Kitty 7/9 amps pmps +4 +6

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kse

kse

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7/9

amps 391 shot 3.7


Pmps. 367 Shot 3.7. (12:30 pm)
+4 279
+6 231 fed


Good Saturday Morning to All!

I increased the dose to 3.7 this morning. My hopes are that the 3.5 has settled the rebound. Throughout the dance, 3.7 has been a frequent dose for us and delivered decent curves. We will see what it gives us. I do not want to get back into the big swings, but I want a little more drop if possible. I just hope we don't get near those HIGH 150s. :mrgreen:

Kitty has now started her Ptitis regiment. She will get fluids everyday---or at least to the extent my schedule will allow and Bupe bid.
The vet did not encourage me to start pepcid, but everywhere I have read it appears appropriate to add it--so I will start with 1/4 tablet sid. A diet change is also in place, this is challenging when you are already trying to reduce protein and carbs. I do not want to feed fish a lot, but I will be adding additional to her diet. The phosphorus is not good on the kidneys, but her kidneys are holding up good and I always can add binders if necessary. I have boiled skinless chicken breast and will add it at a 50/50 ration to her LC FF to reduce the fat, without increasing the carbs. We will retest her in 4 weeks to see if the regiment is working.

At the present, I opted out of the steroids, but they are on the table if necessary.

We have discussed an insulin change, but that discussion is on hold until she is stabilized.

My vet is out of town for a week and we have a standing referral to the vet school--so if deemed necessary, we will head there.

The Good News---Kitty LOVES the bupe!!! The compounding pharmacy is shipping out our "new" supply today. She is eating GREAT and moving around more--so her quality of life seems to have already improved!

Everyday produces a new challenge for a 15.8 year old arthritic, diabetic, cat with pancreatitis--but, we will take it as it comes and do our best! She has stood by me and I will stand by her.

We are on a crazy shoot schedule--I have been shooting early some to keep the numbers down and it has left us on a "weird schedule"--we are now shooting at 12:30 (mid day).

I hope you all have a Wonderful day!

Kim
 
Re: Kitty 7/8

Very nice report. I hope the increase shows her some good numbers. It's amazing what a little bupe can do.

I have boiled skinless chicken breast and will add it at a 50/50 ration to her LC FF to reduce the fat, without increasing the carbs.
Click to expand...

My concern with this is you are also reducing the necessary supplements to make it a balanced meal. I think you need to add taurine, b-complex, (??? probably some other things) back into the boiled chicken. This might be a question to post on health.

Have a wonderful Caturday! cat_pet_icon
 
Re: Kitty 7/8

I have the Taurine....I will ask about the other supplements.

She eats A Lot, so maybe she is still getting enough supplements--I don't know? She eats 3 cans of FF day.

I better check on the supplements. Thanks Marcy!
 
Re: Kitty 7/8

Sounds like you're already getting a good handle on things.

Hope you and Kitty have a great day!
 
Re: Kitty 7/8

Wow! What a long way you have come, Kim. Your post is full of confidence and promise. I am SO proud of you and MIss KItty!
 
Re: Kitty 7/8

I love that you have already put in place your new game plan with a backup plan. :-D

I'm glad Ms. Kitty is already feeling better.

You have done a most excellent job!
 
Re: Kitty 7/9

kse said:
I just hope we don't get near those HIGH 150s. :mrgreen:
Click to expand...

I'm just gonna ignore you! :lol:

kse said:
The vet did not encourage me to start pepcid, but everywhere I have read it appears appropriate to add it--so I will start with 1/4 tablet sid. A diet change is also in place, this is challenging when you are already trying to reduce protein and carbs. I do not want to feed fish a lot, but I will be adding additional to her diet. The phosphorus is not good on the kidneys, but her kidneys are holding up good and I always can add binders if necessary. I have boiled skinless chicken breast and will add it at a 50/50 ration to her LC FF to reduce the fat, without increasing the carbs. We will retest her in 4 weeks to see if the regiment is working.

The Good News---Kitty LOVES the bupe!!! The compounding pharmacy is shipping out our "new" supply today. She is eating GREAT and moving around more--so her quality of life seems to have already improved!
Kim
Click to expand...

I'm wondering why the pepcid works, or if there are any long term problems with giving it every day? I started Thumper but then stopped since we don't have any kind of diagnosis. I've also wondered about the diet, just in case pancreatitis might be Thumper's problem, I thought about changing food but I wasn't sure what was the best & haven't had the energy to research since I didn't HAVE to at this point. So is there no can food that is low fat? I also thought about raw but it just sounds gross to me. :lol: I eat meat but don't like dealing with it & raw chicken is just gross to me so I don't know if I could deal with it! Have you ever considered raw?

You really are becoming quite the expert! I admire how much you have learned. I can't keep it all in my head so thank goodness there are people like you on this board to help.
 
Re: Kitty 7/9

Thanks Sue, I had not seen that. Interesting Feline's Pride is the first on the list. I had taken a look at their website but wasn't sure I could deal with it. Have you used that food?
 
Re: Kitty 7/9

Wow
Great report Kim.

Sounds like Kitty has everything she needs.
All because she has a good mama!

Hope her numbers are excellent today!
:YMHUG:
 
Re: Kitty 7/9 amps pmps +4

I know I say I am not going to worry about the numbers as much, that I want to calm her swings down and deal with the Ptitis...BUT.....

+4 279 not much drop
+6 231 probably nadir


Maybe the ps will come down and we can work from there......

So, is the consensus to ride this out and let it settle? This is pretty typical of the type of curves we were getting before exceeding the 4 unit mark. Oh, but those wild swings!

I will throw this out...maybe factual maybe not..I don't know. My vet said (ugh) that it was better to stay betwen 380 and 200, than to go from 450 to 120. She said the high zooms were much more toxic to her organs even with the lower nadirs. Agree or disagree?

I will throw one more bone out from my vet--She and the internalist said that with Prozinc you should not change the dose for at least 5 days--that it takes that long for the cat's body to adjust to the dose. Don't shoot the messenger...I am just repeating, and obviously I am not sold on Vet comments or I wouldn't be here---but, I am curious of your thoughts!

I am most concerned with the comments on the first topic--better between 380 and 200......thoughts?
 
Not wanting to agree with this vet :mrgreen: ..... and not really agreeing but that is what I was taught in the beginning by Hope and some of the old timers.

That you want to stay away from the steep ups/downs but is it worse than being between 200-380 (where does she get these #'s???) There are so many variables but the 300's are not a good "sitting in" #, regardless. If you figure normal is between 60-120 ..... you are perking in the 300's.

Not even the protocol on pzi says that about holding 5 days, nor does info. put out by Boehringer Ingelheim
say that. From everything I've heard/read 3 doses is standard. Payne does not do well on changing her dose too often, she likes everything even. When we did TR and her dose was changed every time, she did terrible!

Also comment on potency of new vial, since I am opening another one now. Some of us use a lot of insulin and go through a vial every 4-5 weeks, some use one for months .....
 
When I first got here I think holding the dose 3 to 5 days was pretty common and Prozinc was known for having new dose wonkyness hence holding the dose.

As for the first question I don't know if steep ups and downs are more damaging or not but I'm pretty sure they feel really crappy while they are going through it.
 
The problem with riding it out and letting it settle is that in higher numbers things will tend to get worse over time, vs. in lower numbers things will tend to get better over time (assuming they have a pancreas capable of healing). The best bet that I see is to keep nudging the dose up, and if the PSs are not coming down you could try early shooting to avoid the steep drops. Sometimes even doing that for a few days can really help duration.

The tricky part I think with Kitty is you don't know how much is liver training, how much was actual rebound from the drops being too steep, how much is short duration, and how much insulin resistence is in the picture. She may be a cat who always needs a 4u type dose, or she may be a cat who sees 2 days of green numbers and drops her dose in half. You just don't know, and there's no way to find out unless she sees some more greens, or you experiment with early shooting, or you experiment with a different insulin. I am happy to be proved wrong, but I don't see the scenario where she gets green nadirs on PZI and good PSs on BID, unless there is a stretch of early shooting in there.

Sorry not to have easier answers for you!!!! That's just how it looks to me. I think she can get there, I think it's just going to take some tough work or an insulin change.
 
I was looking in the Wiki for something related to what I just posted, and stumbled on this. Kitty gets a good response, so I don't think it applies to her, but I wonder if it applies to any other kitties here?

It is also possible to have symptoms of insulin resistance where the resistance is not directed at the insulin itself, but rather at other proteins present in its composition[6]. Insulins which are either protamine-suspended or Protamine Zinc (PZI) all contain protamine, which is also a protein. It's therefore possible to have an immune reaction to the suspension. Changing to a suspension not containing protamine should solve this.

from this page: http://petdiabetes.wikia.com/wiki/Insulin_resistance
 
My vet is on board with the insulin change.....maybe I should consider it earlier rather than later!

Thanks Joanna!
 
I don' t have a link, but in reading about the Ptitis this week--I read somewhere that Pancreatitis can contribute to insulin resistance. I definitely think there is some resistance in Kitty, thus requiring the high dose.

I did increase .2 today and am going to ride that a couple of more cycles if there are no surprises. In the past, I did not systematically increase--I just increased to what I thought was needed. This time as we move up, I am going to do it in smaller increments-- .2 per change and see if that helps.
 
Here's what I was actually looking for! Excerpts from this page http://petdiabetes.wikia.com/wiki/Glucose_toxicity In reference to spending time in higher numbers and glucose toxicity / insulin resistance.

Raises blood glucose -- temporary insulin resistance

When a diabetic animal is hyperglycemic for long enough, the animal's damaged tissues may start having trouble using insulin. This in turn means that even a well-dosed animal may continue to have high blood sugar, leading to even more insulin resistance.

Suppresses insulin secretion (in cats)

According to Dr. E. Hodgkins and also Dr. J. Rand[3][4], hyperglycemia also suppresses insulin secretion from the beta cells. After just 3 to 7 days at 30mmol/L (540 mg/dL), Dr. Rand found only "minimal" insulin secretion from the beta cells. Combined with the insulin resistance, this means that once a cat becomes diabetic, it will tend to remain that way until treated with exogenous insulin.

Raises insulin requirements

Glucose toxicity can continue to raise insulin requirements for some time, even after the "glass floor" is broken and blood glucose is brought under control. This effect may take a long time (weeks) to wear off, due to the gradual healing of formerly glucose-damaged tissue.

As the damage from glucose toxicity is repaired, the tissues will heal; the process can take 1-12 weeks[5]. However, healing can take place only when blood glucose & fatty acid concentrations are reduced.
 
Possibly relevant excerpt from PZ website: http://www.prozinc.us/faq.aspx#prozinc_work

In the field studies, mean time of the blood glucose nadir was between 5 and 7 hours, and subsequent blood glucose concentrations were increasing in most cats by 9 hours after administration of PROZINC.
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Unfortunately you need a login to get to the Vet page, so more info remains out of reach. Didn't see anything in the non-vet part about how long to hold doses. On a gut level, it doesn't make any sense to me that you would hold a dose longer than needed for Lantus or Levemir. Here's an excerpt from the Lantus sticky:

STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL

[top part edited out - please read if trying to follow this protocol (not a protocol designed with PZI in mind, though much still applies IMO)]

"General" Guidelines:

* Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

* Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Increasing the dose...

* Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.

* After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

* After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...

* If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

* If an attempted reduction fails, go right back up to the last good dose.

* Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...
 
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