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? Need dosing advice - unusual low numbers for us

Discussion in 'Prozinc / PZI' started by Georgiana & Perlutz, May 30, 2019.

  1. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    I need to ask for help yet again... I have a post about dosing advice in the main forum from couple of days ago but I'd like to know what some experienced PZI users think.

    Perlutz has been in constant very high numbers but the last 3 days we've had much lower numbers, went as low as 3.7 (67) at +7. I need to find a better insulin dose to avoid him going hypo when I'm at work or asleep at night.

    AMPS was 6.5 obviously no insulin. I couldn't stall and I wouldn't have been able to stay at home and test. +2 was already 15.5 so I'm expecting a 30+ for PMPS. I need some help with possible dosing for tonight, keeping in mind that I won't be able to stay late and test. As much as I'd like to, I'm exhausted and struggling after getting 4 and 3 hours of sleep the last 2 days. I will set up 1-2 alarms around his nadir though, I need to know he is safe.

    He has had a dental last week (Wednesday) but the numbers have stayed high after it, only went down when we started a new vial of insulin. I delayed opening the new vial on purpose as previously we've experienced lower numbers upon opening a new vial and I wanted to see if it will be the case again. You can see on his SS that after a new vial on the 7th of April we've had similar lower numbers. I know new vials can be more potent, but I'd expect that to last a little longer and not make such a dramatic difference. Of course, this time it could be both the dental and the new vial, I really have no idea!

    This whole thing is beyond my knowledge and experience, please help me help him :cat:

    I'm gonna tag some of you who were kind enough to help me out in the past, hope you don't mind @Diana&Tom @Yong @Elizabeth and Bertie @Djamila @CandyH and Catcat
     
  2. CandyH & Catcat

    CandyH & Catcat Well-Known Member

    Joined:
    Apr 23, 2019
    relative newbie, on Vetsulin, mostly all I can offer is support, empathy, some general knowledge from dealing with human diabetes, prediabetes, and incipient hypoglycemia, and a compulsion to help if I can .. let me say i totally understand the frustration and the desire to do the right thing

    since we can't meld minds with our cats, and since they have chosen not to speak in English (or whatever) and we have only a smattering of Feline, it's a guessing game, an assumption game, an intuition game, and mostly a waiting game (when we want results NOW) ... :confused::banghead::rolleyes:

    oh yes, and like many here, I'm short on sleep, we didn't get home until almost 11 last night (but so worth it, thank you Mialia) and Catcat woke us up demanding food at 5:15 this morning
     
  3. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Only wish I did have some miracle solutions, Georgiana, but like CandyH above, I can only really offer moral support and the occasional reminder to keep your ss up to date or post on another forum... I completely understand how utterly frustrating and exhausting this is, and I hope the clever dose experts will be along soon to give you some concrete ideas. You have an excellent handle on the FD thing in general, it's just a shame that our kitties don't want to do things by the book and do want to keep us on our toes 24/7... sigh!

    Rooting for you!
     
    CandyH & Catcat likes this.
  4. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    This is quite a puzzle, Georgina... If it wasn't for those black numbers yesterday I'd be tempted to think that your kitty might actually be feeling better after the recent dental work...

    In your signature it says that your kitty has a 8mm tumour on the pancreas. ...Has the vet said what kind of tumour this is? I'm just wondering if it is messing around with insulin production.

    Edited to add: Where are you in the UK, Georgina? I just wonder if the RVC have any knowledge in this area.

    Eliz
     
  5. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Hi Eliz,

    We don't know anything about the tumour at the moment. We've been referred to a referral veterinary centre called The Ralph in Marlow, Buckinghamshire. Our app is on the 12th of June and we should find out more about the tumour then but the vet does think the tumour must affect his BG to some extent.

    We are in Maidenhead so not too far from RVC in Hatfield, 1 hour-1.5hours, traffic dependant. I've actually asked the vet for a referral there some time ago and we had an app on the 14th of May which in the end we cancelled and saved the money for the dental last week. I was very keen on taking him there until I found out the appointment was with a student and that the specialists (from the FD trials for example) only see very complicated cases. The appointment with the student was also going to cost £275 and (my choice of) blood tests £350+ and on top of that, he would've been kept overnight for curve which I think most of us here are not too comfortable with. I haven't ruled RVC out completely though, maybe Perlutz qualifies as a complicated cases now anyway, but for the time being, we're waiting for June 12th and hoping the tumour can be removed. Until then though, since we have these low numbers, I don't want to lose the momentum and I'm trying to see if we can find the miracle dose to keep them.
     
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  6. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    As expected PMPS 31.1
     
  7. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hi Georgiana - I'm not on the board much right now because of an overwhelming workload. So thank you for being patient with a response. I don't know that I'd be terribly concerned about that lime green to be honest. It was at +7, so likely Perlutz would have started rising on his own anyway. Having skipped the dose, it may take a couple of cycles to stabilize again. That black number tonight is icky looking. Assuming he's back in more normal-ish ranges tomorrow, maybe try 2.5 or 2.75 (depending on how high the PS is), and see how he does.

    The things with those little pancreas tumors is that they can make dosing the responses rather unpredictable. So you may just have to find some peace in the chaos here. There likely isn't going to be a perfect dose, and like is going to be a fair amount of guessing/trial and error.

    You do a great job of taking care of your sweet baby boy, and you'll be able to keep him safe on the cycles when his pancreas decides to come out and play. Hopefully tonight dose (I think you made a good decision with the 3u, by the way), will bring him back into better numbers, and then fingers crossed that the 2.75ish will serve him well. Of course if he's sky high again, you might have to adjust all of that.

    I'm sorry there isn't a clear path at times like this. Just know that you're not alone. :bighug:
     
  8. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Hi Djamila, thank you for taking from your time to reply! The lime green didn't worry me too much either but I think it's mostly because I was there with him and knew what to do in case it did go lower. But it doesn't seem like we have to worry about that anymore as we're back to blacks and reds :mad: He got 3 units last night and this morning and I'm thinking to maybe go up again to 3.25 if he is still in reds or above. Do you think 3.25 is a good idea or should I stick to 3 and see how it goes?
     
  9. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    I added the most recent blood test results to the SS :cat:
     
  10. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Happy to see another yellow - PMPS 14.3. I gave him 2.5 units as the other day when he had 13 he went to 3.7 at +7 and his AMPS was too low to shoot so I’m hoping 2.5 will bring nice blues and dark greens over night but go high enough for insulin in the morning.
     
  11. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Love a yellow pre-shot! This is more like it! C'mon Perlutz, give your mama some nice numbers now, she's been working very hard to make you feel better :)
     
  12. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    You tell him, Diana! :p
     
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  13. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Looks like Perlutz’s pancreas came out to play again :eek: 6.3 PMPS from a 25 AMPS :woot:

    If anyone is online, do you think I should give him a half unit of insulin or something like that? We will be at home to keep an eye on him but he’s not very happy to have his ears pricked today.
     
  14. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Well I did tell him to give you some nice numbers and this is lovely... perhaps just a little late in the cycle though... pmps will be an interesting decision again :)

    ETA oh that was the ps number!
     
  15. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Now can you please tell him to give me this kind of lovely numbers every day AM and PM? :D
     
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  16. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Sure! (We can always hope ;))
     
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  17. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Oh ref your question... I think it's almost certain that he'll go up again, the question is soon or very soon. I'd be a tad wary dosing at 6.3 though, if he's still using up the last dose he could go very slightly lower and then it starts to get into more worryingly low territory. I know he's fed up with tests but I think if it was me I'd stall for up to an hour and check out the situation then... he might go up sigificantly or he might just surf in single digits for a few hours and then start his usual climb.

    Hmmm. Wonder if @Elizabeth and Bertie is here?
     
  18. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    I have already gave in and fed him, he’s been very vocal for the past hour demanding food...
     
  19. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Yes this is the trouble, very hard to stick to the rules with a hungry cat!
    This is new territory now with low pre shot numbers, there might be a very very fine line between a dose that gives good duration but allows you to shoot, and a dose that's a tad too high and lasts longer than is ideal. And if Mr Pancreas is coming out to play more now, that will add factor x. Maybe this is just a new phase he's in, and you'll just have to keep plugging away and doing your usual excellent job, and see where fine-tuning takes you.
    But maybe Djamila or Elizabeth will have other thoughts...
     
  20. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    I think we’ll skip the dose tonight...
     
  21. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Jul 6, 2017
    I think I would pick up with 2.5u in the morning and hold that dose for a few cycles. Ideally, you want both pre-shots to be shootable numbers. Often, when one is not, that indicates that the dose is a bit high. You are seeing some good response to the insulin now, but things need to level/settle out a bit. So, I would recommend resisting the urge to bump the dose up if you get a high pre-shot result (which you probably will in the morning due to the missed shot). The new lows he is not used to are very likely contributing to some of the highs you are seeing. Jumping to a higher dose when there is a higher pre-shot can keep 'feeding' the volatility. Consistency goes a long way in allowing things to settle out so that you have less extreme ups and downs. It's exciting to see the better numbers! I hope the trend continues.

    (By the way, Djamila is out of town this weekend and is not going to be on. Didn't want anyone to think she is ignoring being tagged. :))
     
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  22. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    I see exactly what you mean with holding the dose and I’ve been thinking the same, although I did give in and raised it some days. But at least this experimenting with the dose gave us a bit more information on how he reacts to different doses. I think sometimes I went with a higher dose out of fear of losing these lower numbers which for us were a rarity. Looking at the last few days it might be that his ideal dose is between 2.5 and 2.75? I will stick to 2.5 for few cycles and see how it goes, it does look like 2.5 might be more appropriate and give us numbers that allow insulin both am and pm.

    Before the dental and before these lower numbers he was drinking a lot more water than he drinks these days and also the litter box hasn’t been changed in 4 days and looks like it might last 1-2 more days at this stage whereas previously I’ve had to change it more often than that. He seems to be feeling ok, pretty much his normal self and that’s the most important.
     
    Last edited: Jun 1, 2019
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  23. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Excellent, Georgiana!
     
  24. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    It takes a village to care for sugar fur babies! Perlutz and I want to thank you all for all the help and kind words! <3 0E596DD3-B78B-428C-910D-696BA96F4F08.jpeg
     
  25. Diana&Tom

    Diana&Tom Well-Known Member

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    Aww love it - it does take a village! A village of caring cat-lovers!
     
  26. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Sooo... we've held the 2.5 dose for 4-5 days now and it doesn't seem to work that well but the 2 times I wanted to increase back to 2.75, he gave me a nice yellow and a blue for PS o_O Yesterday at +7 he had his second highest number, 35.8, but by PMPS it went to 34.4 so it looks like his pancreas is doing some work here and there?

    I'm thinking to increase to 2.75 on days with red and black pre shot numbers and 2.5 with lower numbers.I'm also thinking of experimenting with giving 0.25 or 0.5 on days when he has a blue PS number, given that it is on a day when we are around to keep an eye on him and test. Don't know if I would be comfortable doing it when I'd have to be at work all day. Perhaps not ideal to play around with the dose but if it would help having lower numbers more often it shouldn't be an issue? Any thoughts? :bighug:
     
  27. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Jul 6, 2017
    It is odd that with overall high numbers, you got a blue pre-shot yesterday. It looks like you need to increase the dose, but I understand your concerns about the odd ball drops that sometimes occur. I wonder if that tumor is giving you issues. Hopefully, after your vet visit on the 12th, you will have some answers. In the meantime, I think that I would go ahead and bump the dose up to 2.75. When you get a low pre-shot number, you may want to try stalling for 20 minutes without feeding then test again. You can do that 2 or 3 times before you have to determine whether to give a shot or not since you have about an hour of 'play' time with ProZinc. Maybe rather than skipping the shot completely, you could try a reduced dose in those cases. I am such a believer in keeping the dose as consistent as possible, especially when there seems to be volatility in the numbers, but you are obviously going to have to adjust at least when you get a pre-shot that is too low for the full dose to be safe. You may have some special things going on here with that tumor.
     
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  28. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    I only wish I did know what to suggest, Georgiana, but I'll leave that to the dosing experts. It's so tricky when you seem to get longer duration some days, which could mean pancreatic activity, and then can't dose at usual time because he's too low - and then he shoots up.
    It's true that consistency of dosing is usually the best approach, but that's the text book and most cats just haven't got round to reading the manual. So yes there are going to be times when you might need to make small adjustments.
    Actually I took a look at your ss earlier today and nearly suggested that you consider a tiny dose when you get a blue pre shot, if you can monitor. It might just stave off the otherwise inevitable climb, and mean that you get even slightly better numbers for the cycle. Black mid cycle numbers are not nice!
    Having said all this, I think/hope the picture might become clearer when you know what's what with the tumour... not long to go now for that, and I'm glad you've got a "tumour buddy" to discuss things with afterwards!
     
  29. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    I will bump to 2.75 tonight, given that the BG allows it. I'm expecting a low yellow, maybe even another blue but I can stall in the evenings so we'll see how that goes. Yesterday I had to leave for work, I couldn't stall :(

    I do get that keeping the dose consistent is important, I wish it would be easy and straight forward but since it's not, I guess we'll just have to play some more and adjust here and there...

    Roll on 12th of June!!!
     
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  30. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Yes, I think I'll give him a 0.25 if there's a blue number. I've been thinking of doing it before but I always chickened out... Here's to another fear to conquer!

    It will be interesting to see how things are with Cassandra and Alice too. I wonder if there will be similarities or not as Alice's tumour is mamary and Perlutz's pancreatic. As I told Cassandra as well, I'm hoping we'll soon be tumour-LESS buddies!
     
  31. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    I think he read it in the wrong language :facepalm: :D
    Perlutz.jpg
     
  32. Diana&Tom

    Diana&Tom Well-Known Member

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    Poor baby, so confusing living in a bilingual household ;)
     
  33. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    That's a very old picture of him :) I found myself going through pictures of him from like 7 years ago :D
     
  34. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Well for once I could predict his pre shot number :woot: A blue 10.9! Stalling for now...
     
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  35. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Well if nothing else it's nice to see some blues - at any time!
    I wonder if he's still dropping, or maybe he will rise again fast... testing will tell (poor Perlutz!)
     
  36. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Hmm 10.7 half an hour later. I will try and give it another half an hour although he hates me already and wants his dinner
     
  37. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    +1 10.4

    I’m waiting for him to eat a bit more and I will give 0.25 units. I’m scared even with this much, I don’t dare to give more.
     
  38. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    It is scary I know. I think you've made a wise decision - you have to try this and see what happens.
     
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  39. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    My baby is home!!! After 2 very stressful days for both of us, but particularly for him, he is finally home! The poor thing is so stressed and hungry (he has only had 1 can in 40 hours!!!

    The good news is there is no tumour on the pancreas! But there are other issues... What was initially thought to be a tumour on the pancreas turned out to be a mild enlargement of one of the ileocaecocolic lymph nodes and measures 7 mm. But there are other issues, gastro intestinal and possible very early kidney disease :( The vet will call us on Monday/Tuesday when all the results are back and tell us what the next steps are.

    So far all we've been told is to keep the current 2.5 units dose and not to change it without discussing it with her first. She said we are testing too much o_O and it's not necessary, that the dose need to be held for 5-6 days. We have to test for ketones and glucose daily and continue to keep track of water intake, food and any symptoms like vomiting and diarrhoea.

    I'll type all the notes in the discharge report and the tests that have been done.

    Physical examination - pain on abdominal palpation. A small left thyroid slip and a soft systolic heart murmur which is not always present. The rest was normal.
    under sedation, he has had the following procedures:
    -CBC to assess for signs of anaemia and infection
    -Full Biochemistry: to assess liver and kidneys
    -Fructosamine
    -TT4 to assess his thyroid levels
    -fPLI to assess for pancreatic inflammation
    -VITB12 a marker of intestinal disease
    -TLI marker of pancreatic insufficiency
    -Coagulation profile to assess his capacity to clot
    -Urinalysis and culture to assess his kidney function and reveal any infection
    -Abdominal US which stated: The GB is bilobed. There is bilateral dilatation (5mm) of the renal pelvises and milkd bilateral hyperechogenicity of the medullae. There is a mild enlargement of one of the ileocaecocolic lymph nodes which is hypoechoic and measures 7mm. There is a small amount of fluid in the colon. Liver, pancreas, spleen, stomach, small intestine, adrenal glands and urinary bladder are within normal limits. Conclusions: bilateral dilatation of the renal pelvises is considered most likely secondary to increased GFR, there is no visible dilatation of the ureters and no visible urinary calculi in this examination. Bilateral nephropathy may be considered if clinically suspected. The colonic contents are compatible with soft faeces/diarrhoea; possible colitis with mild colonic lymphadenopathy.
    -Chest xrays pending


     
  40. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Wow! Thank you for this very comprehensive report, Georgiana. The place you took Perlutz to sounds amazing!

    I'm sure you're trying to absorb it all, but for now I'm equally sure that you're mainly enjoying having your baby home. Poor things, they don't understand, so he'll be loving being back home with you!

    I'm not medically informed enough to understand most of the report, but take heart from words like "mild" and "early"... these terms usually mean that issues have been spotted in good time and may very well be treatable.

    I guess you have to do what you're told and stick to the dose as advised, which is fair enough, you're paying a lot of money for the advice, after all. I don't quite see why you shouldn't be testing so much - given that you've had days when pre-shot tests have been pretty low, you want to keep yourself informed of bg. But maybe just don't have to do as many mid-cycle tests...? Hmmm.

    Anyway - I'd relax and enjoy having your boy home tonight, give him loads of love and fuss. If you wanted, you could ask for people's opinions here on the report by starting a new thread and giving it a title that will attract experienced medical types!

    Bottom line - Perlutz has been extremely well looked after and I'm sure that any issues that need treatment will be dealt with just as efficiently.

    Now breeeeeathe!!
     
  41. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    I have to agree, that report sounds good and thorough. It sounds like Perlutz is in good hands. I would also recommend you copy that report and post separately in main health forum. I personally would want to be able to understand it better, too!

    So glad he is back home. That’s the best part. How are stitches looking?

    I feel like anyone who has not personally successfully treated a diabetic cat at home is at risk of telling us it is too much testing. I’ve caught way too much flak for it. Not from my vet personally, but I think that is because she understands human diabetes, so at least she understands the need for data for tracking overall trends. I have crazy animal-loving friends and science nerds and so on who know a lot and still don’t get it..... I could never imagine doing what I do every day now, before. And I did not realize how important it was to test until I started doing it. Living in the trenches, I suppose..... :p
     
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  42. Diana&Tom

    Diana&Tom Well-Known Member

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    Good point, does this vet - good though she is - not want to see how Perlutz is doing on a consistent dose for several days? You'd have thought that would be interesting data for her.
    It also occurred to me - does she want you to give the same 2.5u dose regardless of what the pre-shot number is??? I think I'd want to discuss that with her :)
     
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  43. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    I'm just so relieved to have him home although he is not very happy with me right now :oops: He might be plotting to kill me as we speak :nailbiting: I'm going to give him space today, let him come to me and I think we all need a chill evening.

    I will continue to test as usual, every AM and PM before insulin and if I can or consider it necessary, I will do mid cycles as well. I would not be able to administer insulin without knowing his BG, I don't think that is safe and it wouldn't be able to cope while I'm at work for example not knowing what number I shot on. I think she is worried that if I test a lot, I will change the dose and she is worried that I am stressing him. I tried to be as polite as possible and not sound like I know better, but I did say I will continue to monitor and that he doesn't mind the testing that much. She did mention diabetic food but didn't push for it and is happy with the same diet as long as he eats and although dried food was mentioned, I said I would like to continue with his current all wet diet.

    Oh and the recommendation was to give usual dose if BG is 10+ and 1/2 dose if between 5 and 10 with no insulin under 10.

    I will create a new thread, not sure if tomorrow or after the results come in :bookworm:
     
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  44. Diana&Tom

    Diana&Tom Well-Known Member

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    Well done, Georgiana :)
     
  45. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    No stitches here :p He has only had ultra sound, no surgery. They don't want to do anything before having all the results back and they would rather do non emergency surgeries at the start of a week when everyone is at work rather than close to a weekend. [/QUOTE]
     
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  46. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    The recommendation was to give usual dose if BG is 10+ and 1/2 dose if between 5 and 10 with no insulin under 10.

    She definitely thought the data was interesting, she said straight away that she wants a copy as it's so useful so I was a bit surprised to hear that it's too much testing. Oh well, we'll just have to agree to disagree on this one :rolleyes:
     
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  47. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    [/QUOTE]
    Okay I thought maybe no cutting but wasn’t sure if I missed something. I tried to go back and look but I am tired. :confused: So good to have non-invasive answers! :D
     
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