Galaxy suddenly hypo (high dose cat)

Discussion in 'Prozinc / PZI' started by Galaxy and Edy, Aug 26, 2019.

  1. Galaxy and Edy

    Galaxy and Edy Member

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    Apr 26, 2019
    Hi all,

    so the fluid therapy works, I've been upping Galaxy's SQF to 5 times a day, and he's responding well, so much so that this morning at +11 he was 11.5 (yellow). I was at sixes and sevens dose-wise, but I gave a slim 10 anyway after stalling some and feeding. It being bank holiday Monday I felt safe and knew I was going to be around if the SHTF. So, we're at 2.5 at plus 6. he didn't display any symptoms whatsoever though! probably caught it just in time. Gave Kaminox (sugar-infused Potassium and B12 supplement I complained about earlier, but comes handy in hypo emergency). Tomorrow I have to go back to work and in no way can I come home at lunchtime to check.

    How does anyone think I should adjust the dose tonight and tomorrow morning? I mean, I get goosebumps at seeing these low numbers (yellow preshot?!?!), but it also baffles me as to what dose to give? I've looked around among high dose cat spreadsheets on the forum, but ECID.

    I put the 911 because I need information as soon as possible so I can make an informed decision tomorrow morning. Thank you :nailbiting:
     
  2. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Hi Edy - I'll answer after lunch. You're doing a great job, and you are keeping him safe.
    @JanetNJ also has a similar situation where she can't come home at lunch.
     
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  3. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Direct advice, then discussion. Open to advice from others.

    I would dose on a sliding scale since PZI is a non-depot insulin, and the nadirs appear to be at +6 hrs.
    preshot -> dose
    400 -> 10.0 or back to 9.0
    300-400 -> 9.0 (10% reduction)
    250-300 -> 8.0 (20% reduction), etc
    200-250 -> 5.0 or 6.0
    under 200 -> no dose

    The problem with this advice is lack of data. Galaxy just recently starting giving low numbers. And there are not many test points. One thing is real clear to you now, the importance of preshot tests. If the preshot is 200, and you dosed 10.0 then you would now predict that Galaxy would go to at least 100, or below. Kittehs do not always exhibit symptoms at low BG until the very dire low values such as US. 20 - 30, or lower.

    Meal and feeding consistency is important. Since you won't be home tomorrow, I would be sure that Galaxy has plenty of food available, for all days you are not home. Let's say he goes low. He could eat some food to offset the low BG.

    Doing a "skinny 10.0 dose" is not effective. The skinny and fat doses are more effective at 1.0-3.0 units. For the 10.0, you need to take a percentage off, for the decrease to be noticeable. For example, 5% of 10.0 is 0.5 (a 1/2 unit) -> resulting in 9.5.

    Another issue we have, is that Galaxy seems to be responding now. Could be Acro tumor fluctuation or breakthru of insulin resistance.

    In summary, to be safe I would probably go to a 20% reduction. And if Galaxy has low preshot values like 150-250, then even a further reduction. More testing, including evening post-shot values would be really helpful to establish Galaxy's pattern.

    Look at JanetNJ's chart for C.C. - a sliding scale on a bouncy cat
    C.C's spreadsheet << link
     
  4. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
  5. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I've not dealt with acro but rather IAA which while a challenge not quite the same. I also used a depot insulin.

    I've been accused of being too conservative but if I were you, given that low today, I'd back off tonight by 25% (down to 7.5u) and see what he does and then make a decision about tomorrow AM depending on tonight's cycle and of course AMPS tomorrow. I'd definitely get some mid cycle tests in tonight even if only a before bed test if that's all you can manage.
     
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  6. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    I'm pretty conservative too. That is probably good advice to go to a 75% dose = 7.5 units.

    Then you can build the dose back up after we see how Galaxy is responding.
     
  7. Galaxy and Edy

    Galaxy and Edy Member

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    Apr 26, 2019
    I think it's definitely that latter i.e. resistance breakthrough. I've been told on this forum before that it happens, one just has to be patient, and that nobody believes it first but it is true, the slow increases will eventually break the resistance. I think that's what happened here.
    Yes, I was going to test before going to bed tonight.

    Thank you for the advice, really appreciate it.

    I wonder if the human meter (SD code free) is giving me false results. I read somewhere that human meters are calibrated, well, obviously for human blood, and that the sugar in human blood is actually more in the plasma rather than in the blood cells (or the other way around, can't remember), but in feline blood it's the opposite, and that's why we get lower results with the human meter. And with me giving so much SQF (100+ ml a day), that surely dilutes the blood and the sugar in it, so these results might actually be a lot more off the readings I would get with the AT2 than we think? That is disconcerting. But then some say that it's the trend we need to look at, and that as long as it's under 15 (mmol) i.e. renal threshold, it is no biggie?
    So this is why I am going to get me another lot of AT2 strips, dunno, I'll ask my other half to get them for my birthday lol...

    Oooh, BTW, I had already given him the dose tonight before I saw your responses. But JeffJ, thank you for that reference you put about the numbers (how much to shoot when)
     
  8. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Your hypothesis is logical and has merit. Cat's carry more glucose in their plasma than do humans so "diluting" the blood by having them well hydrated could effect readings. It's logical to assume that the AT2 readings would like wise be affected but just how much difference between human and AT2 meter readings could be attributed to the level of hydration is anybody's guess.

    Having given a full dose tonight after that low today, I think it's safe to assume some of that PMPS is probably from bouncing. A low can make kitty a little more sensitive to insulin so it would be a good idea to get an extra test or 2 in tonight just to be on the safe side.
     
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  9. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Please monitor him close tonight. If he broke through some resistance, then he could go low tonight. He has definitely earned a dose reduction. This is the time to be conservative with dosing. You can always go to a lower base value like dose=7.5 and build it back up. We do not want to see you lose Galaxy to a hypo event.

    Most of the people on the forum are using human meters. Freestyle meters seem popular. Yes, they do give lower results. I always used Alphatrak2 with strips for human meters. Typically strips were Freestyle Lite or Insulinx. And I got the strips off of Ebay. So that is an alternative if you want to continue using the AT meter. Typically I could get a deal for $0.33/strip.
     
    Last edited: Aug 26, 2019
  10. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    One last request....can you please take the "911" off your post title now? It always sends us into a bit of panic and I think you and Galaxy are OK now. Thanks! :)
     
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  11. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    when you can't be there to test, definitely err on the side of caution. I've had a few instances where I had to drive 30 home from work, test, and quickly drive 30 back. man was I cutting it close. hahahahaha.

    Acro makes it hard to judge. my cat was really high for a WHILE. and only in the past 6 weeks or so is down to better numbers. for her the breakthrough dose was like 13... at the moment she's down to around 9ish... but I do adjust a bit depending on the preshot and whether or not I can be home. I'm home in the summer (teacher) so it's been so much less stressful. only have a week left! ughhhhhh...
     
  12. JeffJ

    JeffJ Well-Known Member

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    Hi Amy
    I don't have any special advice for you tonight. It looks like Galaxy is bouncing around. Definitely a challenge to dose. With luck, maybe his tumor will settle down a bit and respond to the ~10.0 dose. If not, then another small dose increase. I hope Galaxy can achieve some more blue numbers this week.
     
  13. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Hi Amy - Galaxy is looking good. It is so nice to see some good blue and green nadirs on his chart. With continued low nadirs and B12, we can hope the neuropathy will slowly start to dissipate. Great job on the keeping your kitteh healthy.:bighug::bighug::bighug:
     
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  14. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    WHOA! Galaxy is looking regulated the past two weeks. That is just stunning. Kudos to you for keeping up with it, and getting the mid-day nadirs. I suppose you are coming home at lunch for them.

    That full testing during his cycles really shows the effectiveness of the dose. Yay for Galaxy.:bighug::bighug::bighug:
     
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  15. Galaxy and Edy

    Galaxy and Edy Member

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    Apr 26, 2019
    Jeffj thank you so much for your encouraging words. Yes we have made awesome progress. He's a lot perkier and got back into the habit of sleeping on the bed at our feet like he used to! Hadn't done that in the past 6-8 months. However, we keep getting these red numbers every third morning or so, I think that's either his pancreas flaring up or his acromegaly. THe night beforethe red numbers he always feels like dead weight, very quiet, like he's getting ready to die or like he's in pain,I can't tell. Either way, he still bounces back, amazingly.
    And you know what I think is making the difference here? The amount of subcutaneous fluid I give him every day - 100 ml!
    :bighug::bighug::bighug:
     
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  16. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    You bet Amy. It makes me real happy to see the history of a diabetic challenged cat get better over time. In the past, Galaxy had those regular black numbers all over his chart. And now you have him in much lower numbers in general.

    Some kittehs just bounce around. Leo did. And many other cats on the forum as well, such as JanetNJ's C.C.. You are probably right, that the subq fluid is helping him. Whatever you are doing - you are doing it right. I just updated Theresa about Galaxy, and she is happy to hear that he is doing better too.:bighug::bighug::bighug:
     
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  17. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Hi Amy - checking in again. I see some VERY LOW numbers on Galaxy's chart. And I looked through the health notes.

    Low lime-green numbers such as UK 1.5 or 1.9 can be very dangerous. The 1.5 from September 9 is dangerous. Such low numbers means there is generally insufficient glucose for the body's cells to process. Any lower than this, and permanent damage or death can occur. If the cat body does not get enough glucose, cells start dying. Please be careful. Some cats do not exhibit hypo symptoms until they cross a low sugar threshold. Each cat can be different.

    If you have dosing questions, please post them. It seems from your notes that you may think that 2/3 of an existing dose will only affect Galaxy by 2/3 of his previous numbers. Insulin doses don't really have that linear effect. Perhaps I have mis-read your notes.

    My general advice, whenever you hit a lime green number, you should reduce the dose. The nadirs on Sept 11 and Sept 12 look real good. Perhaps Galaxy likes doses of 6.0 or 7.0 now. I know how challenging this can be. You are doing a good job with Galaxy. I hope his neuropathy gets better over time.:bighug::bighug::bighug:
     
  18. Galaxy and Edy

    Galaxy and Edy Member

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    Apr 26, 2019
    Hi JeffJ,

    I am considering skipping tonights dose altogether - depending on how low he is at +12. He seems to hold the morning dose for a lot longer than the eve, and i have a feeling that every night he gets dangerously low. This has to stop i agree. I think i need to give him less in the morning, so the am and pm preshot numbers sort of even themselves out. Less, even if he's a bit high. That would bring up his pmps higher so that i can give him a dose closer to what i need to give him in the morning to bring him down into blue at least.
     
  19. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Hi Edy - with Prozinc being an "in and out" insulin, it should have much lasting effects past the 12 hour mark. However, Galaxy might somehow have slow absorption. His chart sure shows low numbers after low PMPS doses.

    If Galaxy does have Acromegaly, this could be a bouncy tumor. I agree with you that a lower AM dose is probably safer. Then maybe you can level out the doses for him. You are keeping him safe, and that is the main goal.:bighug::bighug::bighug:

    The whole situation is MUCH better than the May-August numbers. Now Galaxy is probably feeling much better, out of those blacks. And you can see the incredible value of pretests and nadirs. One of your WellBeing notes is very correct
    ...to think that the vet told me to stick with 9.5 am and pm, and not to test!!! He'd be dead by now.
     
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  20. JeffJ

    JeffJ Well-Known Member

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    Hi Edy - congrats on regulating Galaxy. His numbers are looking great compared to earlier this year.

    I reviewed the WellBeing notes too. I'm sorry to hear that he is not doing very well. He may be eating less because he needs less calories, now that he is not excreting glucose in his urine. Or the issue could be something else, since he is an older kitteh.

    Hunger stimulants such as mirtazipine or ondansetron can be helpful for many cats. But if the cat has nausea, that issue probably needs to be resolved. Anyhow, thinking of you and your sweet kitteh Galaxy.

    My Dad used to live in Havant, when he was on assignment from San Jose, CA. He lived there in 1973-1976. I was just a kid and did not get a chance to visit him there. I know Havant is pretty close to Bournemouth.

    cheers,
    jj
     
  21. Galaxy and Edy

    Galaxy and Edy Member

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    Apr 26, 2019
    HI JJ,

    Thank you for checking in; I think it's old age with Galaxy, I check his urine on a weekly basis, there's still a lot of glucose (brown on the urine test strip), even at nadir, it's probably still the fructose-amine, or I don't know... Also, there is blood in his urine, not visible, but on the test strip, while a few weeks back it was "non-hemolytic", it now has gone hemolytic and the highest number on the strip (although not sure what this means). So his kidney's are probably throwing the towel in. I don't want to wait until acute kidney failure stage. We have considered his age, his general health and quality of life. He's steadily losing weight. We will stop at the stage where we would need to syringe-feed him. He's had a good life with us, been adored and really worshiped, lol... I think it's only fair to give him a humane way out when it comes to that. I think he still has a couple more months in him... well, we'll see.
    lol, certainly, in a USA size country it would be considered pretty close :) would be a nice road-trip though. Over here, the New Forest and Lymington are pretty close. anything further and we pack a lunch lol
     
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  22. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Sorry to hear that Galaxy is fading. I know how it is. Liver failure is tough to deal with.

    With Leo, we kept waiting, treating, and hoping for improvement. He got down to 11.5 pound on a 16.5 pound body and it was obvious his time here was done. We had at-home euthanasia, and it was a lot easier on Leo, and us too.

    I'm glad to hear that Galaxy has had a great life. If you can't spoil them rotten, then what can you do? LOL

    Havant is still close to Bournemouth - only about 20 miles. Some people in Austin TX commute further than that (north Austin area to south Austin area).
     
  23. JeffJ

    JeffJ Well-Known Member

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    Hi Edy - you are doing a great job on Galaxy's insulin therapy. I read thru the well-being notes too. For litter box issues, some people cut the front of the box (low) so the cat can get into it. I know it's hard having an older cat.

    When he eats less food, that will probably reduce his insulin needs. I'm glad to see Galaxy is still getting some outside time. Leo used to love to watch the world go by - out back, or chaperoned in the front yard.
     
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  24. Galaxy and Edy

    Galaxy and Edy Member

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    Apr 26, 2019
    Hi JJ

    So Galaxy was taken to hospital last night. He simply fell off his feet, and kept crying out in pain. By the time I got home from work he had vomited everything up and expelled all fluids out of his emaciated body both ends. I first thought it was constipation because he kept crouching but nothing came - the vet later told me this was diarrhoea but nothing left in him to excrete. He had lost 1/4 of his body weight in a month.
    We made the decision there to put him to sleep.
    In the end as it was taking effect he had this expression of wonder on his face.
    I don't yet know how long it is before I can stop crying. Atm I can't be out in public as it hits anywhere. Will see if I need grief support.
    The vet and team were absolutely amazing in their compassion and support.
    Thank you for checking on us every now and then.
     
  25. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Oh Edy I am so very sorry to hear it was Galaxy's time to go. You gave him a good life and as hard as it is to make that final decision, it is the last final gift of love we can give. Galaxy was so lucky to have such a loving caring home willing to go that extra mile. Galaxy knew how much he was loved. You were his guardian angel and now he is yours. :bighug::bighug::bighug::bighug::bighug:

    RIP sweet Galaxy.cat_wings>o
     
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  26. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Hi Edy

    I knew his time was coming from all the signs and your health reports. You did the best care that any kitteh could have. To me, the grief is overwhelming at the start too. I don't think time heals all wounds, but I do think time makes the grief more manageable. You made the right decision, and it is never easy.

    You gave Galaxy a loving and wonderful home for 17 years. No kitteh could ever ask for more. I think most owners would be proud of having a beautiful cat live so long with them.

    May your sweet kitteh fly freely, and land gently at the Rainbow Bridge, waiting for you there. Galaxy was special, and he was loved.cat_wings>o

    Tears for you and Galaxy from Austin,TX
    JeffJ:(
     
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  27. JanetNJ

    JanetNJ Well-Known Member

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    Oh no what sad news. I'm so sorry
     
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  28. Keskat&Rocket

    Keskat&Rocket Member

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    Feb 4, 2019
    Oh Edy, I’m so sad to hear this. You are the best friend Galaxy could have had; you loved him immensely, and were there til the very end. He is free of pain now. Be kind to yourself during this difficult time... Galaxy knew he was loved, and he loved you. Always remember that. *hugs*
     
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