DoDo AMPS 423 3.00 Units ProZinc - Rough Day

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lovetheduns

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So---

Here is a link to my little fellow's recent DKA episode. The vet wanted him on 3.0 units after not having much success with the 2.5 units in the hospital.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=27125

Today he has just confounded me.

Does anyone have any insight? I was thinking Somogyi but really it does not seem like from 48 hours ago I would still be getting that if that were the case.

Btw, he is still on 1ml of Clavamox twice a day.
 
Hi! I don't have any insight because my kitty is confounding me as well and I don't feel like I can give anyone advice. Someone will be along that will chime in with their knowledge. I just wanted to say that I'm so glad that DoDo is feeling better and home with you.
 
Hi! I would add a line in your spreadsheet between the 7/2/10 entry and the 10/14 entry briefly explaining the DKA. Took me a while to realize there was a gap in the dates, and I would have inadvertently given you bad advice had I not finally connected the dots. Granted that might just be me :roll: but seems like it would be useful to make it more obvious.

Because you are getting a good U-curve many cycles, and it looks like you are testing his blood for ketones and are seeing some, I'd lean toward raising the dose a bit, maybe try 3.2. Especially looking at the a U-curve on the 297 PS and the nadir was only 156, that's where I'm thinking the dose is a bit low, even though you did get perfect #s that one cycle. You want something like a 60-65% drop from PS to nadir, and the 296-156 is around 50%, so it seems like there is room for a slight dose increase.

Since it looks like you are around a fair amount to get in spot tests (do you get any sleep? :YMHUG: ) I would take an approach of giving a bit more insulin, and keeping the hypo kit handy just in case you overdo (not saying to jump up to 4u or anything like that, but just to err on the side of more insulin rather than less, given the ketones). If you see #s a little lower than you like, or good #s but too early in the cycle, you can often balance it with a couple bites of LC food, or if needed 2 or 3 bites of higher carb food. If needed often you can keep them in a trough of good #s without going too low, and keep the ketones at bay. Of course I'm not saying to intentionally overshoot, but with ketones you don't have the luxury some of us have of going light on the dose if we're not sure about it, etc.

Hope that made sense. :) I would also keep posting on Health, especially if you have any crises. There is more traffic there, and some PZI experts who don't visit this forum regularly. Of course post here too :) but don't hesitate to post on Health as well, especially with ketones in the picture. (Disclaimer: I don't have ketone experience!!!)
 
Hey there. I'm on the road without much time. So sorry if I am not reading everything completely. But

Your profile talks about different foods. What food are you feeding? You are 100% raw? It looks like you were feeding A/D recently? The usual advice is to get the kitty on a 100% low carb wet diet ONLY.

Infection? Who coincident was this with the DKA?

Are you doing SubQ fluids?

You are switching to Lantus?

I'm sorry I've been in and out in here but have you posted in PZI before? If not, then maybe the folks in here would try to help you though dialing in your PZI before you need to try switching to Lantus?

Is there any more specific things we can answer for you?
 
Joanna & Bix said:
Hi! I would add a line in your spreadsheet between the 7/2/10 entry and the 10/14 entry briefly explaining the DKA. Took me a while to realize there was a gap in the dates, and I would have inadvertently given you bad advice had I not finally connected the dots. Granted that might just be me :roll: but seems like it would be useful to make it more obvious.

Hi there-- I went ahead and put in a blank line with some information in between the July and October time frame to make it more consistent and understood. I also added the link to his story to make it more obvious. Thanks for the suggestion!

Joanna & Bix said:
Because you are getting a good U-curve many cycles, and it looks like you are testing his blood for ketones and are seeing some, I'd lean toward raising the dose a bit, maybe try 3.2. Especially looking at the a U-curve on the 297 PS and the nadir was only 156, that's where I'm thinking the dose is a bit low, even though you did get perfect #s that one cycle. You want something like a 60-65% drop from PS to nadir, and the 296-156 is around 50%, so it seems like there is room for a slight dose increase.

Here is where I get paranoid. I am so paranoid when he drops to the 100s when it is the middle of the night. DoDo tends to have a late nadir and it worries me so much that if he is already that low will he get even lower and I wont be awake to check him. :(

On the 297 preshot I gave him a very skinny 3.00...that obviously just didn't work for him. On the 412 preshot I gave him a fat fat 3.0 and because I panicked at the 126, I gave him some Hill's AD and still didn't get any sleep since after a tablespoon of AD he was still going lower. Maybe I am just too paranoid. I don't know. *sighs*


Joanna & Bix said:
Since it looks like you are around a fair amount to get in spot tests (do you get any sleep? :YMHUG: )

No, I got no sleep last night. Nor did my mom. She is in the downstairs bedroom and he pretty much lives with her. He sleeps with her so I end up calling her to wake him up and test (usually not so bad she gets off of work at 1-130am and she works from home in her bedroom too). Last night was dreadful. *lol* Neither one of us got any sleep and well.. ok NONE of us got any sleep. DoDo is pretty zonked out this morning too. Luckily I work from home as well, so I don't have to get out of my pajamas and since my commute is 15 seconds from my bedroom to my office and the only traffic is stepping over a kitty in the morning-- I could sleep in later than usual. I don't think I got a solid more than one hour of sleep until 5am this morning. Then I got to sleep until 830. Last night, we pretty much woke up every hour.


Joanna & Bix said:
I would take an approach of giving a bit more insulin, and keeping the hypo kit handy just in case you overdo (not saying to jump up to 4u or anything like that, but just to err on the side of more insulin rather than less, given the ketones). If you see #s a little lower than you like, or good #s but too early in the cycle, you can often balance it with a couple bites of LC food, or if needed 2 or 3 bites of higher carb food. If needed often you can keep them in a trough of good #s without going too low, and keep the ketones at bay. Of course I'm not saying to intentionally overshoot, but with ketones you don't have the luxury some of us have of going light on the dose if we're not sure about it, etc.

Hope that made sense. :) I would also keep posting on Health, especially if you have any crises. There is more traffic there, and some PZI experts who don't visit this forum regularly. Of course post here too :) but don't hesitate to post on Health as well, especially with ketones in the picture. (Disclaimer: I don't have ketone experience!!!)

Well, I definitely learned that a skinny 3.00 is just not cool. *lol* It does not work. I have the u-100 syringes but I don't really *get* them so I have to eyeball the fine tuning. I think I need better pictures or something.

Yesterday was the first time we tested for blood ketones and it ended up at the .4 which the meter says is okay-- although for a human. Meaning nothing to really be worried about for the most part. When I test his urine, it still stays in the tan. The blood ketones I do on the days where I can't get him to pee for me. For the most part he remembers back when he was sick ages ago when I would take him to the bathroom since he was too sick and feeling bad that he was too intimidated to go on his own from the other cats. But if I don't catch him right, he just cant urinate.

You are right my vet said that since we know he will throw ketones now it is so vitally important that regardless if he has not eaten anything he still needs his insulin PERIOD. She said some cats not as vital, but little DoDo still needs his insulin since he will get so high without it. I can't do the little meal of LC when he is lower-- he just wont eat that much and from past experience it just wont move anything. Hence, why I stick to the tablespoon or teaspoons of AD (i actually measure it out with a real measuring spoon). He loves it and will eat it most any time. We gave him 2 tablespoons last night when after the hour of the first one he still was going down and down.

I think maybe what I need to do is do the larger volumes of insulin (where I am not petrified of doing it) during the day while I am awake. I work from home now with the exception of some rare days-- so I should be able to test and tinker with him at all. I have to figure out something so I can sleep at night, for all three of us.

Also-- I need to get him regulated because I HAVE to go on a business trip for a week soon. It was going to be the end of this month, but since his DKA episode I am moving it to November.
 
Gator & H (GA) said:
Hey there. I'm on the road without much time. So sorry if I am not reading everything completely. But

Your profile talks about different foods. What food are you feeding? You are 100% raw? It looks like you were feeding A/D recently? The usual advice is to get the kitty on a 100% low carb wet diet ONLY.

Okay-- so now I am only feeding the Sophisticat low carb foods (Turkey and Giblets and Mixed Grill). I figured it would be easier when talking to his internist about his meal and she would know exactly what he is getting. DoDo doesnt seem to mind-- in fact he devours the Mixed Grill.

Gator & H (GA) said:
Infection? Who coincident was this with the DKA?
Hmm, I think the infection I alluded to was in reference to my civvie cat. I am medicating the two of them. DoDo is being medicated with antibiotics because of the amount of catheters and the feeding tube he had. Other than that he has no infections or signs of them! Thankfully!

Gator & H (GA) said:
Are you doing SubQ fluids?
No. NO subq. I think that is not out of the question in case we go back to where we were. The vet felt that the feeding tube was of more importance even though I have not had to feed him through it at all. It is pretty handy for meds though!

Gator & H (GA) said:
You are switching to Lantus?
I have been leaning that way yes. I have just not felt--- very secure with the ProZinc. My regular vet has very limited experience with it-- and I am actually going to transfer DoDo's care to this new internist. She has far more experience with Lantus. I just feel that there is so much more resources out there right now with Lantus versus even here for Prozinc. Especially with this new internist.

Gator & H (GA) said:
I'm sorry I've been in and out in here but have you posted in PZI before? If not, then maybe the folks in here would try to help you though dialing in your PZI before you need to try switching to Lantus?

Is there any more specific things we can answer for you?

I have before-- when he was first diagnosed. Then, I thought we were doing pretty good. Although we still never quite had the great preshots and it would seem like when we found where his nadirs were in the 80s-low 100s it seemed like the next day BOOM we would be back to 450s for a preshot. It just seems even when I go back to reviewing the details we were always in the throw of swings. My vet was just as new to ProZinc as we were (she used Vetsulin in the past). So I think the reason why I am so intersted in going over to Lantus is because of the more local support I can have, and even the more support and details on the internet. Plus, I like the idea that I can get Lantus most anywhere if in the case I HAD to have another bottle versus having to call my vet, make sure that they have it, etc.

Hope that helps to clarify!
 
Just thought I would mention that ProZinc is now available at Costco [no membership needed - usually 3 days? special order] and many online pharmacies that can have it to you next day. Also BCP can be shipped to you next day Mon-Thurs [so any Tues through Fri you could have it]. Thus, I would not let 'availability' be a minus to PZI. I do appreciate your desire for more support - I wish I had more time right now to really get into your details and offer considered advice. I will say the folks over in Lantus seem pretty serious about their testing - by just looking at the SSs - but you seem pretty on top of testing. Sounds like you have thought things out and are ready to go with Lantus so I guess the longer you delay is the longer the delay?

The Sophisticat Mixed Grill and T&G is 0% carbs? Crazy, I made my own cooked food with no obvious sources of carbs at it had at least 1% carbs as %Kcal. Speaking of "crazy," I'm a little bit of that myself - or maybe I'm just a hard core skeptic. Anyway, if I had more time I would call Sophisticat and get their supposed DM or as-fed and do the conversion.

If you are interested in prepping you own food and want to be able to communicate with your vet about the nutrition of it I highly recommend http://www.knowwhatyoufeed.com .

Some here have seemed to have success with the SubQ fluids reducing the keytone levels while they were trying to get regulated.
 
Gator & H (GA) said:
Just thought I would mention that ProZinc is now available at Costco [no membership needed - usually 3 days? special order] and many online pharmacies that can have it to you next day. Also BCP can be shipped to you next day Mon-Thurs [so any Tues through Fri you could have it]. Thus, I would not let 'availability' be a minus to PZI. I do appreciate your desire for more support - I wish I had more time right now to really get into your details and offer considered advice. I will say the folks over in Lantus seem pretty serious about their testing - by just looking at the SSs - but you seem pretty on top of testing. Sounds like you have thought things out and are ready to go with Lantus so I guess the longer you delay is the longer the delay?

The Sophisticat Mixed Grill and T&G is 0% carbs? Crazy, I made my own cooked food with no obvious sources of carbs at it had at least 1% carbs as %Kcal. Speaking of "crazy," I'm a little bit of that myself - or maybe I'm just a hard core skeptic. Anyway, if I had more time I would call Sophisticat and get their supposed DM or as-fed and do the conversion.

If you are interested in prepping you own food and want to be able to communicate with your vet about the nutrition of it I highly recommend http://www.knowwhatyoufeed.com .

Some here have seemed to have success with the SubQ fluids reducing the keytone levels while they were trying to get regulated.

That is really good to know about Costco actually. I will have to give a call and see what my Costco does.

I am not sure if I really believe that the Mixed Grill and T&G is REALLY 0% carbs. I do know that I picked them up because it had the lowest on the sheet-- and DoDo really tolerates it well. By contrast when the vet was feeding MD he would SOAR higher than all get out.

So.. I didn't mind making my own cat food, but it was some of the time factor. If I ended up making it for just DoDo-- I think that would be one thing but I have to make it for a houseful of cats (8 of my own, 1 foster). So it felt like I was constantly grinding and mixing and storing, etc.

I do have a sample of the Prowl dehydrated raw diet coming in to see how my other critters take it. It is too high in carbs for DoDo, but then I will either keep him on the Sophisitcat or actually transfer him to Wellness which I prefer anyhow.
 
Yes, I just updated the PZI sticky [about Costco] which everyone should read :smile: . If you find any updated info please let me know I I will incorporate it.

Also you can read my list of things that I think of when kitties are not responding to insulin like the perfect little creatures they are:
viewtopic.php?p=77223#p77223
That is just more of an FYI thing and I'm sorry I'm short on time to really do my research on you and your specific sitch.

Posting in here on a daily basis with what's going on will help you get attention too. :smile: It help the folks that are actually following the continuity of things. And don't hesitate to ASK for help with whatever specific help you need. That helps too.
 
lovetheduns said:
Here is where I get paranoid. I am so paranoid when he drops to the 100s when it is the middle of the night. DoDo tends to have a late nadir and it worries me so much that if he is already that low will he get even lower and I wont be awake to check him. :(

The only times I see anything worrisome are in the pre-DKA part of the SS (did I read that right that the 32 was off of a 65 PS?). There are a couple spots where I can see why you might be left with lingering worry, but the recent #s look pretty good to me. He looks to be a dropper, even like you said after something like +5 or +6 he can still drop quite a bit, so it may be that if you start getting blue PSs he will need a lower dose (maybe, maybe not), but until you get to that point, I don't think you need to worry too much. I like your idea about being more aggressive when you are home during the day, then you can get tests in to see how things look, and that will give you a better idea what to be shooting at night without needing to get tests in.

Do you leave food out for him? With Bix, that has really helped me stay calm. I have overshot before (meter issues, long story), and he just ate like crazy to compensate. Of course that's not fool-proof, but I tend to think with many cats if you overshoot by a bit, they will just eat and be fine. Of course that may not be true on a major overshoot, and I wouldn't want to put it to the test, etc., etc., caveat, caveat :roll: but knowing they have food if they need it certainly has helped me be able to sleep without worrying about a hypo.

lovetheduns said:
I have the u-100 syringes but I don't really *get* them so I have to eyeball the fine tuning. I think I need better pictures or something.

Do you have the conversion chart? Let us know what you don't get, we can help! Once you get the hang of it, it really makes life easier, especially with kitties who are sensitive to small dose changes. You have the ones with 1/2 unit markings? Otherwise it definitely won't make sense.

lovetheduns said:
Yesterday was the first time we tested for blood ketones and it ended up at the .4 which the meter says is okay-- although for a human. Meaning nothing to really be worried about for the most part. When I test his urine, it still stays in the tan.

You might want to ask on Health if it's true for cats as well. Makes me nervous nailbite_smile but I don't really know how it works.

lovetheduns said:
You are right my vet said that since we know he will throw ketones now it is so vitally important that regardless if he has not eaten anything he still needs his insulin PERIOD. She said some cats not as vital, but little DoDo still needs his insulin since he will get so high without it.

Did your vet recommend a reduced dose if he isn't eating? I would think maybe a slightly lower dose would be appropriate, but again I don't know for sure...
 
Joanna & Bix said:
The only times I see anything worrisome are in the pre-DKA part of the SS (did I read that right that the 32 was off of a 65 PS?). There are a couple spots where I can see why you might be left with lingering worry, but the recent #s look pretty good to me. He looks to be a dropper, even like you said after something like +5 or +6 he can still drop quite a bit, so it may be that if you start getting blue PSs he will need a lower dose (maybe, maybe not), but until you get to that point, I don't think you need to worry too much. I like your idea about being more aggressive when you are home during the day, then you can get tests in to see how things look, and that will give you a better idea what to be shooting at night without needing to get tests in.

Hi Joanna--- so that time--- he was 65 ps and then within 2 hours he was at 231 after he ate so I went ahead and gave him insulin. I didn't shoot him at 65. That was also back in July. I started documenting everything on my iPhone and I was not transferring it to the SS. I am now using both of them so that it is easier for folks on the board to see. Today was one of those days that he just kept going lower and lower and lower.

Joanna & Bix said:
Do you leave food out for him? With Bix, that has really helped me stay calm. I have overshot before (meter issues, long story), and he just ate like crazy to compensate. Of course that's not fool-proof, but I tend to think with many cats if you overshoot by a bit, they will just eat and be fine. Of course that may not be true on a major overshoot, and I wouldn't want to put it to the test, etc., etc., caveat, caveat :roll: but knowing they have food if they need it certainly has helped me be able to sleep without worrying about a hypo.

So--- right now DoDo pretty much lives with my mom in her bedroom/office. He really has no desires in leaving the room. Sometimes he is adventurous and leaves but pretty much that is his territory. His friend, Krycek, also stays with him in there (he has no desire on leaving either-- plus he realizes that to hang out in that area he gets a fish treat too each blood test on DoDo-- he insists really on the freeze dried salmon treat, my mom says that he deserves it since he keeps DoDo company). The only problem with leaving out food is that Krycek will eat it. Although I have noticed since DoDo has come home from the hospital he tends to eat more slowly and then leaves a little, comes back later, leaves again, and comes back again. Krycek is kind of doing the same thing-- so they end up leaving food on their plates that does disappear within a few more hours. Today, I just end up giving him some Hill's AD. I have noticed the low carb food when he is going low just does not really have enough to make him go any higher. The Hill's does and I usually start out giving a measured teaspoon and a half and if that is not cutting it I bring out the tablespoon measure or 1/2 tablespoon, etc.


Joanna & Bix said:
Do you have the conversion chart? Let us know what you don't get, we can help! Once you get the hang of it, it really makes life easier, especially with kitties who are sensitive to small dose changes. You have the ones with 1/2 unit markings? Otherwise it definitely won't make sense.

Here is where I claim ignorance. I *don't* know if it has the half marks or not. I will take a picture of them and post within the next day.

DoDo is very sensitive to tiny increments. I have seen that. Like today for AMPS I gave him 3.0 units that were a somewhat fat 3.00. I.e. the black plunger line was just behind the 3.00 unit line. It seems that was just too much. The other night when he was higher I had the black plunger a fraction higher than the 3.0 marking and that seemed to not be enough.

Joanna & Bix said:
You might want to ask on Health if it's true for cats as well. Makes me nervous nailbite_smile but I don't really know how it works.

I did and got some really good advice. :) Now if that Xtra meter didn't require so much blood....

Joanna & Bix said:
Did your vet recommend a reduced dose if he isn't eating? I would think maybe a slightly lower dose would be appropriate, but again I don't know for sure...

My original vet recommended the following: Cat doesn't eat dinner/breakfast = no insulin. Cat eats 1/2 breakfast/dinner = half insulin dose. My new vet that treated him for DKA said-- that even in the hospital with no appetite my little fellow just does not get lower BG numbers-- he just soars. She recommended at this point to continue to give him insulin and then tube feed him his calories.

Whew! Hope that helps
 
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