2/1 Terra PMPS 177 +2 337

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KarenAmelia

Member Since 2012
Terra is acting great this morning. Like her old self. Holding off on shot - can do this for a couple of hours. (see updates below)

UPDATE +1 She's in discomfort now either from hunger or low BG or the 1/4 Pepcid I gave at +11. She has a bit of diarrhea, is very agitated, meowing a lot, threw up some liquid.

Hate to lose ground but hate to keep fasting her. Could I do split shot - some now and some later, or a smaller amount at least? Or skip? Not sure if continued fasting is a good thing.
 
Re: 2/1 Terra AMBG 87 STALLING

Wow. Look at that AMBG :mrgreen:
I would not feed her, and test again in 30 minutes.
Someone will be around to guide you. Those links that Sienne posted in your condo yesterday, will help you too.
Good luck and have a great day!
 
Re: NEED ADVICE!!!2/1 Terra AMBG 87 +1 85 STALLING

UPDATE +1 She's in discomfort now either from hunger or low BG or the 1/4 Pepcid I gave at +11. She has a bit of diarrhea, is very agitated, meowing a lot, threw up some liquid.

Hate to lose ground with the insulin but hate to keep fasting her. Could I do split shot - some now and some later, or a smaller amount at least? Or skip? Not sure if continued fasting is a good thing.
 
Re: NEED ADVICE!!!2/1 Terra AMBG 87 +1 85 STALLING

I'm not one to give advice. But of the three choices you listed, the skipped shot or a smaller dose are viable options. Don't split the dose. A skipped shot is not the end of the world if you feel she needs to be fed.
 
2/1 Terra +12 87 +13 85 +13.5 98 shot at +13.5

Terra's up to 98. Shot SLIGHTLY reduced dose: 2.6 at +13.5. Terra is having frequent trips to litter box: either to pee, very small amounts, or because of a bit of diarrhea. Could it be the Pepcid given at +11 (in expectation of food coming in an hour) and a continued empty stomach? Or something else, unknown. Will check with vet.

Her disposition is excellent, other than this. She is acting like her younger self, much energy. She played very happily with bug earlier. Will monitor closely this morning, cancelling my appointment in 2 hours. Oh well, it was just a flute lesson... :YMSIGH: Priorities...
 
Re: 2/1 Terra +12 87 +13 85 +13.5 98 late shot

Usually Pepsid doesn't cause diarrhea but every cat is different (ECID). It sounds like she's got some sort of bug with both some vomit and diarrhea. Checking in with your vet sounds like a good idea.

Remember, since you shot late this morning, your shot tonight will be 12 hours when when you shot. Depending on your preference (and Terra's numbers), you can move her shot 15 min. at each shot time until your back on schedule or 30 min. once a day.

Just an FYI: we link our condo from the previous day to the current condo. That way, if there's something that needs to be found, it's easier to do. Here's your link to your condo from Tuesday.
 
Re: 2/1 Terra +12 87 +13 85 +13.5 98 late shot

Nice shooting! Great numbers for Terra this morning. Hope her tummy settles down and you both have a great day!
 
Re: 2/1 Terra +12 87 +13 85 +13.5 98 late shot

Terra's +14.5 (which equals +1 of morning cycle) is 96, slightly lower than when shot. Trying to keep her eating some.

I have question: how do I indicate on spreadsheet the hour: if shot is given 2 hours late, for example, do I want to reflect everything in relation to shot - such as +2 signifies 2 hours after the last shot, no matter what time it is? What do I do with the numbers on ss that are relating to the last shot time? For example, +14.5 in today's case is now the new shot time, so if i want to log +1 and +2 tests they would overlap with +13 and +14 tests that I already did. How do folks log this so it's understandable to the "experts" on this board? i could make something up but would rather go with your protocol if someone tells me what that is.
 
Re: 2/1 Terra +12 87 +13 85 +13.5 98 late shot

One more thing: vet says she likely has cystitis, and that accounts for her unusual behavior. Started giving Amoxycillin this a.m. Any problems or considerations that you experienced folks have to share about this medication mixing w/insulin?
 
Re: 2/1 Terra +12 87 +13 85 +13.5 98 late shot

Hi Karen,

Look at my spreadsheet for Cini Mini. What I usually do when I have to stall is record all the previous +13 etc info in the AM/PMPS column and then I note the new time in the U (for Units) column to remind me what the new shot schedule time will be.

When you have a moment, if you could re-color the U ( for Units) columns back to their original light blue, that would help. Right now it looks like some of the cells are green and that is making them blend in with the rest of the readings.

As for the Amoxicillin, is it pills or liquid that you are giving? I think the pink liquid has sugar in it since, in humans, the liquid is usually used as a pediatric medication. If it is the liquid and you haven't picked it up yet, you might want to ask your Vet if he knows of a compounding pharmacy that will re-compound it in to a sugar free liquid. I did that for some liquid meds Cini Mini had to take.
 
Re: 2/1 Terra +12 87 +13 85 +13.5 98 late shot

Oh, just noticed in your last post that you already have the amoxicillin.

Still would like to know if it's pills or liquid.

If it's the liquid, and you can afford it, you can still get the vet to call in a new prescription at a compounding pharmacy.
 
Re: 2/1 Terra +12 87 +13 85 +13.5 98 late shot

You're on the right track with the SS. Whatever the number is that you shoot, is your pre-shot number and that's when the clock starts. It's been a while since I stalled a shot so I don't have a good example to show you on Gabby's SS. However, you can see what I do when I test more than once an hour. You can list your test and times in the +11 cell. You will have to manually change the color. If you want to include your behavioral observations, you can also widen the column. If you go to the top of the SS, the row with the letters will allow you to move the margin of the cell to make it wider or narrower.

You might want to take a look at this information from Lisa Pierson, DVM's website on cystitis. Typically, antibiotics are not used to treat this condition unless there's an infection present (and your vet should do a sterile urine draw or cytocentesis along with a culture & sensitivity -- C & S -- to determine exactly what bacteria is present so the appropriate antibiotic can be prescribed). The condition can be painful so a pain med, such as buprenex is indicated. You can also purchase Cosequin, which is a glucosamine and chondroiten capsule, over the counter. These meds can help with cystitis.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

Title got cut off: +3.5 43

Okay, I'm really getting nervous now. Her numbers keep dropping. I keep encouraging her to eat; she does eat, but in small amounts.
 
Re: 2/1 Terra +12 87 +13 85 +13.5 98 late shot

Good morning Karen:

I'm a little late getting started but am also much further west than you are. Great job this morning!!! What a wonderful AMPS for Terra and you did super by stalling.

It would also help us track her today if you could please update your subject line when you get a chance. I believe you shot the 98 so it would look like this:
2/1 Terra +13 85 AMPS 98 +1 96

That way we can easily see (quickly) if we need to hop in your condo to offer any suggestions. Thanks!!!

As I was reading through your earlier posts and saw the peeing small amounts frequently, I knew that she is having some kind of cystitis. Sienne is correct that the majority of cystitis episodes are caused more by stress than infection. Gracie had chronic sterile cystitis for a couple years....meaning never any infection or crystals present. We were very blessed to have found a vet that was able to determine the cause was high levels of aluminum in her system and once she detoxed her, she has not had another episode. That doesn't mean that's the issue for every kitty with cystitis. Unfortunately, vets automatically throw antibiotics at the condition and kitties, like people, shouldn't have antibiotics they don't need. But if kitty presents with the symptoms, it takes a few days to get a C&S back from the lab and if it IS a urinary tract infection, then you've lost a couple days of treatment so vets treat the symptoms and not the cause. Sienne has given you good info on testing for bacteria; however, once you start the antibiotics, it doesn't do any good to test and most vets won't....and you should save the money. She is also on target on the pain med. The other thing I would highly recommend is that while she is on amoxi, it would help her to have acidophilus so it doesn't upset the balance of her good bacteria. You can get Fortiflora and sprinkle it on her food...most cats love it. Lastly, infection can affect the BG; usually we see it go up so it's interesting that hers is down today. The amoxi won't affect her numbers.

Thanks for working to improve your SS for us to read. Cathy has a good idea, however, for those of us helping you or looking back on your SS, the actual times of the tests don't mean alot to us since we are all in different time zones. If you think of the clock being divided into four sections, then if 15 minutes has passed, it's .25 of the hour. I shoot on the hour so if I test at 15 mins after, then it would be, for example, +6.25; 30 mins after would be +6.5; 45 mintues after would be +6.75. I don't stall with Gracie on levemir but if you click on the link to her SS and then click on the "Gracie's Lantus SS" and scroll down to 8/15/11, you'll see a good example of how to do it and how to report if you don't shoot; since you shot at +13.5 today, in the AMPS column I would put 98 @ +13.5 so we know how long you stalled. You can see an example of this on 8/17/11 on Gracie's Lantus SS.

Thanks Karen...have a great day. Hope she feels better.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

I was going to mention the same thing Sienne said....with cystitis, antibiotics aren't used. Champ has had two bouts (both pre-diabetes) with cystitis. It looks just like a UTI except there's no bacteria and, therefore, antibiotics won't help. I think Champ took ketoprofen which is a nonsteroidal anti-inflammatory. Good luck on Terra's tummy problems.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

I just saw her number....sorry...you posted while I was posting.

Ok..If you can get her to lick any HC gravy....a tsp or so....that would be best but if not...time to give her a little karo on her gums if she won't eat. Just rub either a drop or so of karo or honey on her gums and retest in 20.

ETA: I'm here monitoring this so as soon as you retest her, please post and I'll be waiting. When you retest, if she's not up some, then try a little more HC gravy or a little more karo/honey on her gums.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

Just checked her SS and she's at 55. Wonderful!!! I'm glad she responded so well to the karo.

If you can continue trying to get her to eat that would be good. The most important thing now is to keep checking her....about every 30 mins. The karo/honey wears off quickly and they can turn around and she may not have onset yet.

Still here to help you...any questions or thoughts? Good work!
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

Got a bit of honey on gums and then a few treats and some Fancy Feast. She's eating.

+4.25 55
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

Super....we were cross posting so if you could please look back at my last post. You can also take "May Need Assistance" out of your subject line to give you more room for updates. Thank you for adding her numbers in :-D

What kind of treats? We want to try and avoid the dry food unless she won't eat anything else. It takes a long time to kick in and lasts in their system too long.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

Since her nadir has generally been around +6 or even a bit later, I will keep monitoring her closely at least until then. I wonder though about later: I'll check w/ vet but he's not that clued in about FD. So I might like advice: skip tonight's shot? I'll want some guidance as we get closer to that time, which is still quite a ways off.

Lesson learned, to be on the safe side and skip shot when the pre shot number is so low and Terra's sick. I think that may have contributed, but perhaps also the dose of Lantus is proving to be too high. I did rush the dose increases there. Maybe scaling back would be in order, but to what? Any thoughts?

thanks
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

Another question: how much food is too much? Is it okay for her to eat as much as she wants, at this point, or should I give a spoonful every so often? Don't want to push her too much in the opposite direction.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

She earned a reduction with that 43 so tonight you would take a .25u reduction. Her normal dose was 2.75u even though you shot a reduced dose this morning. I think some of what you are seeing today is shed action from the 2.75u. Her new dose will be 2.5u.

Just so you know, if kitty skyrockets after such low numbers, we will often "shoot through the bounce" with the old dose...in this case, it would be 2.75u. BUT....we with Terra not eating well and not feeling well, unless she is in the 300s, I'd probably shoot the reduced dose of 2.5u tonight. What is best is if you can post a +11 tonight and we can then walk you through the best choice for her. Does that sound ok?

Remember that nadirs can move around so please don't get too tied to +6. Also...she got pretty low pretty early....until you get two good, rising numbers that are not food/honey influenced, I would keep checking her regardless of how long it is after +6. Sometimes they'll ride these lows all day. Since she hasn't been this low, we don't know if she'll bounce or not and the cystitis adds another factor.

Many of us are not big fans of skipping shots; yes, we have to be extra cautious if kitty is not eating. But keep in mind that infection plus no appetite plus little or no water can be a perfect setup for diabetic ketoacidosis and if you throw no insulin into the mix, you are adding to that risk. We usually like to be sure and get some insulin into them and if she isn't eating, you might have to syringe feed food/water. The amoxi can make her a little sick and not want to eat.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

how much food is too much?
Click to expand...

I like your idea of feeding her small amounts over time. We don't want her to get too full just in case her numbers come back down. I'm glad her appetite has picked up.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

55 @ 4.25
57 @ +4.75

Holding steady.

How do I know when the numbers aren't being influenced by the high carb first aid?
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

Usually when you haven't fed her for a couple hours...ECID but it usually takes a couple hours for HC and karo to wear off.

If you are feeding her a few tsp of LC here and there, maybe that will get her to "surf". That's where we are able to keep them in green numbers above 50 without feeding the curve. I think she still might have some karo
working here so it's good you are continuing to test her.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

More questions:

You say she earned a reduction with the 43. That number is sort of artificially high, since I immediately gave her a swab of honey on the gums and then some high carbs (small amount but still...) Does it not matter how low the number COULD HAVE gone , as to how much of a reduction? I know the increments of changing dose are small with this protocol, but what if she really needs a large dose reduction? I guess I'm repenting my impatience in the early quick increases of dose and am now worried that I may have increased past what she really needed/needs? Or, if she was noshing on the dog's dry food, perhaps this is a situation where her insulin needs really have dramatically lowered. Would it be prudent to consider a large decrease, say, to 1u, and then to try the whole process over now that some other factors are under control/variables removed.
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

I understand your concerns but I would not decrease her more than .25u. The 43 isn't artificially high because you rubbed the karo on her gums after you got the number. The protocol states:

Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
Click to expand...

Even if she had gone to 30, we'd still have you take a .25u reduction. We do the increases and reductions in small amounts so you don't bypass her fitting dose. You would be amazed at how one drop less of insulin can affect some cats. So we take it slow. If she wants to earn another .25u reduction, she will. No...I wouldn't start over with her.....I think that would be very counterproductive.

Remember consistency....it's better to let them earn reductions then to take them down too much at pme to,e, have them stall out and lose mometum, and then have to take them up. Sometimes you have to go way up to get them to come back down. She's doing great. You're doing great!!!
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

Just checking your SS for an update.

You can delete that entire first row of 2/1 that you had problems with. Just right click on the row number to the left of the SS and select "delete row".
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

81 at +5. Terra's looking up. She's really tired right now, but eating periodically.

Thanks for the help on thinking about dose. I was afraid we might have this scenario play out every day this week! I don't think I can do that!
 
Re: MAY NEED ASSISTANCE: 2/1 Terra AMPS98 +1 96 +2.5 63 +3.

I'm glad she's coming up.

There are no guarantees what she will do....it's possible she will decide to stay in green. That's a great thing. We just take it a dance step at a time.

Could you please take a few seconds now that she is up to update your subject line? Thanks so much!! Have a great day and please continue to check on her
in another hour and then post a +11 for us so we can guide you for tonight.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

Need help with thinking about the evening shot. Terra's sunk a bit since +8.

Guidance please.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

Actually, Terra's numbers are pretty much the same since +8. (There's approx. 20% variance due to your meter with any test.)

What are you thinking you would like to do? Also, is this shot time 12 hours from when you gave Terra her shot this morning?
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

My concern is that I won't be able to be as attentive during the night in case Terra drops again. And another concern/question is whether decisions about the evening shot should be more conservative (whether to skip) - since she will generally eat less during the night, there is less in her system to balance the insulin. I really don't know what the options are, so I'll wait to hear your suggestions.

Also, I shot this morning at 8am. I was thinking to start moving her back toward the 6:30am time, which would mean we could shoot in 15 minutes. But that's not necessary- partly it depends on when I receive advice.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

I was going to say that same thing as Sienne. 122 and 116 are pretty much the same, and it looks like she's surfing along nicely.

Congratulations on the dose reduction. :-D
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

Just a little nervous: shooting 2.6 u this am led to a drop into the 40s and lots of stressing. It was a bit too low for Terra, judging by how she slept a lot. It doesn't seem like these numbers are much above AMPS. I'm afraid of going through the same thing (basically I'm a big worrier.) Reassurance or criticisms please.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

We don't know what her cycle will look like. I don't see any reason to not shoot 2.5u but you are holding the syringe.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

Well, you'll be shooting the new reduced dose tonight. That's a reassurance.
Do you have a timed feeder that you can set for a middle of the night snack for her. I would set alarms, myself, and be testing through the night.

About her sleeping all day, usually kitties are a little off when they are experiencing numbers they are not used to.

Hugs.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

just keep in mind that there can be a delayed response to a dose decrease because of the shed. as marje said, probably some of what you saw today was from the earlier dose of 2.75. decreasing it to 2.5 should be ok. most cats would bounce from the 40's earlier today and be higher by shot time tonight.

if you shoot 12 hours after this morning's shot, is that about 5 minutes from now? you could post that pmps # - it might be considerably higher since the +11. i'll hover and watch for your update. looks like dyana and marje are watching too.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

PMPS 177

Sorry for the delay in posting this. I went ahead and fed her and then shot before getting back over to the computer. It was on the skinny side of 2.5 . Actually the first syringe I used had a giant bubble (way more air than ever before) so I threw it out and started over. My eyes were probably influenced by my nerves: I felt like I was having trouble reading the syringe.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

Good job. I'm glad she went up some, so that you feel more comfortable shooting.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

aw karen - it does get easier. i remember being a bundle of nerves at times too. you did just great.

if you're able to catch a +2 it may tell you where terra's heading tonight. if it's about the same, hopefully you won't see any surprise diving. if it's significantly lower than the 177 then you have to pay extra attention in case she's headed lower.

a timed feeder can give you a lot of mental relief - if you can count on terra eating, a timed feeder set to go off when you aren't going to be around to monitor will let you be able to sleep in peace, knowing she'll eat if she needs to. i only just got one and wish i'd gotten one earlier. i got the kind that rotates the food dish to an opening. if you want ideas on that, just say so. several people have favorites.
 
Re: ??HELP w/PM! 2/1 Terra +4 47 +5 81 +6 80 +8 122 +11 116

Sorry to be so brief before....I just wanted to keep an eye on her numbers and was checking in from the restaurant. I'm so glad Julie and Dyana popped in.

Glad you shot close to the 2.5u and that Terra is on the rise a bit. Please be sure you get a +2 and see if she's going to bounce again or not. If her +2 is not similar to or higher than her AMPS, she might come back
down again tonight.

Once you get her settled, could you please update your subject line so other folks are not stopping in to help since you've shot. Thanks, Karen.

Good job!! Take a deep breath!
 
the great news is that you can relax tonight - don't you love the +2 newscast? i didn't know about that for a while.

have a wonderful evening!
 
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