10/30/10 Squamee AMPS 372 1.2U

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judy and squamee(GA)

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AMPS 372 1.2U ,+4 164

Busy day with kids and grandkids today. Not much time to test. Vet said to eliminate gaba. because we are not sure what she is getting and she struggles so and maybe irritates her mouth. Stick with the phenobarb. 7.5 TID. So far she is taking the pill pocket with fortiflora---but I hold my breathe each time. I gave her a taste of liverwurst and she was not interested. Would appreciate suggestions of other things people think cats often like---but it has to be small and mushy as she has trouble eating. Thanks!
 
AMPS 372 1.2U
+4 164
+14 PMPS OVER 500 1.4U

Damn these numbers. We were out all day and she ate some but not a lot. Just came home and got the "HI" on PMPS. She eagerly ate the pill pocket with Fortiflora (yea!) and did not have mouth symptoms. Was then not interested in food (very unusual). OK--now it's a few minutes later and she did eat some (with mouth symptoms).
 
I'm so sorry Judy. This sux.

I had a bit of an idea that things were still headed upwards. Good for you for taking charge and shooting 1.4. This is the good part to variable, you can shoot as much or little as you want without feeling trapped to a protocol and can adapt to trends faster IMHO.
 
That's funny, Gator. Much as I love compliments, I didn't take charge, I used the chart YOU gave me! But I did think it was the way to go. I had a moment of thinking about 1.5, but when I am unsure I have made myself promise to take the safer option and accept being a chicken. Any ideas about tomorrow? These hi numbers don't follow any rebound pattern, right?---because she has not gone really low?
 
lol now that things are changing again, all bets are off the table. I might say stick with the latest scale? I don't know. S has never had 1.4 so it is just a matter of seeing how things go. I'm totally not being reassuring right now am I? S is hardly going low. And as I said, personally I do not see a panicky liver going on - she's been used to lower numbers and was very sensitive before to insulin and showed no panicky liver scenarios. But that is just my observation. "low" can also be a too large drop too fast - the the body is like WHOA! that was a crazy drop and not being used to that will compensate.
 
So tomorrow morning, if I follow your last chart,

210+ 1.0
275+1.1
350+ 1.2
400+ 1.3
499+ 1.4
But having given 1.4 tonight, I am thinking maybe I should add +.1 to each of these? or maybe to anything above 300? Or am I being too intimidated by these hi numbers?
 
Judy, I'm sorry I'm not thinking clearly enough to give you advice tonight. @-) I'm leaving it in your very capable hands. I'll just say I think it is best I not add my thoughts at this point ;-) I don't see you going too wrong with any of the 'reasonable' choices.

Panicky liver is a pseudo type of rebound that I don't think is really documented as a type of rebound. Much has been discussed here in PZI about it. And again tonight I'm in no shape to detail my thoughts.
 
Rebound is frustrating b/c we don't seem to have terminology that really clarifies. I tend to think of it as:

Somogyi rebound = legit rebound due to either truly dangerous low #s, or sharp drops that cause the body to go into protection mode.

Panicky liver rebound = non-legit rebound, where the liver freaks out due to #s it is not used to, so a nice day in blues for instance, followed by a black # at the end, though there was no sharp drop and nowhere close to truly low #s.

I agree with Gator that Squamee does not have a history of panicky liver, so it would seem weird if it came up now, though of course it's possible. From what I have read something like 3 solid days in high #s is enough to cause their body to start adjusting to that level and pancreas to go to sleep, so that can mean when you get back to blue #s, wonky things will result.

I wonder if she is maybe very sensitive to the drops? Some cats seem to react to big drops more than others, it is possible to get rebound from that. It seems like she nadirs early, some of those +4 good #s followed by a higher +6 throw me off a bit, it is so different from Bix's pattern, which is typically a continued drop from +4 down to a nadir around +6. Of course some cats do nadir that early, but it makes me wonder if she is reacting to the early drop and the rise by +6 is the early stage of a rebound reaction? Just speculating/brainstorming here, I really don't know. You could compare her patterns now to her patterns last go-round, but I think you were on PZI Vet then, and ProZinc now? So the differences could be insulin-related, hard to say for sure. It looks like on the ProZinc she has had some nadirs later than +4, so it's possible the higher +6s are a reaction to the drop by +4.

If you are inclined, and she is showing no signs of ketones, you might try easing off the dose a little to try to flatten the curve some, or sometimes people have success with feeding something around +3/+4 to balance the insulin and soften the curve, but of course that's not really an option with her. Don't mean to contradict any dosing advice you are getting already, as I haven't been following closely.

If it were me, I would probably experiment with lowering the dose a teeny bit and see if things even out better, and if the #s are running higher, I might try shooting at +10 or +11 to head off the really high #s. It can be tricky if you get in a pattern of going from those 500s down to blues and back up - even if the dose isn't too high from one standpoint, those big swings can cause their own problems, and sometimes a lower dose (even if you have to shoot a bit earlier due to shorter duration), can help by flattening it out. You have to be careful of course to be sure you aren't simply underdosing though... it's tricky. What a pain she is throwing those high #s, argh!!! In my experience with Bix, usually if I back off the dose a bit I can tell pretty fast if that was the right move (sometimes then he'll get a perfect nadir, rather than running high at a +6 or so), vs. sometimes he'll just go higher overall and then I know it was a mistake to reduce.
 
A couple things I'll try to counter *maybe* here when I'm feeling better ;-) Except bottom line is that *I* do not see S being sensitive to the hard-fast drops currently.

And with ProZinc there seems to be this pattern that when the dose is too low [especially in the beginning/introduction stage] they seem to have the early nadirs. Just my observation. When the dose catches up the the curve gets more 'reasonable'. But hey, I'm not too sane right now, so take what I'm sayin' with a few ounces of caution. :-D
 
Fair enough - could be there is something else going on that's causing the 500+s. Just seems like a bit of a red flag to me that she has done well on smaller doses and now on higher doses is throwing higher #s.... But again I haven't been following as closely, it's just my gut reaction to seeing black #s in a previously non-bouncy kitty.

In any case, I am sure it will get figured out one way or another!!!! The answer is always somewhere in - lower the dose, hold the dose, or raise the dose. So there's a 1 in 3 shot of getting it right any given day, and if you get it wrong, only 2 other things to try, so there you go, answer usually comes pretty fast with some experimenting. :mrgreen:
 
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