7/19 Blackie AMPS 363

363 @ 5:32 a.m.; was given 1.8 units this time, increased from 1.6 after 3 days of being on 1.6.

 

335 @ +2. She appears to be a bit perkier this morning after this increase of insulin. Time to attack this disease a bit more aggressively and do 0.2 dose increases every few days.

 

259 @ +4 @ 9:28 a.m. So far, so good.

 

Angela, that's 100 point drop in 4 hours...trying to remember where her nadir is? I can check but at + 6 if she is'nt in the blue range (100+) I'll be dissapointed.
I am so glad your willing to get more aggressive altho we usually discourage that. I just hated to see Blackie sustain those highs so consistently without a break. It is not good for her organs, kidney especially. I'd err on the side of slipping too low. and remember a nadir of something in the 50's is not a time to freak out..that is still a normal #. we won't break out the guns unless she gets a low in the early hours, +2 or so.

 

Hope it goes great today!!!

 

Should I stay at 1.8 for 5 days then and see, or what?

 

I decided to do a test @ +10, 333 @ 3:30 p.m. She's giving me purples today, and a yellow. Will see how tomorrow looks. I'm starting to get apprehensive, and frightened.

 

honey don't be freightened, i'm afraid i scared you. you just might have a higher dose kitty. and even that won't necessarily be permanent. i've been here a long time, i've seen far worse. lets take a whole cat report, the 5 p's is she/he peeing, pooping, preening, purring and playing? is she feeling loved, nurtured, cared for, is she getting the best treatment you know how to give her? well, that's one lucky kitty. the insulin it looks like will probably go up...but that's ok. i sent you my # for any scary thoughts you have ok.

 

Well, she's not playing, although, I think yesterday we saw her rolling around rubbing on something. However, she does purr, pee, poop, and preen. I try to put her on my lap, but naturally she doesn't stay. She prefers to lay on the cool floor of the kitchen since it is hot here in Texas, and humid (yep, the a/c's on of course).

I thought we were to increase the insulin every 5 days or so? Granted, the dose at 1.6 was giving us red #'s, which I don't want to see.

How long does it take a for a little body to adjust to a dose increase?

 

at this point not long. that is really a rule for the very first weeks. at this point if it were me i'd raise it after 2 trys, every day. in small increments. i believe you should see results the same day.
IMHO

 

Since she was on 1.6 for only 3 days, and I just raised her dose to 1.8 this morning, I think I'll give her 5 days and see where she goes from here. I'm not comfortable enough to raise it every day. That's pretty much what the vet did, and we ended up giving her 8u BID before her hypo episode where I dropped it to 1u BID and am now staying low, going slow (or trying to at least).

 

but angela the vet raised it by whole U's and that is entirely different than the tiny increments your doing. it's a completely different scenario.
plus your home testing now, don't be so gun shy...you can steer the #'s very easily if you get nervous. actually, this is just what i would do. you are the mom and i respect that.

 

I like raising it every 3rd day, more or less. To me it's less to let their body adjust to it, it's to allow the dose to reach a steady state. With PZI, that is usually accomplished in 2 to 3 cycles as I understand it. Another choice too is to raise in increments of 0.4 rather than 0.2. To me, you can go faster & higher if you aren't seeing good #s. You want to go slower and in smaller increments if the #s are decent, so you don't overdo it. But it doesn't seem like there's much risk of that at the moment.

The nice thing about PZI is that it is so flexible. When cats are doing pretty well symptom-wise and the #s aren't that bad, then it's fine to hold it for several days and move in small increments. If they really aren't acting like they feel well, or the #s just aren't budging much, then I think a more aggressive approach is in order.

In part if we recommend raises less often, it's for practicality - a lot of people don't want to make changes every couple days, it's just too stressful for monitoring and such. Sometimes people want to do something like a curve on a weekend, then raise, and do another curve the next weekend. But IMO in most cases there isn't a specific *need* to wait several days - 5 days, for instance, is an arbitrary amount that allows ample time for the insulin to get to steady-state, some extra time to do some testing, etc. It's more relaxed. But if she isn't feeling well and the #s aren't going anywhere, to me it doesn't make sense to wait that long.

Nothing to be scared of, it's just a process that can be frustrating. I know with Bix I was terrified of both low #s and of high #s, so I feel for you. Once he got to better #s and I could better see how the different doses affected his #s, it got a lot less scary.

Maybe pick somewhere in between 1 day and 5 days and go with that, and/or consider going in increments of 0.4 if you don't want to raise it as often, til you see some better #s. If you are worried about hypos, try to get a test in the 1st half of the cycle to determine whether or not she is going low, and then if you need to you can feed her a little bit to balance the insulin if it turned out to be a little too much. (I don't think you are anywhere close to that, but just mentioning it in case that is one of your worries.)

Sorry if I have scared you too. Which parts are scaring you? Maybe we can help...?

 

It usually takes more than just one day to see how effective the current dose is. General rule of thumb, unless they are throwing consistent high (red) numbers is to try a dose for at least three days before it is increased. Keeping a watch out for ketones is very important, too. Considering she is not eating high carb foods, I do not believe she will ever be anywhere near 8u again UNLESS she has some issue that makes her insulin resistant, or she is an Acromegaly, IAA, or Cushings Cat, (which I seriously doubt).

Generally, if a kitty starts to need ever increasing doses of insulin, the first thing to try is an insulin switch. Some insulins just do not work well for some cats.
If the kitty still needs ever increasing doses of insulin, (even after they have been switched to a new one), and they are on an appropriate diet, it is then time for further tests to see what is the underlying cause of needing the increased doses.

~M

 

Hi Angela,

As a newbie again I completely understand how you feel. I don't know about you but I want my Harley's numbers to be better and I want it NOW.

That said, you need to feel comfortable with what you do. Nobody loves Blackie more than you do, you will not do the wrong thing, because everything you do is out of love for your baby. Listen to the advise given and decide what will work best for both of you. If you wait 3 days or 5 only changes things by 2 days one way or the other.

Besides, you are here now. You know how to treat hypos. You know what food to feed and you have a couple of hundred people here with you in the same boat. Who maybe have already asked those same questions or had those same fears so you don't have to figure it out yourself.

Put your fears out here, you never know when or what tid bit of information will click. That's what this place is for, sharing information, support, venting & comfort in the fact that we are not alone.

Hang in ther sweetie.

Robin

 

Angela just thought of something. that hypo on 8U....it was shot on an amps of 140. now your amps and pmps are much higher than that.
we'd probably have a cut off point that you would'nt shoot at...wait an hour and see if the #'s go up before shooting. that number would probably be 140 or perhaps 130. See, the whole situation is different. i'm guessing if the vet knew your # that morning was 140 she may not have recommended that 8u, and if she did she should'nt be practicing veterinary medicine.
just adding to the thinking process for you.
i think we all thought blackie would be coming down, even slowly, at this point.

 

Well said.

One of the things that was hard for me with Bix was to handle advice that kept changing from day to day. I kept thinking about what someone had told me last week, and trying to apply that advice to today's #s. After a while, I realized that the advice kept changing because the picture kept changing. You do one thing, it doesn't work, so you do something else and have to let go of the old advice. I found that really hard, but when I switched to viewing Bix's #s in the short-term - like "how much insulin does he need today to get good #s, knowing that it might be different than it was yesterday" - I found it easier to swallow.

And I agree, I think we all thought you would be seeing better #s by now. I think I've gotten spoiled by the kitties who come in, get one tiny dose increase and then are in good #s, and then are OTJ before you can even blink. Since Blackie's #s aren't popping into place like that (and no reason they should really), we're kind of shifting into a higher gear. So it may be confusing to first hear 5 days, and now be hearing just a couple days, I know that would have totally confused me!!! When I got here with Bix, I thought you had to hold doses for a week, and I kicked & screamed before I would raise the doses faster. It just takes a while to get the experience I think to feel comfortable making decisions on how much to shoot, and until you have that under your belt, it is REALLY scary to be doing what other people are telling you if it doesn't really make sense to you, and especially when they might be directly contradicting something they told you last week (that used to drive me NUTSO!!!), or when different people are telling you different things.

Anyhow, hopefully you will get some improved #s on this dose. You are doing a great job!!!

 

joanna you really brought back some old memories for me, and old expressions we used to use. like getting out the handcuffs if someone had a tendency to continue shooting after a rebound # "do we have to get the handcuffs out?" and the CS = chicken s**t shot where a person was afraid to shoot a proper amount.
I guess what Angela is going thru has been around as long as the board has. FEAR
But I'd say you Joanna put it very well when you said you have to go with the flow and change course with the new info.
Look at it this way...a good doctor who is treating a disease really examines the individual patient for trends and responses and acts accordingly (and you really don't see those kind of doctors hardly ever) what i'm looking at Angela and what I'd like you to look at are the trends and responses and act accordingly. You can clearly see if you study your SS that you are no where near hypo concerns, you can see your blackie is treading in high #'s without much relief, and you can see he did'nt die on a ridiculouse dose of 8u on a 140. taking all this into account...there seems to be a concensus that it would be better for blackie if you were to respond to the health issues as you learn more about his responses each day. it truly is ECID and a learning process. this time it calls for a more aggressive approach, still slow, but a faster slow....
((((Angela))))

 

hehe... I had to earn my BGPs, lol (mom's will know that one, right?), meaning getting brave enough to shoot the doses that were needed, especially on the lower PSs - I was definitely in the chicken s**t category ;-) I had my reasons of course, like everyone, due to some earlier scares, but Bix didn't get regulated til I grit my teeth and shot more insulin - I'm sure I was shaking the whole time!!!! LOL, it is weird to realize how much things have changed for me since those days (hopefully for the better LOL!!!)

 

i was always a high shooter, the get your handcuffs on me or i'll shoot type. last nite i shot a 128 cuz i just know how tom operates. he was at +12 and definetly on his way up.
most peeps would not do that. but you live you learn.
there is an interesting chat going on in think tank about thinking like dr. hodges(?) and how infrequently cats ever really go totally hypo. i think it was steve and jock, he said in all the years here he has NEVER heard of a cat dying from or getting really sick from hypo. (i'd have to make an exception for stephanie and toonces who got that 20 U shot from a vet tech when she left her cat overnight at facility. that was a nightmare and bascally the end of toonces, but still, he did'nt die.)

 

I've read that discussion, and there is NOT a concensus that hypos don't kill cats, that more aggressive shooting is better than more conservative. Just because a few people want to push for more aggressive dosing and they don't personally know of a cat that has died from hypo, doesn't mean that they are right or that hypo isn't harmful or life threatening. I think there is a happy medium, and being too aggressive CAN kill cats. There needs to be a balance.

That's dangerous thinking, and I would not want to be the one who advised higher dosing that led to a dead cat. :shock: