Update on Andy

[Yvonne & Andy &BJ (GA)]

We're again asking for some opinions on Andy's dosage. I am getting decent #'s at 1u but have been giving snacks around 3+ and 5+ and sometimes more to try to avoid the bounce. However, if I have to do this, isn't the dose still too high? He still bounces if he gets into the lower blues. Thanks!

 

[Sue and Oliver (GA)]

If he were mine, Yvonne, I'd up the dose to 1.25. Even with the AlphaTrak, your blues have room to drop. There are different approaches to bounces. Mine is that they bounce until they stop bouncing - some people call it liver training. Their body needs to get used to the lower levels that it perceives as too low and stop throwing in that extra glucose. He isn't bouncing terribly high; it is still a nice smile curve. It could also be that you need a little more insulin and the dose is wearing off before +12. I think the bouncing is the more likely scenerio but increasing by a little would take care of both.

I would plan to be around to monitor the first cycle you increase if you decide to do that. When I look at his spreadsheet overall, I am encouraged. His preshots are gradually dropping from those higher pinks and reds.

 

[Yvonne & Andy &BJ (GA)]

If he were mine, Yvonne, I'd up the dose to 1.25. Even with the AlphaTrak, your blues have room to drop. There are different approaches to bounces. Mine is that they bounce until they stop bouncing - some people call it liver training. Their body needs to get used to the lower levels that it perceives as too low and stop throwing in that extra glucose. He isn't bouncing terribly high; it is still a nice smile curve. It could also be that you need a little more insulin and the dose is wearing off before +12. I think the bouncing is the more likely scenerio but increasing by a little would take care of both.

I would plan to be around to monitor the first cycle you increase if you decide to do that. When I look at his spreadsheet overall, I am encouraged. His preshots are gradually dropping from those higher pinks and reds.

Thx - I will try this on Thursday. I usually panic when he goes into the blue and give him a low carb snack. Is this counterproductive? Any guidance on snack timing? On another note, he gained .25lb since I have him - now 7lbs but still pretty skinny!

 

[Carl & Polly & Bob (GA)]

Low carb snacks shouldn't cause too much a problem. I guess you just determine what number you are comfortable with, and when he goes that low, give him something to keep him from dropping lower. A lot depends on when in the cycle you see that number.

I'm just going to pick a number out of a hat and say "120" is where you start to be concerned -
If you have the data to feel confident that his nadir is around +6, and you see a 120 at +3, then yes, you'd give him something to slow things down. That assumes that his preshot was like in the 300s.
But if you see the 120 at +5, then maybe hold off and see if he goes lower 30 or 60 minutes later. He might level off on his own, or he might just be having an earlier than normal nadir. I guess it's sort of a game of "chicken" against yourself. And only "doing it" will cause you to gain confidence. The whole "knowing your cat" thing. You'll also figure out "how much" is enough in terms of what and how much you feed to avoid dropping too far.

I think the cycles at 1u are better than the prior cycles on 1.5u, where it looks like the lows were causing bounces to higher preshots. A pink preshot and a mid-blue nadir look like something he's more "comfortable" with. I agree with what Sue said that his blue nadirs do have some room to be a little lower, and I think that on cycles you know you can test around nadir, an increase to 1.25u would be a good thing to try.

 

[Yvonne & Andy &BJ (GA)]

Low carb snacks shouldn't cause too much a problem. I guess you just determine what number you are comfortable with, and when he goes that low, give him something to keep him from dropping lower. A lot depends on when in the cycle you see that number.

I'm just going to pick a number out of a hat and say "120" is where you start to be concerned -
If you have the data to feel confident that his nadir is around +6, and you see a 120 at +3, then yes, you'd give him something to slow things down. That assumes that his preshot was like in the 300s.
But if you see the 120 at +5, then maybe hold off and see if he goes lower 30 or 60 minutes later. He might level off on his own, or he might just be having an earlier than normal nadir. I guess it's sort of a game of "chicken" against yourself. And only "doing it" will cause you to gain confidence. The whole "knowing your cat" thing. You'll also figure out "how much" is enough in terms of what and how much you feed to avoid dropping too far.

I think the cycles at 1u are better than the prior cycles on 1.5u, where it looks like the lows were causing bounces to higher preshots. A pink preshot and a mid-blue nadir look like something he's more "comfortable" with. I agree with what Sue said that his blue nadirs do have some room to be a little lower, and I think that on cycles you know you can test around nadir, an increase to 1.25u would be a good thing to try.

I started him on 1.2u yesterday. This am he was 427 and at +2 down to 273 already after eating a can of FF. He has been bouncing for well over 2 months - that is probably why the prior vet had his dose at 6u. I know you all have heard this before but how do I stop that bouncing? I am very concerned. They had tried Lantus but could not regulate him - my suspicion is he was bouncing then also. Should I consider trying Lantus again?

 

[Sue and Oliver (GA)]

I know it is of small conciliation, but he doesn't bounce super high. This am was a higher bounce, but he has had some preshots in better ranges. Maybe try feeding a little at preshot and a little more 30-45 minutes later? It's a matter of experimenting to see what smooths out the curve - trying food at different intervals early in the cycle can help. Not feeding later in the cycle might help.

And the common wisdom is that cats bounce until they don't. I think there was a cat here on the forum who bounced for two years. That is NOT common! Cats seem to bounce on every insulin and for varying amounts of time. Bobbi's Bubba bounced for several months and has finally settled in. A depot insulin might help, might not....

I'd encourage you to take the numbers as they come and look at the overall picture. He is in decent numbers and gradually dropping over time. We'd probably wonder if they are really bounces, but that early 50+ drop does suggest them. A rise at pmps could mean a little more insulin is needed to stretch out the duration, but I am leaning toward bouncing. Is he feeling better - peeing, pooping, playing, preening? It is easy to think of him as numbers on a meter, but if he is settling into your household and feeling good, that stuff is important.

 

[Carl & Polly & Bob (GA)]

I started him on 1.2u yesterday. This am he was 427 and at +2 down to 273 already after eating a can of FF. He has been bouncing for well over 2 months - that is probably why the prior vet had his dose at 6u. I know you all have heard this before but how do I stop that bouncing? I am very concerned. They had tried Lantus but could not regulate him - my suspicion is he was bouncing then also. Should I consider trying Lantus again?

Kitties on Lantus bounce too, especially at first.
The only way that I know of to avoid bouncing is to have a fairly flat cycle. But if you have a cycle that starts with yellow, pink or red numbers, then a flat cycle is exactly what you don't want to see.

You don't want the low numbers to be dangerously low. So you can feed between shots, when you see a number dropping too far to head that off. But if the numbers are safe, not dropping too fast or too far, then you just sort of let them happen, and you live with the bounces until the cat gets used to see numbers in the "blues" that are still safe and above "normal".

 

[Yvonne & Andy &BJ (GA)]

I know it is of small conciliation, but he doesn't bounce super high. This am was a higher bounce, but he has had some preshots in better ranges. Maybe try feeding a little at preshot and a little more 30-45 minutes later? It's a matter of experimenting to see what smooths out the curve - trying food at different intervals early in the cycle can help. Not feeding later in the cycle might help.

And the common wisdom is that cats bounce until they don't. I think there was a cat here on the forum who bounced for two years. That is NOT common! Cats seem to bounce on every insulin and for varying amounts of time. Bobbi's Bubba bounced for several months and has finally settled in. A depot insulin might help, might not....

I'd encourage you to take the numbers as they come and look at the overall picture. He is in decent numbers and gradually dropping over time. We'd probably wonder if they are really bounces, but that early 50+ drop does suggest them. A rise at pmps could mean a little more insulin is needed to stretch out the duration, but I am leaning toward bouncing. Is he feeling better - peeing, pooping, playing, preening? It is easy to think of him as numbers on a meter, but if he is settling into your household and feeling good, that stuff is important.

He is doing really well otherwise. He does not appear to be "starved" all the time anymore but is still very food oriented. I am just an overprotective mom and too impatient also! Thank you for all your encouragement.

 

[Yvonne & Andy &BJ (GA)]

Kitties on Lantus bounce too, especially at first.
The only way that I know of to avoid bouncing is to have a fairly flat cycle. But if you have a cycle that starts with yellow, pink or red numbers, then a flat cycle is exactly what you don't want to see.

You don't want the low numbers to be dangerously low. So you can feed between shots, when you see a number dropping too far to head that off. But if the numbers are safe, not dropping too fast or too far, then you just sort of let them happen, and you live with the bounces until the cat gets used to see numbers in the "blues" that are still safe and above "normal".

I just wish I knew more about his history. But his #'s are definitely better now than when I got him about 7 wks ago, so as I told Sue, I need to be more patient! Thanks for your reply.