Cookie - Continued (2nd Thread)

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pstanfield

pstanfield

Member Since 2021
Due to the length of the previous thread, I am starting a new thread! Here is the title/link to the first thread:
Very New - Need Guidance (from HI to hypo to HI)

So current update on Cookie - she is still eating on her own (yay) and her +3 is now updated, it was 326. Going to do a +4 as well to see if we are trending down or up. I did take it at the vet after her SQ fluids, but I also stayed with her the whole time, and she was wandering around the exam room until it was time for her fluids. She did not like the car ride, I had to pull over on the way there to change her bedding in her carrier because she peed on it and was NOT happy. Luckily I brought spare bedding. We will see how she does for the day with her numbers! Should I just update the SS, or should I also post in this thread?

Vet update: My vet recommended probiotics as well, so I will be starting that today. She prescribed some Cyproheptadine if needed for appetite, and Zofran with the Cerenia for nausea. We are also trying to stimulate with Churus, Fortiflora, and switching up her FF Classic flavors, as well as Vitamin B, which Cookie seemed to lacking, as she is anemic. That seemed to do the trick last night and today. Agreed on the Clavamox being the potential cause of her diarrhea. Cookie was all pooped out from last night though so I couldn't get a fresh stool sample today, but I will hopefully get one to them on Monday to rule out Helicobactor. I think that's it as far as I can remember!
 
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pstanfield said:
Due to the length of the previous thread, I am starting a new thread! Here is the title/link to the first thread:
Very New - Need Guidance (from HI to hypo to HI)

So current update on Cookie - she is still eating on her own (yay) and her +3 is now updated, it was 326. Going to do a +4 as well to see if we are trending down or up. I did take it at the vet after her SQ fluids, but I also stayed with her the whole time, and she was wandering around the exam room until it was time for her fluids. She does not like the car ride, I had to pull over on the way there to change her bedding in her carrier because she peed on it and was NOT happy. Luckily I brought spare bedding. We will see how she does for the day! Should I just update the SS, or should I also post in this thread?
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You can just update the spreadsheet, unless the numbers are worrying you. But we don't see updates unless you add a new reply here (even if you edit your first post, we don't get a notification about that, just new replies).

Glad she doesn't seem to be dropping too low!

I stopped using bedding and just use disposable puppy pads now.
 
Ok, so +4, +5 and +6 she is 173, 152, 110. Is this something I should be concerned with? Keep testing every hour or go to +2? Or wait to go to +2 when she starts going up?
 
pstanfield said:
Ok, so +4, +5 and +6 she is 173, 152, 110. Is this something I should be concerned with? Keep testing every hour or go to +2? Or wait to go to +2 when she starts going up?
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Ok you're seeing a more typical cycle now. This should be about her lowest point of the day, test again at +7 and see where she's at, it's possible she may drop til about +8. Has she had anything to eat?
 
*these numbers are where we want her, by the way. Low blue nadirs for now, ultimate goal in the high greens. When you get room to breathe we'll have you choose a dosing method, but for now let's just let her (and you!) get settled. I'd only be antsy if I saw this trend very early in the cycle, but this is perfect
 
My one comment to you Patty is to try to give the insulin shot as far away as possible from the injection site for the sub Q fluids. That is so that the fluids don’t interfere with the insulin absorption and throw off the BG readings and the action of the insulin.
 
Deb & Wink said:
My one comment to you Patty is to try to give the insulin shot as far away as possible from the injection site for the sub Q fluids. That is so that the fluids don’t interfere with the insulin absorption and throw off the BG readings and the action of the insulin.
Click to expand...

Just saw this, after giving her the insulin. It was somewhat away, but not as far as possible. Something to consider with her BG readings tonight though! Suggestions as to how often to test tonight?
 
To help you get some sleep I'm thinking another +3.5/4 and +6, but if she's below 150-ish for any of those I'd test hourly until she flattens out or comes back up just to be safe.

As she "evens" out it should hopefully become a little more predictable. Most of us do a "before bed" test at +2/3, and if that's showing a certain amount of drop then we'll get up and test again about an hour or so before what we think nadir will be.

You're doing a great job for a trial by fire intro.to diabetes!
 
FrostD said:
To help you get some sleep I'm thinking another +3.5/4 and +6, but if she's below 150-ish for any of those I'd test hourly until she flattens out or comes back up just to be safe.

As she "evens" out it should hopefully become a little more predictable. Most of us do a "before bed" test at +2/3, and if that's showing a certain amount of drop then we'll get up and test again about an hour or so before what we think nadir will be.

You're doing a great job for a trial by fire intro.to diabetes!
Click to expand...
Definitely trial by fire…but thank you, doing everything I can for this sweetie!

And how do I get back to a different schedule? With my kids’ summer schedules, it would be good to get to a 6-6 schedule with Cookie. Is that something that should be done gradually?
 
pstanfield said:
Definitely trial by fire…but thank you, doing everything I can for this sweetie!

And how do I get back to a different schedule? With my kids’ summer schedules, it would be good to get to a 6-6 schedule with Cookie. Is that something that should be done gradually?
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Where are you at with the schedule at the moment?
 
Bron and Sheba (GA) said:
To get back to 6:6 you can either go back by 1/2 hour once a day, or 15 minutes twice a day.. It will take a few days but you will get there. Does that all make sense?
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Yes that makes sense for sure. I was planning on taking a few days, so that will work out. Thank you so much for the guidance!
 
FrostD said:
To help you get some sleep I'm thinking another +3.5/4 and +6, but if she's below 150-ish for any of those I'd test hourly until she flattens out or comes back up just to be safe.

As she "evens" out it should hopefully become a little more predictable. Most of us do a "before bed" test at +2/3, and if that's showing a certain amount of drop then we'll get up and test again about an hour or so before what we think nadir will be.

You're doing a great job for a trial by fire intro.to diabetes!
Click to expand...

So she is at 139 at +3, although I did just switch to ReliOn, I am not sure if that makes a huge difference. Either way, I should be testing every hour until it looks like she is going up, is that correct. She is still in good spirits and eating.
 
pstanfield said:
So she is at 139 at +3, although I did just switch to ReliOn, I am not sure if that makes a huge difference. Either way, I should be testing every hour until it looks like she is going up, is that correct. She is still in good spirits and eating.
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The ReliOn will read lower than the AT. 527 to 139 is quite a drop. Yes, please test every hour.
Glad to hear she is eating well! If you feed her a little with every test, she will keep surfing.
 
At +6 and her BG is 68. That makes me a little nervous getting that low. Anything I should be doing right now? I will test again in an hour for sure.
 
Have you tested again yet? I wouldn’t leave it an hour with a BG of 68. Test again in 30 mins or as soon as you see this post. Did you feed at the BG 68?
 
Bron and Sheba (GA) said:
Have you tested again yet? I wouldn’t leave it an hour with a BG of 68. Test again in 30 mins or as soon as you see this post. Did you feed at the BG 68?
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Bron, do you think the dose can be reduced to 1U from tomorrow AM? Maybe the food change from Hills W/D (25% carbs) to FF is finally playing out?
 
When did she do the swap from the Hills W/d?
Let’s see how the rest of the cycle plays out. I would hesitate to reduce the dose if she doesn’t earn a reduction with DKA in the picture.
The sub Q. fluids given today could have made a difference too.
 
Sorry, was testing and I gotta say my brain is getting foggy. She is at 64 +7, she did eat a little after testing, and she ate some more just now, post test. She had the Hill's w/d at the ER on June 15th, that is correct.
 
Bandit's Mom said:
Bron, do you think the dose can be reduced to 1U from tomorrow AM? Maybe the food change from Hills W/D (25% carbs) to FF is finally playing out?
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@Bandit's Mom and @pstanfield
I was not thinking about Cookie was getting Prozinc when I said to stay on the same dose….so yes, I think Patty should reduce the dose to 1 unit in the morning if the AMPS is high enough and unless a Prozinc user says otherwise.
Please continue to test for ketones daily
Please press ‘like’ Patty so:I know you have seen this. Thanks
 
pstanfield said:
Due to the length of the previous thread, I am starting a new thread! Here is the title/link to the first thread:
Very New - Need Guidance (from HI to hypo to HI)

So current update on Cookie - she is still eating on her own (yay) and her +3 is now updated, it was 326. Going to do a +4 as well to see if we are trending down or up. I did take it at the vet after her SQ fluids, but I also stayed with her the whole time, and she was wandering around the exam room until it was time for her fluids. She did not like the car ride, I had to pull over on the way there to change her bedding in her carrier because she peed on it and was NOT happy. Luckily I brought spare bedding. We will see how she does for the day with her numbers! Should I just update the SS, or should I also post in this thread?

Vet update: My vet recommended probiotics as well, so I will be starting that today. She prescribed some Cyproheptadine if needed for appetite, and Zofran with the Cerenia for nausea. We are also trying to stimulate with Churus, Fortiflora, and switching up her FF Classic flavors, as well as Vitamin B, which Cookie seemed to lacking, as she is anemic. That seemed to do the trick last night and today. Agreed on the Clavamox being the potential cause of her diarrhea. Cookie was all pooped out from last night though so I couldn't get a fresh stool sample today, but I will hopefully get one to them on Monday to rule out Helicobactor. I think that's it as far as I can remember!
Click to expand...
If her appetite is still poor you could ask for a couple cans of AD Recovery food which is blended smooth if you need to syringe it but it's also high calorie. My cats always get diarrhea on antibiotics.
 
Her +9 BG is 197. So should be OK to go ahead and give 1u about 15 minutes earlier? Do you think I need to test anymore before her AMPS, or safe to go to sleep?
 
pstanfield said:
Her +9 BG is 197. So should be OK to go ahead and give 1u about 15 minutes earlier? Do you think I need to test anymore before her AMPS, or safe to go to sleep?
Click to expand...
Well test her right before the shot but probably yes. She has a few hours to go. Go to sleep. Lol. Hopefully she won't be in the red or blacks! It's a marathon. You're doing great. It won't always be this hard.
 
Beautiful cycle, shame they always happen at night :rolleyes:

I too would reduce to 1U. On the more conservative ProZinc dosing method, you reduce by 0.25U when they drop below 90. For the more aggressive one, you reduce by 0.25U only when they go below 50 (numbers based on human meter). By either measure she was darn close, and with the fluids and antibiotic in the picture I think it's ok to reduce. Can always go back up if needed.

Also, if you're sure you'll stick with the human meter, we'll want to get your spreadsheet shifted over to the one for human meters (the color coding is different).
 
@FrostD
Let's see if @Bandit's Mom can adjust the color coding if Patty plans on sticking with a human meter.

I also want to remind everyone that this is a post-DKA kitty. Please factor that in to your dosing recommendations.

@pstanfield -- are you testing for ketones regularly? I'd encourage ou to test as often as you are able to stalk Cookie to the letterbox. Alternatively, there are blood ketone meters. The strips are expensive but you would only need to test once or twice a day. Could you also put a note in your signature that Cookie was diagnosed with DKA?
 
Sienne and Gabby (GA) said:
@FrostD
Let's see if @Bandit's Mom can adjust the color coding if Patty plans on sticking with a human meter.

I also want to remind everyone that this is a post-DKA kitty. Please factor that in to your dosing recommendations.

@pstanfield -- are you testing for ketones regularly? I'd encourage ou to test as often as you are able to stalk Cookie to the letterbox. Alternatively, there are blood ketone meters. The strips are expensive but you would only need to test once or twice a day. Could you also put a note in your signature that Cookie was diagnosed with DKA?
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I'll keep checking her ketones, it says DKA 6/5/21, so added the dx part and moved it up in the signature line. Since she was 360 AMPS, I gave her the 1u Prozinc. How often do I test today? I'd like to keep everything on the same spreadsheet if possible, so if someone could tell me what the color coding is for the human, I would appreciate that!
 
FrostD said:
Beautiful cycle, shame they always happen at night :rolleyes:

I too would reduce to 1U. On the more conservative ProZinc dosing method, you reduce by 0.25U when they drop below 90. For the more aggressive one, you reduce by 0.25U only when they go below 50 (numbers based on human meter). By either measure she was darn close, and with the fluids and antibiotic in the picture I think it's ok to reduce. Can always go back up if needed.

Also, if you're sure you'll stick with the human meter, we'll want to get your spreadsheet shifted over to the one for human meters (the color coding is different).
Click to expand...

So is the only difference in the color coding the two greens? If so, could I keep the same spreadsheet and then just manually adjust the greens? I like that the BG 62 and BG 64 are not in the super lows on the human meter. That's a relief, I was stressing last night!
 
pstanfield said:
So is the only difference in the color coding the two greens? If so, could I keep the same spreadsheet and then just manually adjust the greens? I like that the BG 62 and BG 64 are not in the super lows on the human meter. That's a relief, I was stressing last night!
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Yes. With a human meter lime is below 50 and normal range (dark green) is 50-99. With the AT, lime is below 68 and normal numbers (dark green) are 68-99.
I can make the formatting changes for you. Will send you a PM.
 
I agree -- keeping things on the same SS makes much more sense than doing everything over. The only difference between the meters is that the point at which a dose reduction is made. It's not as applicable for Prozinc as it is for Lantus. You can either manually change the color or ignore it (or Bhooma can change the formatting).

My knee jerk with testing is to suggest that you get a test at +2 or +3 and let the numbers guide you. If my crystal ball was reliable, I'd guess that Cookie's numbers are going to shoot up this cycle. We refer to this as a "bounce." When a kitty drops into low numbers, numbers that are lower than is typical for that cat, or there's a sharp drop in numbers regardless of how high or low, the cat's liver and pancreas overreact. They release a stored form of glucose along with counterregulatory hormones that cause a spike in BG numbers. This is a normal phenomenon albeit one that is extremely annoying to the cat's caregiver!
 
pstanfield said:
So is the only difference in the color coding the two greens? If so, could I keep the same spreadsheet and then just manually adjust the greens? I like that the BG 62 and BG 64 are not in the super lows on the human meter. That's a relief, I was stressing last night!
Click to expand...
Yep, if you know how to do conditional formatting it's an easy fix! Not everyone does, but I see Bhooma offered to help.

I did have the DKA in mind with the 1U recommendation. I suspect with the fluids, eating better, and infection clearing up she'll come down a bit overall (as we've seen over the last few cycles). Like Sienna said, just keep testing ketones.

She's been clearing the bounces faster and not going as high. I'm curious if she'll bounce today or not.
 
Looks like no bounce!

So the safe thing to do is test her hourly until she starts to rise, but you could potentially wait til +4 if you need a break...she just might be under 100 by then.

I won't be around much, but basic guidance:
- If she goes under 100 before +5, give her small (1 tsp) snacks every hour or so, test every half hour. Need to keep her hungry in case she goes low.
- If she goes under 80, test every half hour until she's coming up. Continue low carb snacks.
- If she goes into the 50s, give 1-2 tsp medium carb food, retest in 20 mins. Give more medium carb if still in 50s. Rinse and repeat until in the 60s or higher steadily for an hour.
- Under 50 is 1-2tsp high carb food, retest in 20, more high carb if still dropping. Rinse and repeat until in the 60s. possibly mixed with honey or karo if she's got awhile to nadir. I'd post a 911 on Feline Health if this is the case and no one is on this thread to help (it's not an immediate emergency but you'll need eyes on it ASAP).

We try not to feed after nadir, but in this case with recent DKA and troubles, let her eat what she wants after you're sure her lows have passed.

If someone comes to help you, they may suggest slightly different, and that's perfectly fine. There's an element of "how fast is she dropping, how long to nadir" that shapes how we handle these situations. It's better to overcorrect with food than undercorrect.

Edit: numbers assume the ReliOn meter
 
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FrostD said:
We try not to feed after nadir, but in this case with recent DKA and troubles, let her eat what she wants after you're sure her lows have passed.

Edit: numbers assume the ReliOn meter
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Thanks for the guidance, I’ll keep testing! Yes, sticking with the ReliOn so numbers will be from that.
 
Hopefully another 2 hours and she'll be on her way up.

I know it's a lot at once, but if you get a chance, it helps to note in the Remarks column what and when you fed on cycles like this (so example: @4.5 fed 1 tsp 4%). It helps to fine tune what to feed and when over time.
 
FrostD said:
Hopefully another 2 hours and she'll be on her way up.

I know it's a lot at once, but if you get a chance, it helps to note in the Remarks column what and when you fed on cycles like this (so example: @4.5 fed 1 tsp 4%). It helps to fine tune what to feed and when over time.
Click to expand...

Does the 4% reflect the amount of carbs?
 
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