07/20 Blackie AMPS 459

She usually does this after a dose increase anyway. Lord knows I'm trying.

 

I hope things settle in today. You're doing great.

 

Angela, sorry I haven't been around, I had house guests.

Blackie's numbers look to me like a kitty with an infection. How are her teeth? Has she been checked for a UTI? The reason I ask this is that Tinkles hit the same sort of pattern, no rhyme or reason to the numbers, when his URI was brewing.

Her numbers look worse to me than ever....if it were me, I would have the vet check her out. If it all checks out, I think you are increasing too rapidly without giving the dose time to settle. Her best numbers were at 1.2u, 1.4u looked a little high, and things just went downhill from there. JMHO

I understand the thinking of not letting the kitty sit in high numbers for 7, 8 days before increasing, I don't think that is helpful. But there is the other side of the coin....increasing so fast that you don't let the dose settle enough and therefore go right past a good dose and end up in chronic rebound. Sometimes going too fast just makes it take even longer to get to regulation. ProZinc, 45 days, crazy numbers, small dose adjustments yield big effects, need time to let a dose settle to see the picture......I may be a broken record, but I hate to see people ending up having to drop back down and work back up again because they increased too fast.....

 

BG's @ +3 274. The dose increase was on the advice of another poster. I'm opting to stay put for a while on this dose and see where she goes. You guys all know what you went through with your cats, and I thank you for all of the advice that I'm getting. I'm still learning this, and I hope that eventually things will settle down. Eventually.

 

Yup, I know, I read the threads. I also looked at her spreadsheet and her numbers have gotten progressively worse. I'm not saying I'm right and others are wrong, I'm just telling you what I see. What you choose to do is absolutely your call!

Has she got any infection symptoms? I think you need to rule that out first.

 

No infection symptoms at all. The UTI I would know as we have a cat who had UTI, and I know what to look for. Her teeth are fine as she has no eating issues at all, either. Could be that this insulin bottle is giving up it's ghost, or perhaps she just needs more insulin. I don't know. All I know is that, like you, I'm getting tired of these #'s, and I want to start seeing some results. On the other hand, I'm apprenhensive about increasing her dosage each day.

Perhaps I jumped the gun and increased her dosage too soon after 3 days of being on 1.6...? I don't know. All I know is that I would like to give this dosage more time for her body to HOPEFULLY adjust to. I'm trying to do my best, and that's all I can do. I don't have near as much experience with diabetic cats as you all do. She's my first (and hopefully my last) diabetic cat that I'm trying to get regulated.

 

I know it's frustrating, and I don't like giving conflicting advice. I don't think any of us necessarily know what the perfect answer is. It makes sense to try a different approach when things are not going in the right direction. You don't know what works unless you try different things, after all!

I don't think it is does any harm to try increasing the dose, but I see an inverse curve a few days ago and high flat curves which could indicate rebound. With the lack of data on the overnight cycles, you could be getting some low numbers there, and the consistently higher ps#s concern me.

Get some other opinions, see what other people think also.

 

Laurie good to see you back. I was of course the one pushing for a dosecreas. The reason I don't see rebound is because that would require that kitty went low then bounced back up.
I hope that varying opinions are taken as a sign of thoughtful considering EVERYTHING and not dissagreeing with one another. if you notice that super high dose was one of the only times blackie saw green, granted too much green, but these current doses are not getting her there.
we all want what's best for beloved blackie.

 

Lord knows I'm trying on my end. I'm on the verge of tears, and usually I'm a strong person.

 

i know you are (((angela))) i truly really do believe this is a process and will work itself out. try to relax with it and go with the flow if you can. like i keep telling you she is getting the 5 star treatment. this has been the road for many many cats here over the years and it all works out. i've seen some cats in the blacks and reds! then they work it out.
just be willing to study your ss, and think it over. it all starts to come together.
and whatever you do, i will totally support you. ;-)

 

What I see is no data at night, and therefore for half of the time, we have no idea what's going on. Tinkles tends to have his lowest nadirs at night, (no food during that time to cushion drops), and I'm sure many cats have the same thing. So do we know if Blackie got low? No, we don't.

I see yellow ps#s when Blackie was at 1.2u, and red and magenta ps#s now. If an increased dose was working, you would expect to see a trend toward LOWER ps#s, not higher, right? The last blue number Blackie saw was at 1.4u. A better dose would give better numbers, wouldn't it? I don't see any better numbers, I see consistently worse numbers.

The reason I don't like to give conflicting advice is NOT that I don't want to disagree with anyone, it's because of exactly what happened here....I got Angela upset because now she isn't sure who is "right". It isn't who is right, and who is wrong, I'm just trying to explain what I SEE. I'm sorry I upset you Angela.

 

Hi Laurie! Nice to see you back!

I've been a bit on the fence since the #s have gotten worse as the doses have gotten up. But I just don't see rebound in the #s. I see U-curves with a few flat ones, suggesting to me the dose is not enough. The only time it would seem to me like someone could miss the perfect dose and head to rebound is through jumping up the scale too fast, like moving in 1u increments. Since Angela has gone in small increments and only changed every several days, I don't see that here.

My take is that Blackie probably has a combo of some insulin resistance, making it harder to break through the high #s, and some liver-training-variety rebound, where her liver has kicked in to some extent and said "no, I'm not on board with all this!!!". One thing they used to say to me was "you can't let his body get ahead of the dose." It's one reason to move faster through the doses - when you give them more time to settle, you give their bodies more time to balance it out, i.e you are letting their livers win the battle, rather than getting them trained to realize the insulin is ok.

In my experience, higher #s tend to lead to higher #s, and better #s tend to lead to better #s. To me that's the main flaw with SLGS - it's a nice idea in theory, but the longer they sit in higher #s, the more insulin they tend to need to bring the #s down, so in that sense to me it can be counterproductive. From what I have seen, cats tend to do better when they get more insulin sooner, rather than the other way around. I'm a big proponent of SLGS when you are looking at stuff like 1u increases every week - that's too fast IMO, but the 0.2u increments are so tiny, I think you can go a lot faster with them. I guess I'm a fan of SLGSBNTS - Start Low Go Slow... But Not Too Slow! :lol:

The biggest question I think is how Blackie is feeling. One thing that pushed me to start feeling like she needs more insulin was when Blackie was just hanging out by the water bowl all day. When the symptoms are flaring up and I'm not seeing signs of rebound, more insulin seems in order to me. The only other choice I see is reducing the dose and going with early shooting, or switching to another insulin - she may just be one of those kitties who doesn't respond well to PZI for one reason or another. I think it's too early to conclude that though, and I think early shooting is too stressful to contemplate unless there is a clearcut pattern that indicates a cat is getting shorter duration, which I'm not sure is even really the case with Blackie.

Anyhow, hang in there Angela!!! The good thing about the board is that we all want what's best for you & Blackie, and although the discussions can end up at times leaving you even more confused, I think it helps to get the discussion out there - we are all looking at the same data, and it's useful to talk through what we are seeing and try to interpret it together.

To some extent there are personal preference differences in how to approach dosing, which is the downside perhaps of PZI's flexibility. But the upside is that there isn't one right answer - there are a variety of approaches that all may work well (or all NOT work well, LOL!). Ultimately your strategy is guided by her needs - if she is feeling well, you have more leeway to be more conservative with it, if she is having more symptoms, you need to be more aggressive.

p.s. Angela, part of the newbie toolkit is a BIG box of kleenex and a boatload of chocolate (and some stiff drinks if that's your thing!!!). Believe me, we have ALL been there, I can't even tell you how much of a train wreck I was when I was struggling though this stuff with Bix. Give yourself a pat on the back, you are doing awesome, and don't let yourself get too worried about the #s and stuff. As people like to say, it's a marathon, not a sprint. If one thing doesn't work, you try something else, and sooner or later it will come together.

 

Laurie, like i said we are all just looking and giving our best thought out idea's. that's what this is all about. let's not look at it as conflicting ideas but thoughts to chew on.
if everyone agreed all the time that would be a dangerous lack of input.
Angela is not upset I don't think with us for caring and thinking it over but please please please let's always maintain respect and not fall into some of the traps that i've seen over in health (and participated in )

 

No, I'm not upset about you folks trying to figure out my Blackie's situation. I'm simply upset that she's doesn't seem to be breaking through the cycle of high #'s since she's started (aside from the occasional good days that I've seen in the past). She's been on ProZinc since May 12th. That's slightly over 2 months on this particular insulin. She seems to prefer the coolness of the linoleum floor in the kitchen to lay on (although last night she surprised me and came to her little bed in the bedroom when I went to bed), and yes, it's very warm and humid here in Texas. Her appetite is most certainly there, so I know she hasn't lost that (thank goodness). Today, she didn't drink nearly as much water as before, and has been napping for at least approx. 3 hours now solid (with the occasional looking up as I walk by). She HAS been sitting up a bit more recently, then lays down, of course, after a bit. She CAN jump onto a chair, and then the table where I test her and give her treats. Today, I made some more boiled chicken, and of course, she wanted some raw meat, which I gave her some (had to cook the rest otherwise there wouldn't be any for treats later). She tests negative for ketones (thank goodness). No UTI problems. She looks like she's gained back some muscle tone in the hindquarters from the jumping onto the chair and jumping down off the table, and following me to the bedroom when it's meal time (she trots beside me, and sometimes runs ahead of me). She's not playing, except that 1 day when I saw her rolling around and rubbing on something that was on the carpet. She doesn't have any bursts of energy (you know when cats get that wild "hair" and start running around all crazy).

I know that you all care about us both, and I greatly appreciate it. I just wish that someone upstairs would hear my pleas and help Blackie's body do better.

 

I forgot.. She DOES preen, too. I just gave her 1/2 doz chicken treats when she heard me try to sneak by her while she was napping, and she jumped onto the table, and got her treats. Then, purred, licked her lips, and started cleaning little cute self.

Off to continue making my lunch... a large salad.

 

One other thing.. After her little 1/2 chicken treats, I don't think she went to the water bowl, and if she did, she may have given it a few licks. Otherwise, she's in her little cubby hole in the scratching post to nap. Oh, and she DID purr after her treats, too. A soft purr, but it was a purr. Perhaps this is a good dose. See what PMPS looks like tonight.

 

Unusual moment... I've put back the lettuce, and normally when I open the fridge door, she's right there. Nope. Not this time.

(extremely cautiously optimistic....... )

 

Awww, I glad she's having a good day.

Robin

 

I don't think there has been any lack of respect anywhere in this thread. :?:

If you think Blackie is feeling better, then I guess that's the important thing.

 

I don't know if she is or not. She's acting like she is, although her nose is warm and dry.

I just don't know.

 

angela give her a few spot checks when you notice good feeling blackie as well as poor feeling blackie. we gotta see where she's going all day #'s wise.
yeah for blackie's preening, purring, eatting and giving up the water bowl :mrgreen:

 

oh i see you did just that! the +4 and +6 are basically the same...so she's probably on her way back up. wanna live a little and try for a 2U tomorow? we'd love to see a blue and our goal has to be a green at least at nadir. she does'nt appear to be in any danger of dropping that far, whatcha think?
not tonight, you'll be asleep.

 

ok

 

oh gosh angela, i don't know how to read that 'ok' it's so innocent and shy.....are you really ok? i love when you just post one sentence after another on a new post...but just ''ok"
that cracked me up. you'll watch her and be ready for anything...however it would be a real shocker if she dipped to low. you have my #, perhaps you should have another persons in case i'm unavailable (like working or something)
maybe joanna?

 

angela let me edit that last post to add, if she give you a nicer than normal amps...stick with it for another cycle.

 

Hey Angela,
Sorry you are having a tough time of it. We all feel your pain...

Infection was mentioned and I have to admit I wondered the same thing. UTI's aren't always easy to spot. Have you had any episodes of peeing out of the LB? Cody got one last week and it really messed us up.
No yellow tint to the inner ears or 2nd eyelid ?

I also wondered if perhaps his nadir could be later. While on Prozinc, Cody's nadir moved from +4 to +8 the longer he was on it. I noticed you don't have many +6 through +9 readings or and any PM readings. Do you think you could get one tonight before you hit the pillow?

Thirdly, I have noticed that certain blood drops look especially thin (watery) and when I test them, and then retest on a different drop, I can get hugely different numbers. Now when i see a "thin" drop, I poke again and don't waste the strip.

The other thing I always wonder about (because Cody is an Acrocat) is insulin resistance and there are some signs that sometimes can help you spot that earlier than just waiting until a cat gets to 5 units. I am posting this for everybody on PZI because potentially 1/3 of diabetic cats test positive (according to some studies)- not because I suspect something particularly about Blackie. I am not on here much lately, so it's good for everyone to know. Here are some clues.

Do they have an unbelievable appetite- garbage diggers, never say no to any meal, steal food off the counter etc/ Do they snore, have respiratory issues, or lost their meow? Are they large, or do they have very large paws, or a large abdomen. Have they survived a large dose of insulin. Do they not respond as expected to changes in dose. Do they have an excessively protruding lower jaw? Have they grown 'larger' as an adult cat? Do they have any enlarged organs such as heart, kidneys, liver?
any combination of them and others can be a clue. Obviously the biggest clue is a very large dose and a flat "curve".

BTW 1.8 is not a large dose. Don't have heart failure, but Cody is moving up to 17.5u units tonight. She may likely just need more insulin, so don't be afraid to give her what she needs. If she survived 8u from a PS of 140, she'll be fine with 1.8u and higher, especially when given on your higher current PSs. Hang in there! You are doing the best you can. If it keeps up, get a urine culture.

 

Just for clarity, want to point out the 8u was on W/D, so significantly higher carbs. I still don't think she is anywhere close to a scary dose for her on low carb, but I wanted to mention that so no one reading might think those #s were on LC food.

Angela, I think you have to restart the calendar with the food switch. You just can't compare the results on the HC vs on LC, and basically it was a do-over starting from scratch when you changed foods. So with that it is more like just 1 month since you started the clock. That is not at all unusual for it to take that long or quite a bit longer to get regulated.

And there's nothing magic about regulation, and with most cats I have seen there is no "magic dose". I looked for that for a long time with Bix until I realized it's a moving target. Now I have learned to just look at the #s more at face value. When you see U-curves that are high overall, you need more insulin.

Tonight's PS looks much better than this morning's, so I agree holding this dose another cycle at least is a good idea - if the AM PS is even better then you stick with this dose, if it is going back up, then I would move up to 2u. If you can get in a bedtime check that is always nice to help fill in the blanks. I would be surprised if you get consistent blue #s on this dose, but as long as the #s are improving it makes sense to me to hold the dose. If the improvement stops, then you know for sure it isn't enough.

She sounds like a real cutie, I'm glad she is purring today, even if it's soft. :YMHUG:

 

I posted a new thread this morning with regards to the dosage. Am updating SS as I go along today.