BUD +5 72 (AMPS 501 0.6u) <<<<<<<<<<<

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Wow, you got an even bigger drop today on that .6u with a much higher PS than you got yesterday.

I would definately drop the dose tonight.

Waiting for your vet update.
 
I'm pretty sure I've found a great vet! Been there 2.5 hours. Gonna get some dinner and will start a new thread on new vet's advice.
 
Vet is very caring and very willing to work with me. Likes the home testing. Drew blood for another complete work up and did urinalysis. I thought it was a good idea, also. Did not feel anything abnormal in her tummy. Spent a lot of quality time with us and rubbed Bud as we were talking. That really impressed me. My ReliOn and her meter were 348/354 respectively @ +11.

I told her right off about this site and how the advice I get here is great as are the people and that Bud probably wouldn't be with us had it not been for everyone here. Only got a little bit of a raised eyebrow ;-). She appreciated the spreadsheet and went over every line and back a couple of lines when things were 'odd'. She agreed with the 100u syringes.

I explained that we were shooting 0.6u from this point as long as we had shootable numbers to get her curves evened out. She feels the 508 this morning was a bounce and that 0.6 may be a bit high. We are going to shoot 0.4u.

Here's the plan:

0.4u twice a day as long as BG over 200, except in case of 1. below.

1. If BG is under 100 at any time during the day, call before giving next dose. If unable to contact, give 0.1u and feed.
>>Then if BG is at 200 or greater for next dose, 0.2u and contact her
>>> if under 200, 0.1u and contact

2. If PS BG <100 Call ASAP and don't shoot. Feed.

3. if BG under or near 150-160 PS shoot 0.2 and call.

4. if BG consistently over 400 then call before changing dose. It will likely run a little high over the next couple of days and takes 4-7 days to reach maximum effect.

I am emailing her the link to Bud's SS and the link to the PZI board.

Her brief bio on the practice's website:
1992 graduate of the College of Veterinary Medicine at Virginia Tech. She has been practicing veterinary medicine at [this] Hospital since 2002. Her special interests are internal medicine, animal behavior, and rehabilitation. She received her certification in rehabilitation at Healing Oasis Wellness Center in Wisconsin.

Comments welcomed and encouraged!

Thank you all
 
Sounds like a winner and wanting to be very accessible to you. If she is willing to take your 5am calls I'll give her props for that alone. ;-)

My only input for you is that it seemed to me that you were approaching a point - a learning point - of being able to adjust the dosing on your own. And you are doing very well. In that I mean that diabetes management is a moving target. This is why I think that the fact that this PZI group does not have a set "protocol" is good. Some who want a set "protocol" though find it a little difficult especially in the beginning. But PZI is so flexible and the cats conditions change so much that I found I got the best results when I just made it up as I went on a day to day basis. But I do realize that some people really want a set thing to do so they do not have to really process too much. I try to make the point of the advice I give to educate people to make their own decisions. I think ultimately that is the best place for the owner to be in - when they can hopefully do it all [or nearly all] on their own. The owner is the one holding the syringe - not the vet or anyone on FDMB :smile: .

I thought that you were currently doing approx .4 at 150-200? Currently I think .2 at that range is not enough and will just lead to more zooming. But I could be wrong now that .6U is looking like too much. Tonight will be a good test of .4u. I really want to stress the large effects of changes like .1u at the dosing ranges you are in. I find that recommendation to be a cautious step for you guys that might lead to higher numbers. I don't understand why she want you to feed at a PS of 99 - that's a great number and does not require anything special other than not shooting [and perhaps waiting and testing if you can]. 99 or 90 or 70 would be an awesome PS number and I wouldn't mess with it or stress over it. I have not seen any evidence that Bud Bud would continue to drop after 12 hours without insulin.

I don't understand "It will likely run a little high over the next couple of days and takes 4-7 days to reach maximum effect." IMHO PZI does not take 4-7 days for dosing changes to work if that is the meaning. And it can take a couple cycles for rebound [if that's what's actually happening] to clear and for them to want to come out of the high numbers after going up.

A BG under 100 is just fine as long as it is not below 40. The more nuanced version is that large drops or fast drops can cause issues, not just the BG they reach.

Basically I see the advice as basically good and I applaud her for actually carefully analyzing the numbers you have obtained and for being highly accessible to you. But, I think the approach is too perhaps cautious and perhaps too rigid and perhaps not nuanced enough. On the other hand I do not find this advice bad and in fact I think it is good in it's caution. I just think maybe too cautious considering your progress. Personally, I thought you guys were doing really awesome.

Of course you can always follow your vets advice and do an experiment and see if you end up in better territory [for you and Bud Bud] in a set time period. I'm appreciative too that sometimes what's good for the owner is good for the cat too.

How often is Bud pooping? When's the last time she pooped?
 
Call during office hours LOL... she's good, but not crazy!

She feels that anything in the 100s is acceptable, there fore the 'no shoot' <100. She does want us to call before in those cases.

Yes, it's a bit cautious. I've gotten cautious.

Can't tell about Bud's poo and pee. She shares the facilities with Itty Bitty. DH takes care of the box and hasn't noticed any change (not that we have been keeping a close eye on it, but will now)

Yes, I am learning (thank you all for teaching) and yes, it is me who ultimately makes the decisions. We were on 0.6 for 2.5 days, but shot the .04 PMPS 194. I feel 0.4 is where to be, now and the other criteria is discussable.

Still going to post Bud's AM and PM PSs and still want input.

Thanks, Gator, for all you do for us.
 
Yeah! Me thinks you found yourself a good vet to partner with.

I hope she does come here and read through the last week or so of your posts and will hopefully see that we are not a bunch of internet wackos.

I agree with everything she said. However I'm a little confused about a couple of things.

1. A non diabetic cat's bg is between 60 to 120 so why wouldn't you want a number below 100 during any part of the day? She can feel free to look at my Harley's ss and see that he typically is under 100 most of the day.

2. If PS is below 100 don't shoot. Absolutely!

3. If you shoot .2u into a PS of 150 you are definately going to go below 100 so why would you want to lose momentum by only shooting .1u into the next 200 PS.

4. I agree she will probably run high for the next few cycles after the very low nadirs for the last 2 days. Kitties become more sensitive to insulin after going low. It will take a few cycles for the new dose to settle in and tell us how it is working for her. But I dissagree that it would take 4 to 7 days.

This is a very cautious approach, but then I am very cautions myself, just maybe not this cautious.

I'm trying out a new vet on Friday and I hope I have as much luck as you had today.

You are doing great.

Robin
 
I really encourage you to do whatever necessary to investigate the pooping thing - especially the the numbers stay wonky and/or you have very high numbers with big drops. Constipation is the thing on my mind and it is easily dealt with. And if you can rule out constipation though occasional, careful monitoring then you know you have no worry about it [for the time being].

Also, I encourage you to test more than just PSs. You may need further tweaks that would only be apparent with testing more than just PSs. Her needs are obviously still in a state of flux and may even be headed lower [I'm hopeful].

You are going to schedule your PSs during office hours? My question is based on what are you going to to when you get a PS you have to call on and she is not in the office? So #2 is just a little confused_cat to me. I think you are still going to be needing to make many decisions on your own and thinking on your feet. You are going to feed - hopefully not anything other that low carb food? You are going to continue to free feed? Especially if you are free feeding I see no reason to do anything other than not shoot [unless you can/want to wait and test]. AND if you were going to wait and test then you perhaps not want to feed. If she wants you to call ASAP and tell her the great news than I'm all for that! :razz: Personally, I think your "no shoot" should should currently be 150 at the moment or maybe 125 with .1u or .2u between 125 and 150 if you really wanted to press things.

If you look at 12/29/10 [a week ago and well within relevant timer territory] you shot .2u on 150 and ended up at 475. I don't think .2u is going to cut it at that range. And I think that currently you are probably going to need to increase a hair above .4u to get where you need to go after the highs wear off. But we will see.

And in terms of waiting a week to see what a dose does - I think that if you wait a week her needs might be less if her numbers improve. So weather that's the dose working or her needs dropping is kind of a quandary. Also I've said that most cats can do OK at high numbers for short periods but it's also true that the longer they are high the seemingly harder it is to being them back down. So this is why I would like to hopefully not be too cautious.

I understand the caution you have developed - but that hard earned caution was based on a dose of way more insulin than you are giving now. Giving 2u to a cat that clearly needed 1u or less is much different than giving 1/2 unit and splitting hairs about 4.u or .6u. Caution is good but too much can be a setback.
 
Great points, Gator.... as usual ;-)

Poop thing.... I could put a bell on her and listen for her headed down the stairs. I could lock her up in my room with a litter box. I learned constipation was a problem and that's why I originally took her to the vet. She mentioned doing X-Rays and ultrasound but didn't as she didn't feel anything amiss in her tummy... and she made a long, thorough external exam of her tummy. Any ideas on how to monitor her... we've a very open floor plan and 2 cats.

I've tested 83 time in 33 days not counting the AM and PM PSs. Evening testing is hard as we're now shooting at 7.00. I"ve thought about going to 5 am again to get more evening #s in, but there's no one here or at the vet to discuss questionable shooting with. And DH sometimes shoots numbers/amounts I disagree with. So, it's a catch 22. I'm staying up til midnight to get at least a +5. DH can get a +9/10. Suggestions welcomed.

"You are going to schedule your PSs during office hours? My question is based on what are you going to to when you get a PS you have to call on and she is not in the office?"
> Post here and get Rob's input.

hopefully not anything other that low carb food? Absolutely - only LC
You are going to continue to free feed? Yes

"I see no reason to do anything other than not shoot [unless you can/want to wait and test]. If she wants you to call ASAP and tell her the great news than I'm all for that!" I feel she wants to keep a very close eye on Bud's numbers.

"I think your "no shoot" should should currently be 150 at the moment or maybe 125 with .1u or .2u between 125 and 150 if you really wanted to press things."good point. can't say that I disagree

"I think that if you wait a week her needs might be less if her numbers improve." Yes, that was discussed. and will adjust accordingly

"Caution is good but too much can be a setback." I will be cautious of being overly cautious :cool:

I still have all of ya'll here for watching and helping us. All of the advice I get here is appreciated and I use it all. And learn. We now have another set of eyes in my vet.

Thank all of ya'll again!!!!!

Suggestions and comments always appreciated.
 
If constipation WAS and issue then I would suggest giving a stool softener all the time [unless the stool gets too soft]. This was my lactulose/Mirilax recommendation. You could probably get started right away with the Mirilax. Kind of like the dog food thing - it is best to eliminate potential sourced of wonky numbers at the start until you can get a grip on things and gain confidence about what you are doing. It does take a little monitoring to get the stool in the correct "softness" range. You would need to look up the right dose but I think it is about 1/8th teaspoon twice per day - but do confirm that. It is a powder that you can put in their food. Or if you are like me and are a control freak like me [or have an inappetent cat] then you can ask your vet for a lactulose Rx [I recommend getting it in pint or 473ml quantities] which is a very sticky syrup that you can syringe in orally. The two stool softeners need to be given all the time and not just on an as-needed basis. In fact they really don't work too well by the time it is too late. They both work by drawing water in from the body into the intestines - so I think you said you were adding water to the food but if you are not be sure to do that. Hydration is another thing that helps constipation.

My comment about testing more than just PSs was based on the apparent point the vet made about testing PSs [and not more??]. I think the amount you are testing currently is more than adequate and you have been doing an awesome job at that! That was not a critique of the testing you have been doing. :-)

I have no tips on the poop thing except that maybe more than one litterbox could help the issue. I've found that they do not like sharing anyway and will sometimes pick a box. Cats also tend to set up territories in houses so putting boxes in their respective "territories" can help encourage the "picking" of a box.
 
I'd second what Gator & Robin are saying. My 2c is that is AWESOME your vet is working with you and you have a plan, but I would recommend that you moderate the couple points where her suggestions IMO can be improved on based on the experience you already have. If you do follow her instructions to the letter, just be sure not to continue with them for too long if they aren't working - i.e. don't lose ground if you don't have to.

Personally I think by being too conservative you risk going into higher #s and losing ground, but on the other hand, Bud clearly responds well to insulin, and as long as she is feeling reasonably well and there are no ketones in sight, I do think you have leeway. If you end up with doses like 0.1 and 0.2 and start seeing more solid higher #s, then you can always go back to something like 0.4 or 0.5 and you know 0.6 or 0.75 works as a BAM dose should that be needed.

Anyhow, I hope it goes well, and please keep us posted!!!! If you do want dosing advice, make sure to let us know. I'll try to keep my mouth shut so you can follow your plan w/o feeling extra-conflicted, and hopefully it will go great! She's gotten better #s these past couple days than I expected, so maybe 0.4 is the ticket. And who knows, maybe 0.2 will be the ticket in a few days! :mrgreen:
 
Joanna........... Nooooooooo don't keep your mouth shut!

I will always want everyone's opions and suggustions. There are disagreeing opions within those here and every one of them is important to me. That is how I learn. That is how I make the decisions that I feel are best for Bud.

I like this vet. I like her suggestions and attention to Bud's #s. It's a new relationship for us and a new patient for her. I don't think she'll feel offended if I question things. Gee... I guess that's why I feel so good about her.... I think she'll be open to discussing change of plans based on data. And I've a few questions already based on the feedback I got from ya'll.

We need ya'll as much as we ever did. Always will.
 
I may have already said this but Kitties can become very sensitive to the insulin after going low.

I would drop to .2u on a PS of 200 until she proves, with much higher bg's, that she needs more than that.

With your 169 AMPS I wouldn't shoot anything, I would test every 2 hours if you can (great information for future use), until you talk to your vet.

Also, start a new thread every day so we can keep each day seperate.

In the subject line you can put "Bud 1/5 AMPS xxx" and then edit the subject with your + 2 bg's, etc.
 
Thanks for keeping an eye on us thie morning, Rob!

the 169 was +10 taken at 5am. (PMPS was 7.00 pm last night) DH got it a bit confused. Her AMPS was 314 taken @ +13 0.4u (i feel like a horrible mom, I over slept)
 
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