Alex - 9/14 -need some advice, pls

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Ginny & Alex

Ginny & Alex

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If you look at Alex's SS, you will see that I've gone from a dose of 1.2 to 1.3, and now 1.4. The end-of-July DKA episode is never far from my mind, so I want to be sure he's getting enough insulin. Yesterdays' AMPS was 180 and today's was 350-ish.

I would appreciate if some of you could take a look at his SS and tell me what you think.

Thanks!
 
When I looked at your ss I saw that the same thing happened on 9/11 and 9/12.
Now, From my experience with Shakes, there were times that I shot a normal dose into
a preshot under 200....the first 12 hour cycle is not flat, but not a lot of movement, he will then hav e a decent
preshot(yellow), but for some reason this is where he goes too low...
I wish you had tested the second period (just keep in mind for next time)
almost like the body fought alittle for the first 12 hour period and the second 12 hour period
the body kinda said, **** too much and went low and bounced.
Maybe if you are gonna shoot a 180 number reduce a little...
Its just funny how you do have a cycle going on here...this week anyway.

just my thoughts from Shakes experience..
 
I don't know Ginny, kinda looks like Thumper's with all those pink PS's then dropping to the blues. I wish I had a crystal ball....or one of those black 8 balls I had as a kid! :lol:
 
I agree with Denise's thoughts....


Keep up the Good Work with Alex---he is doing GREAT!
 
Yes!

I can tell you from my experience, that I cannot shoot the same dose into a 180 or even 220 that I can a 280 or 340. I actually stated on my "Kitty" thread today that these lower preshots are giving me a fit. As long as I am shooting into a mid 200 to mid 300, I can shoot a regular dose and almost can predict the range of the next preshots and cycles. I know ECID---but, I have to reduce on these lower preshots to keep her in "good" numbers. My vet shot 3.3 into 187 last Friday--- the next preshot was 147--and then--there she went---up to almost 400 on the next preshot. She remained in that rebound cycle (high numbers) for 2 more cycles.Truly, I just shot a 3.2 into a 211 at midshot--- and I am certain that was too much and she will be in the 300s tonight at preshot. I am yet to determine what that "lower" dose should be---but, i am experimenting.

I think there is something to the body fighting too much insulin when you stay with the same dose on the lower reading.

I know there is a group that will disagree with my thoughts, but I know that with Kitty--I need to reduce on lower preshots to maintain good numbers. I truly think a lot of or PZ cats are fighting chronic rebound (whatever that is)! :lol:
 
Hi -

Starting with a big caveat because I'm still at the beginning of the learning curve - I second the idea that PZI kitties could be dealing with 'chronic rebound'.

My impression from looking at your spreadsheet is that maybe Alex's dose has crept up too high. It seems like there are clear cases of rebound, even at lower doses (eg. 8/21, 8/23, 8/30). I know that you are concerned, since the DKA episode, about giving him enough insulin, but the DKA episode seems like it was precipitated by other contributing factors (the bladder infection, not eating because he didn't feel well). It doesn't appear that it was driven by him not getting enough insulin, and you might expect his insulin requirement to go down once the underlying infection was cleared up. Maybe try a few days at one of the lower doses where you were seeing more blue/green numbers.
 
Anybody else want to chime in?
I looked back over Alex's SS and he was getting better numbers at 1.2, so that's what I shot tonight.
 
I'll chime in. I always think it is a good idea to reduce your dose based on the PS. Prozinc in not one of the L's where you can safely shoot the same dose into a lower PS because it doesn't have a shed that it is drawing from, Prozinc is in and out, every PS is a new beginning so why not reward a lower PS with a lower dose?
 
well, tonight's PS wasn't really low, but I lowered anyway. Ever since I increased from 1.2, it doesn't seem like I've been gotten numbers that were as good as the 1.2 dose.
 
What Jackie said made me go back and read what Joanna posted the other day concerning rebound, bounces and liver panic...
Report this postReply with quoteRe: 9/12- Lucky - Still not so good...
by Joanna & Bix (GA) » Mon Sep 12, 2011 11:50 pm
As far as I understand it, bounce is slang for rebound.
From what I have read, Somogyi rebound comes in 2 forms - acute and chronic.
Acute is a one-cycle event, where there is either a drop to a low enough # that their body kicks in to defense mode to save the day, or a steep drop in which their body thinks it needs to kick in to prevent dangerous lows. With acute rebound, they will often spike high right after the low or steep drop, and then can either start coming back down soon after that (hence the pattern of the +12 being lower than the high +9), or they may stay high all through the next cycle.
Chronic rebound supposedly is when they have an extended period of acute rebounds, their body just freaks out and throws glucagon (? what's it called again?) at everything. Chronic rebound looks like high flat numbers. From what I have read, there is very little known about chronic rebound - it is hard to pin down, disputed, etc. etc.
Liver training is the fake-out rebound, where their body *thinks* it's in scary low numbers when it's not. So if they go down to a pretty nadir of 80 say (in a cycle with no steep drop) and get all freaky-freaky and throw rebound numbers at you, even though 80 isn't dangerous.
I think it's also important to know that a low number or a steep drop does not necessarily result in rebound. From what I have seen, the first line of defense is that they get hungry, and will eat to raise their BG to a safer level. So just b/c they hit a nice green number and then end up with a higher +12 doesn't necessarily mean rebound. Sometimes it's just that the insulin has worn off.
When it's Somogyi rebound, you need to lower the dose. When it's liver training, you don't want to lower the dose, you want to keep them in the greens til it settles down.
From what I have seen, people generally do a LOT better when they don't worry too much about rebound. It tends to mess with your head and make you doubt every move, I know that's what it did to me. IMO if you are getting low numbers or if you are seeing overly steep drops then you need to reduce the dose, simply b/c you don't want low numbers and you don't want overly steep drops. The rebound is just a side effect. If it's liver training (i.e. you are not seeing low numbers and the drops aren't too steep), then you just ignore it.
Click to expand...

On the days Jackie mentioned specifically, I think that was liver panic rather than true rebound when Alex went into the blues then shot up to his PMPS. And on the days he saw green, it may be just that the insulin wore off after 8 hours or so. Or it was acute rebound. If it weren't for the 2 days recently where Alex showed you blue AMPS instead of pink, and went 125-225 at nadir, it seems that he could use a higher dose rather than a lower one. One that will give you Yellow PS's and green nadirs.
I dunno, Alex confuses the heck out of me!
Carl
 
I dunno either. I did shoot 1.2 last night and this morning and we had a yellow AMPS.
But I really don't know if I should just try to keep going at 1.4 or not.
 
PMPS - 390 :evil:
I don't think this is bounce or rebound or liver panic. I'm assuming this isn't enough insulin.
 
Ginny & Alex said:
PMPS - 390 :evil:
I don't think this is bounce or rebound or liver panic. I'm assuming this isn't enough insulin.
Click to expand...
I agree. I think going up to 1.4 was a good move. I'd hold there for several cycles. And if you don't see numbers you like, I'd probably kick it up another .2
Alex needs to learn to love blue and green nadirs without giving you red PS tests. So your dose is probably going to have to be one that forces the blues and greens on him. As long as he doesn't go way low, and you can force yourself to let the bounces clear. That does increase the stress/worry factor on Momma though.... but that's what we're all here for.
;-)
carl
 
Ginny & Alex said:
I raised to 1.4 again. I feel kinda panicky and in react mode.
Click to expand...

I felt the same way this morning and raised to 1.4 too. It's hard to know what to do when you have no clue what's going on!
 
Hi-

Arrrgh! I'm sorry to see the pink again. This is exactly the sort of thing that I'm going through with Argyle - and judging by how well I'm not doing with her, I can't offer any good advice. It was really helpful to me to have thrown out an idea and see the responses from people who know more about it. So, that said, here is another 'thinking out loud' idea to bounce off of everyone.

Actually this is same idea as last time - I still wonder whether Alex’s dose is too high. This is my thinking this time…

Starting back at the end of June, Alex was on a lower dose of ProZinc (1.0) and the AMPS and PMPS were trending yellow (maybe the pinks on 7/2 and 7/6 were because 0.6 or 0.8 were too low). Then you switched to PZI - I don't know the story there or whether the two are equivalent, but Alex did well on a lower dose (0.8 to 1.0), having yellows and blues, even with the bladder infection. I was under the impression that having an underlying infection would increase a cat's requirement for insulin, because their metabolism was revved up to fight the infection or because the bugs were using the insulin themselves. Then, when Alex got out of the hospital, he started on a much higher dose of ProZinc (1.6 to 1.8) than he was on before he was diagnosed with the infection. It seems like there are indications that that dose was too high - the couple of days when you had to delay the PM shot (8/7, 8/13) and the really steep drops after the PM shots on 8/8 and 8/9. Then after 8/15, you decreased the dose and Alex wasn't doing that badly. Maybe the pink PMPS on 8/16 and 8/17 were due to the 0.4U AM shot. 8/19 wasn't that good, but maybe the pink PMPS on 8/20 due to a missed shot in the AM (?). I see what Carl meant about the pink PMPSs being due to insulin wearing off on 8/21 and 8/23. The next pink PMPS was on 8/28 when you gave a smaller dose in the AM. Then on 8/29, the dose went up to 1.2, and you started seeing blue numbers between shots (good) but more pink PS numbers (bad).

So, I don't know what's going on either, but I guess I wonder about the big picture. In April and May, Alex was on a higher dose, and you had gradually decreased that dose down through July, when he had the setback with the infection. After that, you restarted on a higher dose that had previously been too much. I don’t know what could have changed in Alex's condition which would make him need more insulin after the bladder infection was taken care of. Anyway – that is the food for thought for tonight…

I recently had asked everyone for help with Argyle's, because I was doing a lot of changing this and changing that, and had got myself to a point where I didn't know what was going on or what to do next. The most important thing I took away was to get her on a regular schedule and to give any change I made a few days to take hold instead of reacting to things immediately. (or in other words, take a deep breath and don't panic...) That was really helpful, because while on any given day, it seems like anything could happen to her numbers (depending upon when she ate and when I tested her), having a couple of days worth of data helped smooth out that variability and gave a clearer picture of her actual response to a dose. It feels much better too, because it gives you a global plan instead of feeling the pressure to make a new decision every 12 hours.

Anyway - you have my sympathy and encouragement.

The other great piece of advice I got, from whom I can't remember at the moment, was that I should, in the short term, just aim to keep Argyle comfortable, so as long as Alex isn't showing any signs of discomfort or the ketones don't come back, you do have time to try the different doses out for a few days instead of having to react immediately (obviously easier said than done…).
 
Jackie,
Thank you for your very thoughtful response.
To give a little more background, Alex was DKA when he went to the hospital and frequently it seems, that is an indication of not enough insulin. The internist there didn't see any sign of infection (he thinks the original vet ran the test incorrectly) and he is the reason I increased the dose after he came out of the hospital--in fact, he wanted me to go to 2.0 units BID. I was too scared to do that.

Also, I had switched to BCP PZI hoping to find an insulin that would show more consistent results. The explanation on the website on bovine vs. human insulin made a lot of sense. Shortly after I switched, Alex got sick and while the vet couldn't prove anything, he suggested that the BCP insulin might have caused Alex to get sick so we switched back to ProZinc.

I shot 1.4 this morning and will hold through the weekend.
Other than the time of the ER visit, Alex has behaved fine. I realize that counts for a lot.
 
Sir Alex seems happier today, but his numbers so far have been better.
Stan was out of town for 4 days this week. I wonder if the little stinker missed him.
 
The way I understand DKA, and plenty of people in PZI seem to have had to deal with that problem, is that it is basically initially experierenced due to very high BG. That could be caused by not enough insulin, but it could be (as was the case with Bob) due to the diabetes being "out of control". Bob fit that scenerio because his DKA dx was within a week of his initial dx of diabetes. When originally diagnosed, his BG wasn't too terrible. I got a copy of his initial blood workup, and his BG was only 384 that day. He got worse the first week, dehydrated to the point that every joint on his body was "dry", and when they looked at him next, he was over 500. Two days later, he had to spend the next three days at the clinic, and that is when he was dx'd as DKA. He had been getting PZI for only a couple days, 1u BID, but had also stopped eating the 'scrip wet food, and only was eating 'scrip dry food. He almost died. Anyway, when I got him home, he went up to 2u BID, plus 200ml sub-q fluids BID for a few days.
The danger with DKA is that once kitty has had it happen, it makes it more likely that it can happen again. That's the primary reason that DKA survivors need to get to the point where they are getting lower numbers overall. Reds and Blacks are scary to the beans of DKA'ers. And that's why you'll find just about everyone posting in a thread where the kitty was DKA about the importance of testing for ketones. What makes it extra scary is that ketones can show up even when BG isn't all that high.
Correct me if I'm wrong, Ginny, but that is one of the reasons you worry about getting Alex "lower"? I'm guessing also that this is the primary reason that the vet suggested a dose of 2.0 way back when - so that Alex wouldn't run the risk of another DKA episode?
Alex did okay on 1.2 a few days, and on 1.3 a few days, but not consistantly. On 1.4, the only number that sticks out with me is the 390, but that was off a reduced shot at AMPS of 1.2. I think the 1.4 is working so far. Today you got better than 50% drop. If Alex can live in the yellow and blue zone for a while, his pancreas may heal some, and slowly start to take over the job of producing insulin so you don't have to help as much. If he starts showing you greens on this dose, that would be great news. But I don't think he was about to show you greens on the lower doses.
Look back at 8/13 thru 8/15. If not for the green PMPS that forced you to adjust his doses lower and shoot "off" schedule, that is almost where you wanted to be. If not for the PMPS on the 13th, you could have had a big breakthough then.
Carl
 
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