Good morning RG,
Deb asked Sienne and I to take a peek at Mali's SS. Sienne has given you some input and I agree with her.
Bounces can be triggered, as she said, by low numbers, lower numbers than the cat's body is used to, or quick dives from high numbers down to even yellow and blue numbers.
When I looked at Mali's SS, what struck me besides the bouncing is the possibility that her dose is too high. I asked some of our other experienced members (also lev users as am I) to see if they agreed and I suggested that Mali's dose might need to be reduced to 0.5u bid. The others agreed and Jill, a very experienced lantus and lev user, suggested that you be prepared that Mali's dose might even need to be reduced lower than 0.5u.
What we have found with lantus and levemir is that spot checks, as Sienne suggested, are of more value than curves. Let me give you an example or two.
On 5/27, we know from the tests that Mali got to 85. She bounced the next day. Let's say you had decided to do a curve on the a.m. cycle of 5/28. You would have likely seen all high numbers and felt the dose needed to be increased. In reality, we do not want to increase the dose during a bounce because you could then really get into an overdose situation. Another example is the evening of 5/28. As Sienne suggested, Mali might have gone low again and so she was high all morning on 5/29. You got several tests and you might be wondering if the dose should be increased based on those tests.
What provides a better picture is spot checks in each cycle at different times. You might want to get a +4 and a +8 one daytime cycle and the next day, get a +6 and a +10. We aren't suggesting you don't sleep at night, so if you could get a before bed test, it would give us some info. And if you are up by her +10/+11, a spot check then would also help.
As has been explained, the "typical" lev cycle is onset at +4 and nadir +8 to +12. However, lev can give great duration and if the cycles overlap, you might see a very different kind of cycle than the typical. My own cat, Gracie, does not have typical lev cycles and the data I've been able to collect gives me an idea of her onset, nadir, and duration. Out of curiosity, at what time do you shoot?
We do recommend you take the dose down to 0.5u bid starting tonight and then try to get spot checks. Be aware that Mali might need further dose reductions and it might need to be done sooner rather than later. Keep in mind that lantus and levemir are both depot insulins and a higher dose can affect up to six subsequent cycles. That doesn't mean every cat will will see effects from a higher dose for a full six cycles....it might typically be more like three....but some might. AND if she's bouncing, that could also take time to clear (also up to six cycles). So patience (
at least six cycles worth) will be the name of the game here and the more cycles where you can get spot checks, the better. Remember..you don't need to get tests every two hours. If you can just get a couple each daytime cycle and at least one in the nighttime cycle, it will help.
One of the spreadsheets I think really demonstrates this concept of a dose being too high and the low numbers/bouncing cycles is
Teronto's SS. Teronto was on lantus and the same suggestions were made to her when we saw those really high numbers followed by green followed by high numbers. She did more than the spot checks because she figured out he was going really low and she wanted to be sure she kept him safe. Look how quickly his dose was reduced to nothing and it took over three cycles
once insulin had been stopped for him to be in totally normal numbers.
Please let us know if you have questions. We'll keep an eye out for Mali and hope you will start to see a flatter cycle with less insulin.
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Many people post daily to ensure they get eyes on their cats and are keeping on top of things. You are welcome to continue to post here, I just think that they might be able to help you more over there.