Douglas' ProZinc Journey

[cocokittybrown]

Yes. At least you can listen to what the IM says and then make your own decisions.

The two other vets did not want to do dental until regulated, but maybe if the IM person says he can't get regulated until the dental, then maybe the regular vet office will support doing the dental.

 

[cocokittybrown]

A lot of vets say this. In fact, almost every single vet I know from people on this Board says that same thing. The irony is that as long as the cat has inflammation in the mouth/teeth/gingiva it makes them very hard to regulate. My own vet said the same thing. She did not want to do a dental until he was “well-regulated.” I finally managed (months later) to get her to do his teeth at the same time we had his feeding tube removed. He had to have a feeding tube after a severe DKA from being unregulated and when he got an infection, the combination of unregulated BG and the infection sent him into a very serious DKA.

DKA really scares me too. I test for ketones also. All of this is very complicated and feels very overwhelming sometimes. Progress is not as fast as I thought is would be, or not in the direction I was hoping. However, I am not giving up and will keep making adjustments toward helping him get better.

 

[cocokittybrown]

@Suzanne & Darcy

There was a lot of activity last night the with the Libre3. Last night Douglas PMPS glucose was uncharacteristically low for a PMPS. He fasts 2 hours before his injection, and yesterday I stopped feeding after 1pm too. It was 192 on the Libre, so I double checked his blood glucose with the Contour and it was 160 at 6:39pm and retested (no food) at 7:13 pm and it was 131 Contour. It was dropping, but still normal ranges.

The last time he had a lowish PMPS on March 12, and I'd given him half the dose, and reviewing the response, it turned out to be too conservative of a dose. So last night, we reduced the dose from 2.75 to 2.5. He ate really well before we gave him injection, so I was expecting his BG values to rise, but they kept going down and had an early nadir. The L3 began giving us low alerts, and I was expecting that and did not let it panic me. When the Libre3 got down to 49, I calmly retested the BG with the blood glucose meter at 9:39 pm and it was 83 on Contour and 103 on alphatrak3, so both very normal ranges. But since his numbers were so low early in his cycle (+2.5 hrs), I fed him 2 table spoon of 12% FF pate. I did not have an 8%, and will need to pick some up when I am at the store. The trend arrow on the Libre3 went from down to sideways, which was a good sign. The straight down arrow really worries me. I ended up turning off the "low alarms" which is settable and was at 80. He had 8 alarms last night. The "urgent low" is set to 55 and that can't be turned off. But he did not have anymore of those after 9:30 pm. And the urgent low just means that I need to test his blood glucose.

I kept checking on him to make sure he was not showing any hypo symptoms also. He was trying to sleep, and I kept poking him making sure he was properly annoyed with me.

Douglas and I fell asleep on the couch, and when I woke up around 12:30 am, I noticed that his numbers weren't rising as much as I was expecting and another "low" alert of 78 was logged in the Libre software, but it did not sound this time. I was so tired and wanted to go to bed, and wouldn't been able to sleep if I did not know his numbers were rising, so I fed him the rest of the 12% FF pate.

In hindsight, I should have retested his BG one more time with a handheld meter to confirm that his numbers were still good so I could rest, and not have given him the rest of the HC food. I asked my husband if I should retest him, and he said he did not think so and I should have done so anyway, for my peace of mind. Then I would have seen it looked good and no need to give him the rest of the HC food. It is difficult to think rationally when sleepy and feeling panicky.

Also in hindsight, maybe we should have only given him 1/2 the dose, so around 1.4 units.

This morning, his AMPS on the Libre was HI.

Since we are not feeding him after 1pm, I've decided to only give him 2.5 units. I don't want to introduce too many variables. So yesterday (Saturday morning), not only did I increase his dose to 2.75, but I also withheld food at 1 pm and I don't know which one had the most impact, but both may have been too much of a change.

So this morning, I gave him 2.5 units and will cut off food at 1pm. He is getting the FF pate and I gave him freeze dried chicken as his injection treat.

I haven't decided if I will continue the 2.5 units for his PM shot, or increase it to 2.75. I will need to see how he does the rest of the day, especially after 1pm and no food again until 6:40 pm.

 

[cocokittybrown]

Picture of Dougie restfully sleeping this morning.

 

[Suzanne & Darcy]

Oh he’s so precious!

 

[Suzanne & Darcy]

But since his numbers were so low early in his cycle (+2.5 hrs), I fed him 2 table spoon of 12% FF pate.

I think this was a good decision. It was just medium carb (11-15 percent carbs) that you fed with the 12% and it was, as you said, early in the cycle.

In hindsight, I should have retested his BG one more time with a handheld meter to confirm that his numbers were still good so I could rest, and not have given him the rest of the HC food. I asked my husband if I should retest him, and he

yes. That would have been best, but you already realized it. It was getting late.

 

[Suzanne & Darcy]

Thank you for explaining all that. I would not have been able to make heads or tails of it from the spreadsheet. We ask people to please put every test into one of the hour cells of their spreadsheet. If you have more than one test within a single hour, you put all the tests in the cell for that hour. People either put the BG number and +15 (for 15 minutes), +30, etc or they put the BG number @2.25, @2.5 etc. (indicating the quarter hour, half hour, etc.)

 

[Suzanne & Darcy]

Here’s a screenshot of a portion of my spreadsheet showing the kind of thing I am talking about.

 

[Suzanne & Darcy]

And when you are at preshot time, if you are stalling and retesting, you are supposed to put all of the numbers you get into the +11 cell and when you finally decide to shoot the last number (the number you shoot) is the one that goes into the AMPS/PMPS cell. If you get more than one reading at AMPS/PMPS time because you are comparing the Libre to the AT and/or Contour, just put all of them in the AMPS/PMPS cell and just indicate AT for the Alpha Trak and C for the Contour next to those numbers. That is valuable information.

 

[Suzanne & Darcy]

I think you handled the cycle intelligently last night.

 

[Suzanne & Darcy]

The Churus have tapioca starch in them. I was under the impression that they had only 2.5% carbs and are mostly water (92%). I was under the impression that they had minimal impact. I can stop giving them to him. I tried the Tiki meat tube this morning, because I they don't have tapioca. I have also been occasionally giving him fancy feast savory selects because the other cat eats that sometimes. Those are supposed to be almost 0 carbs. Besides that, he gets freeze dried meat treats. Maybe I will try switching to Tiki treats. The meat tubes really keeps him focused when getting an insulin injection and he looks forward to the meat tube so much, he hops up on the counter when it is injection time. And that is after he just got done eating his fancy feast.

I used to feed the Tiki Stix too, because they were low carb (well, the manufacturer says the chicken one is zero carb.). The Churus don’t have a lot of carbs either. It’s definitely good to have something to keep him happy and distracted at shot time.

I hope everything is going well today.