Kitty 4/10 amps +6.5 pmps... HELP!

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kse

kse

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Kitty's amps was 368. Like Kelly said yesterday, the presot numbers do seem better on the 3.5 dose. Now, if we can just get some downward movement in the cycle.

I shot 3.5 this morning.

Hope everyone has a Great day!


Okay--just checked +6.5 and little movement-- 327.

She ate 1.5 cans at amps and another spoonful at +5.

What is going on? The preshoots are lower, but I can't catch any significant movement. When her preshots were higher, I could see moment.

She is over the testing.

HELP! I feel like this is s bad sign.
 
Re: Kitty 4/10 amps +6.5 ... HELP!

+6.5 --little movement 327.

What is going on? The preshoots are lower, but I can't catch any significant movement.

Help! I feel Ike this is a bad sign .
 
Re: Kitty 4/10 amps +6.5 ... HELP!

With PZI you will often seen more movement from a higher PS. It kind of compresses in a way, so higher PS you might get 400-200-400, but lower PS might be more like 300-200-300. It can actually be a good sign because that means (if it's not due to other reasons) you are getting pretty good duration. If your #s are all in the pinks and you raise the dose and then they are all in the yellows (but maybe still not a lot of drop) that is a good thing really. When cats get big drops, they are often the ones who need a different insulin b/c they don't end up getting enough duration.

I'm guessing you are seeing insulin resistance. I would consider moving up in 0.5 increments every 3rd day, assuming you can get a nadir test in before each dose increase. I'm thinking you need to push the insulin more to get a breakthrough. It's a little more aggressive and you do need to monitor for lows, but with a ketone history I think it's risky not to be somewhat aggressive. If you can, get a nadir-ish spot test at least every other day. I'd vary the times from +4 to +8, and get that as often as you realistically can.

See what others think....
 
Re: Kitty 4/10 amps +6.5 ... HELP!

Question Joanna and all...my vet said that we really shouldn't go above 4 units per cycles of pzi. Her reasoning was Kitty weighs 8.5 pounds and that PZI should be given no more than 1 unit per pound per day. I asked her, could we still continue to up it and she said yes, but that the rule of thumb was anything above that dose, indicated underlying factors.

If this is insulin resistance--can we breakthrough it? I am scared!

We are one month out DKA--does anyone think this is still playing a role?

When Kitty initially started getting insulin, she only got one dose a day---BUT, her nightime cycle without insulin followed the same numbers we are seeing now with 3.5 units of insulin. The dose increase from 3.0 to 3.5 has seemed to lower her preshot numbers--that is about all I can say for it.

My vet also mentioned switching insulins (lantus) if she continues to show little movement.

I am getting desperate and considering taking her to a specialist.

I breathing, but just barely!
 
Re: Kitty 4/10 amps +6.5 ... HELP!

Ok, first .... deep breaths!!!

Next... you are checking regularly for ketones and they are negative, right? So that is the immediate worry, and that is under control.

#3... she is eating ok? That is key in warding off ketones.

If those things are under control, you can relax, breathe, and no need to panic. The rest of it will most definitely NOT be solved overnight, it takes time and patience, and there is nothing to panic over. (I know I'm a total hypocrite as I am a panicker, but I can still say it with authority :-D ).

Insulin resistence: sorry, did NOT mean to freak you out. I use the term loosely, and I may even have the wrong term. I don't mean any big fancy condition, I just mean that with PZI sometimes they seem to get "stuck" so to speak in higher #s. When you see that, you just need more insulin to get through, and then often once you get a breakthrough you need to lower the dose and will still get good results.

Switching insulins: I would post in the Lantus and Lev forums and ask for opinions. There are a lot of former PZI users in both forums, and you can get some great advice both about PZI and about the Ls, and about what is best overall. Generally I would say if you have tried an insulin for a couple months and tried everything within reason you can and don't get good results, switching is a good choice. It's rarely a magic fix though - they often will sit in high #s for a few weeks on the new insulin as you go through the process of raising the dose. There are some shortcuts though, so if you do switch be sure to get advice on the most effective way to do that, and always be sure to mention she has a ketone history.

Going over 4u: I have not heard that, but it could be true. You could check any ProZinc studies, etc. and see if they talk about dosing by weight. I don't think you are at the point where we would consider her a high dose kitty, but you can always read the stickies in the High Dose forum and see what they say (but don't let whatever they say freak you out more!!!).

Specialist: My experience is that specialists don't have any special diabetes expertise unless they are actually diabetes specialists. If you know there is one in your area and they have been vetted by the board here :-D I don't think there's anything wrong with going if you can afford it and want to. It might bring you peace of mind. I think there are some who do consults with Dr. Lisa too, I'm not sure how that works, or where she is located. I wouldn't go to just any specialist though, make sure they are diabetes-savvy, and up-to-date with the latest thinking (i.e. there might be some who think they are diabetes savvy but aren't).
 
Re: Kitty 4/10 amps +6.5 ... HELP!

My vet actually mentioned insulin resistance first, so I will let you off the hook for that "freak out"!

Yes, I am checking for ketones. I just checked last night and they were negative. She is eating like a horse. She seems alert, happy and comfortable. She sleeps alot, but she is 15.5 and arthritic--so she isn't the most active cat.

I really want to use PZI as it is more flexible than the Ls--and fits my schedule better. But, ultimately I want to help Kitty.

I live near the North Carolina State University Vet hospital and have considered calling them to see if there is a diabetic specialist there. But, I must admit I feel like it is all about insulin, so what can they offer that I don't have. My insulin is 2 months old--would it lose any potency at that range?

Maybe Kitty will hear me discussing changing insulins and react like Samwise did!!!
 
Re: Kitty 4/10 amps +6.5 ... HELP!

What Joanna said :mrgreen:

Never heard of 4 units being the max for a certain weight. I would raise the dose by .25 and get in every test you can. See what happens.

If you are going to change, I would try levemir. It is supposed to be less painful at higher doses than Lantus (stinging) and the forum is smaller and more relaxed. With both insulins, they will want more tests more often.

This is hard. We want to have control over things and some kitties just won't cooperate. You are doing a great job keeping her in reasonable numbers and ketone free.
 
Re: Kitty 4/10 amps +6.5 ... HELP!

As far as I know the insulin is good until you get to the end of the vial, or possibly the expiration date. Unless it has been frozen or sat out in the sun or whatnot. I haven't used ProZinc though, so I'm not sure if that is different than PZI Vet?
 
Re: Kitty 4/10 amps +6.5 ... HELP!

I just called Kitty' s vet, and explained the little movement. She agreed that this was not the norm.

After researching the web, I asked her last Tuesday if she thought Kitty could be Hyper T. When Kitty had her last hyper T test done in November she tested 2.3. When she as dx diabetic in Feb, I actually thought the dx would have been crf or hyper T. The vet has to send the hyper t test out, so she was not tested for that in Feb. I have read where it is not unusual to have both of these diseases concurrently. Supposedly, the hyper t effects the metabolic rate, which consequently effects the use of the insulin. My vet told me she had never had a hyper t diabetic, but admitted it was a possiblity.

Anyway, after our talk this afternoon, Kitty will be going in Tuesday for a hyper T test and we will get the results on Wednesday. I don't know what to wish for--negative or positive. If it comes back positive, then I know what we are dealing with. If it comes back negative, then that's good she is negative, but then what is our culprit.

Any suggestions on additional test etc?

Breathing.....hyperventiliating!!!!!!
 
Re: Kitty 4/10 amps +6.5 ... HELP!

No ketones, no hypo, no need to hyper-ventilate! Very frustrating, but not dangerous. I was just looking at your SS. ---it looks like you never tried 1U twice a day? something to think about. And if it were me, I think I would check out how one gets a consultation with Dr Lisa. You seem to be the type of person who is really committed to covering all your bases---so if you can do that, it might help.
 
Okay just got the pmps---477. So, today the 3.5 didn't do a good job holding it down either.

Hopefully we will get a drop tonight.

I checked my blood sugar today to be sure the meter was working properly. Who says it doesn't hurt?!

It has to get better...doesn't it?
 
I am sorry you are so discouraged. And I do understand. You are working so hard to do this right.

So tomorrow, can you be around at all? If you can't be around at least at nadir, I would wait until pm to increase the dose and then plan on a late night. Maybe several tests before bed- an alarm clock to get a nadir?
 
Truly, I don't know whether to go up or go down. If the DKA wasn't a factor, I would go to 2 units bid and see what happens. But, that DKA experience was awful. I will never forget how she looked when I walked in on her. I am not up for that challenge again.

I work a lot of hours and it is so hard to test during the week, but I am thankful I got some mid cycle tests in this weekend. Without the test this weekend, I would have assumed we were making progress with the lower preshots and would have been content. I had no idea we were getting little or no downward movement.

I think I should be the poster child for what not to do with PZI---once a day dosing, not enough mid cycle testing, no ketone testing (early), shooting through the skin....the list goes on and on.

BUT, my heart is in the right place---and I am going to continue to seek help for Kitty. If love and determination can help her, she will get better.
 
Yah, it hurts on your finger. I don't think it hurts their ears though, b/c they usually don't seem to notice. If it hurt I think they would react. I'd probably go up to 4u as soon as you feel comfortable with a dose raise. Like Sue said it's good to be home to test - I don't think it's a big risk though right now. If it were me, I'd probably go with an increase and then try to get spot tests when I can - maybe bedtime, or early morning, or right when I get home but before PMPS time, etc.
 
I can't blame you for being worried and wanting more progress Kim. You and Kitty have been through a lot and it's hard when you're doing everything you can to not see more progress. Don't forget though that Kitty is testing negative for ketones and eating good. I'm a newbie so don't have a lot of experience, but I think Joanna's explanation makes sense. Kitty was getting pretty good drops on ProZinc before the DKA and now after may be a little resistant for some reason (not sure if that's the right term; just may need more insulin to help break through the #'s). Doesn't hurt one bit to start researching the other insulins in case you decide you would like to switch.
 
Where on your finger did you test? THe tip has MANY more nerve endings than the side. I really don't think it hurts our cats much----or they would be even harder to test!

Love and determination counts for A LOT. Don't give up hope---odds are, it will get better.
 
I tested the end of my finger--it really didn't hurt! And definitely,there are alot more nerve endings there than in the cat's ear.
 
I agree with everything Joanna said. Sorry I haven't been around earlier today - very busy day!

These flatter curves do mean that you are getting a good duration. I think the Prozinc is working, we just haven't found "the dose" yet. I would NOT go down to 1u BID for you guys due to the DKA and the 2u dose showing a good drop prior to the DKA. I still think the system overload from the DKA has caused a temporary insulin resistance for you guys. Oscar went through it too, and you truly just have to up the dose until you get a break through.

Don't waste your money on a specialist yet. I did that, and she told me everything I already knew and added more confusion to the situation since I now had to deal with two vets telling me to do things I knew were wrong. I think testing for HyperT is a good thing. Like I wrote in another thread of yours a few days ago - make sure they test more than the simple T4 value since that can be abnormally lower due to the diabetes - it is called euthyroid sick syndrome. Kitty can still be hyperT and have a normal regular T4 value. They can test free T4 and TSH to confirm.

I agree with going up to 4u BID for you guys until you can get a spot check in occasionally. The whole dosing by weight thing is a tie over from the old school methods with other insulins and has *never* proved to be true in my experience. We see people coming here almost daily where their cat was dosed by weight and end up with a starting dose of 4u or more. Just simply doesn't work. Adjust the dose to what the cat needs.... period. If there are underlying conditions, deal with those as they come up, but it doesn't change the fact that she needs a higher dose right now.
 
Hey Kelly, glad you are around.

Assuming the preshots continue in the present ranges, what do you think about holding the 3.5 dose until we get the Hyper T results Wed.?
 
She needs a dose increase now, so I would go ahead and raise to 4u BID. Once you get the results, the you can adjust things as needed once a treatment plan starts. No sense in dealing with these higher numbers while we wait for a *possible* diagnosis. If she is diagnosed as hyperT, I would keep with the same dose and see what the meds will do for her numbers. You can adjust down as needed, if needed.
 
Agreed :mrgreen: Her #s are no where close to anything I would be worried about from a low #s/hypo perspective. Of course you want to keep spot testing when you can to be on the safe side, but I wouldn't be freaked out or anything (if you are) about the risks of an increase. I think ketones are a bigger risk. If she does have some temporary insulin resistance, the quickest fix is to break through it sooner rather than later. As they sit in higher #s their body's ability to utilize insulin goes down, and insulin needs tend to go up.
 
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