3/31 Oscar

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Kelly & Oscar

Kelly & Oscar

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So we've slowly upped the dose to 2.5U over the course of this past week. The thing is - we haven't curved since we were at 2U. His numbers since then look like he isn't on insulin at all. Usually we get a pretty good drop the first day of a new dose change, so I am really confused. Any thoughts?
 
I've seen others note that when they change the dose they will get a good drop the first cycle and then the "oh goody goody" novelty of more insulin wears off.

I will say that when we were re-calibrating our "scale"/dose on ProZinc that I kept upping the dose in very small increments [by generally "0.05" U] and it would seem like the first cycle would hold him with some relatively even PSs then he would start heading back up again. So this might compare a bit to what you are observing.
 
Gator - that sounds like what I'm seeing. We're still doing TID and it seems I get good results for a full 3 cycles (1 day) at the sliding scale I'm building (in progress) before I have to bump it up. We're bumping up by .2 units at a time because I just can't see .05 (btw, what syringes are you using that you can see that?)
 
I use the U100 syringes detailed in the sticky.

Each mark on a U100 syringe with half unit markings is .2 worth of U40 insulin. In between is .1 worth. And in between that is "0.05" worth. Believe it or not when he actually eats about the same amount over a couple days and I have him dialed in, "0.05" U is the difference in PSs of about 20 points. Of course one could argue that the meter error is within this amount but W/E at least I believe it in my head.

Microdose increments:
Anyway, I do have a method for getting fairly accurate 0.05U measurements at least on the every .2U like .4, .6 etc. So .4U is with the very tippy of the plunger at the bottom of the line for 1U on the U100 syringe. 0.45U is with the very tippy of the plunger on the top of the 1U mark on the u100 syringe. Then 0.5U is with the very tippy of the plunger in between the 1 and 1.5U mark and 0.55U is a little more tricky.

If I remember correctly, I've seen others here call "0.05" U "skinny"/"slim" and "fat."
 
Hi Kelly,
When I looked at your ss, I do see a curve, although it is a shallow curve. To me that means not enough insulin. You might stay with the 2.5 for another cycle or two and then do another small increase. Hopefully Joanna or Terri will come on and help you.
 
Kelly,
I noticed that you are noticing ketones and I'm only familiar with the words on the urine strips, (like neg and trace), but the fact that you are registering some at all concerns me. My thoughts:

1) your numbers aren't that bad (in my world), obviously you want better, but some kitties can have high numbers for a long time
2) hows his weight, eating and peeing?

3) again, obviously ketones are bad bad, can you increase his fluids? (If you need ideas ask) could he have some infection somewhere? urine, dental? and keep going on the insulin. I'm sure you know they are a serious concern, I just dont know about the numerical values.

4) if you are on prozinc, try getting a nadir at +4 to +5. that is the most common nadir I have seen. (then just to keep me guessing he'll have a few at +8 to +9 so....

5) I have been really confused on the whole dosing thing myself, (now trying 3x/day :shock: ) but the fact that you have ketones makes me think you need to keep going- I've only seen them once over trace, so I'm no expert.
If you want to see "increase the dose, stay the same, increase the dose, stay the same,....", look at Cody's ss- but then I've had to blame some of it on the acromegaly (pituatary tumor).

6) ditto what Ele said
 
1. His low numbers is what has me confused with why he has ketones to begin with

2. Weight - he gained 5oz of weight last week. We have another check in with the vet on friday to see what he has done this week. He still eats and pees about the same

3. I add at least a 1/4 cup of water to his wet food morning and night. He also still drinks a fair amount from the dog's water bowl and the small water bowl I have in the bathroom.

4. I usually can get the +4 or +5 reading at night. In the past few weeks he has been going the lowest anywhere between +4 and +7

5. The ketone level according to the manufacturer's insert has been right around what would be considered "trace". 0.1-0.6 = trace; 0.6 - 1.5 = problem may be brewing and contact dr.; greater than 1.5 = DKA

We finally got a lower preshot number tonight which is more consistent with increasing the dose. We are finally seeing some blues tonight at +4 too. Its about time! I will be testing again for ketones tomorrow morning.
 
Kelly & Oscar said:
1. His low numbers is what has me confused with why he has ketones to begin with.
Click to expand...

I've been really confused on this with Bix too, not with ketones, but with neuropathy. I can really see it in his legs even when his #s are in the 150 range a lot of the time. I would have thought that range was mostly ok, but I can tell from how he acts that it isn't, at least for him it doesn't seem to be. It's weird, frankly, diabetes is weird.

So I'm wondering overall:

1) maybe meters running low, or #s spiking up and down between readings contribute to average #s that are higher than what we think from the readings we get.

2) maybe some of these icky side-effects happen at lower #s than I realized, so unless you are truly in non-diabetic #s most of the time, there is some risk.

3) In Oscar's case, could the other ketone contributing factors (infection or not eating well for instance) be in play? maybe they can get ketones in those instances even if the #s aren't that shockingly high?

Have to admit it all makes me nervous, how they can have something like ketones when you don't see why they would. nailbite_smile

[p.s. I do remember Jojo posting something once on Health to the effect that technically ketones are not due to high #s, they are due to a lack of insulin, and that it's an important distinction. Maybe this is the kind of case where you can really see the distinction? I'm not really sure...]
 
If you are having keytones you may want to consider doing LRS "SubQ" fluids [unless your kitty has heart issues]. It is a very low fuss [at least in my experience] and efficient way to ensure they are getting fluids. And from the little I've seen it seems to help with the keytones [at least until you can get the dose right].

You should have your vet tech give you a lesson. It is way cheaper to order the needles [I like the 21g Terumo needles] and admin sets from shopmedvet.com and get a case of liquids from a local pharmacy.
http://members.verizon.net/~vze2r6qt/su ... ompare.htm
But if I remember correctly, your vet was very fair with you about the ProZinc pricing so who knows.

IMHO every cat owner should have LRS on hand - unless your cat has heart issues it is a very low risk, potentially high reward thing.
 
Kelly - I wish I could offer you advice, but I do not know enough about Ketones and how that effects bg's. Hopefully you will have a better idea with Oscars numbers in the morning. Looking at his SS. It just seems to me that he's been riding in the yellows due to the low dosage. Upping it gave you the blues tonight and I agree with Gator about upping the dose in very small increments. I've found that if you increase or decrease too much... it will throw everything off.

Hope - Looks to me that your first TID yesterday PS 217 - Aria was probably at her low at +4. If you could of caught +7.5, the 2nd TID would of been more stable. You may want to keep in mind that as dose gets smaller, duration gets smaller too. They maybe in the +3 -+4 range once Aria is riding in the blues. I would also try to stick with one meter as you get closer to these lower bg's. ;-)
 
Michelle & Prudence said:
and I agree with Gator about upping the dose in very small increments. I've found that if you increase or decrease too much... it will throw everything off.
Click to expand...
lol and I thought I was the lonely crazy all this time. I've not been too active lately, but when trying to get things figured out, upping in smaller but potentially more frequent increments is generally my shtick. Everyone is free to do their own thing of course.

BTW I agree with Michelle about sticking with one meter - that seems to be the common advice in these parts :smile:
 
His old personality seems to be coming back more and more each day now. He gained another 6oz of weight this week again! Numbers and ketones have not changed, and our vet couldn't make the drive in today because she got caught at her emergency clinic an hour away. I think I will be following Gator's advice and keep upping the dose a little every few days. Next day for uppage is sunday nailbite_smile
 
BTW, H is on less than one unit, so when I talk about 0.05U changes having an effect, it's good to keep in mind that we don't give as much insulin as some others get.
 
Glad to hear that he is acting more like himself, that is great news! It looks like the ketone level is going down too, so that is awesome. The #s don't mean anything to me, but I know .1 has to be way better than .6!!!!!

If I were you, I would up the dose in 0.5u increments every 3rd day (so approximately 2 days at a dose, I'd give each dose at least 3 cycles, and no more than 6 tops), checking for a nadir in the last cycle before raising. When the nadirs get to be close to 100 or lower, I would switch to raising in only 0.2u increments.

Until you are seeing PSs close to 150 and nadirs close to 50 I don't think you need to have much fear of dose increases. Always good to keep the hypo toolkit on hand and get in spot checks of course :). If the #s do get a little low for comfort, usually a few bites of food are all that is needed to offset it. [Of course that is not the case if there is a major overdose, but if you overshoot a little, usually LC food is enough to counteract the insulin in my experience.]
 
I definitely did a little happy dance this morning with a ketone reading of 0.1 dancing_cat I might just have to break out the champagne when he gets to zero! We are upping his dose tomorrow morning to 3U. Here's hoping for more blue numbers and hopefully a few green! cat_pet_icon
 
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