Gypsy +5 328. AMPS 317 PMPS 312
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BJM
Very Active Member
Re: Gypsy +5 328. AMPS 317
One of the things I do when looking at the spreadsheet is shrink it so I can see the color patterns for several weeks on one page.
What I think I'm seeing is this pattern:
dose
decent response
worsening response
increase
repeat
Is that what you see?
In the earlier part of the chart, you started with yellow, blue, and green. Then it shifts to magenta, yellow, and blue, then you started getting spikes of red, with mostly magenta, and an occasional blue.
I notice that your initial dose was 2.5 units and you increased from there. As you've increased, the overall numbers are getting higher and higher. I'm wondering if the better dose might be LOWER than 2.5 units and what you are seeing is lots of compensatory hormones at work trying to keep her from going too low.
Would you consider a start over at 0.5 to 1.0 units, at a time when you can monitor urine ketones? I'm wondering if maybe you started too high on his dose.
One of the things I do when looking at the spreadsheet is shrink it so I can see the color patterns for several weeks on one page.
What I think I'm seeing is this pattern:
dose
decent response
worsening response
increase
repeat
Is that what you see?
In the earlier part of the chart, you started with yellow, blue, and green. Then it shifts to magenta, yellow, and blue, then you started getting spikes of red, with mostly magenta, and an occasional blue.
I notice that your initial dose was 2.5 units and you increased from there. As you've increased, the overall numbers are getting higher and higher. I'm wondering if the better dose might be LOWER than 2.5 units and what you are seeing is lots of compensatory hormones at work trying to keep her from going too low.
Would you consider a start over at 0.5 to 1.0 units, at a time when you can monitor urine ketones? I'm wondering if maybe you started too high on his dose.
Rachel
Very Active Member
Re: Gypsy +5 328. AMPS 317
That's what I see too. Do you really think maybe we need a lower dose? I can try that. I'm willing to do what I can to get her under control. The vet started us on the higher dose. So if we just shot past the lower dose that can cause her to stay high? I can't really be around to monitor til this weekend...and I work Saturday so I won't be home in the AM. How often should I test for ketones when we change? Are there other symptoms of dka I can watch for?
That's what I see too. Do you really think maybe we need a lower dose? I can try that. I'm willing to do what I can to get her under control. The vet started us on the higher dose. So if we just shot past the lower dose that can cause her to stay high? I can't really be around to monitor til this weekend...and I work Saturday so I won't be home in the AM. How often should I test for ketones when we change? Are there other symptoms of dka I can watch for?
Sue and Oliver (GA)
Very Active Member
Re: Gypsy +5 328. AMPS 317
I think this might be a good test, just to see. Be sure, as BJ said, to test for ketones and only try it for a few cycles. Some of her recent nadirs have been higher than the preshots, so it could be an option. The 2.25 dose did give you some nice numbers, so it looked like a reasonable dose. But starting over one unit always leaves the possibility that you skipped over a good dose.
If that doesn't help, then I think we figure we just have to break through her insulin resistance. And raise the dose again. If that is the problem, at some point we will have to see a change.
I think this might be a good test, just to see. Be sure, as BJ said, to test for ketones and only try it for a few cycles. Some of her recent nadirs have been higher than the preshots, so it could be an option. The 2.25 dose did give you some nice numbers, so it looked like a reasonable dose. But starting over one unit always leaves the possibility that you skipped over a good dose.
If that doesn't help, then I think we figure we just have to break through her insulin resistance. And raise the dose again. If that is the problem, at some point we will have to see a change.
Rachel
Very Active Member
Re: Gypsy +5 328. AMPS 317
Ok. Would you suggest starting at half a unit so we can go up if needed? Do you have advice for testing for ketones with multiple cats? My guess is I will need to lock her in a room with her own box til she uses it. I never thought I would say pricking her ear for glucose tests was easy! :lol:
Ok. Would you suggest starting at half a unit so we can go up if needed? Do you have advice for testing for ketones with multiple cats? My guess is I will need to lock her in a room with her own box til she uses it. I never thought I would say pricking her ear for glucose tests was easy! :lol:
Sue and Oliver (GA)
Very Active Member
Re: Gypsy +5 328. AMPS 317
I think I'd do one unit - don't you think, BJ? If it is the answer, you should see a difference in a cycle or two.
Maybe put her in a room with a clean litter box (They usually can't resist christening it…..)
I think I'd do one unit - don't you think, BJ? If it is the answer, you should see a difference in a cycle or two.
Maybe put her in a room with a clean litter box (They usually can't resist christening it…..)
Rachel
Very Active Member
Re: Gypsy +5 328. AMPS 317
Ok 1 unit sounds good. I will be gone for about 6 hours after AMPS on sat. Should I wait til that night shot since I'll be home? Test for ketones as soon as shot was given or wait awhile? Sorry I have 1 million questions I know but I know how serious dka is and Ijust worry...want to make sure I'm watching her correctly.
Ok 1 unit sounds good. I will be gone for about 6 hours after AMPS on sat. Should I wait til that night shot since I'll be home? Test for ketones as soon as shot was given or wait awhile? Sorry I have 1 million questions I know but I know how serious dka is and Ijust worry...want to make sure I'm watching her correctly.
Sue and Oliver (GA)
Very Active Member
Re: Gypsy +5 328. AMPS 317
Saturday should be fine. Just give the shot and plan to test when you get home? I'd say get a ketone test daily - any time - while she is at the lower dose.
The two other factors besides too little insulin that are generally "needed" for DKA are an infection and not eating. As long as she is eating well and not acting sick, you should be good.
Saturday should be fine. Just give the shot and plan to test when you get home? I'd say get a ketone test daily - any time - while she is at the lower dose.
The two other factors besides too little insulin that are generally "needed" for DKA are an infection and not eating. As long as she is eating well and not acting sick, you should be good.
BJM
Very Active Member
Re: Gypsy +5 328. AMPS 317
I'm thinking re-start at 1 unit also. The first week, 2.5 units after 3 shots, got you to an unshootable pre-shot. If you were to halve that, it'd be 1.25, so rounding down to 1 makes sense to me.
You could wait until Saturday, however my concern is hypo - if the compensatory hormones use up all the stored glycogen (most is in the liver), there won't be anything to handle too much insulin and if she can't eat enough to offset it, you could come home to a cat in very bad shape. If you drop now, you will likely see a couple of days of erratic numbers and then more stable numbers (high or low) and by Saturday or Sunday, you could run a curve.
In my signature link Secondary Monitoring Tools are some tips on urine ketone testing, plus a bunch of other alternative monitoring tools. They do make meters that do blood ketone testing and the strips for these can be pretty pricey. When/if there is a history of DKA, you would want to invest in one of these because it can save you thousands in hospitalization if you catch ketones early. Without a history of DKA, urine testing and monitoring breath smell, behavior, thirst, urination, and appetite can be sufficient, when combined with glucose testing.
Sue and Oliver (GA) said:
I'm thinking re-start at 1 unit also. The first week, 2.5 units after 3 shots, got you to an unshootable pre-shot. If you were to halve that, it'd be 1.25, so rounding down to 1 makes sense to me.
You could wait until Saturday, however my concern is hypo - if the compensatory hormones use up all the stored glycogen (most is in the liver), there won't be anything to handle too much insulin and if she can't eat enough to offset it, you could come home to a cat in very bad shape. If you drop now, you will likely see a couple of days of erratic numbers and then more stable numbers (high or low) and by Saturday or Sunday, you could run a curve.
In my signature link Secondary Monitoring Tools are some tips on urine ketone testing, plus a bunch of other alternative monitoring tools. They do make meters that do blood ketone testing and the strips for these can be pretty pricey. When/if there is a history of DKA, you would want to invest in one of these because it can save you thousands in hospitalization if you catch ketones early. Without a history of DKA, urine testing and monitoring breath smell, behavior, thirst, urination, and appetite can be sufficient, when combined with glucose testing.
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