? 2/24 Arya: AMPS 394 +1 417, PMPS 363 +2 299 +5.5 349, neg ketones Post DKA/HL

At the beginning of treatment, most cats' numbers bounce around. The drops into blues and even yellow range numbers may be lower ranges than what Arya is used to and as a result her liver and pancreas "panic" and dump a stored form of glucose and counterregulatory hormones into her blood stream. It's a protective mechanism that caregivers (CG) find annoying but is a normal reaction. It can take up to 3 days (or so) for a bounce to clear.
 
Hi Katie,
Great the ketone test was negative. Keep trying to get 2 tests in a day to check the ketones. That test is really important.

Yes. Stay with the same dose.
Are you going to be able to get any tests in during the pm cycle today?

Arya is drinking a lot because her BGs are higher than normal and also she is eating the dry food that had a low moisture content. It’s good she’s drinking at the moment.

Most newly diagnosed cats BGs bounce around a lot in the beginning. Insulin is a hormone, it’s not like an ordinary medicine that fixes something when it’s taken. The body has to take time to get used to the way the insulin works.

I know you can’t today, but try and get as many tests in around the +5 to +7 mark in as many cycles as you can as we want to know how low this dose is taking Ayra so we can decide when and if to raise the dose. And the way we decide is to see what the nadir (lowest point in the cycle) is.
 
Bron and Sheba (GA) said:
Hi Katie,
Great the ketone test was negative. Keep trying to get 2 tests in a day to check the ketones. That test is really important.

Yes. Stay with the same dose.
Are you going to be able to get any tests in during the pm cycle today?

Arya is drinking a lot because her BGs are higher than normal and also she is eating the dry food that had a low moisture content. It’s good she’s drinking at the moment.

Most newly diagnosed cats BGs bounce around a lot in the beginning. Insulin is a hormone, it’s not like an ordinary medicine that fixes something when it’s taken. The body has to take time to get used to the way the insulin works.

I know you can’t today, but try and get as many tests in around the +5 to +7 mark in as many cycles as you can as we want to know how low this dose is taking Ayra so we can decide when and if to raise the dose. And the way we decide is to see what the nadir (lowest point in the cycle) is.
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Thank you both for explaining the bouncing, it's very confusing to me being a newbie. I have been trying to get the 2 ketones tests in but at night she hasn't been going consistently (and just jumps out when I place her), in the morning I'm able to catch her naturally when she's still in my room, will keep trying though! I will try to get a +5 tonight if I can make it. Last night I meant to get a later test and I ended up falling asleep with all the lights on..will try to set mini alarms to try to get tests in.
 
@Bron and Sheba (GA) @Sienne and Gabby (GA) PMPS is 363, going to try for a +2 and +5 is that good? Worried she might need an increase but I know she could be bouncing too? She's eating and drinking well still (still trying for a PM ketones). Her ear does seem a little sore/bruised in spots, I think I may have been pushing too hard at the beginning, is there anything I can do to help that (have been using neosporin)? I've been trying to alternate and change places but worried since she's started to flinch a little now :( also is it ok if I can't get any BG test other than AMPS in the morning? I know it's not ideal but I'm trying to alter my work schedule. Thank you as always for your help and advice
 
Are you using the Neosporin Pain Relief? If you use the ointment, you can dab a small amount before you poke. It will cause the blood to bead up and help with any ear issues.

Testing at +2 is good. I would base any subsequent tests on what Arya's numbers tell you. For example, if she's dropping at +2, you may want to test sooner than+5.

As far as bouncing, she may have bounced off of the yellow PMPS last night. The question mark is how soon Arya will clear the bounce. As long as ketones are good and unless numbers skyrocket, you would ordinarily hold this dose for a week. (Since Arya is eating dry food, you need to use SLGS as your dosing method.) I might be inclined to suggest fast tracking the dose given the DKA history and increasing after 5 days or sooner if numbers or ketones are an issue.
 
Sienne and Gabby (GA) said:
Are you using the Neosporin Pain Relief? If you use the ointment, you can dab a small amount before you poke. It will cause the blood to bead up and help with any ear issues.

Testing at +2 is good. I would base any subsequent tests on what Arya's numbers tell you. For example, if she's dropping at +2, you may want to test sooner than+5.

As far as bouncing, she may have bounced off of the yellow PMPS last night. The question mark is how soon Arya will clear the bounce. As long as ketones are good and unless numbers skyrocket, you would ordinarily hold this dose for a week. (Since Arya is eating dry food, you need to use SLGS as your dosing method.) I might be inclined to suggest fast tracking the dose given the DKA history and increasing after 5 days or sooner if numbers or ketones are an issue.
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Yes I'm using the neosporin with pain relief but have been applying after, I'll try it before now and see if that helps. And ok that sounds good still getting the hang of when you test and I want to make sure I'm getting good data in case I need to increase her dose. I will stay the course for now on the dose as long as she's not too high and ketones stay negative..just feeling nervous since I haven't gotten below 200s at all with her and I want to make sure she's ok. Thank you!
 
When you have a few minutes, take a look at the sticky note on dosing methods at the top of the board. The SLGS (Start Low Go Slow) approach will be your general guideline. However, when ketones are in the picture, we tend to be more aggressive.
 
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