Meatball 2/20

Discussion in 'Prozinc / PZI' started by Molly, Feb 20, 2010.

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  1. Molly

    Molly Member

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    Feb 6, 2010
    Of course when we got to the vet last night, Meatball was acting as if he was miraculously recovered ... that's the adrenaline right?

    I had a very long conversation with the vet ... she was just as confused about Meatball being so young as the other Drs have been. She reviewed his BG numbers and dosages and wants me to up the dose to 4u, which I told her I would do, but that seems like too much of a jump from 1.5, so I think I'm going to stick to the plan, and raise his dose a bit more slowly, but more aggressively that I've been doing. I'll up the dose every 2 days if the numbers are not lowering.

    As you may know, I was really wanting to switch to Lantus, but she seemed adamant about not doing that right now when he is so unstable, better to just get him into a more safe place before making that switch.

    I was somewhat surprised that she did not actually DO anything. I went in there expecting at least a shot of fast-acting insulin and some fluids, but there was no insulin, and only fluids b/c I specifically asked for them.

    I am going back today, as the vet called me after I left the clinic last night and wanted me to have him checked to make sure there was no infection in his body left over from the UTI he had last summer. Apparently that can make a cat difficult to regulate - at this point I would never be so happy to hear that Meatball has an infection, at least it would answer some questions.

    So, when we got home last night Meatball was definitely feeling better. He ate some food, and drank a bunch of water, even though he had just gotten the fluids. His PMPS 550... though this was at 11:00pm last night, and I usually take a reading at 8:00pm. He ate this morning as well, his BG is still high, 506, even after the 2u last night... at +2 370... +6 490...

    Maybe I should raise it a bit more tonight? 3u?

    Thanks again for all of your support!
     
  2. Ele & Blackie (GA)

    Ele & Blackie (GA) Well-Known Member

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    Dec 28, 2009
    Hi Molly,
    I'm so glad Meatball is doing better. Did the vet check for ketones yesterday? I hope Meatball continues to do well. I would increase the dose, but I would only increase it .5 to 2.5. Going from 2 to 3 is a big jump. If you still don't get some lower numbers you can increase it again. I usually wait 3 days before another increase, but Meatball's numbers are so high, you might want to increase more often.

    I hope others with more experience will chime in soon.
     
  3. Molly

    Molly Member

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    Feb 6, 2010
    Thanks Ele. Seems like sounds advice, do you think I can raise the level every day until his BG levels go down a bit? or is it still better to wait two days?

    FYI - I think I've fixed the link to my profile.
     
  4. Gator & H (GA)

    Gator & H (GA) Well-Known Member

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    Jan 3, 2010
    As Terri pointed out earlier, technically with PZI you do not need to wait between doses to change the amount. BUT if you change the dose more frequently then you should definitely be staying on top of the testing ball. Like grabbing nadir at least every change and hopefully at least +3 and maybe even mini-curves too.

    One option for you might be to up the dose .25u every day which would be the same as upping the dose .5u every 2 days. If you were using U-100 syringes you could technically even do .2u increments every cycle. But again you would really need to be on the ball and have a no shoot that you were comfortable with and be ready to just ever so slightly back off on the dose when the Mean-bizzy started to come back down.

    Just for others that may be reading this, pretty much the reason I think Terri or I would advocate moving fast at this point for you would be because of the ketone issue [but I wouldn't want to put words in her mouth - I'm just guessing].

    If you do start low go fast approach just be aware that when you do get to a point the Meatball is sensitive to the dose you might have a little tougher/long period of getting the dose just right as it's easier to go past the right dose and you can just into this "swing set" mode of too little then too much then too little and so on. But with ketones in the picture you need to be trying to do what you can to minimize that situation.

    What are your thoughts about using U-100 syringes?

    EDIT: I like Ele's idea of getting more eyeballs on Meatball -potentially posting in Health.
     
  5. Ele & Blackie (GA)

    Ele & Blackie (GA) Well-Known Member

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    Dec 28, 2009
    I just don't feel confident enough to answer that question, but I have 2 suggestions. Post in Health with something in your message about "Increase Insulin?" and edit this post and put the same thing in your subject line. This will get more people to respond to your question. And when you post on Health make sure you say the insulin you're on - not everyone will go to your profile. BTW, I could see your spreadsheet and profile - Good Job!
     
  6. Molly

    Molly Member

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    Feb 6, 2010
    I actually have a very similar post in Health, but I am not really getting any feedback there, and someone posted there that I should post here. I'm not sure how to put an active link to the other post, but this is where that is located:

    viewtopic.php?f=3&t=6775

    Maybe I need to change the title to get more attn?

    His PMPS 490 2.5u

    I'm nervous about the dosing, b/c I work a lot. So basically, Sun - Friday I give a shot and walk out the door for 10-12 hours. BUT... something needs to change and more quickly than it has been. So, I like the idea of upping .25u/day. I have no problems w using the 100u syringes, but i don't have any of them. When it gets to the point where I need a more precise level of dosing, I would definitely switch if that would help.

    I am going back to the vet now to have Meatball tested for infection. I wish the vet had thought of this while I was there yesterday!!!!

    Hope you all have a good night.
     
  7. Gator & H (GA)

    Gator & H (GA) Well-Known Member

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    Jan 3, 2010
    Hopefully you can get to a point where the ketones are not in the picture then you can worry about getting the dose right. On the other hand, hypo is not a good thing either.

    Eventually you are going to want to be precise about your dosing, and you might want to get those ahead. You might be able to get them from Walmart in your area [if you can buy needles without prescription in your area] or from Hocks at the link I provided in the Sticky.

    I have to say you have been amazingly collected though this.
     
  8. Nancy and Cody

    Nancy and Cody Well-Known Member

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    Jan 1, 2010
    Molly,
    I don't know, but this may be something to consider if your kitty continues to have ketones popping in from time to time. Have you considered asking the vet to show you how to administer sub Q lactated ringer soln yourself at home and having a bag on hand? It might come in handy at some 3AM or holiday crisis, when the vet isn't readily available.

    The only time I have seen ketones above trace was one time we were traveling with Cody, late evening, and I immediately hooked up his fluids and was able to avoid finding an emergency vet in a strange city. Next day everything was back to normal but it was scary at the time.

    Surprisingly, I find the fluids easier to give then the injection. I'm not suggesting that this substitutes for vet care if ketones appear, but if he is chronically dehydrated from the high sugar levels, maybe it could help keep him out of trouble.
    Your vet will probably hate this idea....
     
  9. Terri and Lucy

    Terri and Lucy Member

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    Dec 29, 2009
    If you didn't raise the dose tonight, you should do so tomorrow morning. I'd go up to 2.5 rather than 2.25 since you have mid-cycle test data to show that the 2.0 is clearly insufficient. When is the next time you'll be able to get some midcycle tests?
     
  10. Joanna & Bix (GA)

    Joanna & Bix (GA) Well-Known Member

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    Dec 28, 2009
    I'd agree on going to 2.5 instead of 2.25 - the #s are just so high, and I think you'll also get overlap built up faster that way, as well as getting more insulin in his system faster to ward off the ketones.

    One reason you might not be getting as much feedback is that for the most part people don't like to comment too far ahead on what to do, there are just so many variables. When you can post regularly like you are - update your thread whenever you get a spot check, and start a new thread each day with that AMPS (so in the post put something like: "AMPS 450 2.5u trace ketones", and then if you have spot checks add them as: "+3 350", or whatever), that's to some extent what we are used to seeing, so it makes it easy for people to follow along and confirm that you are on the right track, or make suggestions if it looks like some adjustments might be needed.

    Also if you have specific times you think you might want help - i.e. "I'm testing around 6pm eastern tonight and would like to post the PS and get advice if anyone is available", that helps to get someone (hopefully) to show up when you need them. I have been generally only on the board about once/day lately and I don't know others' schedules, but I am happy to stop by at specific times if I know someone needs support, and I'm sure there are others too who can do that.

    Also I think it's just slow sometimes on the weekends, especially when the weather is getting nicer!!! (well not here, it's raining :cry: but I'm sure it's nice somewhere!)
     
  11. Molly

    Molly Member

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    Feb 6, 2010
    Next Saturday is the next day I'll be home to do some mid-cycle testing.
     
  12. Molly

    Molly Member

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    Feb 6, 2010

    Joanna - It was beautiful here today, so I know what you're saying for sure! Will try posting with your suggested titles, TY for the advice!
     
  13. Molly

    Molly Member

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    Feb 6, 2010
    Hi Nancy - I am actually giving him fluids 2x per day since Friday night, want to keep him hydrated! It really isn't as bad as I imagined it would be. I tape the tubing to Meatball's fur with some medical tape so i can use one hand to squeeze the bag, and one to pet him and keep him from squirming. I think this is a lifesaver right now. He is drinking some water, but it seems that he should be getting more than normal to flush out the ketones. It make me feel a bit better about leaving him if I give him 100ml in the am before I leave.
     
  14. Gator & H (GA)

    Gator & H (GA) Well-Known Member

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    Just in case you have not gotten the DL on the LRS stuff:
    Thought I would share this place as a cheap place to get the IV sets and needles http://www.shopmedvet.com . And unlike thrivingpets.com I've been told they do not require a prescription. I should be placing an order with them here this week. I really like the 21g Thermo needles. Even thought they are not listed on that web site [website has 20g and 22g], supposedly if you call them they do have them. Costco with the AAA/Caremark discount card is a good place to pick up liquids [order 12,000 ml or a case at a time]. I wrap the the LRS in a heating pad and bring up to [or slightly less than] 101F.

    Good to hear you have that in your tool kit. It's something every cat owner should have at the ready.
     
  15. Nancy and Cody

    Nancy and Cody Well-Known Member

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    Jan 1, 2010
    Gator,
    I couldn't find the tubing on that site, but the LRS was only $2! It did allude to they only sell to vets, so let me know if you have trouble. I have ordered from vetsupplys.com, which is in Alabama, and with shipping, a case, tubing and needles was about $100.(i think) My vet charges about $22 per set even with price match I think.

    Molly,
    I feel a lot better knowing you have that :D :D
     
  16. Gator & H (GA)

    Gator & H (GA) Well-Known Member

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    Jan 3, 2010
    Nancy,

    This was the post from the old site about shopmedvet.com:
    http://www.felinediabetes.com/phorum5/r ... ?8,1764648

    "Tubing" do you mean the IV Sets? Here are the $1 15 drop/ml 100" IV sets:
    http://www.shopmedvet.com/product/6299/ ... nistration

    Yea I think your vet's somkin' somthin'. "Set" you mean $22 for 1 IV set? I have such a hard time not taking predatory pricing practices like that personally [lol, that's some consonance].

    I'm pretty certain the Costco with the AAA/Caremark is less than $25 for a case of 12 1000ml bags of LRS.

    Wow that vetsupplys.com is fairly expensive. Thrivingpets.com is much cheaper and I have ordered from them but they do need a prescription for the IV sets [and shopmedvet is even cheaper if it turns out one can order from them]. I PMed Sheri from that old post and we'll see if she more info on the shopmedvet.
     
  17. Nancy and Cody

    Nancy and Cody Well-Known Member

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    Jan 1, 2010
    And here I was so happy to beat my vets price! $22 was the whole thing and it may actually been more than that (1 bag 1000ml, 1 IV set and about 10 needles #18) They used to whine, make me wait while they approved it with the office manager upstairs, and give me a hard time with the price matches saying they had to add $5 shipping (so I paid $11). They would make me print out a new price match every time I went there, and if I forgot- Had to pay the full price, makes me mad thinking about it.

    The prescription isn't a problem for me- she wants him on 150ml/day.

    I think vetsupplys total for one bag & set was about $6-7, but the shipping and fees were very expensive (a case is heavy). Which brings me to the point (finally) I'm going to go call SAMS and see if I can get a case there to avoid the shipping. What a great idea! - thanks Gator :D
     
  18. Gator & H (GA)

    Gator & H (GA) Well-Known Member

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    Jan 3, 2010
    Even if you don't have AAA I know my Costco has [and I know most pharmacies have] a special discount program for people [and pets] that are not on insurance. You just have to ask. But the AAA/Caremark discount is better for instance than the regular Costco discount program for people/pets without insurance.

    And even with some persistence you can work on your other local pharmacies [CVS, Walgreens etc.] to see if they can't get it in and for what price. They usually don't carry it. Sometimes you will need to speak with the pharmacy manager. Shipping LRS is RIDICULOUS!!

    BTW I just heard from Sheri and she said she got IV sets and needles from shopmedvet apparently with no prescription ...so.
     
  19. Gator & H (GA)

    Gator & H (GA) Well-Known Member

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    Jan 3, 2010
    Just got back from Costco. A case of 12,000ml [12 x 1000ml] LRS was $23.15 + 9.75% sales tax.

    I spoke with shopmed vet today. They will sell to individuals and they do not require prescription for IV Sets and needles to CA. LRS is considered a Rx/medication.

    If one searches their site for "terumo" ALL the Terumo needles show up including the 21g by one inch ones we like. If you just look at the category only the 1.5" inch ones show up and in only certain gauges.
     
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