

Angela.
 
Re: Persistent Rebound/Feeding schedule.

DMUKCAT said:
Oh and no on the food Melanie, (missed that bit, sorry).

We are feeding low carb high protein wet, and though he does have access to grain free 19% carb/high protein dry because he's been a dry freak for 13 years with a history of anorexia and hepatic lipidosis and therefore withholding what he WILL eat is not an option, he doesn't eat much of the grain free dry AND I've picked it up before now to see the affect on his curve and there isn't one - he has no food spikes, just gentle rise up and down after a small meal because he's a little and often grazer. It's the drops from on high in short periods of time that is his problem, today for example, pre-shot he was around 38, + 6 on Lente he was 16.5, and by + 8 up to 31 before going HI on the meter by +10.
Click to expand...

If I understand you correctly, your dry food has a 19% carbs? That's still way to high. Try a no carb dry food like Wysong Epigen or Young Again.
Low carbs dry foods did not work for me. No carb dry foods are working for me. And that was on a cat that initially tested with a blood sugar of 600.
 
Re: Persistent Rebound/Feeding schedule.

zzyzzx said:
[If I understand you correctly, your dry food has a 19% carbs? That's still way to high. Try a no carb dry food like Wysong Epigen or Young Again.
Click to expand...
Hi,
Angela is in the UK and there are no zero carb dry foods (or even low carb dry foods), unfortunately.

Eliz
 
You may be able to approximate low carb dry by baking some of the low carb wet into a dry format. Use a shallow pan, spread the food thinly, use a temp similar to crackers or crisp cookies, stir occasionaly, and see how it goes. Store unused portions in frig. And the house will smell of baked cat food for a while ... yum [?]
 
Old timers, PRESENT BEANS with REBOUND experience ASAP

confused_cat
Hi Angela, read your posts and having been away from the board basically since 2003 when Barney(GA) passed on to the Rainbow Bridge.I did come back in January of this year when Alexander, age unknown, trapped on my porch on a freezing winter night at 1 am in a hav-a-heart cage around 2004...In January of 2014 he came down with the dire beasties.Unfortunately he never really had enough time left on earth to hometest or give shots to.

You and I had *conversations* about our cats back in 2001-2003 or was it 4?

Am sure if Robin and a few of the old timers (say Janet and Binky, Laura and Murray just a few for memories sake) were still active on this board they would be responding with great, sound, up to date advice. As it is, I'm out of the loop, no DB cat......but am posting this reply in the hopes SOMEONE with similar Rebound experiences will post. I know you are very experienced with caring for your furbabies sickness.Diabetes and Respiratory.

Insulins have changed.Hope someone using the NEWER ones can help you out.

SANDRA AND BARNEY (GA)
 
Angela - I'm responding to you on this thread instead of Misha's. Here's a quote from the Tight Regulation Protocol:
Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:

the formula is 0.25 unit per kg of the cat's ideal weight

if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight

if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
Click to expand...
How much does Mr. Mojo weight? He's have to be a pretty good sized cat to start Lantus on 2U. Starting on 1U is more common, but it does depend on their weight. And with dry food in the picture, the dose would have to be higher. The above formula is assuming low carb wet food.

We typically say to give Lantus 6 months before deciding to switch insulins. I think you've done too much insulin hopping in two months. It helps to remember than insulin is a hormone, not a drug. If you do go back to Lantus, try sticking to it for at least two months. It can take kitty a while to settle into an insulin, especially the depot based ones.

As for rebound, we call it bouncing here when it's just the liver panicking. True rebounding is when kitty's insulin dose is too high. Check out the second post on this thread. The liver can panic either because of getting to a low that it isn't used to (but could be perfectly normal) or because they are dropping too fast. As BJM suggests, you can help the bounces due to dropping too fast by spreading out the food in the first half of the cycle or increasing the carbs a bit. And yes, bounces can go on a long time. Neko still bounces 2.5 years later, just not as high or as long as she used to. We've seen cats bounce for over a year, all the way to remission.
 
Re: Persistent Rebound/Wendy

Hi Wendy,

Thanks so much for input and sorry if I'm late here, I only just revisited this thread and I've literally not been home all day.

In terms of dosing history, there is nothing you've said I don't whole heartedly agree with and didn't fear from the start, except I was under the care of a Specialist and under orders to follow her protocol, so I learnt myself the HARD way.

Bottom line, if you read most official Lantus protocols, they will state that if the cats BG is above 20 at the beginning, the starting dose rate is 0.5 units/kg, and as Mojo is 3.5kg, the 2 unit BID dose was decided by my vet on that basis.

Now funnily enough, by some weird twist of fate, as I keep strange hours and my preferred dosing schedule is 2pm/2am, when we started Lantus at the Surgery from the very beginning, my vet gave 1 unit at 9am, with the instruction for me to give the second half of his dose at 2pm, so I could then dose him 2am at 2 units BID and so on thereafter, but I started testing as soon as we got home, his BG went from 24 to 9 very quickly on the 1 unit half dose in the cycle, I was not willing to give the remainder of the dose as instructed, and from then on the ping pong between the vet and I began with her insisting I was under dosing and as we increased under pressure, my telling her I was certain we were over dosing. She got fed up in the end and switched him to PZI, that wasn't easy to work with, he got a nasty UTI, numbers stayed high, his immune system which has always been iffy started pooling upper respiratory inflammation, higher steroids required, BG numbers meaningless, confusion ruled. He also has pancreatitis so picture the scene if you will, this is no straight forward diabetic!

Anyway, long and short, I restarted Lantus on Saturday at 1 unit BID, I've left him at the Royal Vet college today who agree with the dose, will curve for a couple of days, re-scan, check for insulin resistance and satisfy themselves there is no other underlying nasty stuff lurking. Moving forward, home he comes later this week for what I can assure you will be long term consistent dosing in the hope of improving his jittery numbers which as a stand alone, I wouldn't be overly concerned about given that at BG around 15 he is clinically bright, alert, and not draining the water bowl, but when those rebound highs kick in it is just heart breaking to endure, because the affected gas exchanges elevate his respiratory rate, his inflammation snowballs, and he is generally very unwell so in HIS case I am less concerned with the actual numbers being perfect, and more concerned about the swings taking their toll on his delicate little bod!

I feel guilty to take comfort in the fact others such as you and Diana have experienced persistent rebound because I wouldn't wish this awful disease on my worst enemy but it is sadly reassuring to know we are not alone, and in some cases it does continue for longer than average so thank you for sharing this, it helps mentally, and the old brain is tired of trying to work this stuff out.

Angela.
 
Re: Persistent Rebound/Wendy

DMUKCAT said:
...in HIS case I am less concerned with the actual numbers being perfect, and more concerned about the swings taking their toll on his delicate little bod!
Click to expand...
Hi Angela,

Have you worked out what BG level triggers Mojo's bounces? Or is the speed of the drop? (Or indeed both?)

Eliz
 
Re: Persistent Rebound/Eliz

Hi Eliz,

Both, but definitely more so the speed of dropping in his case, as he's actually very responsive to small amounts of insulin but often starts with elevated pre-shots hence providing a ripe environment for this to occur and the guiding reason for my current plan to attempt mediocre flatter numbers then get those pre-shots down SLOWLY to even things out. The RVC agreed actually, particularly with all his concurrent stuff, they too believe that tight regulation is unlikely for him right now, and his clinical symptoms are what we need to improve on at this point. They also implied too tight regulation is borderline dangerous in any cat because there is for example such a small difference between 4 and 0, so it only takes a cat to miss a routine meal or something to change in their insulin requirements before you find yourself with a cat going hypo, though I suppose this is more risky in those who cant home test or aren't at home often enough to know what their cat is up to in their absence. Even so, we all need to sleep at night and no one can test 24hrs a day so.......

Why I totally empathize with Diana is because the biggest difficulty and learning curve I've had is having to put up with those higher numbers, both generally and after rebound, particularly as in Mojo's case the physical symptoms of high BG are very evident once he gets over 25 and horrendous on the occasions he's gone HI on the meter, so while it seems obvious to me now with hindsight that trying to rush these things is the WRONG thing to do in a cat who has become accustomed to elevated and erratic BG, it isn't easy in the moment. Doesn't help either that my last true steroid cat regulated overnight, as there is always the temptation to believe what works for one works for all, when it rarely works out that way. I should know better.

Thanks for your reply on Levimir BTW, I did intend to Google it when no one responded but got waylaid in the kitchen.....as per. Oh and I haven't forgotten you wanted my PZI stuff but I've yet to update and the RVC have confiscated my hand written bible, though given everything we were trying to do with him during that period and his concurrent disease issues, I'm not sure how much use those will be to you in real terms?

Angela.
 
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