Shots and charts oh my

Discussion in 'Feline Health - (The Main Forum)' started by Lois and Java, Feb 8, 2017.

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  1. Lois and Java

    Lois and Java Member

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    Hi, I've been working with Kris and Teasel and a few other kind folks. I'm worried right now because Java's in the black, and I'm shocked that his BG # isn't down at now +4 after his PM shot. Kris won't be up for hours, E-W time zones.

    I was sure it was a good shot until now - that's the only thing that could explain how high it is now? Is there something that I should do? Give a quarter of a dose or something?

    Take him to the vet ER? He isn't showing any signs of distress, is sleeping curled up with Lily (cat) but I worry because he's 20 yrs old.

    I've ordered new needles and ketone strips, but they're not here yet. I just looked at the ADW shipping order and the tracking number is erronously not HTML enabled so I'm not sure when I'll get them; end of this week at latest. I've never used ketone strips before.

    Eta: on the SS, the bottom part is this site's style. I started with historical data and assigned hours to +1 etc. to do that and it's the top part.
     
    Last edited: Feb 8, 2017
  2. Chris & China

    Chris & China Well-Known Member

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    The best explanation I can give you is that Java is "bouncing" off those blues today.....his body had gotten used to living in reds and purples, so by dropping him back to what his liver thought was a dangerous level and it released stored sugars and hormones to bring his blood glucose back up to where it's "used to being"....we call it "bouncing"

    it can take up to 3 days for a blood glucose to return back down to its former "normal"
     
    Last edited: Feb 8, 2017
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  3. Lois and Java

    Lois and Java Member

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    I'm so grateful for response thank you. I really don't understand this bouncing business. Bottom line, is it safe for him - and me! - to go to sleep now with his BG so high? I wake up a couple times during the night anyway so I could test him.
     
    Last edited: Feb 8, 2017
  4. Squalliesmom

    Squalliesmom Well-Known Member

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    Hi Lois. Yes, it should be safe for you and Java to call it a night. Test him again at his AM pre-shot time and go from there. :)
     
  5. Lois and Java

    Lois and Java Member

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    Thanks. I took a look at your Squallie's SS. You've had some black and the red but things are fine down the line. Reassuring. I can't seem to get over my panic. Thank you, good night.
     
  6. JanetNJ

    JanetNJ Well-Known Member

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    The mid day numbers are still pretty high. When his preshot is red or black I'd go with 1 u.
     
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  7. Lois and Java

    Lois and Java Member

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    3am, or +8, 506
     
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Hi Lois,

    Yup - big bounce numbers. His body is overreacting to the low numbers from yesterday. The numbers don't have to be that low, just lower than usual and/or he dropped there faster than usual. Bounces will stop when they stop unfortunately. Janet has suggested upping his dose when his PS is red or black. He's now had 5 doses of 0.75 u and based on the size of those blue numbers, his dose can be increased. You can try 1 u this AM.

    When you have a reactive kitty like Java (and mine!) you have to look at the PS numbers but focus more on the middle numbers. The PSs are often artificially high (overreactivity). You want to decide on a dose based on how low he goes because that's where the more immediate danger is - ie., going too low. What you can't do is start jumping around in dose size and timing. These kitties need calmness and consistency.
     
  9. Lois and Java

    Lois and Java Member

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    He just woke me up meowing to go out into the rain where the good water is. Prob really high.
    Yup, 570. He's eating now. I'm guessing a shot 1/2 hr early is okay with these #s?
    Check, 1 unit.
    Eta, I'm shooting now. He's demanding to go out and it's a highlight of his life, these am outdoor trips. I want insulin in first.
     
  10. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, 1/2 hour early is fine with PZI. This is when your patience will be tested to the max - trying to sort out when bounce numbers are muddying the picture. It's important to not overreact. If you have time today, doing an every 2 hour curve might help to clarify the BG situation. If it ends up being all high and flat after 12 hours, that's evidence of bouncing. That can mean that the dose is too high or that the bounce isn't finished yet. There are many nuances in playing this game ...
     
  11. Lois and Java

    Lois and Java Member

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    I think I'm going to have a heart attack first. It's all exacerbated by his age; he's so so resilient - 2,4 heart murmur his entire life, so many battle wounds - I'm on edge, knowing it's a count down to the end of his life and hoping it's years, months, not weeks, days. That kind of alertness is not sustainable, so in a way, I'm doing my own form of bouncing between I'm okay he's okay Lily's okay, and omg the sky is falling what is going on with him panic.

    But Squallie's SS had lots of ups and downs and clearly is thriving now.

    I get the bounce info intellectually, but obviously not practically. I thought after that early period with lots of blues and yellows, that it would stay that way. Was a really good pattern, those blues and yellows? Is yes, so frustrating it didn't stay!

    Lately I keep wondering about his kidneys. I've got four years of blood tests, maybe I'll get those entered into the SS today. There was so little change in values, the vet and I agreed to give up Sub-Q fluids. I've been feeling like he should get a rinse via Ringers. Maybe a blood test. Or leave it alone, he's getting stuck enough. He is an extraordinarily good patient, still some stress going to the vet.

    +2, 250 BG.
     
    Last edited: Feb 8, 2017
    Reason for edit: Eta latest BG
  12. Lois and Java

    Lois and Java Member

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    Do people have experience with Young Again treats Carnivore Zero? They sent a sample with the bag of YA Zero Mature, and apparently it is crack. I just gave him two. I'll be sticking him all day so I would give him more today after sticks, but I will wait to see if anybody responds first.
     
    Last edited: Feb 8, 2017
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  13. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I understand the anxiety, Lois, I really do. I had to teach myself not to react to Teasel's numbers or they would have had to drag me away in a white jacket with straps on it. ;)

    If you look at other SSs you'll find many examples of kitties running up and down the dosing scale, often inexplicably. The good dose is a moving target. Repeat that to yourself over and over. It's NOT a situation where you fiddle around with dosing for a while, find a good dose and there you have it, done and dusted.

    I can't advise on the Sub Q fluids because I have no experience. One thing I have read here is that you shouldn't use the same site for fluid administration and insulin injection.

    Lastly, I like the yellow after that infernal black. :)
     
    Last edited: Feb 8, 2017
  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Sorry, I can't help there. I feed my guy Orijen freeze dried meat treats. He especially likes the Wild Boar.
     
  15. Sootyca

    Sootyca Member

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    I know how easy it is to be obsessed over the numbers and to worry over them - it's what makes you a good cat mum :) You have to try and think that he is more than a number :) He's still a cat and still just the same as he was before diagnosis (with just a little extra care needs!)

    I'm trying to pay as much attention to how she my girl is in herself as to how the numbers are. She has had a spell of fairly high numbers (for her) and a couple of spikes but throughout it all she didn't really change personality wise and in her habits so I left her be and with a food change managed to get her back. Today whilst her BG number was technically low enough to just be safe on a very low dose she has been very subdued and quiet so I haven't given her any insulin.

    Sky's insulin dose gets varied (with the vets approval) because she seems to store it up - contrary to what her insulin is supposed to do.
     
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  16. Lois and Java

    Lois and Java Member

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    >> The good dose is a moving target. Repeat that to yourself over and over. It's NOT a situation where you fiddle around with dosing for a while, find a good dose and there you have it, done and dusted.

    Well heck!

    Shouldn't have answered the phone just before I was leaving for a class, but I did, so I missed +4, but +6 is 141. And he is happily sitting outside in the rain again. That's my boy!

    When I helicopter over him, it's too easy to project things onto him, when all he's really doing is sleeping normally.

    His behavior was markedly different and strange when he would go really low, luckily, because, then I'd catch it before it would kill him!

    He yowled to come back in in just enough time for me to go do something that starts in 15 minutes and will get me back here in two, two and a half hours.
     
  17. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That 141 is a nice number. Test when you get back. One unit again tonight. Repeat after me, "
    The good dose is a moving target ... the good dose is a moving target ... " ;)
     
  18. Lois and Java

    Lois and Java Member

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    >> "The good dose is a moving target ... the good dose is a moving target ..."
    Darn it!
    It's 340 at +9.
    He's acting very Ragdoll right now, and it's easy for me to say it's because his BG is high. But really I think it's the time of day, because he was super high this morning and could not wait to go out on his morning rounds.
    All the stuff from ADW came! New needles, ketone strips, lancets. The AlphaTrak came last week.
     
  19. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's a big jump up in only 3 hours - bouncing. When you have a minute could you put the data on your SS? The nadir value of 141 tells you that you can give 1 u again tonight. Good that you have new supplies.
     
  20. Lois and Java

    Lois and Java Member

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    So even though 340 is high, I need to sit it out and wait for 12 hours to go by. This high is the actual bounce...And I'm sure it'll go higher. High numbers are bounce but low numbers are not? Or each is half of the whole?

    I guess I'll find out tonight if it was an accidental fur shot last night. Right? If it even a little bit lower tonight after one unit, as it should, then last night had to have been a fur shot?

    A nadir value of 141 is not low enough to be dangerous, that's why one unit is okay?
     
    Last edited: Feb 8, 2017
  21. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes to sitting it out. You're finally getting a regular routine going and you want to stay with it. When a BG soars in a short time it's a bounce. The lows are proper responses to the insulin. The bounce is an overreaction to low BG, lower than usual BG or rate of drop of BG.

    Hard to say. You'd need evidence of a fur shot to be certain - wet fur at the injection site, distinct smell of insulin (strong Band-Aid like odour). Water under the bridge now ...
     
  22. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes. With PZI you should base dose on both PS numbers and nadir value but if there's bouncing going on that inflates the PSs, the nadir value rules.
     
  23. Lois and Java

    Lois and Java Member

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    Thank you!
     
  24. JanetNJ

    JanetNJ Well-Known Member

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    Exactly... A goal of nadir is to get it into the low blues. Under 150 on a pet meter(120 human meter) is when the pancreas can rest and even start to heal itself. 1 pushed her closer to that goal.
     
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  25. Lois and Java

    Lois and Java Member

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    356 at 3 am, or +7.5
    I was cleaning out the litter box when he got in and started peeing, butt to me. I grabbed an empty cat food dish and collected some urine. Negative on both colours on ketone stick, yay.
    He ate a little. Feels lighter, more fragile.
    Back to sleep for us.
     
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  26. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I like the blue you got last night. Stick with 1 u for a total of 6 cycles but I'm guessing he'll need a bigger dose. Basing that almost solely on how low he goes. His reactive PSs are deceptive so I just give them a cursory glance.

    It's great that you got your first ketone test in. I hope he's an accomodating kitty on that score - makes it a lot easier for you. :)

    Do you weigh him regularly? A digital baby scale is a good tool to have for dealing with an FD kitty. It's hard to get them to gain weight when they're unregulated but also "delicate" eaters. Is he enjoying the YA? It's very nutrient dense and if he's a kibble fiend, you might have to use it more.
     
  27. JanetNJ

    JanetNJ Well-Known Member

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    Do you give any additional b12 to the b right? If not you could.
     
  28. Lois and Java

    Lois and Java Member

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    417 AMPS. 1 U.
    I didn't feel any moisture at the injection site*, but he wriggled again, same as the night it went so high and it had to be a fur shot. If his BG doesn't go down, it almost certainly was an accidental fur shot again. Hypothetically speaking if that happens what do I do? * it's such a tiny amount, but still I would feel some moisture, I would think.

    Oh I wanted to ask somebody about higher doses of B. I did what Tanya's site recommended and opened up one capsule and divided it into 10 servings several times. Now I ballpark-sprinkle that amount into his wet food for almost every serving, because he hardly ever eats a wet food serving down to an empty bowl.

    He does really like the dry food, the young again. I keep a bowl down at all times, based on info here and mfrs info that it won't affect his BS.

    He's out in the rain again this morning. That will be a really alarming thing if he ever doesn't want to go out in the morning.
     
  29. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If his BG doesn't go down it might be a faulty injection but it could be protracted bouncing. Can't tell yet because you're only 10 days into a structured routine. You need much more data to learn his response pattern. You can't rush this. There's a reason why we call it a marathon and not a sprint. I know it's hard because you're fighting a strong desire to intervene whenever you see a high number.
     
  30. Lois and Java

    Lois and Java Member

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    I have to leave in about 10 minutes, it's been about an hour since I gave him one unit so I'll test him now and see if it's moved. He was so drenched, it took took two towels to dry him off. He loves it! His BG has never not gone down with a good shot though.

    306 at am +1. Okay, it was a good shot.

    He just looked at me like, every time you touch me you're hurting me. Should I try for a nadir test around six hours or leave him alone today or other?
     
    Last edited: Feb 9, 2017
  31. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Try for a +6 and if it's unremarkable leave him alone until PMPS.
     
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  32. Lois and Java

    Lois and Java Member

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    337 at +7.
     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Looks like a day of bounce numbers. I think continuing the 1 u dose tonight and tomorrow to see if the bouncing stops is the way to go.
     
  34. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I like that blue from last night. I see that you using an AlphaTrak now. I have no idea how closely it'll compare with the meter you were using. Numbers will tell. Last day at 1 u unless he surprises you.
     
  35. Lois and Java

    Lois and Java Member

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    Janet, do you have suggestions?
     
  36. Lois and Java

    Lois and Java Member

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    423 PMPT just now and I'm kicking myself for not doing a 6 hr. test during the day. I was here, too, just didn't think of it while working in yard - cat assisted part of the time - dumb / such a pleasure to have dry weather. Plus, orb! In the sky!
    I'd assumed the Schein and AlphaTrak would allign but didn't think through saving some Schein strips to double-test both meters, same time, a few times.
    295 at +5.
     
    Last edited: Feb 11, 2017
  37. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Could be rebound off a lower mid cycle but no way to know. If you have time to do +3, +5 and +7 mid day today, that might give some good info. I'd stay at the 1 u until that's done because you need to see what's going on.
     
  38. Lois and Java

    Lois and Java Member

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    Okay, thank you, 447 AMPS, he's woken me up yowling to go outside again, wondered how much to give him. 1 U again, can check every 3 hrs.

    I have to be gone bulk of day Monday and probably Thursday, helping friend to - from pre op, and surgery at Stanford. What I do has to be geared to that. Neighbour can come check in while I'm gone but not comfortable with tests or shots.

    I started reading threads here with "vitamin b" in them, was up until almost 3 am reading Dan and Hannah. Heart breaking, so touched by the support here.
     
  39. Lois and Java

    Lois and Java Member

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    Good news: BG is 142 at +5
    Bad news: BG was 63 at +4
    I know, I'm the worst most erratic flaky cat caretaker ever. Was out gardening again... time ceases to exist. I have to start taking timers and alarms with me.
    He definitely ate before getting a shot and going out this AM - he goes out for about an hour - but not enough apparently. My fault for not testing sooner, I'm so sorry he's paying for it.
    I'm going to do some maintenance on the SS and enter his lab values. I'm going to take him in for a blood draw on Monday, get a complete panel. And cancel theater tonight, what was I thinking, I have to be here to test, give a shot.
     
    Last edited: Feb 11, 2017
  40. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Did you retest right away when you got that 63? It seems so out of place after a high AMPS and then he's back up to blue an hour later. Did you feed him something high carb when you saw that low number? Doesn't make sense ...
     
  41. Lois and Java

    Lois and Java Member

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    I didn't retest at the 63. I had to use 2 test strip, and 3 ear jabs, just not enough blood drops at first. Didn't occur to me to retest. Should I always with a low number?
    When I saw the low number, I gave him agave on the gums, and he ate FF, chicken breast, and 15 Max Cat kibbles. It's time to test him again.
    314 at +7
    Am so fatigued. Shouldn't have stayed up so late reading threads. Am taking nap with the cats.
     
    Last edited: Feb 11, 2017
  42. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Any time there's an unexpected very low or very high you should retest. Sometimes you can have a wonky strip or a wonky reading from too little blood, etc. I assume the blue an hour later is from the agave and kibble. Just read up on agave vis a vis BG and it said had a lower glycemic index than sucrose. Might be better to use honey or karo syrup if you need to raise BG quickly.
     
  43. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Okay.
    334 for PM PT.
    He's eaten some cut up chicken and FF.
    No idea what amount to use.
    .5? .75? Do I stick with 1?
    It's about Java, not me...But this is really depressing.
    Oh no, I hope you see this Kris and Teasel.
     
  44. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think you should give 1 u again and plan to test at +2, +3 and +4. That low green still makes no sense to me. If you get those three tests tonight you should be getting a feel for where BG is heading before nadir hits. If the first test is low - eg. 100 points down in 2 hours - then be ready to steer with food.

    If you really don't feel right with this dose, try 0.75 u.
     
  45. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    I'm so out of my depth w/r/t dosing.
    I can check, yes.
    2, 3, 4, if a big drop at 2, intervene with food. But just more of regular food, not with high carb stuff unless super low?
    There's an end game with 1 unit? no, wait, a good dose is a moving target.

    I just don't know anymore. I've lost my
    moorings. He has slightly more neuropathy and he's lost some weight since I started here. He seems more fragile to me, and yet he's sleeping and active almost the same amount as the five-year-old cat, so I'm not sure how much of it is a projection of my worry because of his age. It's reality, that he's approaching the end of his life and it's a question of when.

    Left to my own devices I would probably do .5, because the 63 scared me for him, but I really am still at sea on the dosing. I see what you're saying about heading it off if it plunges. If it plunges and is headed off, that's not going to kill him right?
     
    Last edited: Feb 11, 2017
  46. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If he's dropped a fair bit at +2 that's a warning that this cycle might be more "active" as we say with you possibly having to intervene with food. Don't jump in with too much food - a teaspoon or two of his regular low carb food is what you'd try first. If he's dropped too much by +3, give a little more regular food. Save the medium to high carb food for +4 and beyond if his numbers are veering toward that lime green.

    Right, the good dose is a moving target. Sometimes you can find a dose that keeps them in good numbers over a period of time but often the good dose that gives good numbers goes up a little and down a little, often for no obvious reason. It's a complex physiologic system. Java appears to be a bouncy cat and that makes dosing more of a challenge. You'll read here often that a bouncy cat will bounce until he/she stops.

    You can try 0.5 u but it might set you back numbers wise than you'd like. Your choice though. Learning how to "read" Java's SS numbers so that you can make good dosing decisions will take time. You've only recently adopted a systematic approach. I know it still causes you discomfort because it requires you to quell your desire to react to individual numbers by dosing in a scattershot way. Patience rules!
     
  47. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You want to head it off before it plunges too low. That's the reason for the early tests - to see if he's dropping earlier and faster than usual which can signal an impending too low BG. You intervene carefully with food to prop up BG and keep him fairly level in good numbers (best case). No, heading it off won't kill him even if he was headed very low because you took measures to raise BG.
     
  48. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    I got worried about waiting more and so I went with .75. I'll check at 2, 3 hours, if nothing terrible is happening I hope I'll be asleep after that. I usually wake up around +6-7 hours anyway, or I can set alarm.
    I hope that it isn't a setback. I think that with the 1.0 doses we are trying to establish a regular routine, but the 63 put that back at the Starting Gate anyway?
    You're right about reacting to the numbers. Thanks for the information where I can check it and read it if I get worried a little bit later when I test him. I really have not had enough sleep, and I'm worried about him, and thinking about the end of his life.
    I'm really happy to get into the 12-hour 12 hour regimen. It's very helpful.
    I want to do the most I can for him to make him comfortable and happy. There was a doctor on National Public Radio who was saying that people think death is an event, but it isn't, it's a process. I think about that often, that what's going on now is part of the natural process, and there's tension and angst not just about not having him the future at some point, but where the btalance is between doing everything to stave it off, and just making him happy and comfortable.
    The 63 told me that he wasn't getting up and seeking food after his feeding in the kitchen. I frequently do bring him food to wherever he is, usually on a bookcase in the sun in the morning. Is that a sign of things to come, or was it just something today.
    Okay I've gotta quit thinking about this. Thank you so much I am really appreciative that you're there, very very much.
     
    Last edited: Feb 11, 2017
  49. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    PMPS 334 - ate some FF
    .75 unit
    +2 - 288 - ate a little FF, pee'd
    +3. - 179 - ate a little FF, drank water, no interest in YA dry food. Jumped to bathroom counter from toilet looking for Greenies fiber treats, had water there, a few YA Carnivore treats. Hind legs strong enough!, though getting wobbly.
    +4 - had a little more FF.
    249 at +6. had some FF, YA, peed. Wobbly hind legs. So relieved.
    Ate more FF slurry from bowl that I held at his pillow in front of him.
     
    Last edited: Feb 12, 2017
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  50. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Believe me, Lois, I understand the worry about aging pets and pet loss. I've been there many times, some of it quite traumatic, but I can't focus on the future or it'll make me crazy. All I can do is love them today and do what I can in the present to help them. That's all you can do for Java. They can sense our anxiety and tension so keeping calm and balanced is better for both you and Java.

    Yes, the 12/12 dosing schedule is better all around. I see that you had a blue last night after the 0.75 u dose. You can either give 0.75 u this AM or try 1.0 u again. If you can be at home, I'd aim for testing starting at +3. That 63 was at +4 yesterday and knowing what the +3 was would have been very useful. I still wonder about the 63. Your testing goal is to learn what his onset of the dose is (often around +3), when he has his nadir (often +5 to +7) and when the dose is waning.
     
  51. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Edit to unbury the lead:
    414 AM-PS
    + 3 - 237
    +4.5 - 145
    +5.5 - 166

    Heard him eating YA kibble at 5:30ish and 6:30ish. Happy sound to me. He got under the covers with me for awhike, and is now on top of the bookcase, waiting to go outside to the good water.
    I felt awful last night, not just angst but ill. Too little sleep, too much worry, upset body.
    Today's another day, got solid sleep after 2:30 for starters. Thanks again for your reassuring presence. Time to test.
     
    Last edited: Feb 12, 2017
  52. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I saw your numbers up to +4 today and they look more typical and are in keeping with yesterday's if you ignore that 63. It's an outlier and I don't think you can judge this 1 u dose based on it. Did you get more data after that?

    BTW - I like your avatar pix. ;)
     
    Last edited: Feb 12, 2017
  53. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Eta, 288 at +9
    Hi Kris,
    No, but if I stabbed him now, that would be +9.
    Help me understand why a need more numbers in addition to all the stabbing I've been doing lately.
    Today, 145 is the nadir, yes?
    It's rising by + 5.5, meaning that it will continue to rise from that point on, which also means that the dose is waning. Yes?
    Should I stab him now anyway? ( Done)
    PS thanks, I enjoy photographing these two.
    PPS I'm curious, are you male or female?
     
    Last edited: Feb 12, 2017
  54. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    About to do the pmps. Assuming similar #to yesterday.... .75 , not 1.0? To fail-safe overnight?

    360.
     
  55. Lois and Java

    Lois and Java Member

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    I've reread everything and I understand that you recommend doing six Cycles at 1 unit. It scares me, what if there's a big drop and I miss it. He's more fragile since the end of January. His hind legs are more wobbly. Sleeps more.
    I shouldn't wait more, I'll do .75 and check in +3 or 3.5.
     
  56. Kris & Teasel

    Kris & Teasel Well-Known Member

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    • Me - female, retired secondary school physics/chemistry teacher
    • Today's numbers look fairly typical for a dose that is effective in lowering BG but not to a very low level
    • By getting that mid cycle BG profile you're seeing when he's lower and how low he goes so that you can judge the efficacy of the dose
    • If 1 u scares you for a PM dose, drop it to 0.75 u
    • There's no magic formula for dosing PZI. It's all data gathering from starting off at a lower dose and raising in 0.25 u increments while testing at strategic points in the cycle
    • As the data picture fills in over time you have a record of responses at various doses to draw upon in making dosing decisions, you learn when the insulin usually kicks, when his nadir usually happens, etc.
    • Once you have a clearer picture and more experience you can move into sliding scale dosing - ie., varying the dose at AM and PM according to the preshot value. I don't think you have enough data for that yet.
     
  57. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Woke up, tested again, it's gone up. If 1 unit, might have stayed lower?
    He ate a little FF slurry.
    Hind legs more draggy. Thinking of taking him to vet in am for blood test, pick up Ringer's solution give him Sub-Q fluids. How might that affect dose?
    How much data is enough? None of prior info useable because not 12-12 darn it.
    Is there hospice type thread? Or you're okay with it here? I wish he could talk.
    My mother used to substitute teach chem, physics. Was an engineer. I'm retired paralegal, exec legal asst. More sleep.
     
  58. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think you can give 1 u again this AM. There's a bit more to be learned about this dose although I think it might have to go up. Have you considered giving a B12 supplement for his neuropathy ( dragging his legs)? Vets will sometimes poo poo that but many here have used it very successfully. You could do a separate post asking for info.

    Re sub Q fluids: I have no experience but have read that you should avoid giving insulin in the same location as the fluids were given. There are limits to the total volume given at one time and over a day as well as risks for kitties with cardiac disease.

    The previous data isn't a waste. It shows that Java does respond to PZI, albeit erratically. That's why you really needed to get him on a routine. It's very early days in that routine, only 2 weeks. You need weeks and weeks of data to get a clearer idea of his responses when doses methodically.

    You're torturing yourself thinking this way, Lois. Take it one day at a time and do the best you can treating his diabetes. Yes, he's a very senior feline but if he eats, pees, poops, enjoys his outdoor walks, etc. he has quality of life.
     
  59. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Saw today's AMPS. Maybe test at +5 and + 7?
     
  60. Lois and Java

    Lois and Java Member

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    I can do 1-5, and 8 or 9 - 11. Taking friend to Stanford Med and back, leaving house at +4.5 actually.
    So I'll do 4.5 and as soon as I get back.
    I'm into a new vial of AT test strips already. Combo starter pack of 25 gone.
     
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  61. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Saw vet this AM. All good news, whew! Hydration is good - skin, gums, and eyes. Wasn't concerned about recent creamy eye goo (instead of brown eye goo); eyes look fine; pollen? Calif. spring is underway. Weight exactly the same as Dec. 30 appt. - 9.31 lbs. (yay! big relief). Took blood for kidney function panel, etc. Hind legs are more bent, some of that is age related muscle loss. Got a B12 shot and came home with 6 syringes for 6 weeks of shots. I'll keep doing the powdered Jarrow Bs in his food. Vet commented sounds like insulin deficiency rather than insulin resistance - based on Java's quick reactions to insulin. Commented he's in remarkable shape for a 2o year old cat even with the diabetes. It's (genuinely) good to know it's me that's coming unhinged - I can work on that.
    Lily bolted from the front door, which is v. unusual, and it took an hour of gardening with Java following me around and napping while I was in one place for her to conclude that she wasn't being shoved in a crate any time soon. So we've all had our fresh air and now I can take off.
    +4.5, 186
     
  62. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Great news! I agree with the vet that his dose is a bit too low. He can come down but his average BG tells the story.
     
  63. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    ? Didn't talk to vet about dosing since he's not been helpful. Vet said insulin deficient vs. insulin resistant is all.
    Because of time diff, might not see you online after pmps. Think I should try for 1 U? Part of concern is getting enough sleep personally, a test at +3 is latest I'm up usually. I wake up anyway at +6ish, other test times require alarms or staying up not sleeping, not good long run. Is argument for .75 perhaps.
     
  64. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I meant I agree with your vet's opinion that he's "insulin deficient" - ie., not getting enough. You can try for a 1 u tomight if you have the stomach for it. I think he'd be OK and a +3 test before you go to bed should reveal whether a plunge is imminent. I usually do a +3 at the latest myself and only set an alarm for a +6 or +7 if I'm worried.
     
    Last edited: Feb 13, 2017
  65. Lois and Java

    Lois and Java Member

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    Kris, any chance you are around? PMPS is 418.
    I can wait about 15 minutes before I absolutely must shoot. Delays at my friend's medical appt. = we just got home; meanwhile, friend who was to take up cat food 2 hrs. ago, couldn't until 30 mins. ago. Looks to me like the AM excitement of vet, gardening, etc. means both cats slept all afternoon - not much FF eaten. YA has been eaten, just watched Java graze on some. Does uncertainty about empty stomach BG testing affect the dose?
    I feel okay about 1 U. I have to follow him around with FF, it seems, to be sure he eats enough of it to not go low. Edit: Am going with 1 U.
     
    Last edited: Feb 13, 2017
  66. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I went to bed a bit earlier last night, Lois, so I just saw this now. I would have suggested 1 u anyway. Yes, unless you know for sure that no food has been eaten for at least 2 hours before a BG test you can't rule out that it's influenced by that.

    I suggest one more day at 1 u and then try an increase to 1.25 u tomorrow AM. I really don't think that low green is a reliable number.
     
  67. Kris & Teasel

    Kris & Teasel Well-Known Member

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    What was his AMPS, Lois? I see the 1 u dose on your SS but no BG.
     
  68. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    I don't remember, just got out of a class. Will fill in when I get home.
    367. 1 hr between test and shot of 1 U, he went outside, up on shed roof (from fence), not expected. Must be B12 boost.
    Labs are in. BUN and creatinine elevated. Something else = possible pancreatitis. I'm not sure what that is exactly, off to Google.
     
    Last edited: Feb 14, 2017
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  69. Lois and Java

    Lois and Java Member

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    Talking to vet. Rather, waiting to talk to vet.
    So, bottom line, the tests show a cat that's being well supported, mostly kidney function are off normal. The values that are high are not Def Con high - BUN, Creatine, PSL, .... where'd the pdf go? grr. Starting up Ringers twice a week will bring all the high values back into normal or acceptable range. I'm running over to get some Ringers and start today.
    +5 was 127, ate/fed.
    Edit - the lab shows values. I did click open with Google docs, so did it populate there by itself?
    Edit - no, those are baseline values, der.
    Edit - I was delayed with Java's shot by 1 hr. after test. Tonight, okay to get back to regular schedule? E.g., 11 hrs. not 12 between shots.
    I need to check the permanent messages, but I got that the injection site for Ringers should be diff than insulin. Ringers, I always do the scruff, and never use the scruff for insulin. If I give him Ringers tonight ... what about timing?
    I'm delaying going to vet to give the friend who's having surgery tomorrow a ride home. She lives near the vet and is in my home town for med appt. right now. Save her a bus ride.
     
    Last edited: Feb 14, 2017
  70. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Shouldn't be a problem. Give 1 u again and consider 1.25 u tomorrow AM if you can be around to test in the middle section of his cycle.

    I can't advise on timing of insulin versus Ringer's. I have no experience.
     
  71. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Where do I ask about the Ringers and insulin? Just start a new conversation?
    Edit - just did. Am hoping someone sees it and replies tonight, fingers crossed!
    I have just enough time before friend out of her appt. Should I run home for a +8 BG test? Would it make a difference? If no, I'll save him the jab, and go with 1 u.
    I'll be home tomorrow around +3 after AM shot, so can do. How often? 3, 6. 9? .
     
    Last edited: Feb 14, 2017
  72. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think you can forget the +8. If you try 1.25 u tomorrow AM, tests at +3, +6 and +9 would give a good indication of how it's doing.
     
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  73. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Kris & Teasel! The pmps was 217. I thought that was low so immediately did another one which came out at 190. Should I do a third? I'm leery of one unit.

    Edit, thinking about why it could be so low. He hasn't eaten much FF but he has eaten YA. I'm not sure what to do. He'll eat FF if I take it to him usually. Then BG likely to go up. But then I could give a partial dose?

    I want to give him ringers, wash away whatever. Advice this site ( thank you!) was do it after PM shot because it could affect BG reading.
     
    Last edited: Feb 15, 2017
  74. Lois and Java

    Lois and Java Member

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    I thought I'd seen something helpful and I found it, and opted for C:
    A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

    I fed him some chicken, some FF, over 1.25 hrs. A re-test after food gave 320. He's been in the 400s PMPT more recently. For a reduced dose, I'm not sure whether to go with .75 or .5. Fail-safe: I'm going with .5.
     
  75. Lois and Java

    Lois and Java Member

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    Kris, I've been bringing food to him, so he's eating a little FF every hr since 7:30 or 8. He got 125 ml Ringers subq around 11 p.m. it's now 12:30 a.m. and he ate more FF 10 mins ago, and got up to eat some YA on his own. Because I gave .5 because of the low readings, BG likely high in the morning? Because of all the delays tonight, this is not going to be the 12-hour shot, which I'm guessing is okay? I can test, shoot up to 10:30 at latest.
    Setting alarm to test at 3 am., At +5.
    Edit, in retrospect I could have given one unit given all that he's eaten, but I didn't know that he would eat so many little snacks, and the shot was already really delayed and I don't think I should have waited any longer.
    3am, or +5, 268, and he drank a ridic amt of water! Only 1 pee in the litter box. Ate some FF also.
     
    Last edited: Feb 15, 2017
  76. Kris & Teasel

    Kris & Teasel Well-Known Member

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    A migraine claimed me last night, Lois. Looks like you figured it out and i think that 0.5 u dose was fine - and safe. At no time was his BG dangerously low so if you can monitor, persisting with 1 u is a good idea. If that scares you, try 0.75 u. This is the way we figure things out. The guidelines are very general. you need to accumulate data on Java's specific responses to build your own reference manual.
     
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  77. Lois and Java

    Lois and Java Member

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    Sorry about migraine. Hope you are feeling better.
    Argh I could sleep another few hours but Java knows it's 8 and almost time to go outside for morning rounds.
    Sounds like fine to resume normal schedule shot times today.
    Edit. 397 amps. I can't get him to eat. He is singularly focused on getting outside and drinking water from the little stream next door. This is what I ran into yesterday, when it took him an hour to come back to where I could grab him again.
    Is it safe to dose him, let him go out, and then feed him in an hour when he comes back in?
    Edit, I got him to eat a tablespoon of cut up chicken. No carbs, but food in his belly. I wonder, he'd eat Max cat Kibbles, but that spikes his BG, but if I ever couldn't get him to eat anything else would I ever give him like 4, 5 max kibbles to get carbs in his system anytime except in a HG situation?
    1 U.
    Sorry to constantly be so talky talky at you! I am perpetually grateful to have someone to talk to about this.
     
    Last edited: Feb 15, 2017
  78. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think that if you're sure his perambulation will be over in an hour you should wait to feed then dose. If this is hisa daily routine then your scheduled shot time have to accomodate it.
     
  79. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Any data to add to your SS Lois?
     
  80. Lois and Java

    Lois and Java Member

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    Yes sorry, worker at house all day. Java had a little chicken, but mostly he's eating YA. He's had hardly any Fancy Feast. I have to take off I'll be back in 2 or 3 hours.
     
  81. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think that 1 u is OK for tonight.
     
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  82. Lois and Java

    Lois and Java Member

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    PMPS, was 376.
    +3.5. 463. Big rise. From FF I encouraged him to eat, or maybe is this a bounce from last night's low?
    (What protocol do people follow for rounding time on their SS? <X:29=the hr before, >=x:30=the next hour?)
    Edit, 4 hrs later, so, +7.5, 524.
    Criminy. I always check for moisture, would've sworn this was a good shot.
    Is it ever indicated to give the next dose an hour or two earlier than 12 hrs?
     
    Last edited: Feb 16, 2017
  83. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If you mean times falling outside the whole number for hours, you can use 0.25, 0.50 or 0.75. For example half way between hour 3 and hour 4 can be entered as +3.5 and you can put in into the cell along with BG number. Have a look at Teasel's SS for more examples.

    Generally, sticking fairly close to 12/12 dosing is recommended. It's possible to dose an hour early/late without messing up the bloodstream insulin levels too much and here are some examples of when you might do it:
    • your own schedule will take you/keep you away at normal dose time
    • you know with certainty you had a fur shot at the previous injection
    • BG has jumped up very high at the end of the dose cycle - this is the least acceptable reason.
    There are circumstances where people change to a 13/11 or 11/13 dosing schedule because a large accumulation of data shows a consistently higher AMPS or PMPS. You're not getting that with Java, Lois. His AM/PMPSs are very similar.

    Ignoring the recent lime green (bogus I say!) and that black, Java is responding typically to PZI in that he comes down nicely for midcycle and then rises back up to a PS that's similar to the previous one. Your data for 1 u is telling me that you'll need to try 1.25 u to see if the nadir numbers can go down a bit. If jumping to 1.25 u right away scares you, try a "fat" 1 u.

    Important reminders:
    • consistency in dosing schedule is very important!
    • don't react to one number - always look at the whole picture.
     
    Last edited: Feb 16, 2017
  84. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Thank you. I'm really grateful that you're willing to keep repeating that, help keep me on a steady course. At 4 am, he was gulping water and staring longingly at the overnight rain, even standing by the door, willing it to open, as it often does, but not at night.
    I tried reading other threads to calm down, not always a good idea I'm learning - Dan and Hannah broke my heart and freaked me out (in retrospect I was unwell also), and last night I read a thread that said cats feel awful when their BG is spiking high. Argh!
    A saving grace is that he sleeps next to me most of the time, so if he's relaxed or sleeping, I can too. My boy! I'm talking while he's out at the end of his morning rounds. Lily and I can keep an eye on him from bed, see photo.
    AMPS, 543, fat 1U.
    Should start a new thread?
     
    Last edited: Feb 16, 2017
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  85. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Do you mean Dan and Heather and their kitty, Mittens, around Christmas? If so, I was part of that group trying to help and it was extremely stressful.

    Stay the course, Lois! Love the pic of Java on the roof. :)
     
  86. Lois and Java

    Lois and Java Member

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    AMPS, 543
    +3, 146
     
  87. Lois and Java

    Lois and Java Member

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    Yes, Dan and Heather and Mittens. I saw you were helping. Heartbreaking, stressful just to read.
    I just checked all my #s against the meter, and had to make 2 corrections. A pink into a yellow on I think 12 or 13, and one more similar # (to another # 2 hrs earlier) wasn't recorded on another date.
    Java's so lethargic right now. I woke him up to test.
     
  88. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Some mighty bouncing going on!
     
  89. Lois and Java

    Lois and Java Member

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    Meaning the 500 down to the 100?
    I like this one. 333 at 3:33 p.m.
     
  90. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Dropping from black to blue in a couple of hours is likely going to create another bounce trajectory. Don't panic. Same dose tonight?
     
  91. Lois and Java

    Lois and Java Member

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    486, Fat 1 unit
    I entered his most recent lab work at the lab tab. Is there a particular place, person, to ask to look at it?

    The lethargy...Except for his regular ventures outside in the morning, he mostly just slounges and sleeps day, night. Often when I pick him up he's completely a ragdoll. He's always been cooperative for medical things but this is really limp. Is it is age, is it kidney disease, is it diabetes, is it all of them, not sure there's anything I can do about it, but I wonder if I should worry about it.
     
  92. Lois and Java

    Lois and Java Member

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    I've looked at your spreadsheet a couple of times and I just get completely thrown by the numbers because it's a different system. I haven't looked at it on the laptop, that's probably part of the problem, on the phone it's segmented, hard to see whole chart.
    But I did see that you've been giving Teasel insulin since 2016, correct? How old is Teasel? Did you see behavioral changes, besides symptoms like thirst and peeing?
     
  93. Lois and Java

    Lois and Java Member

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    Oct 21, 2016
    Was 188 at +3.5.
    He ate some FF slurry, 181 at 2 am, or +6.
    Crazy that I'm still up ( two houseguests did it? Or chocolate)
    I think this is probably the nadir. The FF slurry that I mixed for him will 1) give him some carbs, 2) counteract an hg trend in case bg wants to go lower, more likely 3) will contribute to a rise to the amps value.
    I think I could sleep through the rest of the night without testing.

    Kris, are you happy with the alt test strips you use with AT? I should order more strips. Henry Schein's are slightly cheaper than the AT, and there are things about their meter that I like better than AT - primary is memory counts up, not down; most recent test is always on top, not buried at the bottom. But AT seems to be the standard, if the alt strips work, I'll go there.

    He's so lethargic. I'll call vet tomorrow, find out when ringers would improve snap whatsit test, if it will.
     
    Last edited: Feb 17, 2017
  94. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Teasel was only 5 when he was diagnosed in January 2016. Drinking a lot from his water bowl and excessive peeing, including outside the litter box, were the symptoms that made me take him to the vet. He was put on Lantus insulin at 1 u twice a day but I was doing only what my vet told me, not what we promote here. He ended up stuck in high numbers from chronic rebound (bouncing). The vet told me to stop insulin for 48 hours with the plan to restart (reboot) him but after 24 hours he developed DKA. Once he recovered from that, he was switched to ProZinc and I eventually (I can be slow to change!) came here to FDMB in August last year and finally built up a dosing picture that showed me why his curves for the vet never got us anywhere. He bounces a lot and stays high for a long time. Those curves were usually catching him in one of those phases. I've learned SO much here and now I'm trying him back on Lantus to see if I can tame some of his bouncing. Jury's still out on that because it's only been a week and a half.
     
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  95. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I agree that the AT strips are $$$ but I stockpiled a lot of them when I could get them slightly cheaper from an online pet pharmacy here in Canada. I'm using that meter right now because I'm very comfortable with the numbers it gives and didn't want to change to a pet meter while trying Teasel on a different insulin. I never use the memory function on it. I write everything down in my paper and pencil notebook and then transfer it to my online SS.

    The lethargy that Java is experiencing might be caused by the large changes in BG he goes through in a cycle. The goal with insulin is to get them to good numbers (low 100s or high double digits) for as much of the cycle as possible while having the PS highs be in a "comfortable" low to mid 200s range. He's not yet low enough but he goes too high at PS. Those large changes are hard on them. Teasel does the same and he does get lethargic from it. Java bounces up at the end of a cycle but, overall, doesn't tend to say stuck up there through a cycle. Teasel does.

    Lantus is a depot insulin which means that a portion of every dose acts in a slow release fashion and the hope is that it can keep BG more stable over a cycle. That mechanism works really well in some cats but less so in others. Teasel is probably in that latter category. I'm trying it again because I now know what I'm doing and I hope to get it working better this time around. A switch to Lantus might help Java - something to think about. However:
    • does your vet have any experience with it?
    • it's very expensive in the US (many US users order from a Canadian pharmacy in Vancouver, BC once their vet gives them a script for it).
    I suggest you go to the Lantus&Levemir (another insulin that works like Lantus) forum and read the info stickies there. You might post a message there asking whether it might be a good choice for Java. It's a very large forum with quite a few very experienced, knowledgeable people who can advise. I'm still a newbie there.
     
    Last edited: Feb 17, 2017
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  96. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Any data for today, Lois?
     
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  97. Lois and Java

    Lois and Java Member

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    Yup. Houseguests, class.
    Setting up to test right now.
    Outside in rain 7-8, then AMPS 484, fat 1 U
    Had FF, seen grazing on YA a few times
    Now +4, 78. Oh heck.
    Just ate a little more FF.
    Should I retest I wonder?
    He's back for more a little more FF slurry.
    Fingertip of honey to gums
    Scraped goo from bottom of FF can, eating that.
     
    Last edited: Feb 17, 2017
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  98. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's a gigantic drop in 4 hours. Test again at +5 and +6. If he doesn't go too low, give either a regular 1U or a "skinny" 1 u tonight. Put the numbers in your SS as you get them. I'll check periodically.
     
  99. Lois and Java

    Lois and Java Member

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    I think what happened is that even though he ate, and I watched him eat... because I was making breakfast for guests, I didn't follow him to where he is around plus 1 and plus 2 and make sure he ate some more Fancy Feast.
     
  100. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Was this 78 from the AT meter? The too low number for a pet meter is 68. He's OK for now. Hold off on any more honey/food and retest in 15-20 min.
     
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