Kitty back in the red...amps 476

[kse]

Kitty's pmps last night was 407. I check for ketones last night and they were negative. This morning she ate about 1/4 to a 1/3 of a can of fancy feast +9 on her pmps. I don't know if this would have given her a little spike this morning--but she was hungry and she needs to gain some weight (8.8 oz), so I thought feeding her was more important than a few points. I might have made a poor decision---I don't know.

If I was not checking her numbers, I would think she was doing good. She acts more like herself--grooming well, playing some (she is 15.5!), and interacting well with the other cats. Her appetite is BIG--but, she has always been an eater!
She is doing much better (looking at the whole cat) than prior to beginning insulin. I just want to get her in a better range.

Do you think I stay with the 3 units or bump it up? I would like to test more to have more numbers, but my schedule doesn't allow for a lot of mid week testing. Maybe the DKA is still effecting her numbers---causing these swings---who knows.

Kitty will be boarding at the vet a few days next week---maybe I should let them do a curve and see if an increase is warranted.

One more question---when I get a lower than normal number (like the 260 this week) and I shoot less, am I losing the window of opportunity to pull her numbers down? And, does that lower dose roll forward---effecting higher numbers later---2 to 3 cycles out, or after that 12 hour cycle is that dose history? I hope this make sense!

Thanks for the help!

Kim

 

[Sue and Oliver (GA)]

What excellent questions, Kim. Wish I had excellent answers.

Let's see if others agree with this. In general, but with the caveat that every cat is different, each number at amps and pmps is affected by the cycle preceding it but not by a cycle the day before. PZI lasts 12 hours at the most in most cats; there is no overlap like with the L insulins. BUT there is the bounce factor that doesn't follow that rule. A low number can impact the next cycle and maybe the next, because the body releases glucose as a reaction to that low number it is not used to.

I think we suggested in an earlier post that if you increase, we would suggest only increasing to 3.25 to see if there is a difference. And we are really hoping that this weekend, you will have time to monitor and test and consider a reduction to 2 or 2.5 to see what that does. I know that the midcycle numbers are hard for you to get - any info you can get this week would be helpful, even if it means setting your alarm and getting a +6 in the middle of the night. A number just before bed can also help. Feeding 3 hours before taking the number shouldn't be a problem, but getting a number before feeding would have given us more data. That would have been a +9 number we are missing. I can't remember. Are you using U100 needles and the conversion chart so you can do .25 increases? If not, ask for help.

IMHO, next week at the vet will be a wash. If you have them do a curve, it may be impacted by the stress she feels being in a strange place with noises and smells and all those people who are NOT the mommy. So it won't give you much info. And any doses they give based on stress induced numbers will not help you much when she gets home and is not stressed. A curve done at home this weekend will be of more value (and so much cheaper :mrgreen: )

Again, your whole cat report is good. The fact that she is peeing, purring, playing and eating is great. And no ketones is also great.

 

[Kelly & Oscar]

I have only a few seconds to write - but wanted to give you some info.

Don't waste your money with a curve at the vet. You will have vet stress on top of everything and they charge an arm and a leg for it. Get a spot check in when you can. If your lowest point is still in the mid 200s then try an increase to 3.25 like Sue suggested. I don't think you missed any sort of window by shooting less insulin on that lower preshot really. Its just what kitties do to keep you on your toes ;-)

 

[hollyall]

I like to focus on the good first and no ketones is really good. Also, that Kitty is acting more like herself...yay! I don't know very much about DKA, but I can see how it might possibly affect #'s for a while . Kind of like a cold. I feel really rotten the first week with a cold (had one recently...yuck!), but, even when I feel better the next week, it's usually 2-3 weeks before I'm completely over it. I hope with time that Kitty's numbers become more predictable, which will hopefully make it easier for you as you try to figure out her dose. You're doin' good. I think Sue and Kelly have had good suggestions on some things to try. I would be tempted to try the slightly higher dose the next day or two and see if that does anything with the pre shot #'s and then try the reduced dose over the weekend when you can watch and test Kitty.

 

[Joanna & Bix (GA)]

I agree with your choice to feed at +9. I wouldn't worry too much about one higher # - could be some food spike, but it really shouldn't make a huge difference. If it's just the one #, I'd ignore it. If it's a trend, then she may need more insulin.

The effect of shooting the lower dose on the lower PS is that you will likely lose a little duration - so they might get to higher #s by the next PS. It can affect the next cycle a bit in that then the next cycle is starting off from a higher #, so it has to work harder to have an effect. Sometimes you can see PZI lasting until around maybe +13, and then when it poops out you see the #s zoom way higher. So if you get that kind of duration (which many cats don't) you can get some good overlap between doses that can let one cycle help the next one.

Your question about whether you lose the window of opportunity is sort of a toss up - the reason you shoot a lower dose is that you don't want to risk hypo on a lower PS. If you can get some mid-cycle data to let you know that you didn't send them low, then you know it's safe to keep or raise the dose, depending on the #s, for that PS. So yes if it's too little insulin you're missing out on good #s, but until you do some shooting and data gathering, you don't know what dose is safe, so it's a trade-off.

I'm not close enough to her #s to have a good sense, but I'd say if you aren't seeing a fair amount of blues & greens, she probably needs more insulin. There are some cases where lowering the dose is the answer, but I think more often raising the dose is the route needed, especially with a ketone history. If it were me I would consider raising in 0.5 increments every 3rd day until you see blues & greens, and monitoring as much as I could to be sure I'm not overdoing it. That may be more aggressive than needed, I think what others have suggested is fine too, just saying what I would probably try if it were me. Others have been following along more closely though, so if I'm missing something, I'm braced for the slap.

Personally I wouldn't worry too much about a full curve. I would try to get a nadir-ish spot test when I can, and maybe one day something like a +6 and a +9 to check for any wonkiness in the overall pattern, and get an occasional early test like +3 or +4 to test for wonkiness at that end. If you can get more data, sure, but if you can't, spot checks here & there are fine.