Spicoli pt 2

pmps 463 He didnt rise much after the +6. I do regret not giving him more insulin this morning but not being around today...I just didn't feel comfortable with more than 1.25u. Since we shot late last night, tonight will be the first 3u dose.

I hope I get to see a blue before bed

 

No blues yet... but he did at least drop 50% at nadir. AMPS- 480 +6.5- 238. His nadir is usually +5 just wish I had been home to grab that number. Curve day tomorrow

 

Nice! And getting closer to those blues anyway.

I'm still curious what has thrown him out of remission. Or remission-ish anyway. This seems like such a dramatic shift from where he was a couple of weeks ago. I wish they could talk.

 

You and me both. We've had our ups and downs before but nothing this drastic. He does have suspected IBD, but no surgery yet since a food change /probiotics helped greatly. Who knows...he likes to throw curveballs.

 

Yikes! We have not had a pretty curve today. I wonder if he was bouncing from that early yellow..but probably not.

We finished our ear drops Friday, but he's still shaking his head and sneezing a little so I think we may go back into the vets to see if his ear has actually healed and he hasn't developed an upper respiratory infection. He was sneezing the time before when he stayed over at the vets but they didn't think he had one at the time.

 

I think I'm going to move to 3.25u tonight.
Any thoughts on that?

 

I think you're OK to move to 3.25U tonight. Any luck on a ketone test?

 

Ah I haven't done one today. I need to stay on top of those better! Gosh it's been 2 weeks.... I'll try to catch him in the act tonight. His litter box isn't far from where I watch TV/Computer so if he goes it'll be easy for me to run over. Thanks for the reminder

 

That's what I say to myself every week! lol. "it's already been a week!?!?"

 

Yikes is right on those numbers today! I suppose it's possible he bounced from something lower last night, later in the cycle.

The good news is that he actually had a pretty decent curve, considering where he started. Let's hope 3.25u shows some nicer colors.

 

Let's hope! I'm off work tomorrow so I'll probably do another curve.. His poor little ears

 

It looks like he's hitting nadir somewhere around +4-+5, so you could just grab those two hours if you want to give his ears a break.

 

Or do a kind of mini curve: +3, +5, +9

 

Yuck. Another ugly day. I noted on my SS that his fur did smell like insulin at the injection site, but i think it was from a drop on the tip on the needle since his fur wasn't wet. I switched him back to FF classics last night because I wasn't happy with how picky he was being with the other foods. He has been asking for food most of the day, but he had also lost 2.5 lbs before he was hospitalized 2 weeks ago - so I'm just letting him eat as much FF as he wants while I'm home. Could be part of his high numbers today.

 

That is an ugly +8. The food may be contributing, but FWIW I think feeding him if he's hungry is the right decision. At those numbers he isn't going to be absorbing as much from his food as he should, so the extra calories will be good for him. Are you going to increase again in the morning?

 

From how things have been going I was planning on it.

 

Assuming 3.5 doesn't end up to be the magical number, I would say after that to go up to 0.5u increases.

 

Ketone test negative. Super high glucose but that was to be expected... At least he dropped a little for PMPS.

 

So still running a little high at 3.5u. It seems strange to me that his nadir with 2.5 and 3.5 don't vary much. It looks to me that he pretty much has been responding to those doses the same way. Is this because we just haven't hit our breakthrough dose?

I guess we're moving up to 4u tonight.

Vet apt. Friday since he's still a little sneezy and now pawing at his other ear. The poor thing. It's been a rough year for my old man.

 

He's not looking too bad, really...sure those preshots are high, but you're getting some nice yellows mid cycle. My guess is you haven't hit the breakthrough dose yet and you just need to keep moving up consistently and you'll get there. If you look over his SS, he was getting all pinks mid cycle and now he's getting yellows...which tells me you're getting closer!

 

Yup, he's getting a little bouncy which is actually a good sign sometimes. It may be a ways still, but it does indicate that the insulin is at least enough to do something even if it isn't quite doing what you want it to yet. If you go up to 4u tonight, make sure to grab a test as late as you can.

Sorry to hear he's still a little under the weather. Hopefully whatever that is will clear up soon!

 

I agree with Rachel and Djamila. Try 4 u either tonight or tomorrow AM. His numbers are slowly improving - ignore the bounces and focus on the mid cycle.

 

I stare at that damn thing all the time lol and thanks for taking a look. I know we're getting closer, just not quick enough for impatient me.

He hasn't really been acting sickly, except yesterday morning and that was just acid reflux, so we did some pepcid and nausea meds. Just want to make sure there's nothing still going on there... I put some Dexamethasone solution on the little area outside his ear and it actually helped... He gets itchy sometimes.

I HAVE to focus on those mid cycle numbers more. Those high preshots get discouraging...

Did 4u tonight. PMPS was 537. Forgot to add that to SS earlier.

 

Went to the vet today. His bacterial infection in his right ear was gone, but now he has a yeasty infection in both. We were given Surolan for that - 2x daily. Also was given a Convenia injection since he's been sneezy on and off for 8 weeks and Dr A just wanted to make sure we didn't have an upper respiratory infection that wasn't showing up on blood work since his WBC count was normal. I had talked to the vet about this before but I guess it was pushed to the side since we had a few other problems going on at the time.

AMPS 522
+7 212 new low for us

 

Wow! That 212 is great! I really hope that convenia injection kicks a$$ on whatever infection he has and helps him out.

 

Nice yellow number! Hopefully the AB will help him feel better!

 

PMPS 606

I was ready for a bounce but wow...

 

Woah now, Spicoli don't bounce so high on the trampoline

 

Hey, that's what I said

 

In all fairness, I have no idea what his nadir was today... and +7 212 I imagine he dipped into actual safe "normal" numbers and his little body went into emergency mode.

 

So previous to our latest "high" times, he didn't bounce this much. Is there any way to decrease these bounces or is he just being a slow learner even though he's been in good normal ranges before?

 

There are two main directions with that. First, there are some kitties that are bouncy and there isn't a whole lot you can do about it. Second, you hold the dose longer. However, you don't want to do that until you're getting a nadir that's under 200. You're getting close. Once that happens, then you'll slow down the increases to every six cycles, or maybe even longer. So you raise the dose, the kitty responds and drops lower....then sticks up high for a few cycles, and then either starts to respond again, or stays stuck and you do the next increase.

 

Oh dear. Thats promising

I had no idea. Thanks for this. I was reading over all the prozinc stickies tonight and either missed this or perhaps it wasn't mentioned?
I'm certain his nadir for today would have been under 200. Usually +5 +6 is our lowest and I had to work... but that +7 gave me some good insight all the same. Work tomorrow too, but curve on Sunday. So I think I'm going to hold at 4u till at least Sunday.

 

Oops. yes, that would be because it isn't in one of our stickies. It's in the TR protocol and we don't have a copy of that over here (although we probably should have our own version). You can find it in the Lantus forum, and I believe the idea of increasing every three cycles and then slowing down once you get sub-200 nadirs may have also come from reading around in old threads. It's definitely more of an idea than a rule and requires some flexibility in figuring out what will work best for Spicoli.

I agree that he may well have hit a blue earlier in the cycle today. You could hold the dose now, or do just a little increase to 4.25 since he'll probably be high and flat from the bounce, and is still in safe enough numbers. Go with whatever seems best to you.

 

4.25 defiantly seems like an option and I actually mentioned that dose to our vet today (after telling him I didn't do his recommended 1u increases) and he agreed. I obviously don't jump to what is recommended by him and I explained to him why today and he didn't object. It did make me feel pretty good when he told me I was far more on top of this than many FD cat owners (slaves ) that he's dealt with. Couldn't do it without you guys!!

 

On the bright side with the bouncy kitties, they USUALLY stop bouncing over time...the problem is they jump back on the trampoline too! We did have one kitty here MANY years ago who bounced his way right into remission!

 

He really likes to bounce

AMPS 646
+6 406
PMPS 551

moved up to 4.25u, kind of a high flat day for us.

 

He enjoys that trampoline!!

 

Tonights PMPS 370
should I hold at 4.25??

retested 5 mins later at 366

 

I'd leave it there for now.

 

Thanks!! I was a little panicky since we haven't had a preshot that low in forever (except when I had to shoot early). He must be feeling better because he hasn't eaten as well as tonight in forever. Nearly made it through 2 cans of FF

 

Finally!!! we hit a blue +6 176

 

Woohoo!!!!!!!!

 

So we've been at 4.25u for 9 cycles. He did finally give me that blue, but I'm wondering if I should do another increase or hold where I am and try and let this bouncing calm down a bit?

 

I think with his numbers you're probably safe to move to 4.5U. Are you testing for ketones? Just to be safe .

 

I was thinking so...

I haven't this week... Things have been crazy around here with getting married on Friday... I doubt that he will go tonight but I'll catch him after he has breakfast. And as always thanks for the reminder!!

 

You got married Friday? HEY! Congrats!!!!!

 

Yes, you've had other things on your mind! Congratulations!

 

Thanks!! Tomorrow is the big day!!

AMPS 580, increased to 4.5 this AM.

 

well now that all this craziness has calmed down, I'm back.

We moved up to 5u but this evening when i got home he was at +10 124, we arent due for a shot for 1.75hrs... but I worry that he had actually dropped too low today while I was at work.
I know he's not going to rise 300 pts before its shot time, so should I reduce or just stay and try to get a few extra tests through the night?

 

First of all, congratulations! How was the wedding?

As for Spicoli, he might surprise you. Cats can go up a lot in those last two hours. The last hour, especially. If he isn't there yet, but clearly rising (pink?), you could probably go ahead with your normal dose since that's a pretty odd number. If he only makes it to yellow.....ugh....these choices are always so hard. Most of the time when we reduce, we didn't need to and they end up higher. But sometimes they really are on a low run, and giving the full dose can mean you won't get much sleep, and Spicoli will get lots of high carb treats. I have no doubt you could manage the monitoring and steering, but it depends on how tired you are, and how early you have to get up in the morning? It's important to take care of yourself in this whole process.

 

The wedding was an old fashion Justice of the Peace wedding. His parents were visiting and the week before we decided what could be better than having all our parents there I never really cared for having an actual wedding or planning it for that matter. And thanks

I don't have work tomorrow, so as long as he rises quite a bit I'll more than likely just shoot 5u. I regretted the time before when I reduced because I had to shoot early and he was super high that night. If he's only in the 200s I think I might just go for 4u.

I'll update closer to shot time. Gonna go grab some more cat treats...

 

So we're 20 mins till... 173.
I can't really stall tonight as I do have a thing I have to do. But that'd mean I can't shoot till +3pmps...

 

I might could check again at +1.5.

 

So 124 to 173? Will you be back by +3 to monitor?

I think at least a little reduction would probably be safest. Especially if you're going out tonight and won't be around.

 

I'm putting off what i needed to do... going to recheck at +.5.

 

259 reduced to 4u... will watch till +5

have plenty of supplies just in case he starts dropping too fast.

nice to see him this low though. maybe he ran out of bounce fuel

 

AMPS 608...looks like he still has plenty of fuel.

 

Grrrr....come on, Spicoli! You didn't need to go that high.

 

So I had bumped him up to ~5.25 (had to get syringes from vet only had whole unit markings) but it seems his nadir has changed and is later than it had been before... So I'm thinking about backing down to 5 and running a full curve tomorrow. He's still bouncing ALOT but hey, what can you do.

AMPS 562
+2 383
+5 247
+8 112

 

I don't think I'd back down on the dose. he's still in plenty high numbers. But I would hold this dose for a bit until he settles down. A full curve sounds like a good idea as it does look like the nadir is hitting pretty late.

 

Oh, gosh too late I'll put him back up to 5.25 in the AM.

It's so weird! His nadir used to be +5 +6 but that's obviously not the case anymore... Is there anything that could be causing this? Or is it just the way it is?

I still have so much to learn.

So relieved to see some good (well, better) numbers lately!!!

 

It can just be because he's a cat. It can also sometimes be a hint that the dose is a little too high, but that's usually accompanied by some low dives. Although now that I say that....562 to 112 could certainly be called a pretty steep dive, even if not a particularly low one. My hesitance in having you lower the dose is just that I'm honestly more afraid of DKA than I am of hypos, and Spicoli keeps hanging out in those high numbers that make me nervous. Plus, it's just nice to see some better numbers on your spreadsheet!

It does look like he might need a couple of extra cycles at this dose though. You should start to see either a) the pre-shots start to wiggle down a little, or b) the nadirs start to rise back up again. If (b) happens, then you'll know it's time to raise the dose again. If (a) happens, we'll have to watch and decide.

 

Now I really regret taking him down that .25 tonight even though his preshot was a little lower than it has been. DKA scares the crap out of me and I really don't want him to go through that.
Will do the 5.25 tomorrow...along with a curve and another ketone test.

He's had no symptoms of DKA but I think as long as he's hanging out in these high preshot numbers I'm going to try to grab a ketone test every 2-3 days just to be safe. Which I should have already been doing.

On a more positive note I really feel like we're finally getting close to where we should be The past several days he's actually been running to me at the door when I get in from work, and all around more playful and demanding. Such a momma's boy, but I wouldn't have it any other way.

 

Another thing to remember is that he is more than just a number. You want to focus on how he's doing besides numbers. If he seems happy and playful and himself that's good! Do get ketone tests like you said...more is better while he's in high numbers but don't worry too much. If DKA was going to happen I think you'd know fairly quickly just from how he acted.

 

He's much more. He had a few different ear infections (bacterial then yeast) and is just really getting over that. It's so nice to see him happy again, at least for the most part. He's been confined indoors for quite a few weeks now and just isn't giving up.

 

No no, I'm sure he's fine tonight! Please don't worry.

It is a good idea to test when you can, as Rachel said, but you'd notice if he stopped eating and was out of sorts too.

It's so good to hear that he's starting run around more and play! I wonder if the ear problems finally clearing up might be contributing to the appearance of those blues? Fingers crossed they start showing up more often!

 

Could be possible... Also I think that both ear meds he was on contained steriods (Tresederm and Surolan). The vet said it couldn't be possible that that was keeping them elevated but I wonder.

 

I do think that there can a little absorption of topical or inhaled steroids. Example: humans who are on inhaled steroids for asthma long term are prone to developing a specific type of cataract.

 

Bouncy cat is bouncy!!!
But overall we had a good day

AMPS 497
+2 377
+4 234
+6 142
+9 347
PMPS 596

 

It would make sense... Gonna ask my dad about this tomorrow.
Everytime I see your pic I can't help but think how striking Teasle's eyes are!!