Xuxu, 3/12/13, 572, odd things happening

Xuxu is still yo-yoing, but not going quite as high. He hasn't hit 750 for nearly a week. Since that is the meter's limit, who knows how high he has actually been at that number. He is registering in the low 700's or high 600's though. And he is still going quite low on only a .75 dose. Most of the time he is asymptomatic, so I have learned to stop panicking and don't give glucose, just a couple of his fav, Iams kibble. I test in 15 min and if it's on the upswing, I don't worry about it. I have lowered the dose the last couple of days to .5.

But I caught him at 49 yesterday because he was lethargic and not eating. I gave him fluids and some glucose (gel from those tubes in drug store for diabetics) and a a couple of kibble. I really knew he wasn't feeling well when he didn't gulp down the kibble. But in 15 min, he was up to 61, so didn't worry. Although in 30 min he did eat the kibble, it wasn't enthusiastic, and he seemed quiet the whole evening. He was up to 612 and started to eat some of his canned food again. Because he goes so low, I didn't give him a pm shot, worried he'd bottom out while I was asleep.

This morning, he's down to 572. This has happened a couple of times, his BG lowering without a shot. He didn't eat much though the night. I decided to see what is naturally going on and didn't give his am shot. I saw BJ's response to Mimi and Loki, so perhaps that type of bounce is happening. Anyway, he's acting quite different from the last couple of weeks where he was happy, purring, and eating like there's no tomorrow. The UTI appears to have cleared up. I am checking his ketones while he's not getting a shot.

 

I wish I had some ideas for you, Deb. My experience is with cats that have fairly "normal" reactions to ProZinc, and in those cases I can predict with some probability what might help. I have been here 7 years and never seen a kitty with such lows and highs. You seem to be able to adapt to the curve balls he throws you and keeping him in reasonable numbers at least part of the time and that is certainly a good goal. Wish I had more ideas to help.

Not a TID advisor but might TID at a tiny dose - maybe a drop of insulin - be more a try? It takes more monitoring and you said you had a crazy schedule.

 

Sue,
I've thought of that, but I'd have to throw any schedule out the window and just test and shoot based on the test. In reality, that's what I've been doing for weeks now, but I tell myself I've got him on a schedule.

I didn't go into work this morning because the water went out right when I had a headful of soap. Had to use some of the cat bowl water to get it out and by then, I'd missed my vanpool. But it's a good thing, on the 2nd test this morning, he was showing low ketones, so I gave him a .5 @ 595. Pretty safe, huh. But I just took a break and tested and @ +5 he's down to 29, very lethargic. The problem is he crawls under the bed where I can't see him unless I get down on my knees and drag him out. Gave glucose and he was up in 5 min, is now drinking a lot. His normal nadir is +6-+7. Makes me wonder if he's been on the verge of crashing every day I've been at work and he's just come back on his own.

So I guess now it's down to a .25 dose for the pm shot. I just don't see how you all can do doses below that. I just don't have the manual dexterity to control the syringe plunger. I can barely distinguish .25 from .5. Plus, since there is no "feel" of injecting something, I'm not sure I've got any in him. I'm not sure how to do a drop, does it work to push it out of the needle, pull it back in and then inject?

I thought that is this is how he is, I could live with it, but now I'm not sure he can. I responded on Dr. Pierson's webpage asking for a contact email or info to consult her and have never heard anything. Does anyone have her email?

Maybe I should go ahead with the Atopica, it's about all that's left to try.

 

Hi Deb....

I read your first postings in 'health' and looked at your SS. I would have been scared out of my wits!!!

XuXu is the luckiest kitteh in the world to have you taking care of him. I am a newbie with the diabetic-kitteh thing so I can't give you any dosing advice.....BUT.....I just wanted let you know how happy I am about how hard you are trying. :thumbup

If it wasn't for everyone's help/advice on FDMB and the links to food/testing/shooting/etc/etc/etc. I would have really gone crazy. I am soooooo glad I found this site.

I am wishing you all the best in getting XuXu on track. BIG :YMHUG:

 

So what we see with Xuxu is a very steep curve down and back up again on a very small dose, regardless of what insulins have been used.

A very, very, very rare approach to shooting insulin is called split dosing. That's because you can get into major hypo trouble if each partial dose does not absorb the same, have the same pharmacokinetics/metabolism and the nadirs wind up overlapping. You are already having issues with small doses sending him into hypo, so this would be no different in that respect.

This involves dividing the regular dose into halves and spreading the administration apart by 2 hours or so. The original intent was to extend the time period when folks knew they'd be home a couple hours later than the normal shot time and didn't want the cat to be without insulin for that long.

Theoretically, what it should do is overlap 2 shallower curves due to the half dose in each shot, where the overlap period adds together the insulin from each half shot at the respective number of hours post shot. It might help flatten the curve for Xuxu a bit and maybe keep him from getting so low. Momma of Muse tried this at one point and I believe Vicky and Gandalf did too.

If you decide to try this, you must be at home to monitor until you know if this will work for him. You might try testing 2 hours apart for each of the 0.25 units and test every 2 hours as you would for a curve to see how it goes. At a minimum, you will want to check the nadir time for both shots. And I would give each half dose of 0.25 units in different locations. To record it on the spreadsheet, you might use 2 lines for a day, 1 per shot.

 

Dr. Lisa's email is DrPierson@catinfo.org

Are you shooting with U40 needles or U100s? Have to admit I never had to use the U100s and the conversion chart, but people seem to be able to measure the .2 and .4 doses fairly easily.

Here's the idea on drops:

viewtopic.php?f=10&t=34424#p360982

 

Misty, I whole heartedly agree with you. Xuxu would have been dead long ago without the advice of group.

Sue, thanks for the link to the syringe pics. Isn't there another one too, that shows the syringe lengthwise? I had looked for them earlier and couldn't find them in the stickies, but may have just not hit the right one. I have the PZI 100, so am using 100's. If I ever run out of the darn stuff at this rate, I'll definitely get the PZI 40.

I just tested him again and reposted the SS, I thought we were home safe at 131, and he stayed on the bed with me instead of crawling below. But I just nudged him and he lolled around so tested. Back down to 29! more glucose, he's up but not recovered, still lethargic.

In the beginning, he was going way over the monitor range, we couldn't see how high. But the Hi levels have come down, and his lows are going lower. The monitor low range is 20. It's almost as if he has the same distance from hi to low, but the curve is sliding down the graph. I don't know if that gets me anywhere thinking about it that way, but I'm a scientist, always developing theories. What the H... is his pancreas and liver thinking grr_red

BJ, I'll try that split dosing, but not until Fri. I'd have from Fri through Monday to monitor him. I'm home tomorrow but not Thurs. I'll see what he does on .25 tonight and tomorrow.

I'm on the Alpha Trak 2 and all this testing is costing a fortune, to the tune of $200/month. I'm on the verge of having to order more. I think I'll test on both the Relion on and Alpha Trak for a while to get a feel for it and then maybe I'll switch.

The Dr. P email is the one I used. Wonder if she isn't checking it anymore? I had to give up one permanent email that was listed on the web because the spam on it got so bad.

 

I don't know about Dr. P's email. Tashia&Henry Richmond VA used her recently. You might send Tashia a pm and ask how she got hold of her.

 

To prepare for the split dosing, practice the drop method of measurement. First, push and pull the syringe plunger in and out a few times to reduce any sticking. Next, fill a syringe to 0.5 units with water (colored for visibility, if you like). Now the challenge for hand dexterity - slowly squeeze out 1 drop at a time, making the drops the same size. Some find that twisting the syringe barrel gives them a bit more control. See how many drops you can get out, the same size, every time. Once you 'calibrate' your hands, you're ready to try the drop method for dosing. Remember to discharge excess insulin into the sink, not the insulin container, to prevent contaminating the insulin.

When you're ready to try the split dosing, go with 1 drop, at least 2 hours wait, then 1 drop. The interval between the 2 shots should be one you can do consistently. Ex 6 & 8, am & pm

Next, when your regular vision just doesn't cut it measuring those tiny doses!

At our shopping partner Amazon:

Syringe Magnifiers

Carson Clip magnifiers
- I have several of these and love 'em. I clip them to my glasses and can flip them out of the way when I don't need them for a moment.

Stand magnifiers

 

The syringe magnifier is pretty neat, I've not seen those. I'll order them.

Xuxu seems to have recovered today. He's not jumping up and down, but he's back to eating some of his canned food and not hiding under the bed.