need opinions on these numbers

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hey barb,
What are you concerned about? Your ss doesn't look so bad, it would be great for some more tests at nadir, but your PS numbers look like they're all in about the same range.

Cathy
 
Sorry, I was on my phone yesterday and it's so hard to view ss and type a long response.

I think things look pretty good, but what are you concerned about in particular?

It looks like Chong was bouncing a bit on the 1u before, but has settled into the dose nicely now. You don't know exactly what he's doing since you don't have the mid-cycle tests. I know life gets in the way, but if you could get at least a +6 when feasible, even if you have to set an alarm at night, we can do some more work on the dose. The last 3 days look very good, your amps and pmps are the same within the variance given by the meter, which is perfect. If we know how low the 1u gets Chong at nadir, we can look at adjusting the dose to keep him in better numbers for more of the day. But until you get a few readings at +6 we shouldn't make any assumptions on what is happening. I am guessing you are concerned because you had been seeing more yellow and blue ps's the last few weeks and now you're pink. Chong was adjusting to the insulin and bouncing around quite a bit then, which is why you'd see such dramatically different cycles. The fact that your ps numbers are now all so similar is actually a good thing, though I know the pinks don't look quite as pretty on the ss. If we assume that he is doing similar now to what he did on 4/12, and that he also responds the same on both cycle, we can say he spends the majority of the day in numbers that are considered to be regulated. That's great! The question is are you happy with being regulated, or do you want to try to get the numbers down a little more and be very well regulated and maybe push toward going OTJ?
 
I just took at +6 BG reading --- 331! Last night she was 443 but much lower in the morning. She's bouncing around again.

She seems 'off her food' lately and that is worrying because she was always a great eater and now doesn't seem to be that interested. Very unlike her. I started to give her pepcid AC because she always seemed ill or uncomforatable after she ate and that seemed to help. Then I worried about giving it to her---would it change the acid in her stomach that she needs, etc. She did often seem better with it. I got some pet enzymes and tried to put the powder into her food, starting low, but she wouldn't touch the food. I threw that away and just gave her the reg food but she didn't really eat it.

Ideally I would love OTJ but not sure that is going to happen. I did think so at the beginning of March but then I went out of town and #s never seemed that good or stable again. I don't know if OTJ seems possible now. I thought the goal was to get her about 200 at shot time with about 100 nadir. Expecting too much?

BTW. How does everyone get their sugarkitties pictures on? I tried. It was way to big to upload and it wouldn't let me cut & paste. The orig pic was taken on my iphone and put onto my computer but I can't seem to get it to go into my signature, or anywhere else. I want to be able to share her . . .


She just doesn't seem like she's doing real well right now and I don't know what to do. Who knows, she could be fine tomorrow ...
 
Yes,an ideal cycle would be 200 to 100, but not many cats go there and the ones who do give 200 PS tend to go otj. Let's see what the next couple cycles look like, if she remains flat we may need to start looking at what is going on.
 
Hi Barb,
In your PM today you asked what I had meant when I asked someone this in another thread some time back:
Did you ever do that "feed, test an hour later for a rise, then a couple hours later to see if she was dropping on her own" thing?
Click to expand...
That is something that people can try when they are seeing low preshots and cycles, but aren't quite sure if kitty is ready to go off the juice. Sometimes, people will do it when they are doing the "OTJ trial". The intent is to see how well the kitty manages his or her BG on their own, with no shot given that cycle.

What you do is test like normal, but don't give insulin. Then you feed like normal. You then get another test at +1 or so. That test should show you a higher BG, which would be caused by the meal that you just gave. After that, you wait another 60-90 minutes, and test again. What you hope to see is the BG has dropped. That would indicate that the pancreas is doing the job nature intended. Maybe not 100% of the job, but it is producing insulin, and kitty's cells are absorbing blood glucose for energy like they are supposed to. That causes the BG to go down, because the glucose is being used by the cells instead of staying in the blood. Your curve might look like this:
AMBG 160
+1 200
+2 180
+3 140
etc.

If you normally feed mid-cycle, you could get reading before, and after that meal or snack and hope to see the same sort of rise and fall.

You would hope that it just stayed right around that level or dropped for most of the cycle. It might come back up to 160 or higher by PMPS, or it might not. If it stays pretty much level, then that is fantastic news. Because even though the numbers are still a little above the normal range, at least his body is maintaining some measure of control, and trying to self regulate.
At that point, you are pretty much into the mini/micro dosing phase, and the cat is almost ready to go off of insulin. At the same time, you can tinker with feeding timing in order to spread the BG boost from eating more evenly, which will also help out the pancreas by making the need for natural insulin more consistent, without peaks and valleys.

Hope that explains it...

CArl
 
Barb,

The lethargy, heartburn, and lack of appetite concern me, and chance you could take him to the vet? Get them to look him over for Pancreatitis and everything else, but really the Pancreatitis.

Cathy
 
Thanks, Cathy. Look at today. How do you know what to do!

The only way they picked up on pancreatitis before was ultrasound. Is there an easier and better way?

Barb & Chong
 
Ultrasound as far as I know, liver panel can suggest pancreatitis but diabetes can cause abnormal liver panels as well. If the symptoms continue i would get it checked out, especially if he's had it before. I'm glad you reduced dose, I'm sure everything will be okay, but make sure you get some tests tonight since you don't really have any data on what 0.5 does into a high blue ps. Nice cycle today!
 
To Marcy & Klinger,
Thanks for the info on the avatar. Chong is now posted --- isn't she beautiful! But I'm not prejudiced . . .
 
The pmps 185 looked great! The pinks later, not so much... what did you see this morning?
carl
 
Loss like a bounce last night from those blues, if u you get a blue PS again you might want to hold of on feeding and continue testing until you confirm a rising number, like +12 187 +13 230 and them feed and shoot your full dose.
 
Hi Catannc,
I just posted early (331) and mid-day number (117) numbers. Fed her 1/2 can FF Chicken with digestive enzymes after +6 numbers. After she was off her food before, now she's bugging me! I also want to see if I can stop her hunt at +10 through my high kitchen cabinets. Right or wrong, at 16 I don't think she should be that desparate and I don't want to feed her then when her numbers are high. How much of a problem do you think a mid-day snack is? I go back and forth on this.



Barb & Chong
 
Feed her whenever she wants before +10, any food after that point can influence her +12. Snacks are good, they keep BG more stable and if you feed at +8 or +10 and see a drop or she continues to stay flat after food it means Mr. P is playing around a bit, which is good to know.

When you get your pmps, if it is lower than 200 lets wait it out, see if it rises and shoot the full dose rather than trying the half again.
 
Hey Barb,

I see Chong's not well, I hope they're figuring out what is going on, if it's pancreatitis make sure they give you something for pain. Hope you get a diagnosis and Chong starts feeling better.

DId you skip the shot last night because she wasn't eating?

Cathy
 
Chong is miserable. Went to vet yesterday (Sat), 'emergency' appt, blood work numbers look good. Vet thinks pancreatitis---actually a 'tri-something', pancreatitis, inflammatory bowel, and something else. Got fluids and B12 shot. She was reluctant with the pain meds. I'm not sure why so reluctant but she wants me to give fluids today and see how things are. If not feeling better by Monday, we'll do pain meds.

I'm sorry I didn't see your post until this morning. I would have insisted on the pain meds. The way Chong is now, I should have insisted. If I can see this much pain, it must be pretty bad.

I'm not that comfortable giving fluids. Frankly I don't know if I can. I'm on my own and, not counting the size of the needle and length of time it needs to be in her, seems like it needs more than one set of hands. I did it in the vets office to try it. I also gave her the B12 shot and she tried to bite me---not too seriously because she didn't do damage, but she has been reacting this way with testing lately. I put it off to not feeling well and irritable and didn't think anything of it. At the vets office they took it more seriously on what damage could be done if she really wanted to break the skin. It never occured to me that she would really bite . . .

Discouraged today. Hard to see Chong in this much pain.

Barb & Chong
 
She really needs those fluids, I know it must be hard and also scary, but it is the best thing you can do. Try making a cat burrito with a bath towel, literally roll her up in it if you have to.

If she does bite you, and it breaks the skin, you do need medical attention for yourself.

Not sure on why they wouldn't give something for pain? Maybe fear of an opiate causing any more bowel issues? I would call whatever emergency vet the office uses and ask why no pain meds?
 
Hi Barb,

Sorry Chong is going through such a tough time. My cat, Kitty, has had chronic pancreatitis for the last year, but she just suffered miserably through an acute bout on top of the chronic condition. Pancreatitis is VERY painful and one of the best tools to fight it is Buprenorphin, better known as Bupe-- pain medicine. You need to insist on pain meds-- even if Chong appears to not be as painful, get the Medicine. Cats hide pain very well. The other two primary tools in fighting Ptitis are Sub Q fluids and anti nausea medicines-- pepcid and Odansetron are my prefered drugs of choice. If Chong actually starts to begin vomiting, the you can add Cerenia to the list. Pepcid and Odansetron work good for Nausea-- Cerenia, in my opinion, does not work as well for nausea, but works great to reduce vomiting. So, the three tools you need are-- fluids, pain meds and anti nausea meds. And the forth and maybe most important thing is Time! There is no magic wand for Ptitis-- and it takes time for the inflamation to reduce and the pain to reduce. I also used Zeniquin, which is an antibiotic, but it was used to help reduce inflamation. I would ask about all of these drugs...and I would insist on Bupe.

Kitty was really sick with this last bout and still is not back to herself. She has always loved to eat and she almost quit eating entirely-- in fact, we had to use an appetite stimulant, Mirtazapin- but, it worked great. I am not sure if Chong is eating well, but if not I would also inquire about the appetite stimulant. Just remember this.....Chong is sick and feels terrible, BUT "normally" Ptitis will resolve. Kitty actually looked like she wasn't going to make it this time....but, she is one week off of the pain meds and appetite stimulant and is feeling better-- Not Good though! Ptitis can make you think they are dying-- , it is really painful, but hang in there and give it time. I would also add water to Chong's food and try to get as much liquids in him.

During the height of Kitty's attack, she wouldn't even eat tuna!

I only gave one B12 shot during Kitty's attack, but B12 is a very good choice to add to your regiment. I have read that it helps a lot.

I know it is hard to see Chong sick, but hang it there-- the fluids are VITAL! If you post in health, there are some people that have video links on how to administer Sub Qs. How many mls of Sub Qs are you giving daily? Are you giving them once a day or twice a day?

Laura and Harley are very experienced with Ptitis...if you PM her, I am sure she might have some additional advice. She posts in Lev primarily. She also posted on some of my recents post about Ptitis and offered a lot of good info....you might could just search my posts from about 2 weeks ago and read her comments.

If I can be of any help, please let me know. Hang in there!

Kim
 
Hi Barb -

Cathy said you might be looking for some insight on getting the fluids into Chong. Other than the first time at the vet, I've done them by myself - and now that he (and I!) know the routine, it goes very smoothly. I can even slip out of work and be back 25 minutes later including travel time, test and fluids!

I do 100 mL once or twice a day. Getting ready to do some shortly.

A couple of things. I'm guessing you already have the bag and the IV line is in it. They should have given you needles as well. I have pink 18 gauge and yellow 20 gauge (smaller). I prefer the smaller as they seem to go in easier and hurt less. He does make the slightest little whimper when in insert it, so don't let that freak you out.

The burrito thing would be fine in theory, but with only 2 hands, I don't know how well it would work. Is there a neighbor kid or friend you can ask to help? I initially used the burrito to test, cuz Grayson liked to squirm. Now he lays waiting for the next thing. He just saw me w/ the needles and has "assumed the position"!

In my house, fluids come with food. That's the ticket to doing most anything to Grayson. Face in a food bowl & have your way with him! So I prep the food/water & have it ready to go. Wash your hands. Change out the needle. Flush the line for a second or two (into a cup works - I just shoot into my fireplace). Close the line back off.

Position the food on the table where you can ergonomically insert the needle. My bag hangs on the over-mantel on a coat hanger (looks really pretty in the dining room!). Table is about 4' away - AND I CAN SEE THE LEVEL (very important!!!). There's probably about 3.5' fall from the bag to the table surface. I've also hung it over a door and used the adjacent table. Grayson looked at me as if to say "this isn't our feed/poking spot!"

Give him the food. Take the cover off the needle, and chisel side up, insert under the skin just like you do w/ the insulin (you may need a bigger tent. Once it goes in, assuming he's eating well, I usually just stand by him or sit, holding, not the needle, but the line near the opening/closing valve. I open it all the way. It usually takes me 4 minutes to infuse 100 mL. The line comes from the bag, lays on the table, and then up about 8" to him. There's enough fall from the gravity that it goes in. You should see a bump about the size of 1/2 tennis ball - he looks like the hunchback of Notre Dame!

Yes, he's wiggled, and yes, the needle has pulled out. Have a towel handy. But keep your one hand on the line or near the needle so it doesn't slip out. The other hand is perfect for scratching his head, chin or other parts that he likes having scratched... and... if need be, to scruff him if he tries to walk away.

Grayson's fluids usually finish before he eats one can of FF, so I close the line, remove the needle, hold the injection spot for just a minute or so, in case he leaks, cover the needle, hang the line over the coathanger, and move on to anything else.

If Chong isn't so good at eating, a second person will be key. Good luck - if I can help further, please let me know.


ONE LAST THING. I USUALLY GIVE THE FLUIDS AT LEAST 2 HOURS BEFORE OR AFTER A SHOT. I USUALLY TRY FOR +6 OR SO, DEPENDING ON HOW OFTEN I'M GIVING THEM. Don't know that that's a "rule", but if the insulin is under the skin, and the fluids are... I kind of think of them diluting the insulin. Not sure that's the case, but I've been advised to keep them at least 2 hours apart. This also is a good time, if you're doing snacks or mini-meals at +6.

Lu-Ann
 
Hi,
Thanks for this info I just started a new post string about ptitis & biting & fluids. Please help me there.

I am giving 1 unit. In the vets office & first time I tried fluids I didn't get full amt in but yesterday I did.

Something is not right. She is not getting up but eyes bright & she's responsive when i go to her. She always gets up when i do. Her blood work was good on Sat. I'm calling for pain meds. Thanks for letting me know how imp they are. I thought we were over the hump with fluids but I guess not.

Barb & Chong
 
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