Another low PS...what is going on

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AmyB said:
That must be what he's doing to have low numbers one cycle then go up dramatically the next?
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Yeah, that looks like a bounce!! They're very frustrating, but the more time he spends in normal numbers, the more likely his body will be to learn that it's OK to be there again.

By the time our kitties are diagnosed, they've usually been diabetic for quite some time. Their body has gotten used to living in those higher numbers so when we "force" them down with insulin, the liver thinks there's something wrong and over-reacts by sending stored sugars and hormones to bring them back up...they "bounce".

All you can do is keep trying to get him into good numbers and hope his body learns to accept those good numbers as normal again.

Usually they do eventually start to accept the lower numbers and they won't bounce as high and they'll clear the bounce quicker.
 
AMPS is 482.....I know he at least got down to 167 at +4 last night and I suspect he went lower because he was up all night playing. I just don’t know what to do about this bouncing thing since the vet doesn’t want to clean his teeth unless we can get him in normal range while he does it.
 
The bouncing isn't anything you have control over. It's a normal biological occurrence. The fact that you are getting decent mid cycle tests should be enough for the vet to realize Salem is doing well and is in good shape for the dental to be done. Inflammation/infections usually cause BG to be elevated so getting the dental done should help Salem's BG come down some. If the vet wants Salem totally regulated before doing the dental, you may be waiting a long time and just spinning your wheels. Makes no sense to wait. I'd insist on doing it ASAP.
 
The only guess I can make on what would be considered too unstable for anesthesia is brittle diabetes. I knew one human who would go from 30 to 10 (hit the floor) and back again. Out of all the diabetics where I worked, I've never seen another one like that. His was extremely difficult to control. I don't know the dosages since I'm not a nurse.
 
Yeah my problem is just that he's not consistently staying with the low numbers. Like today he hasn't gone below 300. Meanwhile yesterday he got down to 87. I'm hoping if I schedule it for Friday he'll be a little smoother by then and we can get it done. I'm wondering if he went really low last night and that caused him to shoot back up, but I didn't grab any late cycle tests so I don't know.
 
Bounces can last up to 6 cycles for some cats. Right now it looks like Salem clears bounces by about the 3rd cycle following "normal" or lower BG which is great. That dark green 87 yesterday was lower than Salem has been for quite awhile so the bounce is a bit higher than it was when good blue readings were attained. Eventually kitty gets used to being in the lower BG range again and the bounces become less pronounced and don't last as long. It's quite normal to see higher BG at the beginning and end of each cycle. Salem is doing well for such short time since diagnosis.
 
So this dose is probably a good one if he can just clear these bounces? I’m hoping I can maybe time it right and get him in on Friday to get his teeth cleaned. Of course the vet called me back when I was at work so I’ll have to call him later this week but if I can just get him low enough for one or two cycles that should be fine. The vet said the antibiotic should last two weeks so as long I get him in on Friday or Monday maybe that should be fine I think?
 
actually it's a good thing to get the teeth cleaning while antibiotic is still in system -- my dentist has me take antibiotics before my cleaning too (leaky valve)
 
Yeah he just got the shot this past Saturday so it should still be in his system when I get it done.
 
PMPS is 352 which isn’t too bad. I’ll catch some mid cycle numbers tonight since I’m off the next few days. I know it’s a slow process but I just want him to be better. It still just kills me that he’s only 4 and has all of this.
 
My girl was just 4 when diagnosed too so I understand how upsetting this is but Salem is doing great for so soon after diagnosis. I didn't see the kind of readings you're getting for many many months so be patient. You're doing a great job with Salem and he will be fine. :)
 
Well I ended up giving him a bit more but I'll retest in about 20 minutes. Lately he's been peaking at +4 so I'm hoping that's what he'll do tonight. I honestly didn't expect him to go this low tonight after today. I'm going to call the vet in the morning bc maybe this dose is too much? I know that sometimes if the dose is too high their numbers will be all over the place because they're compensating for it.
 
The dose is not too high. The dose is doing exactly what it should be doing. It's just scary because you aren't used to the normal numbers either. Salem is in no danger although you don't want him dropping much more at this point in time.
 
Yeah I guess I'm just worried because sometimes he doesn't go low until +6? But lately it's been earlier so hopefully we can stay at these numbers for the next hour. I knew something was up because he's been in the living room playing and running around. I just hope at some point I can get to the point where he can be in low numbers and I don't freak out. I just need more data.
 
You will get used to the lower numbers too. It all takes time. The first time my girl threw me a green number, I ran around my coffee table reciting hypo instructions to myself like a crazy person in a total panic. Then I promptly shot her to the moon with high carb treats. By the time our journey was coming to an end, my girl was sitting in green numbers 24 hours a day while I methodically reduced her insulin dose till we finally got to zero. ;)
 
I'm hoping I can get there! :) And I just retested and we're at 128. Probably the result of me giving him too much food or him bouncing, but I'll retest him again in an hour. He's getting annoyed with me poking his ears but it's for his own good.
 
That great! No more food now until the next test. You want to know he is holding there or close without any more food intake.
For future reference, when you get a low number, give Salem a tsp or 2 of food and retest. Repeat as necessary till BG has come up to a more comfortable level then retest without feeding to see if he is holding. If he's holding great. if he's dropped again, repeat the feed and retest again. The idea is to get BG up to comfortable level, try to keep him surfing in the good numbers and not overfeed so if numbers start dropping again, he will eat willingly. If you fill them up immediately, and numbers start dropping again, it gets more difficult to get BG up if kitty doesn't want to eat.
 
How long after should I be testing? +4 will be in about 25 minutes so I was thinking to give it 40 minutes until 2. I just never know when it’s probably safe to leave him, especially with his nadirs moving around.
 
It's fine to wait till 2am to test...he's high enough now. As long as the next BG is the same or higher, you should be fine to get some sleep. Just leave some LC food down for Salem to munch on should he need it. I'm pretty sure he's going to bounce again from that lower reading and the big drop from pre-shot.
 
I'm heading off to bed (it's 2:30am here) so if you happen to need assistance again tonight, which I seriously doubt you will, add a 911 onto your post title to get attention. :)
 
I guess I need to start testing earlier because he dropped a lot from the preshot to +3. And go get some sleep! Thanks for helping me out. :)
 
QUESTION- Okay I don't think he has a UTI but if he did are antibiotics used to treat those? He's been peeing okay for the past few days but just now he was straining a bit when he was going. I've been trying to monitor it but I just don't really know what I'm looking for as far as UTI's go and since he had that antibiotic shot last weekend I would assume it would help if he had one? I'm really trying not to be overly paranoid about him but it's hard.
 
I presume what the vet gave Salem was Convenia which is an antibiotic meant for skin conditions but vets have started using it for just about everything thinking it will save the trouble of having go pill a cat. Problem is that sometimes it isn't the right antibiotic for the offending bacteria causing a bladder infection. Ideally a culture would be done immediately and the proper antibiotic prescribed but as in human medicine, medical professionals often skip this step and go with what works "most of the time".

If Salem is straining to pee, it could be a UTI not dealt with by the Convenia or it could be something else like crystals which some cats, often males, are prone to. If he continues to strain, get him to the vet for further evaluation. The problem now is that a culture of the urine to find the right antibiotic won't be conclusive until well after the 2 weeks post the Convenia shot. I personally have notes on my cat's files that Convenia is NOT to be used without my express one time approval for that very reason.
 
Yeah that was what they gave him. I'll try and watch and see if he pees again tonight but I'm calling the vet in the morning anyways. Maybe while he's knocked out for his teeth they can do a culture just to double check. I mean he hasn't been acting like he doesn't feel well or anything and he's not crying when he uses the litter box he just looks like he's straining a bit and his butt shakes. But my other cat did that when he peed a few minutes ago too. So I have no idea lol. I'm trying to add water to their food and make sure they're getting enough since they never seem to drink out of their bowls anymore.
 
PMPS is 347. I guess I'll see where it goes tonight. Usually I can tell by +3 if he's going to drop a lot or not.
 
+2.5 is at 393. I'm guessing tonight is going to be another high night, unless he drops around +6. I still just don't know how this dose is working, obviously he's getting low enough on it but it's not consistent at all.
 
The numbers are not a lack of consistency. They are a product of Salem bouncing from lower range numbers. He came out of a bounce and dropped back down to 75 the other night which set off another bounce. I know it's like a roller coaster for you and for Salem and looks like the dose works one day but not the next but that isn't the case. Salem will be back to giving you lower readings very soon.
 
AMPS is 202...I’m going to give him like 20 minutes and see if it goes up. I’m guessing he went down late cycle last night but I didn’t get any tests.
 
Just retested him twice and got readings at 178 and 194. I know there’s some variance but it’s like he’s going down not up. No idea what dose I should give.
 
I’ll be home today to monitor so I’m wondering if I should give the 1.5 and see what it does? He just went so low the other night on 300 so I worry what he’ll do when he’s around 200.
 
Well you can skip or give a reduced dose. If you can monitor, you could try 1.25u or 1.0u for today and see what he does. It will take roughly 2 hours before the insulin will kick in so he may start rising on his own before that.
 
I’ll try reducing it a little and see what that does. I’m just trying not to mess with the dosing too much but I think if I give 1.25 it’ll be okay.
 
Okay I gave approximately 1.25. I’ll check him and see where he’s at at +2 and go from there. It’s during the day and I’m off so I feel more comfortable shooting on lower numbers since I can easily take him somewhere if I need to
 
Do you have some medium and high carb food on hand and some karo/maple syrup or honey? You shouldn't have to take Salem anywhere as long as you are prepared to give him a boost should he need it. Also, do you have lots of strips available?
 
Yes, I have all of that. I went and bought more mc and hc food the other day after he went low the other night. Hopefully by +3 I’ll be able to tell if he’s going to go too low. He’s peaking either early or late in the cycle which is weird but I guess it’s an effect of the bounces? Last night he was still in the 300s when I went to bed but he was playing all morning so he must have dropped.
 
Nadir isn't always at the same time every cycle. You can set your watch by some cats and others leave us guessing. The bouncing can also effect the timing but generally nadir will occur between +4 and +7.
 
PS tonight is 145, which is pretty much the same reading I got at +6? I really don't want to skip but I almost feel like I should. I don't know if it's worse to mess with the dosing or just skip for a night.
 
The decision is up to you depending on your ability, willingness to monitor. Did you test at all between +6 and pre-shot? Possible Salem went lower in that timeframe if you didn't.
 
No, I had to go to an interview thing so I didn't get any between them. My other problem is I was trying to back up his shot time since I have to work this weekend and have to give it to him earlier on Saturday morning. He hasn't given me a PS number this low in a while and that was on a lowered dose. I mean I can technically monitor since I don't have to work tomorrow but I was trying to go to sleep earlier since I have to work early this weekend.
 
Well you always have the option of a reduced dose like 1u. Gives him something but hopefully not enough to take him low enough to need constant monitoring. He may have surfed along nicely in the blues today or dropped into green at some point but doubtful he went too low or you'd likely be seeing a bounce starting up. How much earlier do you want to shoot?
 
Well ideally I would be doing it now so I can back it up in 30 min increments. It's two days out of the month I have to be at work at 9 in the morning when normally he gets his shot around 9:30 so I have to back it up to 8:20 or so. It's annoying, but my work schedule is so ridiculous that I can only do it at those times.
 
You have about an hour leeway with shots with ProZinc so while backing up 30 minutes each day for 2 days is fine and ideal, you can shoot an hour earlier if BG is high enough at pre-shot which at this point in time is questionable.
If you would feel better dropping the dose even lower than 1u that is fine. It still gives Salem some support overnight without potentially allowing BG to soar overnight. 145 is lower than any previous pre-shots so it's a guess as to what he will do. How about retesting him now and seeing if per chance he is rising on his own yet?
 
It's still the same at 146. I guess I could give .5 and just see how that does? Adjusting the dose back up wouldn't mess with him at all would it? I guess I still don't entirely understand how insulin works so I'm trying to see if it would be safer to just skip for a night or give a small dose like that. I just want to make sure it doesn't affect anything if I give him the 1.5 tomorrow.
 
ProZinc is an IN and OUT insulin which means that what you see in the 12 hours after the shot is the effect of the last shot. ProZinc may occasionally last up to 14 hours for some kitties but it could also be that the dose needs to be reduced. The antibiotic shot has been at work long enough now that it may be having a lowering effect on Salem's BG. Tough to guess what to do so all you can do is chase his numbers. He is moving in a good direction. Try 0.5u if you feel better with that. This isn't just about Salem. He need you in good shape to look after his needs too. It's not going to put you back in progress but you may see slightly higher numbers for a cycle or maybe not.
 
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