Meatball 2/24 AMPS 537 PMPS 486

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Molly

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I tested meatballs ketones and glucose pretty late last night... there were definitely pretty high levels of glucose in the blood ... so I'm not sure why the vet did not find any. Ketones were still none! I really think the fluids are helping, and I will continue to give them until I can get his BG regulated.

Meatball is sort of playful tonight, not 100%, but he chased his laser a little bit.

I gave 3.5 u both this am and this pm. I just don't understand why this does not seem to be doing anything at all. I'm going to up the dose to 4u tomorrow evening if I don't see any change. And I'm going to do a curve this weekend.

Question, I have to work from 6pm until 2am on Saturday night. I would normally give Meatball his insulin shot at 8pm, but I will be leaving at 5pm. Should I give a shot then? Do you give a lower dose if you're giving it earlier?
 
Is there any way you can move his shot time up to 6pm in max 30min per cycle increments before then? Then that would make the 5p shot only 1 hour early.

Then you could move it back to 8p in max half hour per cycle increments.

Anytime I have a conflict I have to plan ahead so I can move shot time up or back. Obviously the further ahead then better.
 
THat makes sense, and I will certainly give it a shot. I usually get home from work at 8 during the week, so worst case scenario, if I am not able to adjust the time ... still shoot on Sat evening?

Also, I have been doing some reading tonight about the Somogyi Effect, and it's making me wonder if I have missed the correct dose again? Not that I have collected so much data on Meatball, but if i look at the general trends, he was 100-150 points lower on 1 and 1.5 units than on 3 and 3.5.

Is there any relationship between cats believed to be affected by Somogyi and the presence of ketones?
 
Molly said:
THat makes sense, and I will certainly give it a shot. I usually get home from work at 8 during the week, so worst case scenario, if I am not able to adjust the time ... still shoot on Sat evening?
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Yes I would absolutely shoot something especially since the keytones have been an issue. In an idea world I would base the decision to shoot the full amount or something reduced on how low the nadir has been on the full dose you anticipate to give.

Molly said:
Also, I have been doing some reading tonight about the Somogyi Effect, and it's making me wonder if I have missed the correct dose again? Not that I have collected so much data on Meatball, but if i look at the general trends, he was 100-150 points lower on 1 and 1.5 units than on 3 and 3.5.
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On 1 and 1.5 units the Meat-bizzy had ketones right? I remember someone writing that ketones are a result of too little insulin. We've been kind of having these discussion here in PZI about chronic rebound vs acute rebound and then "panicky liver." Rebound can be caused be a few thing: dropping to big, dropping to fast and dropping into territory that the cat is not used to and the liver panics. I'm not having any instinctual thoughts about your SS at this point. And that's partly because of the not overwhelming amount of data you have been able to collect. There are a couple approaches to testing for rebound. One is to reduce the dose by 50% and the other that I try to do is to isolate the time that the rebound is happening then test the heck out of the time and actually try to catch it happening. "Testing the heck" = hourly consecutive tests for 3-4 hours.

At this point you probably don't even really know when Meatball's typical nadir happens? IDing the nadir is usually just a matter of testing +5 to +7 a number of times to see when it's happening. It might also take measuring +4 to +6 or +6 to +8 in odd scenarios.

I'd like to see some mini curves with +3,+5,+7,+9 potentially at various doses. But your schedule is the ultimate limiter.

Sometimes when I test I will just isolate one time like the initial drop or the nadir and test 3-4 consecutive hours.

I hope some others come along and offer input too.

Molly said:
Is there any relationship between cats believed to be affected by Somogyi and the presence of ketones?
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I have no clue. Perhaps a message in Health for that may get more answers.
 
Ketones with high BG is a definite indication of too little insulin. Chronic rebound is usually an indication of too much insulin. It can also be an indication that the insulin is acting too quickly.
 
I definitely would not return to 1u or 1.5u, but as long as you are not getting any ketones and he seems to be acting reasonably well, you can certainly go slower and lower the dose a bit if you want - no need to stay on the fast track once the crisis has passed! For instance, you could try something like 3u for a few days and see how that goes. As long as the ketones don't return, you have room to experiment IMO (assuming he acts fairly well, etc.).

One thing to consider if you shoot early is overlap/zoom. With PZI technically you can shoot anytime past peak, on a rising #. In general terms, if you are seeing a rapid increase of BG #s you will need more insulin to bring them down, vs. if they are flattish, a smaller amount of insulin can produce the same results (i.e. nadir).

When I shot early with Bix I would usually shoot a hair less than the regular dose at +11, 0.1 or 0.2 less at +10, and at least 0.2 less or maybe more if shooting earlier than that. I generally avoided shooting earlier than +10 as his overlap was so good (which may not be the case for Meatball), that I never knew what to shoot to keep him in safe #s, and I tended to either under- or over-do it.

I would probably follow Gator's idea of spacing out the jump in timing over the next few days if that works for your schedule.
 
I also do what Gator does, gradually moving the shot earlier several days in advance. Since it sounds like you are gone a lot, you might try to find a pet sitter who could do insulin shots. I use one of the vet techs at the animal hosp. She loves the kitties, is tuned into when something isn't right, and can test/shoot. If she can't come, and I can't adjust the shot time enough, I try to bring him with ( or I don't go, much to my husbands frustration)
 
Bringing with is a great idea!!!

When I go far with H I put the seat down in the back that goes to the trunk then I put his litter box in the trunk and his bed up front and a bowl of water and food in the passenger side food area. We'll be going 80 on the I-5 and he'll be back there doin' his thing. Funny. He's so dedicated to his box.

Unfortunately H is does NOT like car rides and has to have Cerenia shot before we go anywhere :-( and he breaths heavy the whole time and is generally a mess. At his stage I try not to whig him out too much.
 
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