3/27 Aria

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Hope and Aria

Hope and Aria

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Hey all. We've been doing TID for the last week trying to get Ari to regulate a bit more and get her numbers a bit more stable. It's working out well, all things considered. We've had days where she's stayed under 300 for a full day, so that's really nice to see. I borrowed Michelle & Pru's TID SS but then couldn't get it to add as a page, so I made a new one. If anyone has a chance, can you look and tell me if I'm being a wuss about my doses? I know I panic at night before I go to sleep and shoot too conservatively as we're raising the dose, but I've tried to stop that as much. I've held strong to 1.6 for the last 4 cycles

TID SS:
http://spreadsheets.google.com/pub?key= ... utput=html

Her other SS is still in my signature.

Just for reference - She's on ProZinc. When she was BID, it took to about +2 after a shot to see any decent results and right around +10 is where everything wears off and she zooms. Thus why I went to +8 TID to see if I could hold her in good numbers and shoot in the window where it will work for her right about the time that the previous dose wears off. She's eating and drinking well (FF Orig Chicken Feast)

Thanks!
 
Hi Hope, glad to hear she is eating well, that is really good!

I liked what Steve & Jock wrote over on Kelly & Oscar's thread, that if you aren't seeing DD nadirs, you probably aren't shooting enough. That is what I have found for Bix (and in part why I gave up on TID, I just found it so frightening to shoot higher amounts that often). I don't have any comments on her #s specifically (except to cheer on the absense of the scary colors, YAY!!!), but I felt like Steve's advice applied across the board. Unless there are signs the dose may be too high (which I don't recall that you've seen with Aria except for maybe a couple low #s if I remember, but no signs of chronic rebound or anything like that), if you aren't seeing good nadirs, you probably aren't shooting enough.

If you raise the dose, I would certainly be on the lookout for the sudden breakthrough, but I think you are testing plenty and are on top of things, so I wouldn't be overly worried. If you are shooting a steady dose as opposed to a sliding scale, I would probably consider making a small increase if you aren't satisfied with the #s, hold that for 2-3 days, and then increase again if the #s aren't there.

With TID also you have the hope that duration will improve, so hopefully as you see improvement and/or get to higher doses, you may find it lasts longer and TID is not needed. But I'd let the #s dictate that.
 
Thanks Joanna. I had read that as well and it hit me that maybe I was just giving her slightly less than she needed and that's why we're just not hitting the right numbers.

My hope is that with TID we'll be able to find a good 24 hr dose and then move from +8 to +9,10,11 and back to 12 adjusting accordingly. Theoretically it sounds like a great idea. I was so frustrated with getting to +6 and seeing >300 and knowing I had 6 more hours before I could do anything about it. I started out shooting a sliding scale with TID to try and find the *magic* number that I could use as a standard. I think we're getting close, but with Ari, it seems like every cycle is different. One cycle a 1.6 gets her in the low 100's and the next day 1.6 doesn't break 200. Part of me wants to just go back to BID so the higher doses won't throw me into such a panic, but I really do think she's making progress more rapidly this way.

I still have to say that I crossed my fingers when I shot 1.6 at 204 this afternoon. I'll be testing her in another 1/2 hour to see where she's at, but her clinical signs are all good. Happy cat, lounging around, grooming herself.

ETA Thanks to whoever mentioned the BellyRubs. When Ari has normal bg's she sometimes decides she doesn't want to eat. I've been sprinkling these on top of their food and both girls come running.
 
Should I be concerned that we hit 58? Acting normal. I brought her a plate of food to eat and she ate once I stuck it in front of her, but she wasn't planning on getting up to get it herself, she was just going to continue her nap. So thus, naturally, I'm concerned about giving 1.6 again tonight.
 
Hey Hope, I wish I saw this sooner. All I can do is tell you what I've experienced with Pru. The first time her bg dropped... I freaked out, but now that I've had to go through these low numbers with her... I've realized that if she goes 60 - 40ish.. All I have to do is give her some reg canned cat food. Usually something with gravy so her number will rise. If you give syrup or treats (which I did at first) that will throw her numbers off. Another thing I've learned was to try not to skip a dose. Just give a smaller amount.. her body needs something vs. having her body reach those high numbers again.

I was told to think of it this way -
Think of pushing your child on a swing. How hard you push matters a bit, but WHEN you push is the most important thing. If you keep pushing at the right time, you don't need to push very hard. Same thing with 8-hour insulin doses. If you wait till 12 hours, it's the wrong timing and you have to push a lot harder. Aria's is low now because she's built up some overlap from all those tightly-spaced shots. Don't stop them, keep it going every 8 hours, but reduce each one until she is riding around 70.
Click to expand...

If you've notice with Pru's SS. When I was doing BID, she was at 1.6 per cycle. When I started TID, I made the mistake of giving too much insulin which dropped her right away, but found myself going to just 0.9 units for a full cycle. Since you're doing TID, I think you will be dropping the dose soon. It's been 2 weeks now that we've done TID and we're at 0.6/0.5 per cycle.

Looks something like this:

0.8 2x = 1.6 BID
First day - TID total cycle 1.5 which was too much at the time b/c of overlap from BID

Second day - TID total cycle 1.1

Third day - TID was at 0.9 for total cycle

Then I went to 0.7 total for cycle due to overlap, but doing well at 0.6 for over a week now.


Hope this helps.
 
Hey Michelle - I ended up having to crash last night. She was rising at 129 at 11:30 then went back to 109 at 12:30. This morning at 6:30, (+16) - 559. Gave her a full dose (as if we were shooting 12/12) just to get her back into the good numbers. Usually when she goes this high, I have to give her 2 or more to get her back down, so I went with the 2.4 which should be close to her 12/12 dose but may wear off since her overlap is gone.

I didn't completely freak over the 58 because she was acting fine so I gave her the normal LC FF. I had read previously to remember that the meters are not completely accurate and can be off so to check for the cats signs as well and just keep monitoring before giving any high carb treats, etc. A little Bellyrubs on her normal food got her eating right away. Since she starting coming up a 1/2 hour after the 58 (and not rapidly) I mostly was worried about being able to shoot again. I'm sticking with a no shoot of 200 still and 129 to 109 was definitely a holding pattern instead of a rising pattern, there was no way I could shoot then sleep. Set the alarm for 6:30 and crashed. Nice big black number this morning but she also seems to have them right after we see any greens, so it wasn't a complete surprise. She's coming back down slowly so today is going to be a monitor and watch day. I may have been rambling here. The broken sleep leaves me feeling a bit wonky.
 
My civvie tested 56 before his evening meal. Buddha has hit the 40s and 50s on my Contour and was acting fine. I do get him to eat, I used to push kibble, but I found just his normal fancy feast does him fine.

Once, before I started testing before every shot and was following the vet's advice to give 3u bid, the kids came running to me and asked what was wrong with Buddha. He was just lethargic, would respond and focus when I talked to him. But otherwise sort of lolled off into la la land. He tested then at 21. So I popped open a can of fancy feast and he jumped up and followed me to the food dish.

Of course any time he dips into the green he will rebound, whether its the high 30s or the 90s.
 
Donna - Glad I'm not the only one who gets spiky numbers any time a hint of green comes up. Ari doesn't like to show any signs of anything. This morning she was happy and perky and in the 500's. Last night in the 50's she was calm, and purring. Then of course when she was in the 100's she fell asleep and rolled off the couch. Blood testing is our best friend. It's the only way I have any idea what's going on with my girl.

The TID has been working out nicely for us for keeping her under control. Ideally, if we could go to +10 shots, that would be about perfect for her, but that really would have me up at all times of the day/night so I don't think it's feasible.
 
58 is awesome if you are somewhere in the nadir zone. Sounds like a nice breakthrough, and it also sounds like it cancels out my previous advice to raise the dose... nice of her to let you know to ignore me!!! :lol:

If I saw it at +3 or something I would probably feed 2 or 3 bites of HC (like the FF/gravy) and retest in 1/2 hour. If you balance the food right they can stay in a nice trough sometimes til you are past peak - it takes regular testing & feeding small amounts though. But again it depends on the timing. If it were +6, I would just make sure Bix's food dish hadn't gotten empty, and not think twice about it (ok, realistically I would probably worry & retest :roll: but really it's a good #).

My civie tested 54 on my meter, which helped me relax about the lower #s. I would not say the same for a cat meter, on mine Bix would be well in hypo #s IMO with a # like that, but I think most people are using people meters.

I found it useful to read the Tilly guidelines over in the stickies on L lands. We can't follow all the same things exactly with PZI (like the no-shoot, I like 150 for PZI), but I found that (as well as Dr. Rand's guidelines for different insulins, also over in the L stickies) helpful just in giving me some perspective on how to approach things.

Bix used to spike high too when he saw blues or greens. For him I think it was liver training. Once he spent some really solid hours staying in those #s, the spiking gradually seemed to recede over the course of a few days.

That's funny to picture Ari rolling of the couch!!! Bet when she landed she pretended that's what she MEANT to do, lol. Cats. ;-)
 
You know what? I would have been the happiest camper if that 58 had been followed by a PS of >150, but that 100.. Oy! I wish I had the energy last night to stay up a few more hours and catch her on the rise, but I was plum beat. But, it did give me more data, which is always good. In hindsight I should have set my alarm for +12 to see where she was at then, but I was in that state of too tired to think.
 
Ok, we're back from the vets. Aria seems to be doing well. Very hungry. They said she was cracking them up this morning because she had gotten food stuck inside the "cone of shame" and was trying to figure out how to eat it in all contorted positions.

Here's the results from all her tests. It looks like to me that only her BUN is still elevated.

Urinalysis
Transparency - Cl
Sp. Gr. - 1.015
Color - Lite Yellow
PH - 6
Glucose +++

All the rest had slashes through them

Blood Glucose
They gave her 2 units at 2:20pm yesterday.
Got a call at 11:00 pm (my vet and the tech who takes care of Ari went in) because she was at 135, so they wanted to see what they should do. I told them they needed to recheck in 1/2 hour to an hour if they were going to give her a shot and leave and that I'd be more than happy to come pick her up if she needed to be monitored overnight. Dr thinks that the fluids were holding down her bg's somewhat. I told them that if she was holding steady or dropping to not shoot, but if she showed that she was on the upswing to give her the shot as she shoots up high and fast. They ended up not shooting.
7:30am- 441 (which makes sense since that was +17 and she usually gets +8 shots) - gave 3 units
10:30 check - 347
2:20 I-stat - 172
3:20 Gave 2 units Prozinc
5:30 came home

I-Stat
I thought they gave me the sheet from yesterday too, so I'll get that from them. We go in next week for another I-stat. Dr said that her BUN went up slightly, but her creatinine went down.

Na - 147 mmol/L
K - 3.3 mmol/L
Cl - 116 mmol/L
iCa - 1.36 mmol/L
TCO2 - 22 mmol/L

Glu 172 mg/dL
BUN 56 mg/dL <--- This is the one number that's giving me the willies
Crea 1.7 mg/dL
Hct 30 % PCV
Hb (via HCT) 10.2 g/dL
AnGap 13 mmol/L
CPB: No

She's home and acting normal and is even being a little perky (not her usual laid back self.) The vet gave me her Prescription for ProZinc with no extra charges. She's got a new Drinkwell and seems to be settling back in well.

Thanks everyone for the advice and help this weekend. I don't think I've gotten enough sleep and I'm sure I'm way emotional, but I do appreciate all the support.
 
H has had slightly elevated BUN here for a while. There is some thought that the ranges for "normal" cats are for ALL cats not ones that may be on a higher protein diet like many here may be. The "N" in BUN is for "nitrogen" which as I understand is the metabolite of protein. In the melamine food recalls they were testing for nitrogen in the grain not protein. Since melamine has lots of nitrogen in it that is why it was added to fool the tests - so that the buyers would think it was a higher protein grain. Anyway, the thought is that a slightly elevated BUN might be OK for a cat on a high protein diet. The reason many cats here might be on a high protein diet is that cat food has only three nutritional components: protein, fat and carbs [cats don't drink alcohol]. So if you squeeze the bag at one end [lower the carbs] then the bag will balloon at the other end [fat and protein].

Were those tests done at a lab or on the vets machine in his office? Seems like you got results from the overnight stay pretty quickly. Just checking because I do not trust the machines in the office. They have led us down some costly and unneeded paths in the past. Antec and Idexx are the two big labs I'm aware of.
 
I'll find out where the tests were run. I'm going to guess in office because when I called, he already had the test results back and that wasn't very long after they ran them.

I'm going to have to give them a talking to for giving her the last shot (2 units) without a BG reading. She's acting funny and I just checked her at +2.5 and she's 390 (which I've never seen at 2.5 with a PS level in the 100's.) Now I don't know what her PS was really because the number was from an hour before so maybe this is fine, but I really think they may have given her too much. 3 is a huge change from her highest amount of 2, even if she was in the 400's. I'm going to monitor for tonight. She's not a talkative cat, but she's walking around chatting up a storm. THIS is why I asked to be able to pick her up in the morning or come in to give her the shot. I gave them dosing instructions. Obviously I should have been a little more strong in passing along my expectations that they be followed.
 
IMHO, I would demand that any tests in the future go out to a lab like Antec or Idexx. IMHO it is a waste of your money and time otherwise. My feelings are that the in-office machines should only be used in an emergency.
 
((((hugs)))) hope you are both recovering well :)

ROTFLMAO at the picture of them calling you to report her BG and ask what to do, and you giving them a lesson on retesting and shooting on a rising #. I mean, it's awesome & I'm really glad you got them on board with that, the picture is just so funny in my head (I mean, aren't we usually the ones who are supposed to call THEM and ask what to do?). Too bad you don't get paid a vet's salary for it. :lol:
 
p.s. don't stress yourself out too much about her #s & stuff today & tomorrow - it will be 100% wonky most likely, the combo of the late shot (so going into this last +8 shot her overlap will be reduced), the vet-inspired dosing ohmygod_smile , all the stress, etc.

I would just test whatever amount you feel like you need to for safety - she may run high for a while if they ended up rebounding her, or just from leftover stress & stuff. I'd focus on being sure she eats decently, doesn't have a low nadir (doesn't sound like that will be the case), and then getting her back on the shot timing & doses that you want.

& then give 'em hell next week :) 2u is a lot IMO at a +8 following on 3u, and a decent PS. She should be fine though if you keep an eye on her & get in a spot test here & there.

My cats are often wired after getting home from the vets - adrenaline? - hopefully it is nothing more than that. They can act funny if they hypo, but it doesn't sound like it from the #s. Hope she is fine, and everything settles down soon. Vet trips are their own sort of roller-coaster, right? :roll:
 
Just because I know you'll get a kick out of it. My 7 yo DD came with me to pick up Ari and to hold my hand when I got the bill. Yep, the kid is the calm one in this family.
 
Ok, we're at +5 and she's through the roof. If she maintains this high, do I shoot at +8 or do I need to let her body go through this process? I've always gotten numbered reading in the 500's, but never have I seen the monitor just say HI. I've got a few more hours and I'll keep testing, but I figured I'd send out the call for help before I got to shot time.
 
Hi Hope,
I don't think Aria's numbers look bad at all. The BUN should never be taken alone to indicate anything. The high protein diet will cause elevated BUN. The creatnine is good. The HCT is borderline anemic, from what I've read. I think, but I'm not sure, that the specific gravity might be low, but that can also be the case in diabetics. These are all things you should be able to talk to your vet about. If you go to http://www.felinecrf.org/diagnosis.htm You can read what all of those blood results mean.

I know you'll get Aria's bgs in control soon, but I'm sending positive thoughts anyway.

Ele
 
Sounds like she may have rebounded. I think the standard advice is just stick with your "good" dose, ride out the cycle or two of higher #s, and try not to let it freak you out (probably too late for that! :lol: ). Ideally, you want to ease her back into good #s rather than perpetuating the seesaw, so though it's counterintuitive you wouldn't raise the dose. If she gets a nadir and is rising back up by +8 I would stick with TID, if her #s are dropping at +8 I would wait til they rise to shoot. It may be confusing for a few cycles, but hopefully it will settle down soon.
 
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