5/8 Asia +8 92, +10 357 0.1R, +11/R1 328

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Stacy & Asia

Stacy & Asia

Member Since 2017
http://www.felinediabetes.com/FDMB/...145-1-r3-89-2-r4-71-3-r5-79-4-94-5-93.195237/

+10 213, I don’t have a ton of recent PM cycle data, so I had to do a bit of guesswork. I have a lot of high AMPS and I know she likes to rapidly climb in the 2 hours leading up to that. Is this one of those cycles is anyone’s guess even if I had all the +10 data. So I split the difference between 0.1R and 1 drop and gave her 2 drops. If it’s a rapid increase, it likely won’t be enough to settle the AMPS, but better than nothing. If it’s a surfing and non dramatic late cycle, hopefully 2 drops won’t be too much. Gathering from the +1 data, it looks like she was on the rapid rise so we will see what happens.

I’m so, so, so pleased with just this one cycle last night. It wouldn’t have happened without the R help, she would have likely taken hours to get to green if she even got there at all. I think it’s been so long that she has stayed away from mostly blues and greens that she’s not very used to it anymore and this feels a bit like starting over. That’s okay. As long as she gets there, I don’t care what it takes or how annoying it is. :cat:
 
+1/R3 119 I’m not sure this will get her over the hump, hopefully she won’t go up too much before +3. Still, this is so, so hopeful. :woot:
 
So happy to see a good response to the R. Keep on surfing Asia :smuggrin:. BTW thanks for the response yesterday in Titans thread, we are just " all at sea" as to what to do with gabergoline. :cat:
 
MyTitan said:
So happy to see a good response to the R. Keep on surfing Asia :smuggrin:. BTW thanks for the response yesterday in Titans thread, we are just " all at sea" as to what to do with gabergoline. :cat:
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I know, it must be even more overwhelming in largely unpaved territory. Asia has a lot of issues and I struggle with what to do/what not to do. Like if she needs fluids for her kidneys but her heart won’t take it, you have to sacrifice one to save the other and at the end of the day, both conditions are deadly...but there are many, many cats with those same problems and I have a lot of others people’s experiences to base my decisions on. Rock and a hard place for sure.

I get analysis paralysis sometimes and will make ignorance is bliss decisions to save myself some sanity. I knew Asia likely had a kidney infection (to get a slam dunk diagnosis, they’d have to sample urine from her kidney which is super dangerous and not typically done) and I’m also one of those people that reads package inserts for drugs, the best antibiotic for kidney infections is fluoroquinolones. I knew from previously reading about them a long time back that there are a lot of potential nasty side effects, but the risk of not treating the kidney infection or using a less effective antibiotic was far too great. So I squeezed my eyes shut and refused to go back and review side effects and hoped that she just wouldn’t have any. It sounds silly when I type it, but it did help and sometimes it’s better to not think about/dwell on the risks when I know the benefits outweigh them.
 
+10 357! Ah ha! There's all that Karo and gravy and potato flakes that didn't work when I wanted them to! :rolleyes:

Can't wait to see what happens when she's on the right L dose. Getting there.

0.1 R

+11/R1 328

Apologize if it looks like my SS is not up to date, it is, you just can't see it. :p Our internet is on the fritz so I have to access the board on my phone which I loathe to do and my SS is on my iPad and will update online whenever the cable gods work their miracles.
 
So happy to see the R is working so well
:)
....and you seem to have a great handle on a R dosing strategy that is working wonderfully for Miss Asia ;)
 
Beenie (GA) said:
So happy to see the R is working so well
:)
....and you seem to have a great handle on a R dosing strategy that is working wonderfully for Miss Asia ;)
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I wouldn't say I have a great handle on it, but I'm figuring it out. I think if I can use it to fence her in to a range of numbers and give the L something nicer to grab on to, she won't have so many dramatic dives and rises. I also really want to see what a proper L dose looks like on her. She's rarely had one, I've always had to give her a little too much to get most of her numbers where I want and then monitor like crazy and augment with sugar. It would be so cool to not have to do that.
 
Kathy and TiTi said:
Asia's doing so well, even with all her "issues". I'm wondering about R for TiTi. Asia's response was dramatic.
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TiTi sure is zooming down on dose, that's nice to see! :cat:

I have a good hunch that if Asia's pancreas makes any insulin at all these days, it's very minimal at best. I've done a lot of reading up on human diabetics and some things are quite different regarding how you use insulin and what results you get if you are type 1 vs type 2. Having some of your own insulin changes the landscape entirely, it helps in some ways and complicates in other ways. I think Asia's R results are a little more predictable because she doesn't have much if any extra insulin of her own to muddy the water. I'm using it to bridge the lack of duration she has and get rid of these really ugly preshot spikes. So far it looks promising.

I don't know how it would do with TiTi, might be useful for the occasional bounce, but her SS looks pretty great to my eyes. :)
 
@Stacy & Asia

Just posting this here since I didn’t see a condo for today.

I looked at her labs...sorry it took me a bit.

First, I do disagree with your vet on the SDMA.....it’s a really solid test for showing the early CKD. However, I wouldn’t get too caught up in it having some variance. If you look at your own labs, I’ll bet you’ll see numbers vary. The bottom line is that it still indicates she has CKD. I’d try to look at it in that respect and then focus more on the creatinine and those changes. SDMA doesn’t really tell you how bad it is (think of the specfPL test and how it can vary in number but it doesn’t equate to severity).

Second, great job on the P!!! WOW!!! And also her HCT!!! The weird thing is that high reticulocytes are usually more associated with anemia and she’s doing much better on that front so I’m not sure I’d get too wrapped up in the reticulocytes. Reticulocytes will tell you the kind of anemia (regenerative vs nonregenerative) if anemia is present. When the bone marrow tries to make more red blood cells, then that’s when the reticulocytes go up (reticulocytes are immature red blood cells which means they were just produced by the bone marrow). The reticulocyte test is not usually accurate unless you are looking at a cat with a HCT or PCV below 20%. I wouldn’t worry about MCH ...it's related to the hemoglobin which is fine.

Potassium....Asia, you little bugger....what’s up with that? One cause of higher potassium is metabolic acidosis but her TCO2 and Anion Gap are normal. ACE Inhibitors can also raise the K+ but she’s not on them. I don’t think she’s at the panic point yet but you don’t want that number at 6 or above. That’s when you really need to get concerned unless you start seeing symptoms of hyperkalemia like lethargy, twitching, and seizures which are also the symptoms of hypokalemia. Was there any hemolysis noted and, if so, does it state if it has had any effect on numbers? Because her K+ is rather consistently at the high end, I doubt you’ll see any hemolysis effects. But, definitely, if you give her any fluids at any time, or the vet does, stay away from LRS and go towards saline or Normosol (which stings). And keep an eye on the K+ and any potential symptoms. The interesting thing, as you noted, and which I often see in diabetic cats, is that the insulin “should” cause the uptake of potassium into her cells so that the serum levels are lower. Of course, where you ideally want the potassium is in the cells but whatever the level is in the serum, it’s usually lower in the cells. That’s why we get concerned when the K+ is below 4 because that means it is even lower in the cells.

I think her values look pretty good :):):):)
 
Thanks so much @Marje and Gracie

I’m glad you think they look pretty good. Her BG wackiness just has me wondering what is going on and I was hoping the labs would point to something.

I think you and my vet agree about SDMA, she just doesn’t think it means anything at this point. I didn’t realize it was like the pancreatitis test where it says yes or no reliably but the value doesn’t suggest severity.

I was so mad at that high p I went ham to get it down! I’m glad it worked and I hope it sticks! The reticulocytes confused me, vet said it was from stress, but she’s been stressed at any other vet visit and they had never been elevated. I read that about anemia and that’s why it worried me.

No hemolysis notes, I include them in the SS when there are. She’s stayed on the high side with the K, so it’s not overly concerning as it’s normalish for her anyway, but high K is dangerous and I don’t want her going any higher, that’s for sure. I wonder if it elevated a smidge as her insulin needs decreased?

I was hoping kidney values would come down some instead of go up because it might prove the antibiotics are doing their job. It’s frustrating in the absence of confirmed bacteria and her numbers being wacky makes me wonder if it’s the wrong abx for the job or if it’s taking a long time to work or what, this could be the kidney infection not totally stomped out from the last round, I had to beg for every week of antibiotic. Asia stopped having pee pee pants 2 days after antibiotics started again, that’s no coincidence.
 
PussCatPrince said:
That's great news.
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It is the best news! :) Why it’s so sad when her numbers are higher, she’s not herself when they are and the numbers have been so high these past few weeks. Then after a few hours of some green, there’s Asia back from her snooze fest.
 
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