7/1 @Blackie - another set of eyes?

Hey guys! I was just reviewing Blackies SS from another thread and had left it open. When I went to close it, I noticed something that I thought maybe I could get another set of eyes on. I didn't want the question to get buried in another thread, thus my posting here. You know how I like trends, so bear with me.

Remember this is post MAJOR rebound, but when Blackie was switched down from 8 to 1 unit it was held for 8 days (nice job!) The first couple of days got those wonky #'s, but it's off of a recovery from hypo, so no big.

6/25 - Nadir happened at 4 hours which seems early but the curve was smooth.
6/26 - Seesaw PS's...
6/27 - Considerably lower AMPS from the previous PMPS. It happens, so ok... but then the dip is really minor - with minor variations, could be a flat curve.

If all of these had been normal, no problem, but then comes 6/29 which is where my red flag got raised. Back to the 4 hour nadir (although it held nicely) but never hit blue and then the ever famous uber-spike into reds. THEN - at +1 an immediate drop of over 100 points.

I'm saying that 1 unit might be slightly high leading to a liver kick and then rebooting back to good numbers and back again. She just raised the dose, so I really wanted some more eyes on it.

Thanks all!!

 

i'll go...

 

ya know hope some cats instead of spiking after a meal get a little pancreatic action. this happens with tom alot. i don't think blackie ever gets low enough (barring 8U's) to get that panicky liver...possibly has a pancreatic reaction to food and a start on insulin at the same time...
tom also get's that +4 nadir. blackie and tom may have the same game.

 

Yeah, I need to know what's going on, also. I just got a sick feeling in my stomach.

 

Thank you for checking into her chart. I'm still very new at this, and have only been hometesting her for over a week now. I decided to give her a +4 test today, despite telling her that I was going to go it at +6.

Could it be that she's still trying to get acclimated to the insulin...?

 

I seriously hope that I don't ever give her another 8 units BID again, or even 4 units BID again. After going through what I went through with giving her that much, especially on a high carb diet (per the vet's request), it makes me sick to my stomach. Frankly, as much as I didn't ever want to have Blackie go through the hypo thing, I'm glad that she did because it made me drastically change things in order to help her better.

I'll keep at what Mary's suggesting for her, and we'll go from there. I'm glad that I have friends who know more than I do, and can help me with getting her regulated. My vet is very limited on knowledge of the disease, I'm guessing. No fault of their own, but I hope that they'll one day do some further research on the subject on their own time. It would help to save more cats' lives.

 

Lori -Thanks for looking so quickly. I wish I had seen some greens in there because that's the part that's odd about the whole thing. I'm keeping fingers crossed that it is pancreatic action. That would be wonderful. Again, thanks for the look.

Angela - She's doing great!! Do not panic!! This was just to get some more eyes looking at her #'s. I think I would stick with the 1.2 for a few days and see what you see. If it is too high, that will show in the #'s. ECID which is also why I wanted another set of eyes. For Aria - a drop at +1 was a definitive sign of the dose being too high. As soon as we lowered .1 or .2 units, it would settle down. For other cats, and fingers crossed it's like Lori said and is Mr P action, it's a great thing for that initial lowering.

I agree with Lori that we haven't seen a green nadir yet, which is the goal so no panicking! There is no way she's going into hypo with that .2 increase you did. The worst that's going to happen is you now have Lori and I taking a closer look at upcoming #'s. I like getting lots of different sets of eyes on #'s when there's anything odd about trends.

Also, you have to know that there's very rarely a cat that throws normal happy curves. It's just not in them. That would make our lives too easy

 

LOL Yeah, if our furbabies made our lives too easy, where's the challenge? LOL (knocking on wood that it never happens for any of us... the immense challenge, that is). LOL

I encourage any of your expert eyes to peruse her chart. If you see anything unusual and voice your concerns, I can pass it along to Mary and see what she thinks. With all of your help, and my doing the work, I'm hoping that we can finally get her lower than 1U BID, if not totally off of it one day. She's been on ProZinc since May 12th, so if you count the 12th, the total amount of days would be 51, and if you don't count the 12th, it's 50 days that she's been on ProZinc. I hope that makes sense.

In the meantime, I'm also combating her diarrhea issue. Per Mary's suggestion, she's getting one 100% psyllium capsule per meal, and her meal consists of Fancy Feast Classic chicken flavor (but will be picking up some FF Turkey & Giblets this weekend and see where this takes us). Today, however, her stool was a bit more solid looking, and not as runny. Just soft, with a bit more definition of it looking like stool should look without as much pooling (if that makes sense.. Kind of hard to describe poo LOL).

 

I am not sure that 100+ point drop by +1 that one time is an indication of too much insulin. Blackie was definitely rising before the shot so I don't think the drop was due to insulin still being in the system. It vary well could be a rebound zoom (don't know the numbers from the day before due to no testing), and sometimes they can drop much quicker after they zoom too.

 

Hmmm, interesting question.

The only wonkiness that makes me wonder is that +1 the night of the 29th. I'm not sure how much weight to put on the one # though, especially with pooper problems in the mix that day and laying by the water bowl, could have been higher #s from stress that were already clearing when the insulin started kicking in, or something wonky like others have suggested.

Except for that one #, everything else to me looks like nice pretty U-curves. I'd attribute last night's red PS to liver-training (it's a pain, but good news to get to that point!!!!).

When I look back at 6/23 too, although there is rebound wonkiness from the day before that could be confusing the picture, you can see what looks like new rebound even in that cycle - 341PS - 257 @+4 - 453 @+10 - then back to 396 for PMPS. That is a classic rebound curve to me (i.e. rebound in that cycle, not from previous). But I see 0 reason for rebound - drop isn't steep, #s no where near low, so that makes me think panicky liver.

Rebound always drives me nuts b/c I have a hard time telling from the #s what is Somogyi rebound (dose too high) and what is liver training (need to stick with/raise dose til liver is trained). I tend to look at it as: if I see low #s or a steep drop, then try lowering the dose to test for Somogyi. If I don't see those things (and I don't here, on the whole), then stick with small dose increases every few days. Sometimes though I think you have to experiment to tell what it is. With Somogyi if you lower the dose the #s will improve, with liver training if you lower the dose the #s will get worse (or sometimes PSs improve but nadirs get worse).

If it were me, I'd probably stick with this dose another day, then raise if #s aren't better. My guess is she will be one of those cats who needs some dose increases to get in better #s for longer, and then may be on a quick dose reduction path soon after.

 

Joanna, considering that she's been increased to 1.2 last night (Wednesday night), Mary suggested that we keep her on that low dose for about 5 to 7 days max and see where she's at. I'll keep posting the #'s, and you guys have my blessing to keep checking on her, and whatever red flags you see, let me know and I'll give them to Mary for her to decide.

The next posting will be PMPS today. I told Blackie that I'd test her only 3x today, and I'm going to keep my promise to her little cute self.

I keep telling her that she needs to become a vet in the field of diabetes. LOL

Again, thank you for your help, and support. I'm glad I'm on this board, too. *HUGS*

 

I don't see anything that sends up red flags to me. Prozinc is a quirky insulin, you get some wacky numbers with it. We got wacky numbers and frankly, I ignored them because they were red herrings. :razz:

I think you're doing just fine. Stick with what you're doing. Whatever you do, don't start dose hopping. You'll only get confused and frustrated.

 

I'm not sure what "dose hopping" means, however, I'm only doing what is suggested by Mary. In a way, she's kind of treating Blackie like she's hers, and what she'd do. So, I'm learning what her methods would be, if that makes sense. LOL I trust her judgment, and I know that you all and her wouldn't steer me wrong. I've come to the right place.

 

dose hopping means changing the dose too often (like every day, or even every cycle with no consistency) - this can give the cat no time to adjust to a dose and leaves them in perpetual adjustment mode (ie - wacky numbers)

 

Nope, I'm certainly not doing that. LOL No worries there.

 

I didn't think you would, but wanted to warn you about it. Nice steady dosing is what you want at this point.

 

Definitely working on it. After about a week of having her on the FF Classic Chicken Feast flavor, I'm trying her on the FF Classic Turkey & Giblets flavor, which is the lowest in carbs, and see where we're at for about a week or 2, or more. I started feeding her this at the PMPS, and then 1/2 can before bedtime (about 10:30 p.m.). Still on 1.2 units BID. For now.