New to Forum - Zima's Glucose Level and mini curve

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Lyn Pusztai

Lyn Pusztai

Member Since 2015
Hi Everyone,

I am new to this site, though I checked it out when my dear little 15 yr old, Zima, was diagnosed with Diabetes last July, 2015. So far, it has been somewhat under control, but recently, I have begun to have problems. I am doing a mini curve today at 8am, 2pm, and 8pm, right before she eats and has her 4cc's of Vetsulin, according to my vets instructions.

The problem is that in the past two weeks, she has lost wieght... according to my scale about a pound, bringing her down to 6.8lbs. She is eating Hills wet m/d according and I have dry as an option (same brand) if she will not eat the wet. So far this has been working, but in the past two days, after her shot or later in the day, she has had vomiting and diarreah. It is the weekend, (isn't that when this stuff always happens?!) and I can't reach the vet until tomorrow morning. I had called Friday and we missed each other, so she left a message on my machine to call her Monday Jan, 11th with the curve readings and we can go from there. That is where I am at as of this morning, Sunday.

My questions:
1.) Her first glucose reading this morning at 8am was 324, so it's high. I'll continue at 2pm and 8pm tonight. So far no vomiting, but I am concerned how dehydrated she seems. I have a bag of IV fluids from July when I was instructed to give 1cc a day when she was first diagnosed. Does anyone know if the fluid would still be good 7 months later? Should I give 1 cc fluid to rehydrate her without speakign to the vet?

2.) Any solutions on easing up the vomiting? I have pepcid at home. Once my vet told me to give 1/4 tablet to my other kitty to ease her tummy. Wondering if I should give to Zima now?

Her attitude is "okay"... she is not her usual, extremely sweet and affectionate self, but she is not hiding or anything. She is thirsty (sink on constant drip and bowl full of water), her urination is more than usual but not crazy, and she just seems so "boney".

Any thoughts or speculations on what is happening or if there is anything else I can do? Does she need to see the vet tomorrow or should I wait and talk to vet first? I am feeling overwhelmed and so worried about her. I had been reading on the site all night and just need some support from people who understand.

Thank you all so so much. Your help is deeply appreciated.

Take care,

lyn
 
Hi Lyn

This is just a quick 'hello' - bit tied up at the moment so can't post a proper reply just now (sorry!).

I'm sorry to hear Zima's not feeling very well. With both vomiting and diarrhoea in the mix I would look to get Zima to the vet as early as possible tomorrow.

Have you any ketone strips at home? If yes, please test Zima's urines to check for ketones. If no, then I strongly recommend you get hold of some today and do the test. If you do get anything more than 'trace' ketones she would need to go to the vet immediately to get the ketones flushed (otherwise it could turn to DKA).

I also recommend that you get a blood glucose test at 11am (i.e. 3 hours after the insulin was given). It will help you to see how fast the Vetsulin lowers the BG and may help you to catch an early nadir. (Vetsulin really kicks in around +3.)

It's impossible to know what is the cause (it could be as basic as a GI upset but pancreatitis or other problems may be contenders). I'd ask the vet to run a full blood work-up including kidney panel and B12/folate. If pancreatitis is a possibility a Spec fPL should be included.

I can't answer about the IV fluids (no experience). If it were me I would put in a call to your vet's out of hours service for advice. (They may be able to recommend something to help with Zima's electrolytes.)

It is good that Zima is drinking. Make sure she eats, too. (Again, to avoid ketones.)

It's impossible to know without more data how the Vetsulin is working for Zima. Four units of Vetsulin twice a day is a not insubstantial dose. Is there any correlation between the increased thirst and weight loss and any Vetsulin dose increases?

Please can you post your BG and urine test results here.

I must away. Will check back later. Sorry this is so rushed.



Mogs
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If the bag of fluids was opened 7 months ago, then they would not be suitable for use. The potency is questionable and the bag itself could be compromised. You would be better off adding water to the food you give Zima or syringe the water.

I do agree that pancreatitis could be an issue here. As for help with the diarrhea, two benign options that won't taint blood work are: about 1/4 to 1/2 tsp of plain pumpkin (not the pumpkin pie mix, make sure the only ingredient is pumpkin) or a pinch of unflavored psyllium husk.

I would give the 1/4 tab famotidine. It will help if there is a problem with acid. If eating is a problem you can give baby food meat. Just be sure there is no onion or garlic, read the label and make sure it contains nothing but meat and broth.
 
Mogs and Anita,
Thank you both so much for your feedback. Very useful. I will take another sample at 11am (+3 hrs). Zima ate twice this morning after insulin at 8am and has not thrown up again. She seems to be feeling a little better today. No vomiting or diarrhea yet today.

I do not have ketone strips. Is that something I can get a Walgreens? the vet is closed and I don't drive or have a way to get there. : ( I am not sure how to test urine - I have clumping litter - is it something I can stick in a clump? (sorry so ignorant on this). I looked up the term DKA to educate myself on that.

I can post the BG as the day goes on. Right now it is:

8am - 324

If she vomits again I will try the pumpkin.
Thank you both SO MUCH for your input and help. I'll check back in later in the day.

lyn
 
You can buy ketone test strips at most pharmacies and at Walmart. They are only about $10. With Merlin, all I had to do was watch him very closely when he would go to the litter box and stick the strip (me holding onto the strip) behind his tail and catch the urine flow. Some put plastic wrap in the litter box so it would catch little pools of urine. Then you would stick the test strip in one of those pools. I wouldn't trust the reading if it was contaminated with litter.

When you shoot, how long do you wait to shoot Vetsulin after Zima eats? Have you been regularly home testing? Do you know how low Zima's BG numbers are within a 12 hour cycle?
 
Hi Lyn,

I see Walgreen's are a pharmacy chain (I'm across the pond). Maybe give the one near you a call to see if they have them in stock? I assume that they carry supplies for testing blood glucose so it's likely they'll carry the ketone strips as well.

I see Merlin has given you some tips. I use the plastic wrap trick. Some people stick a small ladle under their kitty's hiney to catch a sample! :)

Re the GI problems, if the food you've just given her seems to stop the vomiting, I'd suggest sticking to just that variety for the time being until the vet checks her over. Also, if you feed her little and often it might be easier on her digestive system and help against build-up of stomach acid (the latter tends to be worse on an empty tummy).

Just brainstorming here: how long is it since Zima passed a solid poop? Is there any chance she might be constipated? Sometimes liquid faeces manages to squeeze around a stubborn stool and it can be mistaken for diarrhoea. Also, is there any correlation between when Zima vomited and her visiting the litter box? Sometimes constipated cats may vomit when they try to poop. More info on this subject at www.felineconstpation.org.

Until you're sure about the constipation question, I'd suggest holding off on adding fibre to Zima's diet until you can get the vet to examine her tomorrow (just to make sure she's not backed up).



Mogs
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I think you mean you are giving 4 units, not ccs, right? One cubic centimeter equals 1 milliliter (mL) and has either 40 units of insulin (ProZinc and Vetsulin/Caninsulin) or 100 units (Lantus, Levemir, Humulin/Novolin NPH).

Some other assessments you may wish to make are described in my signature link Secondary Monitoring Tools.
 
Mogs, BJM, and Merlin,

THANK YOU so much for your help. Zima is overall much brighter today than the past two days. I will walk to Walgreens inbetween BG tests and get the ketone strips and follow instructions on fetching the urine. I am assuming human/pet ketone strips are the same?

I did the 11am suggested BG test and it was 62 (per Mogs suggestion to test at +3 hrs since she is on Vetsulin). She isn't vomiting or walking hunched like the past two days and is not snoozing as much. Interacting more with her sister Sera, so that's good. She has eaten the wet food 3 times and it's 11:30am here, so also good.

Here are the BG tests so far today. Next one at 2pm. Hopefully I can get the strips and will post that reading also.

8AM - 324
11:AM - 62 (is this what you referred to as the Nadar?- not sure what that means but here is the reading : )
2PM
8PM

You guys are wonderful. deep thanks for your suggestions and input.

Kind regards,

Lyn
 
Vetsulin is a pretty harsh insulin. It's nadir (lowest BG number within a cycle) is very early and is typical for Vetsulin. For other insulins like Lantus, Levemir and Prozinc, their nadir is typically +5 to +7 for most kitties. Zima dropped pretty quickly at +3 and probably should be tested at least +4, or maybe earlier at +3.5 to make sure he doesn't drop below 40-50. If you are using a human meter, it shouldn't drop below 40. Here is additional information regarding hypos.

Hypo Kit: Always good to be prepared for possible hypo events (low blood sugar) which means that your cat has reached dangerously low numbers. It can be fatal, hence, the importance of home testing and collecting data in a spreadsheet. In each of the Insulin forums are stickie’s labeled Hypo Links. Here is one: How to Handle a Hypo. Please print and post on your refrigerator so everyone in your household is aware of hypo symptoms. You will want to create your hypo kit that would include and not limited to; extra testing strips, honey/karo/maple syrup, high carb food, medium carb food, vet information, etc. Hopefully you will never need it but probably at some point in time, you will need to deter from going too low. I like to get a couple of small Fancy Feast Gravy Lovers food for the high carb. It really doesn't take much to increase their BG number.
 
Hi Merlin,

Thank you so much for your input. I am learning a lot quickly! I didn't know that about Vetsulin and it is helpful to understand.
Unfortunately, I didn't see your email until after the +3.5 and +4 after insulin note : ( I am taking the next reading at 2pm and then 8pm according to what my vet had told me prior for "mini curves". But at least I will have the information of her 3 hr. (11:00am) reading to give the vet tomorrow.

I will be going out to get ketone strips and karo syrup later today after 2pm reading (I have fancy feast here and mix in with the Hills wet m/d which she likes to eat). I ordered more testing strips and lancets which will arrive by Tuesday for the AlphaTracker 2 which is what I am using.

thakns you again for you input. greatly appreciated. Zima is sleeping comfortably now. fingers crossed.

Lyn
 
Zima's 2pm BG reading was 100. So for the day it is:

8am-324
11am-62
2pm - 100

Heated rice bag in a sock worked great! She loved it. : ) thanks for the suggestion. While she is not running to the testing site yet, the procedure went better. also, adding pressure to the puncture after seems to have helped stopped bleeding and she was happier. Thank you for all the input everyone.

lyn
 
Hi Lyn,

Delighted that testing is getting easier for you both and that the rice sock was a big hit with Zima. :cat:

You did great getting the curve data today. Thank you for posting it here and, most importantly, for confirming that you're using an Alphatrak meter.

The 62 you got today is too low (approx hypo threshold is thought to be around 68mg/dL on an Alphatrak). The dose is too high.

You need to reduce the dose straight away (i.e. this evening). Can you clarify the dose you are giving Zima, please? Is it 2 units of Vetsulin twice a day? Or 4 units of Vetsulin twice a day? Also, do you have an out of hours number for your vet?


Mogs
.
 
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Hi Mogs,

awww... thanks for the vote of support. I went out and got the ketone stix and I am just "waiting for her" ... ; ) I lined the box with seran wrap so hoping she decides to go soon.
While I was gone (3:30pm ) getting the stix, she vomited and had soft stools again in the box when i got home. : ( I gave her some tuna juice because she wouldn't eat her wet food and she lapped it all up. She seems "fine" but cats... they hide the pain I know.

To clarify on the Vetsulin: About a month ago I went from 3 units's to 4 units's because she had a shift in behavior and was not herself. Her readings then on a mini curve were: 8am - 284, 2pm 180 and 8pm 291. So my vet too her to 4units and she seemed to perk up and be doing better in general except for the slow weight loss. The only other change was I started adding a teaspoon of Fancy Feast to her Hills md/wet to entice her to eat more (which works). She drinks a lot of water (I leave the drip on the sink and fill the bowl). So that was the month of December and the "change" just started this January.

the vetsulin is currently 4 units twice a day 8am and 8pm

I am so frustrated because I don't want her to suffer. She seems "okay" right now... she is in "meatloaf position" on my table and wants to be close.

No after hours number for the vet. We are supposed to talk in the morning first thing they open tomorrow

deep thanks for your help and input.

lyn
 
Lyn Pusztai said:
... she is in "meatloaf position" ...
Click to expand...
Is she tense, Lyn? If it's a 'tense meatloaf' that can be a symptom of nausea. My Saoirse has chronic pancreatitis. Here are some links I found helpful when I was learning how to help her (nausea is a big issue):

Nausea, Appetite and Vomiting (Symptoms and treatments - from Tanya's Site)

IDEXX Labs Pancreatitis Treatment Guidelines

The IDEXX document is very helpful as a basis for discussion with your vet should pancreatitis be the problem (I hope it's not), but even if it's not pancreatitis there's really useful information on treatments for nausea and lack of appetite.

Sending some special 'feel better soon' vibes to little Zima, plus a little bit of TLC for her mama. :bighug:


Mogs
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2016-01-10 17.23.59.jpg

hi mogs : )
i am not sure what a "tense meatloaf" looks like, but here is a picture of her right now. I will ask the vet about the pancreatitis and read what you sent. She hasn't urinated yet so I don't have a number : ( for the ketone. I also found out my vet will not be in until Tuesday morning but I am going to see if another vet can see her tomorrow or talk to me at least. I can't drive so it greatly complicates things in addition to not having a lot of funds, but where there is a will there's a way always and both my babies are worth whatever it takes.

back to feline ville.

oh - what should i reduce the vetsulin to? 3cc's this evening at 8pm? or leave at 4.

thanks so much!

lyn
 
You DEFINITELY MUST reduce the dose, Lyn; the 4 units is too high and it's taking Zima into dangerous numbers. (@BJM - can you suggest something for a reduction?)

Lyn - if you don't hear from BJ, I'd suggest reducing by at least 1 unit - then you might be able to get hold of the vet tomorrow before she is due her next dose? What ever you decide upon, it must be below your current 4 units tonight and tomorrow morning. Then you can review dose with the vet tomorrow.

Are you able to monitor Zima overnight? I strongly recommend that you get a +3 tonight (i.e. 11pm if dose is given at 8pm) on the reduced dose to make sure that Zima will be safe overnight (sometimes it is possible to get a little carryover into the next cycle). If she goes low, post a new thread on Feline Health to ask for help if you're not sure how to get her back to safe numbers.

BTW if Zima's PM preshot test (PMPS) is higher than normal tonight that might be a bounce (a temporary, protective elevation of BG that sometimes happens when a cat goes too low, into numbers lower than it is used to, or when the BG drops by a lot and quickly during a cycle and the liver dumps extra glucose into the blood for protection). You still need to work with the low number mid-cycle today. Don't be tempted to give the 4 unit dose; it's dangerous.

It's tricky to know whether Zima's uncomfortable from the photo. Sometimes there's a 'tightness' to the facial expression that, together with a meatloaf posture can indicate discomfort, nausea or pain. Here's an example of the difference between comfy and uncomfy:

http://ibdkitties.net/pancreatitis.html (scroll down the page to see pictures).

Hope all goes OK tonight and at the vets tomorrow. Let us know how you both get on. :bighug:


Mogs
.
 
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Mogs,

thank you for the feedback. I just did the 8pm BG and it was 253. Then I gave her the Vetsulin - I took it down to 3 units (what I was doing a month ago) as you suggested. I will check again at 11pm per your suggestion also. (BJM said earlier maybe even +3.5 or +4 ... so 11:30pm or 12pm... any thoughts on that?) Zima is resting in her bed now. I gave her some tuna so she would have something on her stomach. I have heard tuna is not great for cats but I wanted her to eat something and she turned her nose up at the Hills wet m/d mixed with Fancy Feast.

So here are the final numbers for the day with the exception of 11pm.

8am - 324 Administered 4units's Vetsulin
11am - 62
3:30 - soft stools and vomited - watery brown and some undigested food
8pm - 253 Administered 3units Vetsulin

I have only been doing a mini curve testing once a month, so I don't know outside of that what the usual numbers would be. On 111/22/2016 it was 8am 284, 2pm 180 and 8pm 291. That is when my vet changed her from 3units to 4 units, just so you have a background.

She is resting now and seems okay. I hope I can get in to the vet tomorrow. : ( I am so worried about my dear friend.
Mogs - you are the best. Thank you for helping me!!!

Lyn
 
Critter Mom said:
You DEFINITELY MUST reduce the dose, Lyn; the 4 units is too high and it's taking Zima into dangerous numbers. (@BJM - can you suggest something for a reduction?)

Lyn - if you don't hear from BJ, I'd suggest reducing by at least 1 unit - then you might be able to get hold of the vet tomorrow before she is due her next dose? What ever you decide upon, it must be below your current 4 units tonight and tomorrow morning. Then you can review dose with the vet tomorrow.

Are you able to monitor Zima overnight? I strongly recommend that you get a +3 tonight (i.e. 11pm if dose is given at 8pm) on the reduced dose to make sure that Zima will be safe overnight (sometimes it is possible to get a little carryover into the next cycle). If she goes low, post a new thread on Feline Health to ask for help if you're not sure how to get her back to safe numbers.

BTW if Zima's PM preshot test (PMPS) is higher than normal tonight that might be a bounce (a temporary, protective elevation of BG that sometimes happens when a cat goes into numbers lower than it is used to, or when the BG drops by a lot and quickly during a cycle and the liver dumps extra glucose into the blood for protection). You still need to work with the low number mid-cycle today. Don't be tempted to give the 4 unit dose; it's dangerous.

It's tricky to know whether Zima's uncomfortable from the photo. Sometimes there's a 'tightness' to the facial expression that, together with a meatloaf posture can indicate discomfort, nausea or pain. Here's an example of the difference between comfy and uncomfy:

http://ibdkitties.net/pancreatitis.html (scroll down the page to see pictures).

Hope all goes OK tonight and at the vets tomorrow. Let us know how you both get on. :bighug:


Mogs
.
Click to expand...
 
Correction: it was Merlin who suggested testing at +3.5 or + 4, not BJ. Sorry for the error - I am still getting used to names here. Thank you everyone.
Lyn
 
I took Merlin's advice and tested BG also at 11:30pm (+3.5) and her number was 55 : ( I dropped her dose to 3units at 8pm per the advice 4units was too high. She seems fine, just drinking a lot of water and wants to sleep. Eating her Hills md/fancy feast mix and also tuna juice.

I also ran a ketone strip and it was at 5 (trace). I submerged it in the urine that collected in the seran wrap and matched it at exactly 15 seconds according to the instructions.

I have to leave for work at 8:30am but calling the vet at 8am and already sent an email to them. My regular vet is out tomorrow, so I'm going to try to drop her off and pick her up after work so she is at the vet for the day. I only have 2 BG test strips left. New ones coming Wednesday.

Any advice appreciated. thank you so much for helping me.

Lyn
 
to put today in context, here are the totals for the curve:

So here are the final numbers for the day with the exception of 11pm.

8am - 324 Administered 4units's Vetsulin
11am - 62
3:30 - soft stools and vomited - watery brown and some undigested food
8pm - 253 Administered 3units Vetsulin
11:30pm (+3.5) - 55
Ketone strip at 11:30 = 5 (Trace)

thank you so much.

Lyn
 
AACCKK!! 55 mg/dL is still way too low on the AlphaTrak!!! You don't want that number going below about 90 mg/dL on an insulin like Vetsulin, to allow you enough margin of safety.

The nadir is the lowest glucose post-shot and is the number you use to adjust the dose, with consideration of the pre-shot once your test data have shown how she drops at different doses.
Would you be able to shoot every 8 hours? I suspect the insulin will probably wear off before 10 hours when you reduce it to a safe dose that won't take her too low.

The pancreatitis may be affecting her digestive enzymes, too, hence the partially undigested food in the feces. Discuss with your vet the use of some supplemental digestive enzymes.

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.
 
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BJM said:
AACCKK!! 55 mg/dL is still way too low on the AlphaTrak!!!
Click to expand...

Similar reaction here. Thank goodness you're home testing, Lyn.

You did great getting all the BG tests and the urine test, Lyn. With the trace ketones and the GI upsets I think you really, really need to get Zima seen by a vet today. It's always safest.

Your vet may be able to run an in-house SNAP fPL test which would give you a yes/no result pointing to whether pancreatitis is an issue. It's not as sensitive as the Spec fPL (which returns a number that may indicate both the presence and the severity of pancreatitis).

How is Zima's appetite at the moment? Healthy cats need to eat enough, under-the-weather kitties doubly so. If Zima were to lose her appetite it would make things much more stressful for you both and difficult to manage, especially considering she is on insulin and she has trace ketones).

I suggest asking your vet about the following treatments:

1. Anti-nausea medication. - A Cerenia injection could help with the vomiting. Generic ondansetron is a tablet, and you may be able to get Cerenia tablets in the US, so both might be administrable at home.)

2. Appetite stimulant - Cyproheptadine is gentler in action and more controllable in terms of dosing than mirtazapine as its effects wear off after a number of hours. Check liver status for cyproheptadine. Mirtazapine can induce serotonin syndrome (potentially life-threatening) and remains in system for several days. Also, buprenorphine may potentiate the effect of mirtazapine. (Nova, a new forum kitty had a bout of serotonin syndrome last week. Cyproheptadine is the antidote.)

3. B12 cyanocobalamin injection (followed by a course of same if B12 levels are low on blood tests).

4. Buprenorphine if pain relief is needed (see warning about mirtazapine drug interaction above).

5. A probiotic of some sort for the diarrhoea.

6. Flagyl or Stomorgyl 2 for diarrhoea (both contain metronidazole, Stomorgyl 2 also has another antibiotic ingredient). Our vet says Flagyl tastes absolutely foul, but Stomorgyl 2 is not as lousy-tasting and is easier for the cat to get down.

7. Famotidine or Ranitidine if stomach acid is considered to be an issue. (Needs to be given two hours clear of other meds to avoid possible malabsorption of the other meds.)

All of the above are covered in the IDEXX pancreatitis treatment guidelines.

It helps so much to have a supply of anti-nausea and appetite stimulant meds available at home. Zima may never need them, but if she did you'd be able to respond to dwindling appetite really quickly and that can make an absolute world of difference because you can head inappetence off at the pass.

I'll look in later. Hope to get an update from you then. Sending 'get better very soon' vibes to Zima and some :bighug::bighug: for her Mama Bean.


Mogs
.
 
Hi Mogs, Merlin and everyone,

It's been a long two weeks. I am so frustrated. Zima's numbers are just whacky and I don't know what else to do. My vet Dr. Jenny is out of town 1/16 - 1/26 and then I am leaving town from 1/27 to 2/7 and because of cost have to leave Zima in my neighbors care. She has given shots for many months to help out, but i feel like I need to get the numbers under control. I finally have enough data to enter into the spreadsheet (see my signature line here to see numbers)

I took Zima in to the vet last week and Dr. Jenny kept her the hole day and did a full Senior Panel with extra Pancreas, Kidney and Fructose tests. The long short of the tests were that the kidneys were slightly elevated as was the pancreas. She gave her an antibiotic shot on 1/15 and on 1/12 gave her a shot for nausea, and a B12 injection and 100ml of fluids. I have also been sent home with a bag of fluids and giving 100ml every night. I got the AlphaTracker test strips and lancets FINALLY in the mail, so I am trying to take the AMPS at 7:30am before food, the give the insulin at 8am (after she's eaten) and insulin again at night at 8pm after she's eaten and try to take another PMPS number before she's eaten. Also 100 ml fluids after all that.

Zima seems basically fine even though her number tonight PMPS is alarming to me at 498. The "fill in" vet, Dr. Boyd, said if the PMPS was still high, to increase the vetsulin to 3.5 units which I did.

She is sleeping in her basket now and seems fine. Her appetite is good (Hills MD with FF classic chicken mixed) and eating Pure Bite treats. Drinking Normal. No vomiting or Diareah.

I am starting to wonder if my AlphaTracker meter is reading this right. I got the new strips and programmed it according to the instructions (Cats Code is 37) and that is what the tracker reflects when I put in the strip. Argh!

Any comments on her general numbers or insights would be great. I feel like I am just begining to sort of understand this and just want to do the right thing for my sweet baby.

Thanks!
Lyn

Zima's numbers
https://docs.google.com/spreadsheet...CfOfs1eDWBdZqnl9OueYJez6Xc/edit#gid=361360320
 
Hi Lyn

Just tried to look at Zima's spreadsheet. You need to click on the Share button on the top right of the screen in Google Sheets to give permission to anyone with the link to view the spreadsheet. (NB - view only, not edit.)


Mogs
.
 
Hi Mogs,

thanks. I just did what you said. Can you please try again to see if it's working? Thank you.

best
lyn
 
We can see Zima's data now. :) I see from your notes that Zima's another cat who likes waitress service. ;)


Mogs
.
 
Good job on the spreadsheet!
Remember: the insulin dose is adjusted based on the nadir, the lowest glucose post-shot, not the pre-shot tests. You are likely seeing some bouncing - when the glucose drops fast and/or drops to an unfamiliar number and/or drops too low, this triggers compensatory hormones which release stored glucose (glycogen) to bring the levels back up ... and then some ... for up to 3 days. You just have to grit your teeth and avoid the temptation to increase based on the pre-shot tests when this happens.
When you can, snag a test or two in the +9 to +11 hour period. Many cats run through the insulin before 12 hours is up and this also may be a reason for elevated pre-shot tests. You'll see it in these tests as a sudden rise in glucose level if that is happening.
 
Thanks BJM. : ) Zima's AMPS was 406 on 3.5 units this morning. PMPS was 498 last night so vet told me to increase from 3 to 3.5. I wish I was home to get a +4 or later a +9 or +11, but I have to work : (
I am so glad you all are here.

all input welcome.
lyn
 
Hi Lyn - Great job in getting your SS set up. That helps a lot. You may have already heard that Vetsulin is a fast reacting insulin which means it drops the BG numbers down pretty quickly within a cycle and may not last as long. Some kitties do well with Vetsulin but some do not. Sometimes the nadir is earlier than +6 and sometimes we see in kitties that the nadir is at +3 to +4 with Vetsulin (that is why I suggested a +3.5 test in the other day). You may be dipping lower just 3-4 hours after your shot and may be the reason why you are seeing such high pre-shot numbers. It would be great on one of your days off (maybe weekend?) if you could get a curve (+3, +5, +7, +9 or something like that) in to see how Zima is reacting to Vetsulin.

Something else that would be helpful if you could add some additional information to your signature like Zima's age, Diabetes DX date, any other illnesses like Stage ? CKD, Meter (AlphaTrak), Insulin (Vetsulin), Place where you live (this is to help with the time-zone support), etc. The more information you can squeeze in the signature is most helpful. You can view others to get an idea. To get to your signature, just go up to top right of page and click on your avatar. Should have two columns of things you can update.
 
Hi Cindi,
I am uploading zima's most recent Senior Profile (from last week) here. I do not see how to put it anywhere else for people to view it. The panel also has also got the pancreatitus and Fructose reports I had done separately at the same time per Dr. Jenny's suggestion. I added Zima's diagnosis date to my signaure (july 2015 ) and her age 15 + and that we are keeping an eye on Kidney and Pancreas. I am so worried about her. I hate being a work and not being able to stay on top of the +3 to +4 readings : ( I feel like a bad mom.

Thanks for your help. If you see anything in the numbers below I should know that will help me understand Zima better it would be great to hear. : )

take care
lyn
 

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Merlin said:
if you could get a curve (+3, +5, +7, +9 or something like that) in to see how Zima is reacting to Vetsulin.
Click to expand...
I'd suggest adding a +2 to that list. It would give you a clearer idea of where in the cycle the Vetsulin is kicking in and might give some pointers as to how quickly Zima may be metabolizing it.

I notice that Zima's Spec fPL is a little elevated. Just for information, here are a couple of links I found really helpful for Saoirse. (Worth getting familiar with nausea symptoms - they can act as a great early warning of a flare brewing. Quick treatment is key with pancreatitis; tackle the early symptoms and it reduces the risk of becoming a full-on flare.)

Nausea Symptoms and Treatments

IDEXX Pancreatitis Guidelines

The nausea link above takes you to Tanya's Site; the go-to internet resource for all things CKD. There is a shed load of information there. Also, they have a support group.

Vetsulin curves typically look like buckets (Small comfort, I know ... :( )


Mogs
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@Critter Mom - Good point Mogs - a +2 would help us determine when the insulin is kicking in prior to it's nadir (low point).

Lyn Pusztai said:
I am uploading zima's most recent Senior Profile (from last week) here. I do not see how to put it anywhere else for people to view it.
Click to expand...

When Merlin would get lab results, I just added a tab on to your already made SS and label it lab results. It is great to record this and then compare it to subsequent lab tests. Click on Merlin's SS and then look at the bottom at the tab that says "Merlin Lab Results." You can see multiple lab results and how they all compare to each other as well as the reference range.
 
Merlin said:
You can see multiple lab results and how they all compare to each other as well as the reference range.
Click to expand...
I've done that for Saoirse. It is a great help and it also makes for much more productive consults with vetty beans.


Mogs
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Thanks, Mogs and Merlin : ) Zima's numbers are FINALLY coming down. I am so happy. Not perfect but I'll take anything. I will check out everything both of you suggested for sure. I have posted all the numbers. she is still on 100ml fluids a day which really seems to help her feel better.

Lyn
 
I have heard that subq fluids will also lower the BG number. I think some have strategically scheduled their fluids so it doesn't bring them down too fast.
 
I didn't know that! I am giving them to her at 9pm, which is 2 hours after her insulin shot. Hope that is okay. Thank you so much for the feed back. Do you have an idea when is a good time to give fluids if shots are given twice a day, 12 hours apart?

Thanks so muych
 
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