2/8 - Sami - PMPS 380; +2 322;+4 264 +5 274; +8 338

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Tina & Sammy

Tina & Sammy

Member Since 2010
Yesterday's Condo

You all were completely right! I am so sorry for doubting your experiences, but because no one really had experience with fluids I was just really nervous. Sami is back up to 510 today. Could this be another bounce from the lower numbers last night or do you think she was climbing all night. I now wish I had gotten up a few times during the night to check her so I knew what she was doing.

When I saw that she was at 213 at +4 I was very tempted to go ahead and give her a shot at that point, but I didn't want to be off schedule by that much.

I went ahead and gave her 2 units this morning and wondering if I should hold off on the fluids until we can get her more regulated on the insulin. I am very tempted to give her fluids today just to help bring her down from this high, but then we will probably see another bounce. I would like to bring her down into some more comfortable numbers though.
 
AMPS - 510 - Ate ⅓ can (5.5 oz)
+0.5 Fluids - 50 ml
+1 - 590
+2 - 538 - Ate 1/6 can (5.5 oz)
+3 - 520
+4 - 413 - Ate 1/6 can (5.5 oz)

I am hoping that we can get Sami back down to the 200's today.

So far I am finding that the fluids have about a 4-6 hour onset of dropping the glucose. I am trying to brainstorm to figure out the best time to give fluids. I am still up in the air. I will probably be sticking with the 2.0 units for now. I know I have to stay here for at least 6 cycles again before making changes because we skipped last night. That is unless Sami earns a decrease, which probably won't happen just yet.

I would like to figure all this out so that I can keep Sami from bouncing so much.
 
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Milo and I ate hoping Sami gets down today. Don't doubt your decisions, you did what you thought was best in the situation. Hope you have good numbers today!
 
milosmommy said:
Milo and I ate hoping Sami gets down today. Don't doubt your decisions, you did what you thought was best in the situation. Hope you have good numbers today!
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Thanks I really need to stop freaking out and just stick to the protocol, but it is so hard when you have the Vet trying to get you to do one thing and the protocol is telling you something else. Then you add the fluids on top of that and everything sort of goes out the window.

I am probably going to give Sami and myself a bit of a break and not test again until +10 AMPS. I just hope I can distract myself so that I don't feel the need to test. Maybe I will be pleasantly surprised with her number at that time. At least that is what I will be praying for.
 
There actually are people here who have experience with FD and giving fluids.

You might want to consider putting an asterisk in the cell reflecting the time you're administering fluids. That way, we can see at a glance when you're giving fluids and what the effect is. There are a couple of considerations to think about. When you give fluids at pre-shot time, it is helping to lower numbers which allows the Lantus to "grab on" and further bring numbers down. That may be a good thing but there's always the risk of a fast drop followed by a bounce. Do we know how Sami responds if you were to give fluids after nadir? It may be a means of flattening things out and lowering the next pre-shot number.

Fundamentally, you may need to experiment with the timing of fluids so you have a better sense of how Sami responds on a routine basis.
 
@Sienne and Gabby

I have tried giving fluids at the beginning and middle of the cycle and nothing has been predictable. I have yet to figure out when Sami's nadir is, with or without fluids.
 
I need help to determine when is the best time to give sub-q fluids. Sami tends to drop anywhere from 100-200 points when given fluids, and it tends to cause a bounce nearly every time. So I am wondering if there is time that is better than another to administer the fluids or if I should back off on the fluids for a bit until we can figure out the best insulin dose for Sami. Or maybe I need to only give fluids every couple of days rather than every other day or less fluids and given every day. I am really clueless about this and my decisions over the last few days haven't been the best.

Any advice would be very much appreciated.
 
I think I did mention this once before in Sami's condo- for Trix - and remember ECID - I had to separate the insulin and fluids locations quite a bit, otherwise she would drop like a rock - no matter what time I did fluids in relation to insulin (with having to go to work factoring into the picture as well - we can really only do fluids during the evening). The only thing that helped me control the drops was to do her fluids up by her shoulder, and insulin in her flank; when I made that change, she went back to being much more stable, BG-wise.

I wouldn't back off the fluids unless your vetty says it's OK to do so - if Sami needs fluids, they are something want to keep up with.
 
@Amy&TrixieCat

Thank you, I will try that again. I did that before when you mentioned it last time, but we weren't seeing much progress in her BG coming down, but that was also when Sami was on a much lower dose of insulin. I won't give fluids until tomorrow evening, but I will do that. Thanks again.
 
Tina

Why is she getting fluids? Does she have CKD? What are her BUN and creatinine?

I gave Gracie subq fluids when she was first dx and started Lantus as our vet thought it might help bring numbers down but it didn't seem to affect her BG...possibly because I was giving fluids in her a.m, cycle after nadir. Or because her depot hadn't quite established. Not sure.
 
@Marje and Gracie Sami only has slightly elevated kidney values and as a precaution we started giving fluids. When her numbers were a bit higher we were doing fluids daily, but reduced down to every other day or every couple of days. The last time she had tests in January her numbers were better than they were in November. The doctor isn't really too concerned about her values, but since I had another cat who had CRF I already knew how to do fluids so it was something that we decided to do as a precaution.

@Amy&TrixieCat Did you give fluids at every shot time? I was just reading a bunch of different websites and threads on different forms and was wondering if I should give insulin in the flank only when I give fluids at the same time, and in the scruff for all other injections. From what I have read injecting in the flank tends to have a quicker action, but less duration, where as injections in the scruff have slower onset and longer lasting and later nadir. I am just wondering if it would be good to very where I give the shot based on whether I was giving fluids or not.
 
Just asking because I've had four CKD a cats and typically fluids aren't started until the creat gets up around 3.5. It's best for kitty to get as much fluid as possible through drinking for as long as possible.

That's why I am curious as to her creat because if it's 3 or below, it would be worth talking to the vet about stopping or backing down to a couple times a week.
 
Trix went OTJ very shortly after we started fluids (her story is an odd one....), but if I remember correctly, once I started shooting in the flank, I did it both morning and evening, jsut to be consistent. She did (and still does) get daily fluids at the time. When I switched to shooting in the flank, I can't say I noticed anything different about her response to insulin (compared to her pre-fluids days when I shot in the shoulder) . Even with shooting in the flank, we did fluids a couple hours after shot time.
 
Sami has made some fantastic progress today, even after my mistakes of yesterday. I am hoping that she came down slow enough that we don't see a bounce from the 200 point drop that we have seen so far today. And based on what everyone keeps telling me, we still might see more action tonight, because her +2 was lower than her pre-shot.
 
Yes, when the +2 is lower than the preshot it's a signal that you may need to pay more attention than usual. The only thing is that once BG tests are in the higher ranges, the meters don't always measure consistently. So . . . hard to say, but it's never a bad idea to pay attention.

I like Sienne's idea of putting an * in the cell when you give fluids so that we can look at it in context of the BGs. You might try giving her the fluids in the second half of the cycle, at a time when one would normally expect BGs to be rising. I can see that of course, that doesn't happen every cycle. Sometimes she's bounce-clearing. But it might be worth trying. Another option might be to give less volume but every day. I think you said you're giving 100ml every other day, right? so perhaps 50/day might be worth trying.
 
@julie & punkin (ga) I will start putting an * in the cell when I give fluids, but I also have a column over to the right showing how much and what time I gave fluids. I have started to give only 50 ml of fluids every day, but I was still seeing a major drop within 6 hours after the fluids, which is primarily why I decided to skip last nights dose. I won't be giving fluids until tomorrow evening, or maybe I will wait until Tuesday to see how she is doing on the 2.0 dose without fluids.

So when I see a +2 that is lower than pre-shot, what would be the best testing protocol? I was thinking about testing at +4 and +6 and depending on where she is at +6 possibly testing at +8. Is this enough testing, or should I test every hour?
 
Sami and Milo look like they have plans to go blue or hopefully green tonight. I'm waiting for the +4.5 to see my plans if I have to get up.
Good luck with Sami tonight. ..hope you get some sleep
 
If you see a +2 that is about the same or similar to the PS, you can probably test at +4 provided you didn't shoot a dropping number or, for now, provided the number isn't green. If you shoot s dropping number or s greenPS, for now and until you have data, you should get a +1 and +2. If the +2 is much lower than the PS even if it is yellow, I'd get a +3 at least until you build some data.
 
Marje and Gracie said:
If you see a +2 that is about the same or similar to the PS, you can probably test at +4 provided you didn't shoot a dropping number or, for now, provided the number isn't green. If you shoot s dropping number or s greenPS, for now and until you have data, you should get a +1 and +2. If the +2 is much lower than the PS even if it is yellow, I'd get a +3 at least until you build some data.
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When you say much low, how much lower? Last night we went from 380 t0 322, is that much lower?
 
No...it's the same number. Remember meter variance of 20%. Much lower is in excess of meter variance and then a little more. Sorry to not define it but ECID. So I'd be cautious until you figure out what "much lower" is for Sami. For Gracie, even on levemir, much lower is more than meter variance.
 
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