2/08/12 Marilyn: Holy Ketones...

Hi All,

I'm sure most of you are "done" for the day. It looks like this is how it will be...when I'm able to post at all. I had my daily nineteenth-nervous-breakdown while testing Marilyn for Ketones. She's been in much higher numbers, for extended periods of time, without ever showing a number this high. I was afraid it could have quickly turned ugly, so as my heart was pounding out of my chest, I broke out the R. While this was going on, another kitty was crashing and burning right before my eyes. So...I've got 12 plates and bowls lined-up down the kitchen counter for afternoon feedings/meds, crash & burn kitty is vomiting all over the living room, I'm making Marilyn "drink" her food (more water than food), and I'm trying to make a vet appointment for Miss "crash & burn"; I also let my vet know of Marilyn's ketone situation. My vet stated that I have too many special needs animals for her small practice...apparently, she only has clients with very healthy animals. So if anyone out there has an animal in perfect health, I have a wonderful vet to recommend...although, I'm not sure why you would need her...maybe just for an annual exam and labs? I dunno, it beats the hell out of me.

Oh, and Lori, if you're reading this, Marilyn has been blogging. The only problem is she needs me to post it to FDMB (I won't give her my password), and I haven't been feeling well, but I'm hoping to get to it eventually. I don't think I'll even be posting her numbers daily. I'm just taking it day by day.

If anyone has dosing advice...I'm all ears (actually I'm all nose, but for internet purposes, you guys can pretend that I'm young...with perfect features...almost goddess-like). I'll check back as time allows...right now I'm checking the house rafters to see if they will hold my weight. Jumping off ledges...swinging from rafters...as Janis Joplin once said, "It's all the same f'ing day man"). In case nobody got that reference...I AM NOT OLD...please refer back to the goddess portion of this novel. Thanks for listening everyone!


Marilyn's Today 12/08/2012:

PMPS BBK = 1.4 Ketones (what the what?)
PMPS BG = 425
1.0u ProZinc + 1/2 Can Friskies Salmon (bowl filled with water & smashed into thin soup)
PM+0.75 = < 0.1u R
PM+1 = 462
PM+2 = 399
PM+3 = 339
PM+4 BBK = 0.4 Ketones (that was a relief)
PM+4 = 283
PM+5 = 259
PM+6 = 236 + 1/8 Can Friskies Salmon "soup"
PM+7 = 292
PM+8 = 320 + 1/8 Can Friskies Salmon "soup"

Hey Deb,

I'm usually the only "nightowl" up this late. SOmetimes Carl is online this late, but depends on his work schedule. Wish i could give dosing advice, but i'm still to new at all this myself and don't feel qualified. I'm sure others will be along in morning and post some advice.

So sorry to hear about the ketones. Is this the first time she has ever had the ketones? That has got to be scary. Sounds like you handled it well and caught it early. I don't have any experience with ketones, thank God, just issues with neuropathy(severe).

I can say, it will get easier and to be patient. It does take time for the kitties to get used to the insulin change and get the right dosing. I know it's frustrating because you just want them to get better fast. I'm there most of the time.

Just wondering today how you were and howMarilyn's blogging was doing. I haven't had the time this week to play around with it. Maybe this weekend. I do hope others will come along and help you out. Be patient!

How many kitties do you have? Twelve? How many are special needs? I'm having a nervous breakdown with just one special needs kitty. Couldn't imagine twelve. God bless you!

Well i must head off to bed for 4hrs until next feeding.

Keep in touch! We do care about you and Marilyn.

Lori

Hi Deb,

Looked at your numbers.... How many cycles has Marilyn been on the 1.0u dose? Just so you understand my logic (not sure if you've seen my "say" this here, but if you have, well....you're just going to have to hear it again).

When I look at a pzi/prozinc spreadsheet, I look at it from a percentage perspective and don't really pay too much attention to the numbers per se. ...damn, look at that illiteration!

So, she started at 425 and dropped to 236 at +6....(but with a teeny-weenie dollop of R as a chaser.) That's about a 45% drop. I figure 50% is okay, and 60-65% is a good drop. My advice, if she stays on the pink/red line at preshots is that you could up the dose a smidge, like .2, which is I think how you have been increasing so far? That makes two assumptions. One that she stays up around the 400 line at PS time, and two that you hold the dose for at least 4 cycles once you increase. I really think it takes a few cycles until you can evaluate how a dose is going to work. Dr. Lisa said it really well.

Look for repeatability before panicking or making any important decision.

Click to expand...

I consider "dose adjustments" to fall into the "important decision" column, so I normally wait until I see something repeat or show a pattern before I vote "up" or "down". Most people here tend to be more conservative than I am when it comes to how long to hold a dose time frame. 3-5 days is "normal". But I believe that if the goal is to get numbers down as quickly as possible, then you might have to be more aggressive. Aggressive can mean bigger increases or decreases in dose, but I don't like to advise that. So I figure that quicker adjustments in small amounts is another way to be aggressive. I think you can adjust if nothing improves after 4 cycles, maybe 5.

Marilyn's numbers look like there's plenty of safety zone under her nadir number where you could increase the dose, maybe catch a blue nadir. Then I would hope to see her preshots come down gradually, and if the dose becomes ineffective, you'll either see a rise in her PS numbers, or a smaller percentage of drop from PS to nadir - the curve will flatten.

That's my 2 cents!

Carl

Grain of salt, I've been doing this for 3.5 weeks.

If you check out the first part of my spreadsheet you can see that 1U wasn't doing much at all and I safely upped to 2U for a week until Scout's PS numbers dropped. I know people here seem to go up and down in 0.2 increments but I can't measure that accurately and Scout's numbers never went that low even on 2U. Once I saw greens I dropped the dose. You have pretty flat curves with high nadirs and you have ketones. I'd say go ahead and up the dose, maybe 1.5U and see how that goes? You're testing often enough that you'd notice a bounce if you had one and I think you're a long way from that.

Lori

Thanks Guys,

I increased to 1.2u before midnight. I shot early since she was already in the red. I don't want to up it too fast and miss the dose. I could've shot the 1.2u this afternoon...but when I saw ketones (unusually high for her) I made the executive decision to break out the R, and keep the PZ at 1u one last time before increasing. I didn't want to wait until a ProZinc nadir kicked-in, and I didn't want a PZ increase on top of R usage.

So my question to Carl: I'm a little confused about holding the dose. I thought you didn't have to do that with PZ???? Is this only in the beginning when you're trying to find the dose?

Deb,
The numbers on any one given cycle are influenced by a dozen other things besides the dose of insulin a kitty gets. One day she might eat more, or less. She might be more active. Her system might produce more or less of its own insulin. In one of her other posts, Dr. P. listed 10 or more "other factors" that go into the daily life of a diabetic cat. Holding a dose is just a part of the "start low, go slow" approach that is recommended.

You don't have to hold a dose. You can adjust it by using a sliding scale, for instance. But you need a good bit of "history" in order to analyse what kind of dose makes sense for a certain preshot number. There isn't really any "prozinc" protocol like the Lantus or PZI tight regulation protocols, at least not that I am aware of. So we more or less follow the SLGS one in most cases.

But we're up for anything! Every case is different, and as long as we can follow what is happening, we're all always learning something.

Thanks Carl,

Then I'll wing it until she has more PZ data. I was willing to "go slow"...but won't be able to stick with that game plan if the ketone situation repeats. That number was just too atypical for her. The highest she's ever gone is 0.7...I thought we were heading somewhere bad...fast.

Keeping fingers and paws crossed Marilyn likes the 1.2u. And sprinkling in a dash of "go away ketones" dust. Hope it doesn't make you sneeze! :lol:

Hi Deb,
Sorry you are having such a shotty day and night!
you have a lot on your hsoulders but you are doin great!
hang in there!