? 17 Oct | Girlie | Solid high black: dose question

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Wendy&Neko said:
Put on those tight patience pants, and wait the full six cycles.

How is Girlie doing otherwise? How are the 5 P's?
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Wendy, I put this here as I've started a new thread for today.

No poo; no purring; no playing (doesn't becase of arthritis); what are the other P's?

@Wendy&Neko , is there a reason why I wouldn't increase her dose tonight to 0.75 if she has yet another day of solid black? Is the fear hypo - but DKA is also a consideration, isn't it? She really seemed solidly stuck at 0.25 and now stuck at 0.5

I'm thinking of what I read below from the Myths Debunked post. I'd really appreciate your thoughts on this:

Re: Myths debunked: Should you follow the "Nadirs over 200: who cares if there is bouncing, cat needs more insulin, increase after 2-3 days" or are there exceptions to this? I'm just trying to get my head around this so I can be more confident tonight when deciding whether to do a dose increase as it will be cycle 5. :)

Further on, at post #17, I just read this:
"One other note:

Every high number is not a bounce! Numbers go down, numbers go up. Often I see people comment that their cat is bouncing, when really they are just seeing the natural rise at the end of the cycle or a food spike. Other times I see people whose cats are stuck (really stuck) in a high pattern who think it's a bounce. If your cat has been in pretty good numbers for a while, then suddenly loses regulation, don't hold the dose, get the regulation back! If they are used to good numbers, it is much, much easier to get the good numbers back if you do it quickly."
 
Girlie's mom said:
No poo; no purring; no playing (doesn't becase of arthritis); what are the other P's?
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Preening (grooming) and peeing.

How is her appy?

I can't advise on dose but just ask questions
Can you monitor round the clock?
Have plenty of strips, mc/hc food? Honey/karo?
Is she drinking?

Has she had ketones (DKA) previously?

Any thing else wrong? I know that is hard to tell. How about her teeth? Any pain that you can tell?
 
LizzieInTexas said:
Preening (grooming) and peeing.

How is her appy?

I can't advise on dose but just ask questions
Can you monitor round the clock?
Have plenty of strips, mc/hc food? Honey/karo?
Is she drinking?

Has she had ketones (DKA) previously?

Any thing else wrong? I know that is hard to tell. How about her teeth? Any pain that you can tell?
Click to expand...

Appy ok

Can't monitor around the clock until Friday PM (4 days from now)
Have plenty of supplies
Is drinking
No DKA previously

Nothing else wrong

Is grooming as usual (not so much as has arthritis) and is peeing, though not as much as I would expect as she's drinking a lot from her water fountain and getting extra water with food. Usually when she's this high so drinks TONS of water and also pees a LOT. Not doing so this time.

Had a test last week and no sign of UTI.
 
581 @+4

Unless she's going to do something she's never done before, she is not moving out of black today. :(

This is going to be another solid black day.
 
I've asked this same question three days in a row, and I'm just curious: no one has replied to answer it. Is it somehow not an okay question to ask?

Is the fear hypo - but DKA is also a consideration, isn't it? It's now 17 Oct in Australia: She started on black with 0.25 on pm of 9 Oct (then those two BCS shots at 0.1 but she was high before that); was almost completely solidly high on 0.25; and now stuck at 0.5

Re: Myths debunked: Should you follow the "Nadirs over 200: who cares if there is bouncing, cat needs more insulin, increase after 2-3 days" or are there exceptions to this? I'm just trying to get my head around this so I can be more confident. How does one decide when to hold and when to increase? :)

Further on, at post #17, I just read this:
"One other note:
Every high number is not a bounce! Numbers go down, numbers go up. Often I see people comment that their cat is bouncing, when really they are just seeing the natural rise at the end of the cycle or a food spike. Other times I see people whose cats are stuck (really stuck) in a high pattern who think it's a bounce. If your cat has been in pretty good numbers for a while, then suddenly loses regulation, don't hold the dose, get the regulation back! If they are used to good numbers, it is much, much easier to get the good numbers back if you do it quickly."
 
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I think you could go up to .75.....or even 1U as long as you can continue to test at least once mid-cycle during the AM cycle and at least get a test before bed at night (and be able/willing to stay up as long as necessary IF she's dropping quickly)

It sure seems like "something" has happened with Girlie....I haven't gone back and read everything since these black numbers started, but if she hasn't had a good check-up from her vet, I think that's a good idea

We do sometimes "fast-track" a cat, which is increasing every 4 cycles instead of waiting for the 6 cycles, but once they start responding, it's important to slow down again.

Since her nadirs are over 300, the TR protocol says you could go up by .5

Others may disagree, but that's my opinion.
 
The fast track is not appropriate in this case. It is for kitties who have not seen blue, much less green yet. I think you could go to 0.75 tonight, if you can monitor and she doesn't come down.

From reading the SS notes, it looks like she is constipated. That can cause higher numbers. What is the plan to deal with that?

High numbers can also be a sign of too high a dose. Since she got green on the previous dose, caution is warranted. As for DKA, have you ever seen ketones? Is she lethargic? How is her appy? Any infection? The equation for DKA is more than just high numbers, but be vigilant in testing for ketones.

Sorry for the short response, typing from a ferry.
 
Wendy&Neko said:
The fast track is not appropriate in this case. It is for kitties who have not seen blue, much less green yet. I think you could go to 0.75 tonight, if you can monitor and she doesn't come down.

From reading the SS notes, it looks like she is constipated. That can cause higher numbers. What is the plan to deal with that?

High numbers can also be a sign of too high a dose. Since she got green on the previous dose, caution is warranted. As for DKA, have you ever seen ketones? Is she lethargic? How is her appy? Any infection? The equation for DKA is more than just high numbers, but be vigilant in testing for ketones.

Sorry for the short response, typing from a ferry.
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She was constipated: she had an enema here at home three days ago (14 Oct) that cleaned her out. It can take up to 3 days after that much of a clean out for another poo to come. Girlie only poos every other day.

No UTI or other infection: got a complete checkup at vet's on 10 October (sorry the dates are so different: 10 October for me is 9 October for those in North America). Only thing of note: elevated creatinine (from 190 in July to 290 now)

I've never seen ketones: touch wood.

Appy is as usual, maybe a little less, but it's hot here and she loses her appetite when it's hot.

She hasn't got a lot of energy, but she's not looking comatose: she looks up when I go to see her on the verandah and responds as usual. Again, it's a little hot, and she's old, so she's not a jumping bean on the best of days.

No worries with short response: I understand re: ferry, and I know you're busy with other things, as well. :-)
 
Chris & China said:
I think you could go up to .75.....or even 1U as long as you can continue to test at least once mid-cycle during the AM cycle and at least get a test before bed at night (and be able/willing to stay up as long as necessary IF she's dropping quickly)

It sure seems like "something" has happened with Girlie....I haven't gone back and read everything since these black numbers started, but if she hasn't had a good check-up from her vet, I think that's a good idea

We do sometimes "fast-track" a cat, which is increasing every 4 cycles instead of waiting for the 6 cycles, but once they start responding, it's important to slow down again.

Since her nadirs are over 300, the TR protocol says you could go up by .5

Others may disagree, but that's my opinion.
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Hi Chris,

Thanks so much for your reply. The "something" is the question. She did get a Zydax injection, but the concensus is that that shouldn't have shot her numbers up. She was constipated, but that's been sorted out, and she's been constipated before.

She's gotten a lot of experience with blues and greens lately, so I wouldn't have expected the 83 on 10 October to send her into the stratosphere in response. And even though I gave her two BCSs, she was already up to high black before, and when I've given her a BCS before, it hasn't taken her this long to respond once I've given the previous dose.

But she is stuck: there's no question about that. :banghead::banghead::banghead:
 
Well as long as you can continue to test, I think you could go up to .75 and see how she does

I know it's got to be very frustrating for you to have her up to high without any idea of why!!
 
Chris & China said:
Well as long as you can continue to test, I think you could go up to .75 and see how she does

I know it's got to be very frustrating for you to have her up to high without any idea of why!!
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Yup: going slowly out of my mind, here. I know both DKA (although no signs of that, yet) and Hypo are dangerous: at least hypo doesn't last as long as these days and days in high numbers!

I've asked her why: she won't tell me. Sigh...sigh...

I find it hard to believe that just a vet visit and/or constipation could make her decide to stay up so high so long; and the two BCS were so quick: could the depot drain THAT quickly?
 
The last time of a run of blacks was right before you switched vials. New vial brought her right back to better colors. Is there any chance this vial was left out or froze in the back of the fridge? (If a fridge is set too cold, things along the back lower wall can freeze)
 
If it were me, I would increase to .75 as long as you can monitor as you have been doing. Even her last greens of lately were higher greens and we need to get her out of these blacks.
 
Bronx's dad said:
The last time of a run of blacks was right before you switched vials. New vial brought her right back to better colors. Is there any chance this vial was left out or froze in the back of the fridge? (If a fridge is set too cold, things along the back lower wall can freeze)
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I started a new cartridge of insulin this morning, but no joy today, unfortunately... I was thinking the same thing you were thinking, though!
 
Bobbie And Bubba said:
If it were me, I would increase to .75 as long as you can monitor as you have been doing. Even her last greens of lately were higher greens and we need to get her out of these blacks.
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True, Bobbie: Because of the yellows and pinks that cropped up from 7 - 10 October, I was wondering whether it was time to increase to 0.5, but then she threw the green 83 on 11 December - and then ascended to the higher realms, very, very, very unfortunately...
 
Bronx's dad said:
The last time of a run of blacks was right before you switched vials. New vial brought her right back to better colors. Is there any chance this vial was left out or froze in the back of the fridge? (If a fridge is set too cold, things along the back lower wall can freeze)
Click to expand...

Another good point re: fridge temperature. A while ago I bought several fridge temperature gauges so I could be sure that the insulin wasn't too cold or too warm: just right. (Where's Goldilocks?) :-)
 
PMPS 632: Increased dose to 0.75

Wish Girlie and me luck! Scary, but...yikes... I hope this goes okay... :eek:

I'll monitor closely tonight and tomorrow; if I have to cancel work tomorrow afternoon and/or the dentist on Thursday, so be it. We're having a massive restructure, and it looks like I and my colleagues might lose our jobs anyway, so what the hey! :-)
 
I can't help, but here is good luck!! :bighug::bighug:
1927436332-Grumpy-Cat-Notecards_9781452130859_in02_norm.jpg
 
I hope the increase works its mo-jo. I would just stick with the protocol as close as possible until Girlie starts coming back down. Geesh - how is she feeling? I imagine not too good. Gizmo has gotten so used to the greens and blues that this morning @ 190 he was lethargic and dopey. Poor lil girl. :bighug:
 
Darrah --
The last time Girlie had a run of black numbers was at the end of August. Was there anything other than increasing the dose back up to 0.75u that you can think of that contributed to the earlier run of high numbers? While the Flixotide shouldn't have a huge effect on numbers, it's still a steroid and some cats may be effected by an inhaled steroid.

The current numbers may simply be that Girlie can't sustain the current dose. Some kitties' numbers go up and down whether it's because of something like constipation or the stage of the moon (seriously!).

FWIW, I was reading up on the Zydax. While it's primarily used with dogs, it is used off-label in cats. The dosing is generally once a week for 4 weeks. I don't know if you're going to see much improvement in Girlie's arthritis the way your vet is administering it.
 
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