Cliff Notes: Week of 12/5

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MiCo

MiCo

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Starting a new thread for this week:
  • Still seeing some black BG #s in ss :(
  • I'd like to go up in dose, but I won't be around during the days (work) so I don't want to increase then, and the next couple of nights my husband and I have plans. However, I'm wondering if I should cancel/postpone the plans to be around to increase his dose by 0.25?
On the topic of ketones:
  • The Nova Max Plus meter showed up today, yay!
    • Pro's: It's here.
    • Con's: There was no solution to do a control test.
  • I did a ketone strip test and it came back 0.6 -- which from what I can tell in the package insert and a quick google search online is right at the border of negative and trace ketones.
    • But if anyone has a better link to the ranges for blood ketones in cats, please let me know!
  • I saw there was a fresh urine sample in the downstairs box, so I did a urine test (or three) using the ketone stix and 1 of 3 looked "negative" while the other two *might* have been showing "trace." The difference between those two, negative and trace, sure is tricky!
So, I would I would lying if I didn't say I was concerned about Cliff's consistently high #s and the risks associated with that. While his energy did seem to improve when we started him on the insulin, I've noticed him being more lethargic since the end of last week. He is still eating, and peeing and drinking (but not excessively.) He has needed a little more prompting at his meal times to finish his plate, but he always gets up to eat, he always eats, and he always finishes his plate. No other symptoms to note.

My plan is to keep an eye on his ketones and general health, but I'm not sure how often to test, or when I should worry/contact the vet.*

*I am also trying not to stress out too much... so please, share your experiences on this topic, but try not to freak me out too much. :) Thank you!
 
Hey Michele, don't try to fixate too much on the black numbers. I know it's hard but you are just starting with this prozinc train, give it some time!

I should definetely increase with 0.25 (maybe even 0.50 if Cliff were mine) and I don't think it is a problem that you aren't around. He's high enough to increase his dose.
 
I agree with Ruby's advice. Try an increase of 0.25 u if that feels safer to you but don't hold it longer than 3 cycles if it doesn't give you a lower BG. If you aren't around during the day then plan a before bed test every evening. Once you're at a dose that seems to be more effective you can add in one overnight test by setting your alarm and you can do a curve on the weekend.

No need to freak out. :) It's very hard to distinguish between negative and trace ketones on the strips. I have no experience with a blood ketone meter though. I think your immediate goal is to increase the dose at a good pace (every 3 cycles?) until you see (at least) some yellow breaking through. Extra tests/curves as I mentioned above will be your monitoring protocol for now. So far he's been fairly high and flat over all so you don't have a true nadir to help you judge the dose. I also think he's a bit "stuck" in high numbers from being there a while. They become less sensitive to the insulin and need an increased dose to nudge them out of their complacency. You're starting to learn some of the intricate steps of this sugar dance ...
 
Quick notes:
  • Set-up the PetSafe5 tonight. Gonna test it out this weekend, when I'm around. Hoping to use the automatic feeder during the day when I'm at work (I've been running home over my lunch 3-4x a week for the past month.)
  • Cliff is due for a curve that I'll send to the vet this weekend. I'm thinking of doing it overnight, starting at 6pm tomorrow evening. I would be awake for the 6, 8, & 10pm for sure. Could probably stay up until midnight reading. Then, would just need to set an alarm for the 2a and 4am. I could sleep in after that, or nap Saturday. :)
  • Trying not to stress. Easier said than done. Need to remember to breathe and take it one day at a time.
 
Will you do a curve on 3.25 u or raise him to 3.5 u? Looks like a dose increase is imminent. I predict some action near 4 u ... any takers? Of course, you'd go up there very slowly. :)
 
Kris & Teasel said:
Will you do a curve on 3.25 u or raise him to 3.5 u? Looks like a dose increase is imminent. I predict some action near 4 u ... any takers? Of course, you'd go up there very slowly. :)
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He is due to go up to 3.5 u at tonight's dose. Is that OK, to increase dose before I do the curve?
 
It is probably a good idea. You can see how the new dose is working. I would also plan to monitor the cycle for the increase, if it is not the cycle for the curve.
 
MiCo said:
He is due to go up to 3.5 u at tonight's dose. Is that OK, to increase dose before I do the curve?
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Yes, you can increase to 3.5 u before you do a curve. You already have data that shows 3.25 u is too low. It would be good to have data for 3.5 u to discuss with your vet. He'd have had 3 cycles of 3.5 u if you do the curve on Sunday. Should be enough for ProZinc to do what it's going to do at that dose.
 
Kris & Teasel said:
Yes, you can increase to 3.5 u before you do a curve. You already have data that shows 3.25 u is too low. It would be good to have data for 3.5 u to discuss with your vet. He'd have had 3 cycles of 3.5 u if you do the curve on Sunday. Should be enough for ProZinc to do what it's going to do at that dose.
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Hm, so maybe I'll wait until Sunday to do the curve then? Last curve was 11/26, and the vet is asking for one every two weeks. I like the idea of having data at 3.5 to report, especially since I've done up on my own from the 3units Rx'd by the vet after the last curve. thanks!
 
MiCo said:
Hm, so maybe I'll wait until Sunday to do the curve then? Last curve was 11/26, and the vet is asking for one every two weeks. I like the idea of having data at 3.5 to report, especially since I've done up on my own from the 3units Rx'd by the vet after the last curve. thanks!
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Yes. Sunday is good. Starting to feel a bit more confident about managing this, Michele? You're doing really well! :)
 
Interesting that curves at 1, 2 and 3.5 u gave almost the same range of numbers. The simplest reason is that you haven't reached the right dose range yet. You could go up to 3.75 u and hold not more than 4 cycles if there's no positive change. You could also jump to 4 u because that's not a huge increase at this dose magnitude. Any feedback from your vet?
 
Kris & Teasel said:
Interesting that curves at 1, 2 and 3.5 u gave almost the same range of numbers. The simplest reason is that you haven't reached the right dose range yet. You could go up to 3.75 u and hold not more than 4 cycles if there's no positive change. You could also jump to 4 u because that's not a huge increase at this dose magnitude. Any feedback from your vet?
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Thanks for checking out his recent curve, @Kris & Teasel ! I was too tired to post about it last night, but was hoping to post an update/new thread later today.

The vet replied with, "Still not much change." and asked me to go up another 1unit and track again in 2 weeks. She asked if I could check hourly for the first 4 hours during the next curve, to check for Somogyi effect? She wants the hourly tracking in the early part of the cycle to make sure we're not missing something.

She also inquired as to how Cliff was doing. Overall, he's eating well. His energy levels fluctuate, but I really think that directly correlates to how his BG #s are. (When his #s are lower, he's more active.) His weight seems to have stabilized, but we can't weigh him at home (too skittish.) But, by eye-balling, I think he's maintained or maybe even gained a little.
 
MiCo said:
asked me to go up another 1unit
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You might well get there. It might be less anxiety causing for you to go up by 0.5 u first. Leave him for a few days, then go up another 0.5 u so you're at the vet's recommended increase by the time you do your next curve.

MiCo said:
She asked if I could check hourly for the first 4 hours during the next curve, to check for Somogyi effect?
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Yes, that's one way of checking whether he's gone low in the early part of his cycle and then bounced up high. Whether you call it bouncing or Somogyi, the end result is the same. I think, strictly speaking, Somogyi is said to be caused by an overreaction to too high a dose. The BG soars to high levels and can stay elevated for some time.What we call bouncing here is broader in definition - a reactive spike in BG as the result of either; 1. BG going too low; 2. BG going lower than recent levels; 3. a rapid decrease in BG even if the numbers aren't that low.

MiCo said:
His energy levels fluctuate, but I really think that directly correlates to how his BG #s are. (When his #s are lower, he's more active.)
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Teasel is the same. I find him happiest when his BG is around 140 - 180.
 
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