Loki - 2-10-2019 - AMPS 500+

LokiL

LokiL

Member Since 2019
Hello all. Previous thread here. I'm a bit surprised/discouraged by the readings I'm pulling today. 2/8 and 2/9 we got a good number of purples, and even some yellows- but today it seems we've drifted back into black. The only difference in care I've administered is the evening of 2/9 I did not give any sub-q fluids.

Additionally, we're sitting at about 36 hours since his last bowel movement. The last one he took was rather large, but well formed and decent consistency. He has been gassy for about 12 hours or so, which typically means that a movement is imminent...but, so far, nothing.

As far as updates on labs: His GI panel came back, and he does not have exocrine pancreatic insufficiency (was previously a concern)--- his markers for the health of his GI tract were good. We have sent another lab out on hyperthyroid. Specialist's reasoning being "There’s only about 10% of the feline population that are hyperthyroid with normal T4 but I want to make sure we know whether that’s him or not."

Just wanting to see if anyone has any thoughts. I've managed to get myself sick, so may not be the fastest responder today while I try to rest to be able to work tomorrow (I've already burned a lot of my PTO for this guy...need to ration it).
 
LokiL said:
He has been gassy for about 12 hours or so, which typically means that a movement is imminent...but, so far, nothing
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Is Loki showing any signs of abdominal discomfort? Gas can be very uncomfortable which could be at least to some degree causing some BG elevation? How is his appetite? Activity level? Five P's still OK? Have you checked to see if he is well hydrated? Check his scruff by pinching up the skin and checking to see if it falls back into place immediately or takes a moment to settle back into place or feel his gums to see if they are good and moist or sticky. It may be he needs some SQ fluids while his bowels get back to normal.
 
I wouldn't say there are any signs of discomfort- in fact he is *very* eager for belly rubs. Appetite is still very much in place. No change in any of the other P's, minus waiting on poop. Gums feel moist. Prescription for fluids was 50 ml ever 24-48 hours. I went ahead and attempted them now. I may have given just slightly shy of the 50ml, but he was done sitting for me
 
Apparently there is data that can be pulled that shows what happened every 15 minutes- just isnt easily viewable by the end user. Specialist pulled it and said she wants to bump him to 5u. Based on my reading on here, that's a wildly big change to make at once. If I were to do partial units, what syringes would I need? Currently, I only have the u40 syringes from when I was dosing PZI, so I'm assuming I need to make a shopping run.
 
You need U100 syringes 3/10ml, 8mm, 31 gauge syringes with half unit markings. Walmart has Relion brand that many folks use, however the staff apparentl don't always know they have half unit markings so ask to look at the syringes before purchase to ensure you get the right ones. There are of course other brands available at any pharmacy (BD, Monoject etc.) but Walmart's pricing is good.

You are right that full unit changes are too large and can easily cause you to go past the best dose for Loki. I'd increase by 0.25u at a time right now. If dosing changes have been done 1 unit at time up till now it is possible the right dose has already been skipped over and the fact that the suspected fur shot the other day seemed to result in slightly lower readings just ups my suspicions that might be the case. Too much insulin can look just like too little so I would definitely NOT increase by a full unit at this time.
 
Grabbed the Relion syringes since that was the easiest stop for me. They do have the half unit markings, but I severely doubt my eyes can dial in on .25 here, that's a *very* thin strip between .5 and 1u. Would .5 still be acceptable?

As far as increases on insulin. His previous vet, unfortunately, just did spotchecks in the beginning. It was mainly 1u increases of PZI, but we did try him on just .5u at one point before going to 1u. Vetsulin, we didnt get far enough to increase from the initial Rx (ketosis). Lantus, the initial Rx dose for me was 4u. I requested both vets provide the curves they performed while they had him, and they said they would once they were back in the office. Hopefully that will give us more visibility on our end
 
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LokiL said:
Apparently there is data that can be pulled that shows what happened every 15 minutes- just isnt easily viewable by the end user.
Click to expand...

I'm manually parsing through this and adding the hourly readings to my spreadsheet. Went ahead with 4.5u since I know there was practically no chance I would be consistent with guessing at 4.25. That is an incredibly thin line on that syringe.
 
Sorry I was out last night and am just seeing your posts.
I know those quarter doses can be difficult to eyeball but one trick you can use is to take a used syringe and draw up what you perceive to be the 4.25u dose (just an example) with coloured water. Use it as a comparison guide for future shots at that dose. While you want the dose to be close to accurate it's never going to be precise. Consistency is more important that precision.

That said, had I been in your place I would have gone with the 4.5u too so no worries and I see Loki dropped into some nice yellow numbers so he's definitely heading in the right direction. Glad to see he finally pooped. Wonder if that had anything to do with those higher numbers the past couple of days.
Have to admit, that being able to get hourly BGs off the Libre certainly allows you to see exactly what is going on even if the readings are possibly a bit high.
 
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