Update on Purrfect - flat numbers today

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Astra&Purrfect

Astra&Purrfect

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Hello, everybody!

It’s been a long time since I posted. A family member’s health (heart attack) rather distracted me away but I would like to thank the contributors on the forum once again who replied to me earlier in the year. I’d also like to give you an update about Purrfect:

Purrfect's dose has been gradually increased to 3u of ProZinc 2/day since the end of June. His pre-shot numbers are still very high in the 400s but we managed to get him down to a 280s number at nadir in July and August.

After a couple of duff strips a couple of weeks ago which prevented us seeing his nadir, we did another test today and were alarmed to see that his nadir level (474) is higher than his pre-shot level (432).

This is terribly worrying.

Do you think he’s got a Somogyi rebound? Or could something else cause these flat numbers? Lately, we’ve reduced his feeds 6 hours post-shot to try to lower his levels. He has drunk less since.

He seems fine with a good appetite, no fever and he’s not even drinking a lot which is weird with those high glucose levels. I’ve done a Ketodiastix strip and he has no cetones and “medium” level of glucose in urine (450 mg/dl).

What shall we do? Retest him later pre-shot and give him the same dose or less?

I’d be so grateful for your advice. Thank you.

Astra and Purrfect.
 
Hi Astra and Purrfect! I'm so sorry to hear that you've had health problems in your family. A heart attack is so scary! I hope things turned out all right.

First off, I wouldn't be too worried about those numbers. With the 20% variance, 474 and 432 are basically the same number. It's hard to tell you what's going on without seeing some recent numbers, but my GUESS is bouncing. Having a high, flat cycle like it looks like is happening today, is a classic sign. Most likely, Purrfect had a low number last night (or lower than he's used to) and that caused his numbers to bounce back up! Sounds like you're doing some great things to keep an eye on him...he seems fine, you're testing for ketones, and you're testing his BG.

You say you increased gradually, correct? Like went up by 0.25 or 0.5 and then gave it a few cycles?

My suggestion would be to definitely check BG tonight before the shot, and then most likely stick with that same dose. You could post your number here and we'll be glad to give advice.

Are you testing preshot every day? And getting mid cycles when you can? If you do that, and keep your SS updated, we'll be glad to help you out! My guess is you're going to catch a low number if you can get mid cycles whenever possible and that'll confirm the bouncing.
 
Hi Astra and Purrfect! I agree with Rachel that it might be bouncing, but we really can't know without seeing some other data. It sounds like you're doing some testing at home which is great. If you can update the spreadsheet with any data you have, that would be really helpful. And then check the pre-shot numbers and any mid-cycles you could get over the next few days. Then we'll be able to give some better thoughts on what might be going on with Purrfect.
 

Hello, Rachel and Djamila,

Thank you so much for your replies. I can’t tell you what a relief it is to have someone to talk to about this. Our vet is great but she has very little experience of diabetes treatment (only Caninsulin in the past) and we’re the only one of her customers using ProZinc!

Djamila. I’ll certainly get any test data I have and update the Spread Sheet.

Rachel, thank you for your kind words. Yes, regarding the family, he’s recovered from the heart attack and had a stent fitted. All very stressful!

Now, Purrfect, yes, we started at 1 unit at the end of November and he’s been gradually increased to 3 units in increments of 0.25 over several days (usually weeks).

I’ve just tested Purrfect before the evening shot and he’s at 475, only one digit difference from the last test (474) before his meal at 6+ hours. I’ve given him his usual 3 units.

I guess Somogyi rebound is the clinical term for bouncing? If so, I suppose the remaining glucogen from his liver might make his numbers flat for a while, a day or more?

I have to say that we have not been doing very regular testing, and certainly not every day. I find the whole process a bit trying. But I see that we’re going to have to do more testing over the next few days to find out what’s going on.

One thing though is that in an effort to reduce his stubborn 400s numbers in the morning we have been reducing his meal at 6+ hours and especially in the middle of the night. (Yes, I know it’s nuts but I get up in the middle of night to give him a meal!) In the last two weeks it’s been reduced from 60 to 40g (2.1 to 1.2 ounces) and last night it was 30g (1 ounce). Maybe it’s been reduced too much although the vet has this idea that we should only give him food with his shots and nothing in between!

Thank you again so much and if anything occurs to you in response to this post I’d be very grateful for your thoughts!

Astra and Purrfect.
 
Hi Astra! That pm number you got still makes me think bouncing. Yes, it's basically the same as Somogyi. You could see these high flat numbers for a few cycles.

The testing process can be tough! Is there anything we can do to help make it easier for you? If you tell us what's making it tough, we can try to help. More testing is what is needed at this point I think. If you can grab preshots for every test and then whatever mid cycle tests you can get, that will help us all figure out what's going on!
 
Hi Astra,

We "talked" earlier in the year when you first joined. I'm sorry you've been through some difficult times. I agree with Rachel and Djamila. If you can update your SS and work at implementing a regular BG testing routine, we can help you figure out Purrfect's numbers. Testing is a bigger challenge (mostly to the human) both physically and mentally/emotionally when it isn't part of your regular routine. That changes quite quickly when it's an everyday thing and you see how helpful the data is in managing your kitty's FD.

We're here to help! :)
 

Thanks, Rachel and Kris for your latest posts. Yes, indeed, Kris, I remember your helpful replies earlier in the year. Thanks to you both.

I have just finished updating the Spread Sheet with the figures. The thing is that I had to give back the glucose meter to the vet this morning. She had loaned it to us but she had an appointment today with a diabetic cat and needed it. She also said that she has now acquired two new diabetic cat patients so will be needing the meter more often. She said we could however borrow it for a few days again from tomorrow afternoon.

I did one last test 3 hours after his evening shot last night and as you can see whereas normally his numbers would start to go down they have barely changed.

I have a couple of questions - it’d be marvellous if you could give some advice:

1. Because I won’t have the meter either this evening or tomorrow morning, I’m worried that Purffect might come down again off his bounce and maybe go too low, although I’ve never yet detected a real low in his numbers. But then again, tests have been rather infrequent to catch any low. Shall I give him his same 3 units (or less) this evening and tomorrow morning and just feed him well?

2. This leads me to my next question. Obviously, we need to buy a glucose meter of our own. The pet-specific ones and their strips are very expensive. I’ve read some recommended human models on the Feline Diabetes site but do you recommend the human Freestyle Freedom Lite Model with ZipWik strips? I’ve heard human meters read off much lower levels than pet-specific ones but just how far are they off? For example, 10, 20%, etc., lower than the real reading?

Regarding testing being tough. I’ve got some great tips off this site: rice bag, the right place to prick the ear, etc. It’s just I’m afraid of poking his ear and don’t know quite how much pressure to apply. Purrf’s so good but he makes a little meow and then I see I haven’t pressed hard enough and haven’t got enough blood so I have to do it again and then he does a little meow again. It’s that which puts me off doing the tests. I suppose I’m just going to have to be braver for his sake!

Thanks very much.
Astra and Purrfect.
I’ve attached a photo of Purrfect taken a few minutes ago!
 

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Astra&Purrfect said:
Shall I give him his same 3 units (or less) this evening and tomorrow morning and just feed him well?
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I suggest you stay at this dose for now but make sure he eats well. You're feeding low carb wet food, correct? The next issue is:

Astra&Purrfect said:
This leads me to my next question. Obviously, we need to buy a glucose meter of our own. The pet-specific ones and their strips are very expensive. I’ve read some recommended human models on the Feline Diabetes site but do you recommend the human Freestyle Freedom Lite Model with ZipWik strips? I’ve heard human meters read off much lower levels than pet-specific ones but just how far are they off? For example, 10, 20%, etc., lower than the real reading?
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Buy yourself a human meter as soon as possible. I use a Freestyle Lite meter. I think the Freedom Lite is similar. The test strips for my meter are identical to those used in a common pet meter, the AlphaTrak, but a lot cheaper (they aren't batch tested to work with the cat code setting on a pet meter). They use only a tiny blood drop.

Yes, human meters read lower and the difference is larger at higher BG numbers and less at lower BG numbers. The main thing to know is that the "take action" number is 50 on a human meter and 68 on a pet meter. Take action doesn't mean a symptomatic hypo, only a BG level that needs attention and maybe some propping up with higher carb food. Once you start using a human meter forget all about the ranges on a pet meter. Everyone here understands human meter readings. If your vet insists on a having a curve done with a pet meter arrange to borrow it for a day.

Astra&Purrfect said:
It’s just I’m afraid of poking his ear and don’t know quite how much pressure to apply. Purrf’s so good but he makes a little meow and then I see I haven’t pressed hard enough and haven’t got enough blood so I have to do it again and then he does a little meow again. It’s that which puts me off doing the tests. I suppose I’m just going to have to be braver for his sake!
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You'll get better at poking with more practice. I use the lancets free hand and find that I can see where the needle enters better. A quick, sharp poke is best after the ear is warm. You might go right through the ear occasionally but it heals quickly. Sometimes a poke will elicit a little reaction from my kitty but he's very forgiving. It seems that Purrfect is too. :)

Once you're testing regularly and have several days' more data at his current dose we can help you decide on next steps.
 
My kitty reacts to the tests too, but I know it's harder on me than it is on him. If it was really that awful, he would refuse them and run away, but in truth, he comes when he hears me open the vial of test strips because he loves the treats and attention more than he dislikes the tests. And if I ever lose track of time, I will find him sitting in the testing place waiting for me. It took us awhile and some practice to get here, but at this point, he's really so good about it despite the meows, and as you said, we have to be brave for their sake. It's the only way to keep them safe, and it's also the only way to help them get into the numbers that will bring them some healing.

So just know that you're not alone in how you feel about this. But we can be brave together! :bighug:
 
Ahhh, I totally get that! Those tests are tough on us...but as others have said, it's harder on us than them! I freehanded the lancet too...I found it MUCH easier than using the device. :)
 

Hello and thank you so much for your replies, Kris, Djamila and Rachel.

Thank you for all your encouraging words about the testing. I certainly need that!

Yes, I feed Purrfect only with high-quality cereal-free and sugar-free wet food.

Well, it’s been a hectic day today what with work, dad’s birthday and then I went to town to get the Wellion glucose meter from the vet! I’m writing this near midnight over here. I didn’t want Purrfect to get too hungry near mid-cycle when I went to town so I gave him 20g of wet food before leaving.

I did him a test when I got back, 7 hours 30 post shot. It was 404. Now considering that’s one and a half hours after nadir and he’d already had a small meal, it was still lower than his reading of 474 on the 22nd at nadir without eating.

Even though it’s still high could this be a slightly positive sign?

I will try to do another test tomorrow morning pre-shot. I tried to do a test before his evening shot but I’m sorry it was a failure. I pricked his ear three times. Twice, there was no blood and the third time it was not enough to give an accurate reading. Purrfect had had enough at that point so I couldn’t go on. I presume it’ll be in the 400s though. I gave the usual dose of 3 units.

I enquired at the pharmacy (here in France) about the Freestyle Lite but it’s no longer sold. They can order the newer one called the Freestyle Papillon Vision for 48 Euros. It uses Easy electrode strips which only need 0.3 microlitres of blood. The vet’s Wellion glucose meter needs 0.5 microlitres, so this could be a boon not to need so much blood - less stress on me and Purrfect to get blood out!

What reading does a human meter give for 400 on a pet meter?

Bonne soirée, as they say over here.

Astra and Purrfect.
 
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Hi Astra! I think that 404 is a positive sign...it's so darn close to 400 it's basically a pink number. :) It's hard to know for sure what's going on without that preshot, but I understand how frustrating it can be! In the future, I'd suggest trying to get the ear prick 3 times...if it doesn't work, give a treat and walk away for 10 minutes or so. Then try again. Sometimes that works. And don't forget a little treat for yourself too! You deserve it!

It's hard to compare human and pet meters. Really, all we can do is tell you the take action number on both and the too low to shoot for new folks number on both. Beyond that, the meters are just different...they read different. If you are getting a low red on a pet meter, though, odds are you'd get a middling pink number probably on a human meter.
 
Hello, Rachel and everyone!

Thanks for your post and tips! Today was more successful - I got three readings from Purrfect.
AMPS 450 6+h 396 and PMPS 447. 3 units AM and PM.

Now, that's a drop at nadir of 54 as opposed to a rise of 42 on the 22nd. I hope this is positive although today's readings are nothing like as good as earlier in the year even at lower doses. But, as you say, it can take a few cycles to clear a bounce.

What do you think? I'd also like to ask forum readers opinions about mid-cycle feeding and whether they do it or not and if so, how much. Perhaps it's worthy of a new thread so that people can contribute their experience about feeding mid-cycle? (The vet doesn't recommend it but then again perhaps that's more for Caninsulin patients which she has experience with.) But I just don't see Purrfect not eating for 12 hours!

Tomorrow, the Freestyle Papillon Vision glucose meter should be in at the local pharmacy for me to buy.

Thank you all so much again for your help.
Astra and Purrfect.
 
Congratulations on getting those readings! You'll build up his response picture over time and it'll be easier to know what needs to happen dose-wise. On the face of it, it looks like he needs a higher dose. He's been in high numbers a long time and has likely built up some glucose toxicity. That just means the constant exposure to high BG has made his body less sensitive to insulin. The way out of that is gradual dose increases of 0.25 u but not leaving him at an ineffective dose longer than 3 or 4 days. Eventually you'll reach a "breakthrough dose" and his BG will come down - sometimes very quickly. Daily testing is the way to track that and keep him safe once he starts responding to the insulin.

Astra&Purrfect said:
What do you think? I'd also like to ask forum readers opinions about mid-cycle feeding and whether they do it or not and if so, how much. Perhaps it's worthy of a new thread so that people can contribute their experience about feeding mid-cycle?
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Most of us feed multiple times a day and take food away for the two hours before a pre shot BG test. Some kitties who are grazers have food available all the time except for those two 2 hour time periods. Most cats are happier with more frequent feeding.
 
Kris has given you good advice about the dosing, so I'll just address the other question.

Yes, my cats eat all day. I work all day, so when I leave in the morning, I put out their food (one cat eats all raw, the other eats a mix of canned and raw), and then they just snack on it all day. When I get home in the evening, I throw out whatever is left over, and give them fresh food, then they snack on that all night. They eat most of their food within a few hours of breakfast and dinner, but do eat a little at other times. I add an ice cube, or freeze some of it so it will stay fresh a little longer into the day, and they just eat it when it thaws.
 

Hello, everybody.

Thanks very much for your replies, Kris and Djamila about the feeding.
Oh dear, glucose toxicity? I remember reading about that a few months ago. It can be a vicious circle and quite difficult to break what they referred to as the “glass ceiling” to get BG to go down.
So, these high, flat levels might not be a bounce then?

I think it would be terrible if Purrfect is not really responding to 3 units anymore. It’s not exactly a small dose but then again maybe he needed more to start with. I just wish we’d upped his dose a couple of months back to prevent resistance, if that’s what it is.
His levels were useless today. 433 pre-AM shot and exactly the same 433 ! at 6+ hours. I raised the dose by .25 giving him 3.25 units today. Purrfect got fed in the middle of the night rather late (2 and a half hours late) and I don’t whether it was that which put him off his stride today. I think that regularity and consistency of feeding are important for him. Although I note what you and Djamila say about being less strict with feeding

It’s all rather worrying that his ‘lowest’ level is flat.
We bought the Freestyle Papillon Vision meter today and did a side-by-side comparison with the Wellion pet meter at exactly the same time. 433 on the Wellion corresponds with 315 on the Freestyle! So, it’s 40% difference. I think we’ll do a test on one of our healthy cats to see what a low level looks like and whether it’s still 40% off.
What does anyone think - shall I continue with the slightly higher dose to see what happens? Thank you again for any advice and thoughts.
Astra and Purrfect.
 
Don't let glucose toxicity scare you Astra. It's not fun, but we've seen it plenty and the way out is those steady consistent increases. Then one day you break though and they usually head back down the scale afterwards! It really does happen I promise!

Yes I'd stick with that increase.
 

Thank you for your reassuring words and concern, Rachel. I’m so glad that you guys are out there!

Out of interest, we tested our healthy cat Felix with the Wellion pet meter and simultaneously, the Freestyle Papillon. The results were 124 and 85 respectively. Along with the earlier results of 315 Freestyle and 433 Wellion, this gives:

Low readings under 100 on the Freestyle, add 45% to get pet meter reading, and;
High readings over 300 on the Freestyle, add 38% to get pet meter reading.

We just used the Freestyle again and the PM pre-shot test was 311 (converted to pet = 429). We are actually very pleased with the Freestyle after having used it now for a second test. I was having difficulty getting enough blood out and we said let’s just try with what we’ve got and the Freestyle did work with less blood than the Wellion.

However, I think Purrf’s right ear is getting a bit sore now. I don’t whether I could do tests on his left ear as I’m right-handed and it’s best he faces way from me. One thing though, if his mid-cycle reading is fairly high, I’m not sure it’s worth putting Purrfect through the PM test, for his sake. We know it will be at least as high as the mid-cycle reading especially with giving him food.

About knowing whether high readings are a bounce or glucose toxicity: I suppose that if this had been a bounce or Somogyi, it would have cleared by now? So presumably it’s resistance. It’s just that it’s so important to know which one it is because the action for glucose toxicity is a higher dose and Somogyi is a lower dose! I hope we’re doing the right thing.

Have a good evening, everyone.

Astra and Purrfect.
 
We've been where you are now Astra...I remember how terrified I was! There were some really lovely people who were here for me and I enjoy being here for you and others in their memory and honor!

I usually tested in both ears...Gypsy sat in front of me so I just leaned over a bit to do the left ear...I found one ear was easier for me than the other, but I tried to swtich a bit. Remember you can also move around the outer edge of the ear some too. Do you use Neosporin (gel, not cream)? I usually used a little of it with the pain relief...it helped the blood bead up some too!

I wouldn't skip that PM test...you just NEVER know if he will have gone low suddenly. I think we all pretty much agree you're seeing glucose toxicity more than bouncing. Bouncing you probably would have seen a lower number at some point. I'd put my money on that.

Are you testing for ketones by the way?
 
It looks like there is a note on your spreadsheet that you're going to use the results of your test today to convert the numbers going forward? Is that right?

We generally recommend just putting the values you get from the meter and indicating if it was human or pet, but not trying to convert. I found this note in one of the threads where the reasons for that were discussed. Here is what was said by some folks who know way more about it than I do:

We report the numbers we get, without adjusting for meter type. due to the following.

There is no standard conversion from a human meter to a pet meter, nor vice versa due to the meter variance issue of +/- 20 % per the FDA allowances, plus Dr Rand of the University of Queensland observed in her research articles that a human meter reads about 60-70% of what a pet meter gets.
Thus:
human meter estimate could be from 0.6 * pet meter to 0.7 * pet meter
to go the other way,
human meter / 0.7 to human meter / 0.6 could be a pet meter estimate

Individual meters differ in their consistency over glucose levels. To work out a proper formula for a particular meter, you would need to get hundreds of pairs of tests, with each pair of tests on the same droplet, over a range of glucose levels from low to high, using a given pair of meters. Then, you would need to determine the standard deviation, the standard error of measurement, the regression equation model, test-re-test reliability, and more. (I have advanced coursework in statistics and measurement.)

If you want to learn more about it, the whole thread is here: http://www.felinediabetes.com/FDMB/threads/pet-meter-to-human-meter-spreadsheet.139027/
 

Thank you very much, Rachel and Djamila.

Yes, indeed, I test for ketones using Ketodiastix urine analysis strips every 1 or 2 days at the mo.

I wipe iodine afterwards on the pricked area - I don’t generally use anything before for fear of skewing results because I did use a bit of Vaseline once on the vet’s advice and got a funny result! So, you can use both the inner and outer part of the ear near the marginal vein then?

Thanks for that interesting info and link re human meters, Djamila. I see what you say and will change the spreadsheet to put the numbers in from the Freestyle. I will put the approx conversion in brackets for my own reference more than anything else because at the moment, those low human meter numbers don’t ‘mean’ anything to me yet!

TODAY: I’m afraid to say Purrf’s totally flat again today: 278 pre-shot and 280 6+ hours on the Freestyle (approx 404 pet meter just for reference). We gave back the Wellion pet meter today after one last comparison with the Freestyle human meter which rendered 45% difference (403 Wellion v. 278 Freestyle).

So, I suppose continue at 3.25 for a few days yet, hopefully to see change, and if not up to 3.5 units.

Thank you everyone!

Astra and Purrfect.
 
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Hello, everyone!

I thought I’d post an update on Purrfect. As advised here, because his numbers were high and flat in the 400s, I’ve been gradually increasing the dose in 0.25 increments every week. Yesterday, he went from 3.75u to 4u twice a day and I was looking for confirmation or not of a pattern I’d been seeing every time we increase his dose.

So, now, for the third time, as you’ll see from Purrfect’s spreadsheet, every time we increase his dose by 0.25, he responds well the same day and has a proper nadir (reduction in blood sugar) at 6+ hours. The next day, his numbers flatten out and he has no nadir at 6+ hours or even an increase in blood sugar!

This is just so disappointing and worrying and I’m wondering why this is happening. Has anyone ever seen this pattern before? Is it resistance, tolerance or is he creating antibodies to resist insulin or something else? Does it mean that we could put him up to 5, 6 7, and so on units and potentially he would still counteract the insulin? Sorry, that’s several questions in one go!

Other than high blood sugar, I should say that his clinical symptoms are virtually non-existent, i.e., he doesn’t drink a lot, his coat’s shiny, and looks in good health with a steady weight of 4.9 to 5 kg, in other words, his behaviour and symptoms are certainly a whole lot better than without insulin. So, somewhere along the line, it is having an effect, just not so much on reducing numbers. But evidently, high numbers are not good for his system.

I haven’t mentioned this flattening-out pattern the day after an increase to my vet yet. But I did mention his high, flat numbers to her 3 weeks ago. She said that colleagues have gone up to as high as 5 or 6 units twice a day to get a cat under control. She said don’t hesitate to go up to 4.5 or 5 units. But if all he’s going to do is flatten out, what’s the point, or should we try?

I’d be grateful if anyone would give me their thoughts on this and what we should do next. Thank you so much.

Astra and Purrfect.
 
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Hey there Astra! I think you're seeing a bit of bouncing. You go up in dose, you get a good nadir, then the next day or 2, Purrfect stays high and flat. It happens...we have several bouncy kitties here. I think you're handling it right as it looks like he starts to break the bounce after about 2 days. You might also be seeing a bit of insulin resistance that keeps you from getting lower numbers...but that isn't a forever thing. We've found that if you just stay consistent with your dose increases, you'll eventually break through and the numbers will get lower! Yes, you could go up to those higher units, but THAT'S OKAY. We've had plenty of kitties get up into the higher doses and then come back down! Whatever dose works for Purrfect is fine. I know it seems scary and you want him to need less, but it takes some time to get there unfortunately. Eventually, he should get to the point where he doesn't flatten out after a dose change...or if he does, he flattens in pretty green and blue numbers!

I will say, I'd stop putting the approximate pet conversion numbers in your SS for 2 reasons. 1. There is no real good way to do that. The conversion simply isn't reliable. 2. It's messing with your colors. I think your SS would have better colors if you just used human numbers...and honestly, it would make you feel better to see that and it would actually REALLY help us. If you really want to keep the approx pet conversion, maybe put that in the notes section?
 
Hello, Rachel.
Thank you so much for your reply and insights into Purffect's reaction - it's very reassuring to have people to confer with. From what I now understand, bouncing is quite different from a Somogyi rebound when levels go to near hypo. Maybe because Purrfect's body is so used to being in high numbers, he reacts to lower numbers even if they are not truly low and bounces up again.

I understand what you say about removing the pet conversion numbers on the Spread Sheet. Djamila mentioned this too. I've done it now because I do understand that many people on the forum use human meters and are used to seeing those readings and the associated colours. I note that the colour coding isn't different between human and pet meter spreadsheets, so a pink on a human meter is actually red on the pet meter and so on. Now I've put only the human readings, it gives a rather optimistic look to the spreadsheet!

I was very surprised to get a low 217 on the human meter this morning pre-shot, so surprised, in fact, that I tested him immediately again which gave 208! However, at 6+ hours, he's gone and bounced up to 320! So, it's all a bit topsy-turvy really.

Thank you again from Astra and Purrfect.
 
Astra&Purrfect said:
Hello, Rachel.
Thank you so much for your reply and insights into Purffect's reaction - it's very reassuring to have people to confer with. From what I now understand, bouncing is quite different from a Somogyi rebound when levels go to near hypo. Maybe because Purrfect's body is so used to being in high numbers, he reacts to lower numbers even if they are not truly low and bounces up again.

I understand what you say about removing the pet conversion numbers on the Spread Sheet. Djamila mentioned this too. I've done it now because I do understand that many people on the forum use human meters and are used to seeing those readings and the associated colours. I note that the colour coding isn't different between human and pet meter spreadsheets, so a pink on a human meter is actually red on the pet meter and so on. Now I've put only the human readings, it gives a rather optimistic look to the spreadsheet!

I was very surprised to get a low 217 on the human meter this morning pre-shot, so surprised, in fact, that I tested him immediately again which gave 208! However, at 6+ hours, he's gone and bounced up to 320! So, it's all a bit topsy-turvy really.

Thank you again from Astra and Purrfect.
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Hi Astra,

Yes, the way we use the term "bouncing" is different from the concept of Somogyi rebound. There's much debate about whether Somogyi rebound is even "a thing" in cats but there's no need to go there ...

Here's something I wrote about bouncing quite a while ago:

Here's how it works:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
 
Hey, thank you, Kris. That is a very good, concise description of the bouncing effect. I hope Purrfect learns soon how to accept lower levels and stops supplying his system with glucogen. I'll continue testing and I suppose if he hasn't gone down to better levels, take him up another 0.25 in a week's time?
Have a lovely evening,
From Astra and Purrfect.
 
Astra&Purrfect said:
Hey, thank you, Kris. That is a very good, concise description of the bouncing effect. I hope Purrfect learns soon how to accept lower levels and stops supplying his system with glucogen. I'll continue testing and I suppose if he hasn't gone down to better levels, take him up another 0.25 in a week's time?
Have a lovely evening,
From Astra and Purrfect.
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There's really no need to wait a week if he's running high. He can get more "stuck" the longer he sits up there. With ProZinc you can increase by 0.25 u after 3 or 4 cycles and then slow the rate of increase once you see a good array of blues starting to appear.
 
Hello, Kris.
Thanks very much for your reply. When I said in a week's time, perhaps I should have worded it more clearly. I meant a week from the time I increased the dose rather than from the day I wrote the post. Recently, I have been giving each dose increase one week to take effect as per the ProZinc instructions, in order to give it time to "balance" out. Is that wrong? I'm so afraid of making increases too fast.
Today, AMPS he was 357 (human meter) the highest I have ever seen! He had been shut on a room for some time while I fed the other cats. He wanted to come through. I wonder if that stressed him and put him up higher than normal. Anyway, I was out today and couldn't test him at nadir but he was 296 PMPS. Better than 357 but still too high. So, it'll be up to 4.25 u tomorrow.
Have an excellent evening.
Astra and Purrfect.
 
Hi Astra - The protocol we use here for Prozinc calls for increases every 3-6 cycles when the nadirs are staying high like this. Staying at one dose for too long can cause a cat to get "stuck" and make it harder to get a good insulin response from them. The quicker increases help keep that from happening, and then you can slow the increases when you start getting better numbers. When doing quicker increases, monitoring is important too so you can catch it when it starts working, before they drop too much.
 

Hello, everyone.

Thank you for your post and info, Djamila. I see, so, 6 cycles would be 3 days. I wonder why ProZinc say seven days should pass before dose increases. Mind you, they say increases should be in 0.5 or even 1 unit increments - 1 is much too much!

Since we’ve put Purrfect up to 4.25 units yesterday, his AMPS, PMPS have been appalling with no nadir, only a rise at 6+ hours. These are some of the highest numbers I’ve seen (they would be constantly red on a pet meter). The pattern I had noticed before of achieving a nadir at least on the first day of an increase is no longer there.

This is so worrying. I despair of getting his numbers to go down. With these results, are we doing the right thing? His numbers are no better now than when he was at 3 units one month ago.

I should mention that since last night he has a bit of a runny tummy (very soft, almost runny stools). Could this make a big difference? I wouldn't want to raise his dose prematurely if he has a tummy bug.

Do you think I should check him at 3 or 4 hours post-shot tomorrow to see if he’s bouncing? Not that I’ve ever seen him go very low at that time before.

I’d really appreciate anyone’s advice - has anyone seen this result before with their cat? Thanks so much.

Astra and Purrfect.
 
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As a P.S. to my last post, perhaps I should mention that Purrfect has been given alkylglycerols to boost his immune system for the last two weeks. Today was the last day. Has anyone noticed whether this makes a difference to numbers? Thanks!
 
I've never heard of alkylglycerols, so you might want to post on the Main Health forum and ask about that. Tummy upset can definitely impact BG numbers, and high BG numbers can cause tummy upset. It can be hard to tell which one is the cause on that. Hopefully Purrfect's tummy will settle down soon. I've definitely seen cats where the dose goes up and up and it looks like it's doing nothing at all. Until one day it does something. I would suggest going forward with the quicker increases, keep monitoring, and if you get to six units and still don't see a response, then get him tested for one of the high dose conditions.

Has Purrfect used any of the other insulin types besides Prozinc?
 
Hello, everyone,

Djamila, thank you very much for your reply. Purffect's tummy seems to have settled down today but instead of descending, his levels are rising. Purrfect's pre-shot level this morning was 271 (human meter). I've just tested him at 4 hours twenty minutes post-shot and it's rising at 330. This is so wrong because he doesn't seem to be bouncing from a lower level, just rising.

Another weird thing is that although his levels are so high he's not drinking more than 20 ml a day (but I do add around 80 ml of water to his food to keep him hydrated). Since I put Purffect on 3 units in July and slightly reduced the size of his meal 6 hours post-shot he doesn't drink anything like he used to. But I just hope to goodness his kidneys are still working normally to flush out glucose. On a urine strip, he usually shows a medium level of glucose.

To answer your question, Purrfect has only ever had ProZinc, started at the end of November, last year. I believe it has only been made available quite recently here in France. Before this, the vet had used Caninsulin on other cats but wasn't very impressed with it.

As ever, any thoughts from anyone would be much appreciated. Thank you.

Astra and Purffect.
 
Oh, yes, I forgot to say that alkylglycerols are shark liver oil, prescribed by our vet to boost the immune system.
 
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