Why Did It Take So Long for # to Come Up?

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Jenna Josie

Jenna Josie

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So I'm looking at Josie's SS and noticing how different her last time with a low # was from this time. Last time: 51 at +6. Steered her with food, and she came up and held her own.

This time, 38 at +5, she came up to 90 by +6 with steering, but then she was back down to 53 by +9, then up to 81 at +10. But then she took off like a rocket and was at 271 at +12 (PMPS). So I guess that was the pancreas (or something else) releasing what's called the "bounce fuel" in the stickys explaining what bouncing is . . . Is that right?

And why did it take so long for that to happen? Does that mean she doesn't have a lot of "bounce fuel" to release? Or did she maybe not take off like that the previous time because her little body didn't think it was in (very much) danger and so didn't release the "bounce fuel"? So she didn't spike like she did today in just two hours?
 
Well now, that was unexpected!

I believe it's the liver that releases stored glucose when they go low, but honestly, I'm better at finding spreadsheet patterns than I am at remembering the physiology of all of this.

So why did it take so long? Honest answer: who knows? I'll take a couple of stabs at it though. First of all, was there any difference in what food you used to steer? Any difference in the foods in the days surrounding the two episodes? Your PS numbers are comparable. The dose was 0.5u higher this time. In both episodes, the low numbers appeared after several cycles at the same dose, so it looks like Josie really needs stability before she'll get active on a dose, so keep that in mind going forward. My hunch is that she's one of the kitties that takes awhile to adjust to a dose, then will overreact, and then will stabilize. So you may need to just ride it out when she does this and not really lower the dose afterwards. Maybe skinny it, but not really lower it.

Sorry, off track again....why did it last so long? I think the main reason is that she had more insulin on board this time, and the other possibility is that her pancreas added a bit of natural insulin to the mix today to prolong the greens. At this point, there's really no way to predict that. All you can do is give her a snack and scratch her chin and keep an eye on her.

Because it looks like Josie is a little bouncy, I would encourage you to avoid adding carbs when you need to steer, if you can. Try steering with regular food first and see if that will be enough to get her numbers to rise into safer territory. Especially when she's already in those hours at the bottom of the cycle, you can often avoid the extra carbs. If she's 38 at +3 or something, then by all means bust out the honey, but if she's there at +5, you may be able to manage it with just plain old food. The reason I'm encouraging that is because whenever we add an influx of carbs, it can make them extra unpredictable for a few cycles, and Josie already leans that way as it is.

I see you lowered her dose quite a bit tonight. I imagine that 38 was a little scary since she hasn't spent much time in any green, let alone one that low. As you become more comfortable with all of this, I encourage you to make smaller adjustments whenever you can. I've read on here that some cats are a little insulin sensitive after a low, but honestly, I have only seen that on very very rare occasions. What is far more common is that they'll stay high and flat for a few cycles after a low. So keeping the dose close to normal can be helpful in the cycle following a low. maybe a small reduction, but not too dramatic.

Okay, enough rambling. The good news about the reduction is that you and Josie can most likely relax tonight, and after that cycle today, I'd imagine you could both use a good rest!
 
First, I'd just like to report that her +2 was 286, and she is PLAYING right now, just as if nothing had happened to her today! :)

Djamila said:
Well now, that was unexpected!
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Yep. Worst thing is that it came out of nowhere! It maybe felt a *little* risky to give the full 2 units based on her PS, but I looked back and saw that she had done fine before in similar situations and so decided to be bold. *rolls eyes*

Djamila said:
First of all, was there any difference in what food you used to steer? Any difference in the foods in the days surrounding the two episodes?
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Yes to both. The first time she ate an entire 3 oz of HC food (I didn't actually intend for that to happen. Just left the half-full can on the floor when I went to grab my computer to post for advice, and by the time I got back, she'd eaten the whole thing! Which was kind of funny since Chris and China replied not to feed her too much in case we needed to feed her more later. Oops!) This time, I just gave her the gravy and then 1/4 can of LC FF. Also, vet has me no longer feeding her as much as she wants now that her weight is back on. We've been one week at giving 1/2 can as her PM snack vs. a full can, so her recent calories "on board" this time at shot time were 1/2 of what they were last time.

Djamila said:
it looks like Josie really needs stability before she'll get active on a dose, so keep that in mind going forward. My hunch is that she's one of the kitties that takes awhile to adjust to a dose, then will overreact, and then will stabilize. So you may need to just ride it out when she does this and not really lower the dose afterwards.
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Yes! This does seem to be her thing! I'm not sure I have the nerve not to lower, but I will definitely keep this in mind.

Djamila said:
pancreas added a bit of natural insulin to the mix today to prolong the greens.
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I would love it if her pancreas were working a little!

Djamila said:
I see you lowered her dose quite a bit tonight. I imagine that 38 was a little scary since she hasn't spent much time in any green, let alone one that low. As you become more comfortable with all of this, I encourage you to make smaller adjustments whenever you can. I've read on here that some cats are a little insulin sensitive after a low, but honestly, I have only seen that on very very rare occasions.
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That last part is interesting. Rachel -- who I totally trust! -- did advise us to go to 1.75 (or 1.5 if we were nervous), but a) I'm a *lot* nervous, and b) we were pushing an hour late at the time, and since I have to take her to board in the morning and really want to get at test/shot in tomorrow before taking her in, I went for a lower dose. Maybe not the best call, but definitely what I felt comfortable with given both today and the boarding.

Djamila said:
The good news about the reduction is that you and Josie can most likely relax tonight, and after that cycle today, I'd imagine you could both use a good rest!
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Oh, I'm going to have an extra glass of wine, that's for sure! :D
 
Djamila said:
In both episodes, the low numbers appeared after several cycles at the same dose, so it looks like Josie really needs stability before she'll get active on a dose, so keep that in mind going forward. My hunch is that she's one of the kitties that takes awhile to adjust to a dose, then will overreact, and then will stabilize. So you may need to just ride it out when she does this and not really lower the dose afterwards. Maybe skinny it, but not really lower it.
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This is a pattern in some kitties, especially bouncers. My guy (not on ProZinc but it doesn't matter) is definitely in this category and I know I can't make any "sudden Moves" in dosing. He can have little reaction to a tiny increase for 4+ days and then drop low out of nowhere followed by a higher spell that persists. Eventually I have to give him a tiny dose boost to get him moving again.

It's almost as though there are kitties who have (using a metaphor? analogy?) an insulin "gas pedal" with a very smooth action and others have a very sticky gas pedal. Make sense? That sticky gas pedal tends to be a trait of the kitty and doesn't usually change (much) over time. It's a characteristic of their physiology./biochemistry.
 
It sounds like the differences in food are likely the explanation for why she jumped up faster last time, and lingered longer this time.

As far as lowering the dose, we always say around here "you hold the syringe". We will give you our best advice, but in the end, since you are the one that has to live with the consequences, you have the final decision. @Rachel is someone I totally trust too! She's been on here the longest and is such a wonderful wise presence! The 1.75 would have likely been a good dose to try last night, but again, it's fine that you went a little lower. Now you have some data on that and you can use it the next time this happens.

It's rough timing that this happened right before you have to board her for a couple of days. As I recall you're boarding her at the vet though, aren't you? So at least she'll be in a place where there are people who know how to take care of her! Has there been discussion about what dose to have them give?
 
Yes, and I just took her in, and when they were confirming her dose, I had to say, Well . . . And then the vet came out, and I was Talked To. Gently, but still. (They think 1/2 dose -- one unit -- if she's below 220 and no shot under 150.) They'll test her, and I believe we agreed on 1.5 (a compromise).
 
Ah, the talking to. Yes, that is a common occurrence around here. Despite having a much better track record for managing feline diabetes than just about any vet, they still do no like that we do it without them.

The good news is that it's just a few cycles, and Josie is in good hands so you know she'll be safe, even if not in optimal numbers.

And good job pushing for a compromise. It can be hard to push back on an "expert" ;):bighug::bighug::bighug:
 
So Josie is back from her 50-hour stay at the vet/boarding. They say she did well although she didn't want to eat much on day one (luckily, she did eat almost her whole 3 oz. breakfast right before I took her in, which was also her shot time); they say by the 2nd day, she was eating normally; and I picked her up today, day 3.

They gave her 1.5, and I just tested her at +5 = 219.

Her neuropathy is worse, but I'm hopeful that's at least in part because she was cooped up for a couple of days.

The main thing I'm worried about is that her ears feel HOT, but I don't know why. I've never felt them so hot before. She is eating great, even pulling herself up on the counter on her poor gimpy back legs because I was taking too long to get her her lunch. (She appears to be trying to make me believe they starved her . . . .)

(Relatedly, the tests before she dropped so low, her ears were quite cool -- took some rubbing to get them to warm up enough to bleed for the test -- and maybe felt a little waxy. Is that a thing?)

EDIT: Her ears feel normal temp 3 hrs. later.
 
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Sam's ears get super hot when he's excited about something or when he's upset about something/stressed. It might have been from being at the vet, or it might have been that she was just really excited to see you and get back home.

As for the cold ears and feeling a little waxy, that's often dehydration, or just being cold.

Glad she seems to be back to normal now! And welcome back! Did you have a good trip?
 
Well, she was definitely excited to be home . . . until she remembered there's a civvie here that she doesn't much like!

Her PMPS was 230, which is kind of amazing -- I truly was expecting something in the low 300s -- and so of course it makes me worry! Right now, though, she's just jumped up on the couch despite her gimpy legs to lie beside me and purr and was rolling around on the floor a minute ago, so I guess all is well so far.

Edit: OMG, she just jumped on the dining room table!!! I can't remember the last time she was able to do that!!! (Although she is not, of course, allowed on the dining room table. lol)

And the trip was great -- took 15 really extraordinary college students on a retreat of sorts.
 
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Thanks! (Seriously. Thanks so much for checking in on us. ) We’re disappointed that she’s essentially unbudged at +4, but at least it confirms the increase was the right move. :/

I can’t believe her forever-long night was only two days ago! Seems like it’s been ages! Hopefully the increase will get her into some regular blues and greens. Looking back, it seems that most of her best cycles were at 1.5, so I’m optimistic.
 
Some kitties really seem to require a few cycles before a dose increase hits them. Gypsy was like that...she needed a few before you'd see a dose increase drop her. Could be that Josie just needs to "settle in" to a new dose!
 
Yes to what Rachel said. And it gives you good info for the next active cycle that she may not need a decrease right away. Maybe just skinny the dose a smidge next time.
 
Djamila said:
Yes to what Rachel said. And it gives you good info for the next active cycle that she may not need a decrease right away. Maybe just skinny the dose a smidge next time.
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Yes, and I think that was your thought at the time, too! That whole cycle was just goofy. This darn cat :rolleyes: But I couldn’t sit home with her so better safe than sorry. (And also, not being able to be home is great cover for being a wimp ... I probably would have reduced even if I had been able to stay home with her ;) Still, having this data does help to shore up my nerves for whenever the next time comes.)
 
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