12/01 Frank PMPS 510 /+3 399

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Tina and Boozle

Tina and Boozle

Member Since 2013
Doing a lot better yesterday

Wow... AMPS 160. How much fun is that? :lol:

Hope everyone is having a great morning. ~O)

ETA: Dropping off numbers to fit new ones. Here is the curve:
AMPS 160
/+1 157
/+2 290
/+3 456
/+4 503
/+5 588
/+6 588
/+7 510
/+8 451
/+9 493
/+10 587
/+11 587
 
Re: 12/01 Frank AMPS 160

Whoo hoo Frank!!

What a blu-ti-ful PS number! It will be interesting to see how the rest of his day goes!

Have a great day Tina :-D
 
Re: 12/01 Frank AMPS 160 /+1 157

So far, so good. He generally takes a nice spike upward so I went ahead and gave him his shot at his regular time. Last time I waited and it ended up being a fiasco. lol Close enough to 200, me thinks. He is starting pretty low. We had a small leak after shot this morning so anything could happen. He'll be a pin cushion today. :lol:
 
Re: 12/01 Frank AMPS 160 /+1 157/+2 290/+3 456 /+4 503 /+5 5

Whoa!! BOING!!! :dizcat Those are some crazy numbers Frank my boy. That blue musta really freaked his wee body out. He just needs to get more used to it, and he will ;-)
Have a great day Tina!
 
Re: 12/01 Frank AMPS 160 /+1 157/+2 290/+3 456 /+4 503 /+5 5

I think his fluids are dispersed and maybe I farkled up his shot this morning. ohmygod_smile There was no wet, just a little smell, so I didn't think he would go that high. Oh well, I am going to finish the curve anyway and see what the PM brings.
 
Re: 12/01 Frank AMPS 160 /+1 157/+2 290/+3 456 /+4 503 /+5 5

yuck. this is what we call a "save a strip" day. he's bouncing. he wasn't used to those nice blue numbers - and wahoo on the amps! - and he's reacted to it. if i were you, i'd wait to check him again til pmps. no point in poking his little ears or wasting your strips. he could take up to 3 days to clear the bounce, or could clear it sooner.

if you want the refresher on what a bounce is, look on the "new to the group" sticky and scroll to the bottom. it's in with the New Dose Wonkiness link.
 
Re: 12/01 Frank AMPS 160 /+1 157/+3 456 /+4 503 /+5 588/+6 5

It's a real ugly one, too. He is holding steady at 588. Based on the criteria for a bounce and the fact that he needs to be well hydrated to carry the insulin to the cells, it looks like we are getting into low numbers for a few days, he is bouncing back up and losing fluids, then he is in a perpetual state of being in high numbers because he can't get the insulin in his cells properly. I think the next step is going to be adding regular fluids to his treatment until we can get him better regulated and hydrated. What do you think?
 
Re: 12/01 Frank AMPS 160 /+1 157/+3 456 /+4 503 /+5 588/+6 5

hmmm, i'm not sure. many people add water to their cat's food to help with hydration, but i have not heard that dehydration is related to high numbers. i've never heard of any suggestions to add subq fluids in order to help high numbers or bounces.

if it were me, i think i'd keep things simple and not give extra pokes unless there was a clear-cut reason for it. i'd go with the water in his food route.
 
Re: 12/01 Frank AMPS 160 /+1 157/+3 456 /+4 503 /+5 588/+6 5

Well, he is getting water mixed with his food at the same ratio as his food and that isn't helping much, which is why there is suspected kidney dysfunction there. His poor little kidneys are smaller than they should be too. As far as dehydration goes, it can cause a type of insulin resistance in humans. Cats are not humans, but at the cellular level, I can not see where it would be too much different. The cells need to be properly hydrated in order to provide a vehicle for the insulin to travel where it needs to go. I'm not sure how bad it has to be before it gets to that point, but I can say that Frank's skin turgor is poor. He has been in and out of severe dehydration regardless of how much water we are putting in his food.

This is something we discussed with the vet when he went in, but it also something I learned about when I was in nursing school. If it isn't anything you have had experience with here before, perhaps it is something worth looking into. I'm on my last two weeks of the semester and am bombarded with work so it isn't anything I can do now. When I get out for Winter break, I will be happy to see if I can find some academic sources that relate to cats to see if the effect of dehydration is similar. I'm convinced that this is the case, but I certainly wouldn't call it gospel without some evidence. :lol:
 
Re: 12/01 Frank PMPS 510

What an ugly day today has been. :sad:

Looks like tonight's shot went in just fine. No smell, no wet.

Tomorrow marks the start of a new busy week...vacation is officially over when I wake up. Boo Hiss.
 
Re: 12/01 Frank PMPS 510

I think what you're referring to is diabetic hyperglycemic hyperosmolar syndrome. This is a dangerous condition with symptoms including coma, convulsions, and confusion in humans. In cats, the condition is rare and is considered an emergency situation. It is related to ketosis except ketones are not present. Metabolic values are off which makes this an emergent condition.

Given that Frank isn't regulated, it's more likely that his PU/PD is causing him to be slightly dehydrated. While you're beginning to see better numbers, you want to increase his dose every 3 days/6 cycles unless you're in a situation where a bounce is clearing. If the majority of Frank's nadirs are consistently above 300, you could even consider increasing his dose by 0.5u.
[url=http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581:1tyx3q5r][b:1tyx3q5r]Tight Regulation Protocol[/b][/url] said:
Increasing the dose:

  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
 
Re: 12/01 Frank PMPS 510

oh my gosh - that sounds terribly serious, sienne. let's hope that's not frank's situation. i agree with sienne, that let's assume this is likely from simply being unregulated. although if you see the serious symptoms mentioned, then that would change the picture.

in the meantime, these numbers today all reflect the bounce from this morning's amps. that was awesome. we don't worry as much about bouncing numbers than if they are untreated high numbers - what i've been told is that the reaction from the liver is not as damaging from the body as if these highs were from being completely unregulated. because this is a bounce, you'll want to wait to change doses until it clears. might take as long as 3 days.

frank will get there. he'll get used to this morning's numbers.
 
Re: 12/01 Frank PMPS 510

That isn't what I am referring to, although I can see how my explanation could lead to that conclusion. What I am referring to is a temporary insulin resistance due to chronic dehydration. Regardless of the cause of dehydration, when you are dehydrated, absorption of insulin administered subcutaneously is going to be hindered. It has to do with how well the skin tissues are hydrated, not the concentration of the blood. It only makes sense that this would be the same with any mammal. Think about dropping a drop of food coloring on a piece of paper. On a dry piece, that food coloring isn't going to go as far as if you wet the paper first. Right now, Frank has very little under his skin. He has barely any fluids, fats, or muscle. He does not have the proper vehicle for transport under his skin.

I'm going to have to be a little stubborn on this one. I have seen good numbers immediately following the administration of fluids and I am convinced that this is what he needs. That does not mean that I do not appreciate everyone's help or that I have not considered that I may be wrong. We would be going crazy over here without the support of this group. I want to see where this goes, however.
 
Re: 12/01 Frank PMPS 510

...let's assume this is likely from simply being unregulated.
Click to expand...

And I do agree it is something simple. He was in DKA when we took him to the vet. He apparently went on that way for a while because he was a bag of bones when we took him in. You could pull his neck skin up and it would stick straight up. When you pet him, he feels like a triceratops.
 
i think if you're seeing better numbers after giving him subq fluids, then by all means do it. some people give fluids daily for a variety of reasons. cats are different in how they respond to things and perhaps that's exactly what frank needs.

good to see he came down a bit tonight.
 
I don't think there is a disagreement on whether chronic dehydration can cause insulin resistance. I would just first ask what his bloodwork looks like. Is his BUN elevated? How about his gums...are they slick?

If you and your vet have determined he needs subq fluids, our only suggestion is that you separate the two in terms of site and time of administration. It is a fairly common thing to see subq fluids drop the glucose. If you and your vet are seeing dehydration that you believe is contributing to insulin resistance and higher numbers, I would to avoid giving them at the same time. I would imagine if you get them in the same location at the same time, you risk a possibility of diluting the insulin.
 
Thank you, Marje.

His BUN and creatinine are a little out of whack and his kidneys are smaller than they are supposed to be. His eyes have been sunk in and his skin was sticking straight up when you tented it. This week, his hydration levels are much improved, but he still has a ways to go. The goal is to get him better hydrated then do another chem panel to see where he is at.

The time...I probably won't be able to do much about. I stick him while he is eating because that is the only time he is distracted and he will stay still. We started by trying to give him insulin while he wasn't eating. That didn't work out too well with that tiny needle. I am afraid of what his reaction would be if I tried to stick a nail in him. In terms of physical injury to everyone involved, we'e determined food time is the safest time to do any big needle sticks. And unfortunately, it only works when he is really hungry. We do opposite sides for the site, however. He gets insulin in the rear and fluids in the front. If we shoot on the left, we give fluids on the right.
 
They are actually 18 gauge needles that I got from the vet. I didn't know about keeping them in the freezer. How does that help?
 
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