Kitty pmps dose- help!
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donnahc
Very Active Member
That sounds reasonable to me, Somewhere between 2 and 2.2? (can’t remember what syringes you use)
Both times you shot 2 into a 200 something you got a mid 300’s amps.
I’d at least try to get a test in before bed, just to be a little more sure. I know I am a test freak, but I can’t sleep anyway if I am worrying :shock:
Both times you shot 2 into a 200 something you got a mid 300’s amps.
I’d at least try to get a test in before bed, just to be a little more sure. I know I am a test freak, but I can’t sleep anyway if I am worrying :shock:
Sue and Oliver (GA)
Very Active Member
Nice job you two! See, you can give dosing advice. Truth be known, it is usually thinking out loud and sometimes picking the middle ground like you did. Good work!
Joanna & Bix (GA)
Very Active Member
OK I haven't looked at your SS in a while and just took a peek. Keeping in mind that it is the end of a looooooooong week and I may be brain dead :dizcat I am thinking you need to be more aggressive with dose increases. Like hold a dose for 2-3 days and if you do not have a breakthrough to blues & greens, and no clear signs of the dose being too high, raise by 0.5, or 0.2 if you are seeing signs of clear improvement, but not quite the real breakthrough. If you can get in a nadir test every couple days, as well as your PSs, that can confirm for you whether or not you are hitting better nadirs.
What do you think? What does anyone else think? I haven't been following super-closely lately, but the #s just look too high to me overall and I'd hate to see ketones come back.
What do you think? What does anyone else think? I haven't been following super-closely lately, but the #s just look too high to me overall and I'd hate to see ketones come back.
kse
Very Active Member
Kitty was on 3.5 and heading to 4.0 units. The vet thought she was insulin resistant and did extensive testing this week, looking an underlying reason. After all of the test came back negative we started fluids, to support her kidneys (high end of normal), and we got a new vial of insulin. It appears the inslin had lost it's Potency.
This is the first week she had had any movement , so I am trying to figure out what her "dose" needs to be. Truly it is like dosing s new cat.
Please give me your thoughts. She is also receiving 100 mls. of fluids every other day.
This is the first week she had had any movement , so I am trying to figure out what her "dose" needs to be. Truly it is like dosing s new cat.
Please give me your thoughts. She is also receiving 100 mls. of fluids every other day.
Kelly & Oscar
Very Active Member
It probably is a combination of new insulin and the fluids. When do you hear back from the follow up tests you guys did? Good call on the 2.25u... hopefully you guys can zero in on a good continuous dose here soon!
Joanna & Bix (GA)
Very Active Member
Just wanted to add a note for everyone (don't mean to pick on you!!!) b/c I see a trend that concerns me. I think we have developed some collective confusion with sliding scales and dose reductions on lower PSs.
Here's how I see it:
The idea of the no-shoot is to set the limit where you make *some* sort of dose change, either reduce the dose for safety & data-gathering purposes, or wait/retest. We suggest newbies (or not-so-newbies without a lot of data on lower PSs) start with a 200 no-shoot as this gives a nice margin for error compared to the hard no-shoot of 150.
So that means that any number above the no-shoot is fair game for the full dose. If we had a concern that the full dose would be risky at something like a 250 or a 300 PS, then we would set the no-shoot there. If the no-shoot is 200, that means full dose on anything from 200 and up, and below 200 is a choice of reduced dose or wait/retest. (Exception is no-shoot of 150 where lowered dose (vs. wait/retest) is *not* recommended unless you have a lot of experience & data and a very predictable cat.)
Sliding scale on the other hand is for cats who do not seem to respond well to one steady dose, or where we can see clear differences in their reactions on different PSs, or where the bean has a scale where they are actually hitting green nadirs on many shots (like Sueandsamwise) and the scale lets you aim for that perfect nadir from any PS while protecting you from overdoing it.
Things that *don't* make sense to me:
- Reducing doses on PSs above the no-shoot, unless you have concluded your dose is too high overall. I've seen reductions lately on PSs like a 210, or wait & retest on something like a 210, and it doesn't make sense to me. The idea of the 200 no-shoot is if you see a 200 or a 201, SHOOT.
- Using a sliding scale when you don't have clear reasons to go that route and aren't hitting green nadirs anyhow.
- Using a sliding scale that is overall too conservative and keeps the cat always in higher #s.
Now all that said, I certainly don't begrudge anyone lowering a dose for safety or for data gathering, and when you have something like tonight's big drop from the AMPS to the PMPS there is some reason to speculate that the dose might be too high b/c that's a heck of a lot of progress in PSs from just one shot.
But on the other hand, I think sometimes people are losing good opportunities by not capitalizing on any breakthroughs or progress, b/c it seems like we are always lowering the dose as soon as we get any better PS. I know that I for one am someone who did that, and I know it delayed Bix getting regulated. He only got regulated once I got up the courage to just shoot the doses & close my eyes and go nailbite_smile . I can tell you I cringed big time the first few times I shot enough insulin (intentionally), and hovered like a crazy-woman, worried I had overdone it. But that's what worked. And no amount of undershooting ever did anything for him.
This is where I think PZI-land really suffers from not having a protocol. The Ls just spell it out for people and so I don't think there is as much "bravery" factor - you just shoot what the directions tell you too. With PZI, somehow it seems scarier I think - maybe it's the bigger drops, maybe it's the lack of a protocol, maybe it's the wonky times when a dose reduction helps and that throws us into that thinking pattern, hoping a reduction will work for other cats too. I know all those things affect me too, not trying to point any fingers here.
Ok, stepping off the soapbox.
Final word, I don't mean to sound critical and I don't want to pressure anyone into shooting more insulin than they feel is safe, NEVER do that! I just want to be sure we aren't underdosing by being overly cautious. With so many kitties around these days with a ketone history, it seems like it needed a little soapbox time. 
Here's how I see it:
The idea of the no-shoot is to set the limit where you make *some* sort of dose change, either reduce the dose for safety & data-gathering purposes, or wait/retest. We suggest newbies (or not-so-newbies without a lot of data on lower PSs) start with a 200 no-shoot as this gives a nice margin for error compared to the hard no-shoot of 150.
So that means that any number above the no-shoot is fair game for the full dose. If we had a concern that the full dose would be risky at something like a 250 or a 300 PS, then we would set the no-shoot there. If the no-shoot is 200, that means full dose on anything from 200 and up, and below 200 is a choice of reduced dose or wait/retest. (Exception is no-shoot of 150 where lowered dose (vs. wait/retest) is *not* recommended unless you have a lot of experience & data and a very predictable cat.)
Sliding scale on the other hand is for cats who do not seem to respond well to one steady dose, or where we can see clear differences in their reactions on different PSs, or where the bean has a scale where they are actually hitting green nadirs on many shots (like Sueandsamwise) and the scale lets you aim for that perfect nadir from any PS while protecting you from overdoing it.
Things that *don't* make sense to me:
- Reducing doses on PSs above the no-shoot, unless you have concluded your dose is too high overall. I've seen reductions lately on PSs like a 210, or wait & retest on something like a 210, and it doesn't make sense to me. The idea of the 200 no-shoot is if you see a 200 or a 201, SHOOT.
- Using a sliding scale when you don't have clear reasons to go that route and aren't hitting green nadirs anyhow.
- Using a sliding scale that is overall too conservative and keeps the cat always in higher #s.
Now all that said, I certainly don't begrudge anyone lowering a dose for safety or for data gathering, and when you have something like tonight's big drop from the AMPS to the PMPS there is some reason to speculate that the dose might be too high b/c that's a heck of a lot of progress in PSs from just one shot.
But on the other hand, I think sometimes people are losing good opportunities by not capitalizing on any breakthroughs or progress, b/c it seems like we are always lowering the dose as soon as we get any better PS. I know that I for one am someone who did that, and I know it delayed Bix getting regulated. He only got regulated once I got up the courage to just shoot the doses & close my eyes and go nailbite_smile . I can tell you I cringed big time the first few times I shot enough insulin (intentionally), and hovered like a crazy-woman, worried I had overdone it. But that's what worked. And no amount of undershooting ever did anything for him.
This is where I think PZI-land really suffers from not having a protocol. The Ls just spell it out for people and so I don't think there is as much "bravery" factor - you just shoot what the directions tell you too. With PZI, somehow it seems scarier I think - maybe it's the bigger drops, maybe it's the lack of a protocol, maybe it's the wonky times when a dose reduction helps and that throws us into that thinking pattern, hoping a reduction will work for other cats too. I know all those things affect me too, not trying to point any fingers here.
Ok, stepping off the soapbox.
Final word, I don't mean to sound critical and I don't want to pressure anyone into shooting more insulin than they feel is safe, NEVER do that! I just want to be sure we aren't underdosing by being overly cautious. With so many kitties around these days with a ketone history, it seems like it needed a little soapbox time.
Joanna & Bix (GA)
Very Active Member
OK, if it turns out the last vial was bad and that's why all the higher #s, then just ignore my advice about raising doses. I'm always happy to be wrong, especially when it's in a good way (like when a cat gets good #s for other reasons).
I'm always happy to be wrong, especially when it's in a good way (like when a cat gets good #s for other reasons).
nancy and payne
Very Active Member
In some ways I feel the same .... that you need to go higher. From your SS it doesn't look as if you've ever gone too low, that's true? I think the combination of the right dose and the SQ fluids could level you off and that's what you're looking for now, a period of building from the DKA. I know you have been higher but you were either working up to/in/coming out of DKA, that takes A LOT out of Kitty! This is the time of re-building of beefing her up, adding the weight, not the time to worry about how little insulin can we get by on. Some of my worst mistakes with Payne was always trying to reduce her dose. You are trying to re-align her. And once again, breathe.
Nancy and Payne ......
Nancy and Payne ......
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