Poncho diagnosed diabetic 1/15

Discussion in 'Feline Health - (The Main Forum)' started by christoph, Feb 5, 2015.

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  1. dirtybirdsoaps

    dirtybirdsoaps Member

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    K. Thank you for the clarification. I have no experience with DKA and/or pancreatitis was just curious if that was an option since theres the concern for vet bills.
     
  2. BJM

    BJM Well-Known Member

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  3. christoph

    christoph Member

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    I'll be BG testing at +2 and +3.....do I keep testing every hour or every 2 hrs?
     
  4. BJM

    BJM Well-Known Member

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    We're still working out how low Poncho goes on a given dose, so I'd check at +2 and go from there.

    For the fluids, it may help to have a dark background behind the bag, with good lighting, to improve the contrast.
     
    Last edited: Feb 7, 2015
  5. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Flow rate varies too much like for needle size and needle placement. Thus, time is a very poor indicator of fluid volume. You can try placing tap at where yu want to stop . It is easier to se when the fluid level meets the tape.
     
  6. Critter Mom

    Critter Mom Well-Known Member

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    Good point.
     
  7. Marje and Gracie

    Marje and Gracie Well-Known Member

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    I would like to underscore one thing here. If a cat has ketones that high and the numbers last night were not low, I'd be feeding a higher carb food and not reducing the dose. Advice to not give insulin if he's below 200 or drop the dose back really worries me for a cat with ketones that high. As @Meya14 said yesterday and I will repeat....give higher carb food....even mix karo in it if necessary to keep the numbers up and get the insulin in. No shot numbers do not apply in this case when the kitty has high ketones and still having BGs well above 100.
     
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  8. BJM

    BJM Well-Known Member

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    We don't know how much Poncho drops at given doses and Christoph is having trouble getting food in. A GUESSTIMATE is that 0.25 units MIGHT drop 85 mg/dL based on last night, so at 200, it could be safe to give that (ProZinc, not Lantus). It is only a guess, though. The last thing he needs is a hypo on top of everything.

    The numbers from last night using our +# from time of shot
    348 @ pmps (10:45); 0.5 units
    180 @ +6 (4:30)
    160 @ +8 (6:30)
    221 @ +10 (8:30)


    so far, the max drop starting at 350-ish is about 190 mg/dL for 0.5 units of insulin. Edited to add: THIS IS LIKELY TO VARY.
     
    Last edited: Feb 7, 2015
  9. phlika29

    phlika29 Well-Known Member

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    @Marje and Gracie I questioned this insulin advice too but I have a feeling it was meant to read that as soon as the numbers go over 200 (even if that is only at +9, + 10,etc) you give a 0.25 dose to keep it low rather than wait the whole 12 hour cycle and allow them to go up higher as we would with lantus. Ie you chase the lower numbers. I guess tonight will tell. I am hoping @Sue and Oliver (GA) will also chime in if she comes online.
     
  10. Marje and Gracie

    Marje and Gracie Well-Known Member

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    @phlika29 I understand but even with Lantus or levemir, you can shoot early and shoot the full dose in these cases if you can monitor.
     
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  11. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    My basic stance is ketones trumps pretty much everything. I've posted this in the past and I'm happy to reiterate -- I don't care if you have to feed a kitty an ice cream sundae to get food into a ketone prone cat -- you've got to get an adequate amount of insulin on board or you don't just have ketones, you have a cat that's critically ill with diabetic ketoacidosis. And DKA cannot be managed at home.

    In other words, shoot the effective dose and feed high carb, syringe feed, do whatever it takes to get both food and the insulin in. The high carb will circumvent low numbers and provide the calories necessary to also combat ketones. DKA circumvents nothing.

    I know of no "rule" that says this will consistently happen. Cats are way too unpredictable and there are too many factors that influence the action of insulin. Furthermore, there's not enough data on Poncho's SS to draw any reliable conclusions about the nadir.
     
    Last edited: Feb 7, 2015
  12. christoph

    christoph Member

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    I just tested @ +2.....240, but this was after I had to take Poncho down 4 flights to meet a mobile vet who was able to swing by and give him another B12 shot and we had to wait in my truck for 15 minutes so stress might have pushed his BG up.....make sense? Or was I on the low side on the dose? Plus the clinic called while I was right in the middle of the BG ear pricking......they said bring him by @ 2 for a cerenia injection. I'm still waiting for Poncho to pee for another ketone test. I'm going to have to take cat naps until this levels out. Next BG test is due at 1:45, when I'll be on the way with Poncho to the clinic for the cerenia. Wait till we get back home to BG test him between 2:45 and 3? Bad timing but he needs the meds.
     
  13. phlika29

    phlika29 Well-Known Member

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    Could you get a +3 instead of a +4 and still make the appointment?

    Whilst you are there get them to give you some cerenia pills. They should have some. You don't have to always go in for the injection especially as it adds to ponchos stress. In fact couldn't they give you the pills instead anyway. Are you okay giving pills?

    What did the mobile vet say?

    I think with meter variance the 240 is almost the same at the preshot dose. So I think what with the food and the stress that would be as you might imagine.
     
  14. phlika29

    phlika29 Well-Known Member

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    Just looked back to check your preshot reading and I noticed that you said that you took the reading at +10 but waited till +11 to give the insulin. I think at the moment the aim is to give more insulin as soon as he does over 200 rather than wait any more time. If you did wait an extra hour it might have risen some more.
     
  15. christoph

    christoph Member

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    Ok....I wont wait next time. I'll BG test @ +3. Poncho and pills are a disaster. I had to switch him to clavamox liquid from the pills. Unless I could crush one and give it via syringe feeding. I'll call them and ask about the pills. The mobile vet had nothing to add.
    BG +3 was 218 The clinic said they have no pills but that I can ask the vet for a prescription.
     
    Last edited: Feb 7, 2015
  16. phlika29

    phlika29 Well-Known Member

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    No best go in for a syringe and then you don't have to worry for now.
     
  17. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Christoph,
    You're doing an awesome job in very difficult circumstances. And I just want to create a moment's space in this thread to give you a
    :bighug::bighug::bighug:(((huge HUG))) :bighug::bighug::bighug:
     
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  18. Meya14

    Meya14 Well-Known Member

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    Innova or Evo kitten foods are higher cal. Natural balance is higher cal as well, and has higher carbs and lower fat than the other two, which might work well. I think you can crush the pills and mix with a tiny bit of food (not too much in case it's hard to get in him) and syringe it.
     
  19. BJM

    BJM Well-Known Member

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    Exactly what Siene said - I was GUESSTIMATING and trying to keep him safe at the same time in the ABSENCE OF MID-CYCLE DATA while trying to get the glucose down.
    We have exactly 2 periods of data with mid-cycle numbers
    1) the aborted curve on 1.5 units starting in the high 300s and dropping down to 60ish, at the vet which may be measures from an unknown meter or lab equipment
    2) last night, where, due to that aborted curve at the vet, I suggested 0.5 units to see if it might help without sending Poncho into a hypo on top of the ketones.
    And that is ALL the mid-cycle data we have.
    If Christoph can't get food in and we don't know for certain how low Poncho will go on a given dose of insulin and the ER isn't an option, what do you think will work better? I'm doing the best I can for him while trying to keep Poncho safe
     
    Last edited: Feb 7, 2015
  20. BJM

    BJM Well-Known Member

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    And yes, I meant as soon as Poncho gets high enough (200), shoot the ProZinc to try to keep him as low as safely possible given the minimal data on how he responds to it.
    As we collect more data about how he responds, we can tweak that to optimize the glucose control. We just need the data to be able to do it!
     
    Last edited: Feb 7, 2015
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  21. Marje and Gracie

    Marje and Gracie Well-Known Member

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    There is no reason to yell just because others might disagree with you, BJ. We all have Poncho's safety foremost in our minds. No one wants Poncho to hypo and we wouldn't be giving the advice we are if we thought there was potential for him to do so.

    As Sienne pointed out, right now the primary issue is safely getting as much insulin as we can into Poncho to prevent DKA which is costly to treat and Chris cannot afford. With Chris monitoring as he is, if numbers start to come down, there's nothing keeping him from even syringing a ml or two of karo into Poncho, if necessary. Ideal...no. But if it keeps him from dropping lower than we want, it's better than letting the BG stay too high and the ketones continue to rise.
     
  22. BJM

    BJM Well-Known Member

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    I'm not as confident as you seem to be that he'll be able to get Karo in given how Poncho has been about eating.

    And its not about disagreement, its about not understanding what I've meant. So I've tried to clarify, and highlight, and color code things so they don't get misunderstood.
     
  23. phlika29

    phlika29 Well-Known Member

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    @Elizabeth and Bertie I have another question that was raised by @Meya14 this morning but never picked up on. You may be able to answer.

    Do/can people dose prozinc three times a day? If so how does that affect the dose? Whilst I understand prozinc is not the same as lantus I am guessing that there may be some affect of dosing earlier than the normal 12 hours. Chris gave a reduced shot at +11 after his cat got to just over 200. What,if any, are the implications of doing this again? Say if next time the reduced dose wears off at +7 and he raises over 200 ? In effect dosing three times in 24 hours.

    Just thinking ahead. Sorry I know you won't know all the answers but you may have some idea.
     
  24. BJM

    BJM Well-Known Member

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    Yes, it can be dosed every 8 hours (TID), earlier if needed.
    Depending on the dose, duration, and cat's response, there may be some overlap. In this case, any overlap should help keep the numbers down which is desirable.
     
  25. tiffmaxee

    tiffmaxee Well-Known Member

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    Cerenia is available in tablet and injection in the U.S. Some do better with ondansetron, some with cerenia and some need both. Whichever you use needs to be given every day until the appetite is back to normal. I use cyproheptadine as an appetite stimulant and just a crumb, 1/8 a 4mg once or twice a day works for nearly 16 pound Max. He has had chronic pancreatitis for 5 years and I think is having his first real episode since diabetes struck a year ago. This time it was likely brought on by a dental and having three teeth extracted. Hang in there.
     
  26. Meya14

    Meya14 Well-Known Member

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    When asked about the TID dosing, since it looked like his BS was peaking too stongly maybe dosing less (.25 or .25skinny) but dosing TID might keep him more even and still give him the insulin he needs.

    Probably, prozinc is not right for him (seemed to hit too fast and hard, then wear off before next dose). This probably isn't good coverage in the long run. But until he's out of this acute situation, it's what he's got to work with.

    Thoughts?
     
  27. BJM

    BJM Well-Known Member

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    He either needs a different insulin, probably a depot type, or very cautious, sliding scale dosing on the ProZinc.
    I'm trying to piece together the data Chris reported last night. There appears to be a likelihood of lots of unrecognized bouncing, plus the vet based the dose on eating, not on pre-shots.
     
    Last edited: Feb 7, 2015
  28. Critter Mom

    Critter Mom Well-Known Member

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    @tiffmaxee - Sorry to hear that Max is having an episode, Elise. :(
     
  29. phlika29

    phlika29 Well-Known Member

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    Hey Chris

    Just wondering if you managed to get a +3 and to ask how things went at the vets? Please don't forget to update us.

    Hope you are holding up to as well. Don't forget to eat and get a few naps in.
     
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  30. christoph

    christoph Member

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    BG @ +3 was 218. Well, I drove to the clinic and mentioned that I had started Poncho back on insulin starting with a lower dose, and got a lecture about following their directions or find another vet......this after they stopped his insulin and gave me 2 options...a greedy specialist I can't afford or euthanasia. The tech also said the upper respiratory infection had no bearing on the curve. So they refused the cerenia injection and said if he's not throwing up he doesn't need an injection or pills. When should I check BG again? I need to add to the SS and have to buy some more BG strips. Poncho got a B12 shot but his appetite is still down. I did get 2 more cans of ad. More syringe feeding ahead.
    Thank you Elizabeth and Bertie for the big hug and encouragement! I'll relay the hug to Poncho.
     
    Last edited: Feb 7, 2015
  31. BJM

    BJM Well-Known Member

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    Well, we still aren't entirely sure when he nadirs. Prozinc often has the nadir somewhere between +5 to +7 hours after the shot.
    So now would probably be good. Be sure to enter it on your spreadsheet; the color coding really helps to highlight the changes.
     
  32. Chris & China

    Chris & China Well-Known Member

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    I've just been following along and praying for Poncho and Chris....Hang in there Chris!! :bighug::bighug::bighug: (you can always use more hugs too!)

    I know little about DKA and not much more about ProZinc, but just one thing I wanted to ask/add....IF he were to drop too low, can't you rub the Karo on the gums or give it rectally if necessary to get it INTO him?
     
  33. BJM

    BJM Well-Known Member

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    The directions for managing a hypo say you can. I'd rather not find out!
     
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  34. Chris & China

    Chris & China Well-Known Member

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    Yeah that's something I've never been really keen on trying either....I was just thinking of IF it's an emergency it's an option
     
  35. Meya14

    Meya14 Well-Known Member

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    If the DKA can get under control and he starts eating again, assuming there is no other underlying issues (liver disease, pancreatitis) then a cat can recover rather quickly and lead a perfectly normal (diabetic) life. Euthanasia is not a necessity due to the DKA alone. It is very complicated to treat, however, and expensive because it needs hourly attention from the Vet/techs. I think a lot of vets are misinformed, or just do not have the motivation or experience with it. I'm blessed to have a cat-only vet who is the top vet for diabetics in my area (this is probably 1/4 of her clientele). She's not a "specialist" but just a very smart lady.

    It's not by far a hopeless situation, just a lot of work. And you are doing a good job.

    For a timeline reference, when Max was sick his ketones were "high" when initially tested. Max was listless and wouldn't eat or really even move. We started force-feeding, subQ and insulin the day he was Dx. Force-fed for 2 days, added the anti-nausea on the 3 or 4th day, and he began eating with some forcefeeding. At 5-6 days, he was eating/drinking on his own. Watered down his food for the next week. After 2 weeks he was close to normal.

    Where do you live about? Maybe someone on here can recommend a vet. You need to find someone that is willing to get meds for you at least, better if they can give good guidance and do labs as well.
     
    Last edited: Feb 7, 2015
  36. BJM

    BJM Well-Known Member

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    Ok, he's popped up to 333 and needs more insulin.
    I think you could give him 0.5 units. The others might suggest 0.75 units.
    If you feel confident you can get Karo syrup into him if he goes too low, go for 0.75. He needs to get the glucose down as much as possible.
     
    Last edited: Feb 7, 2015
  37. christoph

    christoph Member

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    I'm in Kansas City MO. I have been talking to my old vet Larry Zeis in St Louis and might drive Poncho there at some point but in the meantime he's been in touch and I had SPCA fax Poncho's file. Right now Poncho is exactly as you described Max. It's heartbreaking esp when force feeding.....he looks at me as if to say "Why are you hurting me, Dad?" Just a couple days ago he was eating.....not normally but he wasn't like this. I'm still waiting to test the ketones again. Should be able to just after fluids.

    Poncho's 4:45pm BG was 333. When do I test again? I need to get more test strips and get back before 6:30.
    I'll do .5 but should I wait until I get back? or get the strips later .....
     
  38. phlika29

    phlika29 Well-Known Member

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    Did you see BJMs response above. You don't wait anymore you give 0.5 or 0.75 , if feel confident to handle a possible hypo, now. How long can you go out and get back with the strips?
     
  39. BJM

    BJM Well-Known Member

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    He appears to nadir toward the late side so if you got a +5 from the shot, that could work.
    Although, at the vet, he dropped to low levels by +4. Lets go with a +4 from the shot.
     
  40. christoph

    christoph Member

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    So give it now 5:45 and run to Walmart for strips.....1 hr trip total?
     
  41. phlika29

    phlika29 Well-Known Member

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    Yes it seems so. As he has gone higher than you want. So now you have to decide on 0.5 and 0.75. Depending on how you feel you could handle a possible low blood glucose.

    An hour straight after the injection is the best time to go out.
     
  42. christoph

    christoph Member

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    Ok....gave .5 and off to get strips. BG test every 2 hrs tonight?
     
  43. phlika29

    phlika29 Well-Known Member

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    Yes please. I am afraid I won't be able to stay with you all night as it's time for my bed. Please look after yourself you are doing great. Hugs to both you and poncho.

    You need to carry on with the food as advised before. And keep the water intake up and test for ketones. Others will keep and eye on you.

    Just in case numbers go low. Keep this link handy and follow the protocol and post up your numbers either in this thread or start a new thread. Hopefully they will go low but not too low

    http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

    Best wishes

    Sarah
     
  44. phlika29

    phlika29 Well-Known Member

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    Okay I am signing off now. You are doing really well.

    So to confirm you gave 0.5 units of prozinc at +7 after blood glucose rose to 333. A blood test will be done at +2 and then every two hours. If poncho drops low then the hypo protocol (posted above) is to be followed. When poncho has gone past his nadir and blood glucose levels begin to rise again above 200 then another dose is to be given (unless the consensus is otherwise). Dosage to be confirmed but likely to be 0.5 or 0.75. Please post all results here and add to spreadsheet.

    Continue to assist feed and ensure hydrated (please review posts by @Meya14 ) .

    Ketone readings to be taken whenever possible and the results posted and added to spreadsheet.

    Chris I am sure other members will be able to keep an eye on you but if you are concerned then start a new thread with a 911. See you in a few hours. Please do eat and get some rest. Just remember to set an alarm!

    To anyone else reading. Please correct me if I have got anything wrong. :)
     
    Last edited: Feb 7, 2015
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  45. BJM

    BJM Well-Known Member

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    I'm here and can stay up for roughly 5 hours before I'll have to crash.

    It could be another long night. If you need to nap, snag 45 minute multiples (45 minutes, 90 minutes) as a sleep cycle lasts about 45 minutes and it is easier to wake up at the end of one.
     
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  46. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    just want to add my encouragement Chris. With ketones it's really important to stay the course with the insulin and adjust food/carbs as needed to keep him safe.

    Hang in there!
     
  47. christoph

    christoph Member

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    Just got back. Thanks Sarah....sleep well. We'll be ok.
    Thanks julie and punkin
    I appreciate your help BJM I'll try to get some short naps.
     
    Last edited: Feb 7, 2015
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  48. BJM

    BJM Well-Known Member

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    Hang in there, Chris.
     
  49. BJM

    BJM Well-Known Member

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    If you shoot earlier than +12, color the cells in front with gray and note the early shot so folks don't think you missed the pre-shot.
     
  50. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    Didn't want to interrupt when things were hairy but now that it's sort of 'breathing' time - CHRIS! You're doing wonderfully!! HUGS!

    Lots of thoughts and prayers for both of you...
     
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  51. christoph

    christoph Member

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    What the heck.....+2 BG 366.....test again? Ketone test was 40....down from 60 from last night.
     
  52. Jmeli

    Jmeli Member

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    Chris I have been lurking and following along. I am new here as well so can't offer much but I just wanted to say you are doing Grrreat!!!
    ((BIG HUGS)). I hope Poncho gets to feeling better soon.

    Its true what BJM says about sleeping in 45 minute increments, It really is easier to wake up because you aren't in the middle of the deepest REM sleep.

    And regarding the vets comments about its my way or the highway.... I had a vet tell me that once, and I hit the highway and never looked back.
     
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  53. BJM

    BJM Well-Known Member

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    Whenever you get what seems to be a wonky result, re-test.
    If you get 2 numbers within 20% of each other, they may be considered the same.

    Also, if you fed him around the time of the shot, there is often a food-related glucose spike by +2 hours after the food.
     
    Last edited: Feb 7, 2015
  54. christoph

    christoph Member

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    Ok BJM, I'll test again. I'm not sure how to color the squares.....if I'm understanding you right.
    Thank you Jmeli. I called the vet on a screw up 2 weeks ago and guess she never forgets/forgives.
    Retest BG 364@+3 Did I mess the shot up?
     
    Last edited: Feb 7, 2015
  55. BJM

    BJM Well-Known Member

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    To manually change the color on a square,
    Click on the square.
    Up at the top, there is a small icon depicting a bucket of paint; click on it and select a color.
    That's all there is to it.
     
  56. christoph

    christoph Member

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    Thank you for your kind words and hugs, Squeaky and KT!
     
  57. BJM

    BJM Well-Known Member

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    Chris, if you've got a Face Book account, join the Feline Diabetes group there so you can post your fund raiser.
     
  58. christoph

    christoph Member

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    Thanks BJM, I'll check it out.
    BG@+4 326
     
  59. BJM

    BJM Well-Known Member

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    It is possible he is bouncing some from getting into the hundreds last night.
    A bounce happens when the glucose drops suddenly and/or to an unaccustomed level. This triggers compensatory hormones to release stored glucose, which then brings the levels back up. This effect can last for roughly 3 days.
     
  60. christoph

    christoph Member

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    So how often should I check BG levels.....every 2 hrs?.....shot time determined by BG level at certain time?
     
  61. BJM

    BJM Well-Known Member

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    At this point, I'm thinking once you're past +6 (about the nadir of ProZinc, when there is one), unless he suddenly drops, he's high enough to shoot again with 0.5 to 0.75 units. You could nap until then, and possibly nap for 3 hours after you shoot, too.

    How's the eating and the fluids going?

    @Meya14 if you're on, what do you think?
     
  62. Meya14

    Meya14 Well-Known Member

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    I lost track of how you guys were dosing (twice a day, TID, every X hours, at a certain cutoff, etc?), BJM, if you could refresh me, that would be great.

    I'm not sure that his higher numbers are due to him being lower yesterday. You are providing more foods, and as his body starts to compensate for some of the stuff going on, he will probably start needing more insulin. This seems to happen. Don't be afraid to give more insulin to keep his numbers down. Goal is under 300 at all times. Better if he can stay near 200 for most of the day.

    I don't have a ton of prozinc experience, and for me it's easier to have a consistent dose (rather than sliding a dose) so I can see if patterns develop. I use Lev, so my approach is quite different, and BJM has a better understanding of the nuances of prozinc. My advice, however, is err on the side of a higher dose if you can't decide.

    Oh and congrats on the lower ketones. That's a good thing.
     
  63. BJM

    BJM Well-Known Member

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    Meya, thanks for the input.
    ProZinc is an in and out insulin that usually nadirs around +5 to +7.
    Last night, Poncho hit a nadir of 160 around +8.
    Tonight, with a similar pre-shot (he shot early), he's just staying high and flat.
    If the numbers do reflect more food with higher carbs, then I'd agree, lets kick up the ProZinc, maybe even to 1 unit.
    And while we don't usually do this, I'm thinking as soon as the nadir is past, if the glucose is high enough, shoot to get it down, just scale the dose to the pre-shot level whenever it is.
    I know in a hospital, they'd have an IV drip of R going in for more or less continuous glucose control until they got electrolytes, and glucose stabilized. Shooting as soon as its high enough post-probable-nadir makes sense to me in this situation. Think of it as shorter versions of overlap/depot.
     
    Last edited: Feb 8, 2015
  64. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    Yeah, I agree with the more frequent dosing, cause you can give a smaller dose more frequently, and not send him down too far like what was happening. Instead of watching the numbers for indication of when to dose it's probably easier for him to do every 8 hours, and it will be easier for everyone else to follow what is going on and help with changes. 8 hours should be just past the nadir and would let him see a small rise (ie. safety), correct? What dose to begin with?

    Also, if he is dosing this way, maybe someone could add a column to make it a TID spreadsheet?
     
  65. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    The simplest approach may just be to use a row for each shot and gray out the unused part. That keeps it all in 1 spot and he can label it as shot 1, shot 2, shot 3 on the respective lines.
    He may be grabbing some sleep and be back shortly.
    I need to crash - will you be around for a bit?


    If high carb food is going in, it could be safe to do 1 unit at maybe 250 or higher., but I am guessing.
     
    Last edited: Feb 8, 2015
  66. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    1 unit TID seems like a big jump? What was the last shot, 0.5U? I think that if he is closely monitoring, trying a cycle or two at 1U and see what happens might be ok, and lower to 0.75TID if he drops below 80ish on his nadir.
     
  67. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Chris
    When you come back, if you think it will be easier to shoot every 8 hours, just put each shot on 1 line and label the line so folks can follow it.
    If you're feeding higher carb foods and/or Poncho is soaring over 300 mg/dL you can increase the dose.


    This is a draft of a sliding scale for dosing. Right now, it looks like pre-shot numbers
    over 300 could get 1 unit,
    250-300 could get 0.75 units.
    200-250 could get 0.50 units, and
    under 200 could get 0.25 units.
    - this is just a draft/estimate. Use your judgement and get feedback from others.

    If/when a nadir happens, it may be anywhere between +5 to +8, so that is when you'd most need to monitor and test.
     
  68. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    That looks great. I have to go pretty soon as well. If I wake up or can't sleep, I'll check in.
     
  69. christoph

    christoph Member

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    Feb 2, 2015
    I dozed off for 30 minutes and woke at midnight, did a BG and was +6 @ 274. I force fed him a few hrs ago a little over 10 ml of Hills ad. He can't deal with it more than that. Got fluids 8pm or so and ketone 2nd test today was @ 40 moderate both times as opposed to high 60 last night (Fri) He has no appetite and is pretty down and out even after a B12 shot. I wish he could tolerate forced feeding better. I'd like to find something more concentrated so feeding/stress is lessened. So when to give next shot? .5 again now @+7 after new reading over 200?
     
  70. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    Hi Chris. You seem to have me again:).

    Now before I give advice I have to say I have zero experience of prozinc and so I am going to have to give you my advice based upon my reading here and my limited experience.

    As BJM said above his nadir is somewhere between +5 and +8. So the +6 of 278 might not be is lowest but them again it isn't that low and so we need to catch it as it is rising. Could you test in 30 mins to give us some more data to work with. So a +6.5. Don't feed again until after the test.okay?
     
  71. christoph

    christoph Member

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    Feb 2, 2015
    Ok 30 minutes I think it will be +8 so I'll test and see if it's dropping or rising from last test #. I'm only able to feed him every few hrs due to the stress on him and I think that amount is at least 1/2 a can per day of ad for a 7-8lb cat. I need to kick it up but the stress on him is major. I wish he'd start eating again like before the vet took him off the insulin.
     
  72. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    Oh sorry, I got confused in my early morning stupor. Go ahead and test him now and then based on the reading we can decide on the dose.
     
  73. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    This is the food I feed remi when he was very sick. He had been throwing up for weeks and would gag and be sick if I tried to feed him. Yet when I made this up into a syringe he accepted it much more readily. It is like a milk consistency and not much smell or taste. Certainly not a meaty one. Remi loved it. It won't be low carb but from what I have read that it not our main priority at the moment
    http://www.vetuk.co.uk/royal-canin-...n-convalescence-support-instant-sachets-p-254
     
    Last edited: Feb 8, 2015
  74. christoph

    christoph Member

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    Feb 2, 2015
    +8 BG is 245 so .5 unit do you think?
     
  75. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    Hmm I don't know. It's so close to the 250 mark. I am thinking go for 0.75 but let me ask @Elizabeth and Bertie to comment. I think she is online.

    Peer need to get poncho into good numbers and I just worry that the 0.5 might not kick it enough but as I say not any experience with prozinc.

    You have karo/honey don't you and plenty of strips? And able to test?
     
  76. christoph

    christoph Member

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    Feb 2, 2015
    I have some honey and plenty of sticks. My concern is the sharp drops he had during the two curve attempts. Not sure what caused those.
     
  77. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    Right I don't she her online anymore so it looks like it is up to us to work this out. We have limited data. I think that BJM would point out that the 274 and the 245 are within 20% variance that you find with meters and we are sort of dealing with the same number the last two readings.

    Yesterday's shot of 0.5 got us into the mid blues but no lower. If you look at your spreadsheet you will see yesterday's slight dip. If we want lower numbers then I think that we need to increase just a tad and if necessary support with high carb or honey as the others have mentioned.

    When he crashed before he was on 1.5. So even if you go to 0.75 that is still only half the dose. Would you be happy with that?
     
  78. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    Is 274 and 245 within 20% of each other:confused: My maths is terrible:nailbiting:

    Edit-yes just checked and it is:D
     
  79. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    I'm here! Just give me a second to read that last few posts.
     
  80. christoph

    christoph Member

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    Feb 2, 2015
    I think the second crash he was given 1 unit....I need those numbers.
     
  81. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    Okay let's see what Elizabeth says in a second. If you don't want to give a 0.75 then you could always give a fat 0.5 but we need to get him into better numbers.
     
  82. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Yep, it is within 20% (you were quicker than I was working that out, Sarah...)
    However...
    The trend of the last few tests are that the BG is falling.
    That last test may have been correct and not just a +/- 20% variance.
     
  83. phlika29

    phlika29 Well-Known Member

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  84. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    BJ may be right that there is some bouncing going on.
     
  85. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Definitely retest.
     
  86. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    Retest then please Chris
     
  87. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    I know it's important to give Poncho insulin.
    But if the numbers are falling (and may be dropping out of a bounce) it's hard to predict the effect of the shot.

    Just gonna get coffee...:coffee:
     
  88. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Just looked at Poncho's spreadsheet and it looks to me like he bounced from those blues yesterday (hence little response in the cycle after that) and he is now coming out of the bounce.
    Have a look at that Sarah, can you see what I mean, or do you see something different?
     
  89. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    I sort of see what you mean but I don't have much experience of reading spreadsheets and so reading them appears abit of a dark art to me. What about the 0.25 dose yesterday? That must have played a part in the higher numbers in some way though?

    So depending on the next test result it sounds like you are going towards the 0.5?

    @christoph do we have another test result?
     
  90. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    It may simply be that the .25 wasn't enough. Or it could be that the same thing would have happened even it it had been .5 (if it was a bounce). We just don't know...

    I would certainly advise very cautious dosing indeed if the numbers appear to be dropping.
    Let's see what the next test says, and hope for a rising number...
     
  91. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Chris, just checking that you're OK
    Maybe you're grabbing some much needed sleep.
    Will check back here in a little while.
     
  92. christoph

    christoph Member

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    Feb 2, 2015
    I was waiting for a green light and couldn't see new posts and dozed off, woke up at 3 central and went ahead with 0.5, then all the new posts appeared with the latest conversation. I needed to pre shot test I guess.....I'm a bit confused.....and don't know how to enter this on the spread sheet since it's designed for 2 shots per day and this was to be the 1st of 3, right? Going to test him now.....hope I didn't mess up. BG is 258, but was supposed to shoot @ 2am right after the 245 reading so I was an hr late.
     
    Last edited: Feb 8, 2015
  93. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    No you didn't mess up. Me and @Elizabeth and Bertie are both in the uk so for ease how many hours ago did you give 0.5 and what will the test you do now be? A +1 or +2. Not sure about your spreadsheet. You gave the 0.5 dose around 8 hours after the last one didn't you?

    Not sure why the comments didn't show up. Just make sure that you refresh your browser regularly.

    Just to also check you are still giving fluids and syringe food aren't you? Did you see the link I gave to the food I have remi when he was very poorly?
     
  94. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    I'm glad you managed to grab some sleep, Chris.
    This whole situation must be exhausting for you.

    I'd suggest getting the first test in as soon as you can, just in case Poncho's blood glucose has continued to drop.
     
  95. christoph

    christoph Member

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    Feb 2, 2015
    Almost an hr ago @ +9, when I had intended to give it +8. The test was 20 minutes after the shot. It's my error.....lack of sleep and drifting in and out. I should have gone to my inbox like I just did. Lack of sleep=stupid. I'll see if they carry that food here in US.....thanks. Last fluids were 8 hrs ago. He likes to wrestle with me on that too....frustrating......hate that big needle.
    Since the 258 BG was so close to the shot (15 minutes post shot) I entered it on the spread sheet as pre shot test.....make sense? Still have to figure out the 3 shot daily charting. I need a 3 hr window for sleep.
     
    Last edited: Feb 8, 2015
  96. christoph

    christoph Member

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    Feb 2, 2015
    I think it was going up when I shot. I'll test again in 1 hr.
     
  97. phlika29

    phlika29 Well-Known Member

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    Okay so we have a sort of preshot at 245, a 0.5 unit given at +9 from the last dose and a +20 mins of 268. That sound okay to me.

    When did he last eat? I know its tough but you need to keep on with that.
     
  98. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Thanks for that recap, Sarah.
    That 245 and 268 are sort of the same number, so, no drop or rise at that point.
    Doing OK so far.

    Chris, how are you holding up?
    .
     
  99. christoph

    christoph Member

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    Feb 2, 2015
    ok...need some sleep after some force feeding.
     
  100. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    (((Chris)))
     
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