What levels can trigger a bounce?

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Amy & Papaya (GA)

Amy & Papaya (GA)

Member Since 2012
I don't seem to be able to keep Papaya on any dose of insulin for more than a few days with predicable results. I thought I was on the right track this week, as the numbers were good.

AMPS was 8.6 (that's 155 for you Americans), which is about the lowest I will shoot a normal dose.
+5 was 2.9 (52). She came to the kitchen wanting food, which is normal for that time of day, and ate normally, not frantically like she's done on a couple of occasions that were near-hypos. Since it was already well into the cycle I thought eating the normal low-carb would be enough.
+6.5 was 3.7 (67) which seemed good as it was going up a bit as expected. She wanted to eat again, so I gave her 1/4 can of Fancy Feast pate, the regular food.

BUT . . . the PMPS jumped up to 23.9 (430)! There's no way the last bit of food bumped it up this high, right? Is a bounce from her liver panicking over the lower levels?

I'm assuming I need to decrease the dose again because of the apparent bounce, even though technically the nadir wasn't low enough to earn a reduction? I've been trying to level out the cycle by feeding small meals - 1/2 can at shot, 1/2 can 2 hours later, leave 1/2 can out for later which she usually eats around +5, but there still seems to be so much up and down. Is there something I am missing here? Any suggestions are welcome.

And I've just created the profile and published her spreadsheet, so apologies if they are not set up right - tell me if there's a problem and I'll try to sort it out.
 
Amy,
A bounce can happen without a really low number, so it's possible she either went lower than what you happened to catch on the meter, or that the drop was relatively quick. Sometimes it's how fast the numbers drop, not just how far.

You've been on 1.5u for the past 5 cycles from what her SS shows. There's no reason to increase or decrease right now, and certainly not due to tonight's PMPS number. It's the nadir number that will determine whether you need to increase (or decrease) the dose, not the preshot numbers. And right now, the nadir number hasn't pointed the way to an increase or a decrease. I would give it a couple more days.

The food at +5 and at +6.5 would have raised her BG a bit (but not to 430). It's pretty safe to assume that if she hadn't eaten at +5, she might have dropped below 50, but the food stopped the drop. If you look at it that way, that's a good reason for a bounce to happen (dropping below 50). Look at what it did a few days ago when you got a 2.7. She bounced into a black number.

I would keep the dose at 1.5u. And I would try to get a test at +3 maybe. If she's dropped a good bit by +3, it can indicate that the cycle is going to be an "active" cycle, and give you a heads up that she might go lower by nadir. If you "see it coming" before it happens, you can sometimes slow things down before she drops too far. And that can help lower the chances that a bounce will happen afterwards.

Her numbers do look good on this dose so far, ever since her last bounce when she was on 1.75u.

Carl

Edit - I should have also said that if you don't feel comfortable with staying at 1.5u, and want to reduce down to 1.25, then you can do that. The protocol sets a great set of guidelines, but it's not etched in stone. And you can do that in the morning if you choose, since you already shot tonight's dose.
 
Thanks, Carl. I will take a look at the +3s.

If at that point in the cycle it does look like it's going low, do you think I should I be giving her the regular food, or should I maybe offer some of a moderately higher carb one at that point to try to level things out?
 
At +3, you would want to give her regular food, and not a whole lot. Just a tsp or two. We try not to break out the higher carbs unless the numbers are dropping really fast or really far. If you can slow things with low carb, it'll keep her in good numbers for a longer period of time.

And if the +3 number concerns you, post it here and ask for advice. If this forum is quiet, post the question in the Lantus Tight Regulation forum. There's usually someone on that forum all hours day and night.

Carl
 
Oh, forgot to say...

Your SS and profile look great and are working fine. :smile:

Carl
 
Carl, I just saw your edit, and it's what I was kind of thinking, glad I was hopefully on the right track. I shot the same 1.5 this time because I knew it would take a cycle or two for the bounce to clear. I'll see what tomorrow's numbers look like. If I start getting preshot numbers around the point that I know she may go low-ish, I'll drop to 1.25 and see how things go. At this point I'm just happy that the dose is going down, not up!

Thanks for confirming the spreadsheet etc. links are working OK, too.
 
Yes, cat's can 'bounce' if the BG drops too low or too fast. 'Low' doesn't necessarily need to be a dangerously low number, it may just be a number that is lower than your cat is used to...

I used to refer to my cat at 'Bouncing Bertie' because he SO prone to the bounce... Mostly his bounces were triggered by steep BG drops (in his case in excess of about 5.5 - 6 (99 - 108) per hour).

Small snacks can be immensely useful in slowing steep drops. I can generally tell by about +3 whether Bert is heading into one of his BG nose dives, and a small snack (ordinary low carb food) given at that point can usually slow the steep drop and sometimes prevent him from dropping too low. This strategy works well for us. I actually can't remember the last time Bertie bounced; and something similar to this may work for your cat too...
 
That's good to know, Elizabeth. I think I have a "Bouncing Papaya" here, too!

Carl, the +3 suggestion was very helpful today. She started out still really high at 20.3 (365), so I gave the normal shot, but at +3 had already fallen to 3.3 (59.4)! I fed her to hopefully keep it from going any lower, and am glad I caught this early.
 
I'm glad the advice was helpful! That's exactly what you want to look for - either a fast drop, or a big drop. In this case, I'd say it was "both".

Carl
 
Looking at your SS, it looks like she continued to stay in low but safe numbers for quite some time.

What you want to keep track of now is -
how much did you feed, and when did you feed, to keep those numbers from dropping more. That's very much an "every cat is different" thing, and keeping good notes will really help you in "knowing YOUR cat", because it's a really safe bet that this won't be the only time you see something like this.

When you get to the numbers in the 50's, it's a good idea to feed a tsp of food (and you'll learn which type of food will do the job, whether high, medium or low carb), and test again in 20-30 minutes. It'll take that long for the snack to start showing up on the meter.

If you get an even lower number after 30 minutes, then you feed again, and depending on how low it is, you'd most likely try a higher carb, or even just a tsp of the gravy from a higher carb can. This can sometimes go on for a few hours, and while you want to use food to bring up the numbers, you also don't want to overfeed. Because that can cause a cat to "scarf and barf", or it can also cause them to not be hungry if you need to keep doling out the small portions.

Especially the first time or two this happens, it's very helpful to have someone "there with you", so always post on the board to seek advice or assistance. Don't be afraid to add the "911" icon to your original subject line because that is sure to catch our attention if we happen to be online. If it's an emergency to YOU, then it's an emergency to "us" and somebody will come running.

Carl
 
Oh, and with that amount of drop, and how fast it happened, don't be surprised or discouraged if you see another "bounce" by PMPS time.

Carl
 
ehmeelu said:
Carl, the +3 suggestion was very helpful today. She started out still really high at 20.3 (365), so I gave the normal shot, but at +3 had already fallen to 3.3 (59.4)!
Click to expand...


Hells bells!!! Now THAT is a steep drop! :shock: Thank goodness you tested! Good catch!

Edited to add:
Do you how long after the shot it takes for the insulin to start working in your cat? (Insulin 'onset'?). It might be useful for you to know that; by maybe checking the BG at +1.5 or +2, for example..? (It has certainly helped me to know that insulin almost always starts working in my cat at about an hour and 45mins after the shot.) It might be that you need to give your cat a snack earlier than the +3 point in order to slow down the drop...?
 
I'm starting to have a bit more confidence in handling the low numbers. The first time I let her eat too much, too high carb, and of course she went really high. Now I do it bit by bit and monitor.

Today actually worked perfectly - since it was such a fast drop early in the cycle I did use some 13% carb food, and it kept her numbers pretty steady. And HOORAY no bounce by the end of the cycle - still very good numbers. I have reduced the dose a smidge now that the bounce has cleared. It is of course anyone's guess what the numbers will be this cycle!

Elizabeth, she usually does eat at two hours after the shot, like clockwork she comes out looking for food right at that point. She was just lazy today for some reason - even when I woke up and tested her at +3 and caught the drop, she was sleeping contentedly next to me . . . so she actually got breakfast in bed then and again at +4! What a life ;-)

Thanks everyone for the input and support.
 
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