Newly Dx Kitty, strange curves: too much PZI?

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Avery

Avery

Member
Hi,

I've introduced myself and my Kitty, Turtle, on the Health Forum, and it was suggested I come over here for help with some glucose readings I'm getting on PZI.

Background: Due to a miscommunication between our cat sitter and her boss, my 16-year-old Turtle was left unattended for 3 1/2 days. She had no food the entire time. She appeared OK the night we returned, but the following night she suffered seizures, blindness and very weak back legs. The Emergency Vet ran a blood panel on her and found that her numbers all appeared OK except for the glucose, which was off the charts. After being hospitalized and given IV fluids for two days, it was determined that Turtle is diabetic and needs insullin. She was prescribed 2 units of 100 UL PZI twice a day and put on Hills M/D formula food.

Six months before this happened, I had taken her off of dry food completely and changed brands of canned to a lower carb formula (Natural Balance Venison & Green Pea). I did notice larger clumps of urine in her litter box in the last 6 weeks or so and was planning on getting this checked out at her next checkup. The Emergency Vet said that she had been probably been diabetic before this Medical Crisis, and the not eating for 3 1/2 days sent her system into a tailspin.

So, two days into her insulin regime, I ran a curve at home using a Freestyle Lite glucometer. These numbers resulted:
7:00am 285, food
7:20am shot (2 units PZI)
9:15am 265
1:00pm 143, food
3:15pm 145
6:00pm 133
7:00pm food
7:20pm shot (2 units PZI)
9:30pm 219.

It didn't look too bad to me - there was definitely a curve there so the insulin was having an effect. Over the next few days I was seeing similar patterns with spot-checks. About five days into this, she had a glucose curve at the Vet's. Her preshot number that morning was 139. Two hours later, at the Vet's, my meter read in the 400's. AFter two readings the curve was stopped and the Dr. recommended doubling her dose to 4 units twice a day over a period of two days. I resisted, showing her my numbers from the previous few days. I had never had a reading over 285 at home. Vet said the high BG in the Clinic could have resulted from Stress and agreed to *not* increasing her dose. Her BGs began falling considerably that evening when she came home, and the next morning her preshot number was down to 207. I was relieved that i'd gotten out of increasing her dose.

Yesterday I ran a curve on her at home. This was a week after the curve above. These are the numbers I got:

7:00am 178, food
7:20am shot (still 2 units)
9:45am 262
11:30am 195
1:00pm 254, food
3:00pm 270
5:00pm 285
7:00pm 278, food
7:15pm shot
9:30pm 301
11:30pm 282

The numbers are higher overall and I don't see any "nadir" to speak of unless you count 195 at 11:30am! It's been suggested to me that inverse or flat curves may be indicative of too much insulin. The low preshot numbers I was getting early on may have been a warning sign. I think that I am going to cut back to 1 unit twice a day, put her back on her old lower-carb food, and basically start this whole thing over. I know that my Vet is going to take these numbers as a sign that she needs her insulin dose increased, not decreased, and I am still very uncomfortable with this. I will be talking to another Veterinarian today to get his take on things, but if he too suggests increasing her dose, I'm afraid I'm going to be on my own here.

Any thoughts?

Thanks! -Avery
 
I agree that reducing the dose is the best plan, testing before each shot and increasing by small amounts as needed. The other vital thing to add, when reducing a dose as a trial, is to test for ketones. Here is some info: http://petdiabetes.wikia.com/wiki/Ketoacidosis

You can buy the ketone strips cheaply at any pharmacy. If he won't pee on command :mrgreen: we have tricks to try.

I hope we can get your spreadsheet transferred so you can add to it.

https://docs.google.com/spreadsheet/lv? ... lZQMjk0TXc
 
Hi and Welcome to PZI Avery and Turtle,

First off great job of testing, that is usually the hardest part to get the hang of.

I agree that 2 units looks like it is too much insulin, I would drop the dose down to 1 unit and like Sue said test for ketones.

We usually recommend to any newly dx kitty not to shoot any insulin unless their bg is over 200. Untill you have enough data in your spreadsheet to show you how Turtle is responding to the dose so you know what to expect.

Glad you joined us over here.

Robin
 
Avery and Turtle,
Welcome to our group. I don't give a lot of dosing advice, but it does appear that Turtle is getting too much insulin.
I'm mostly here for moral support.
 
I responded in Health last night, and was in agreement with Sue (and now Robin and Ginny) that a drop back to 1u seems like the best plan. That "curve" that wasn't a curve indicates "too much insulin" in most cases.

This "dance" is very confusing at times. No drop from the insulin can mean too much insulin, and it can also mean not enough insulin. However, when you aren't sure, the safe thing to do is to drop the dose and see what happens. Once that routine of too much insulin goes away, it might take a couple days, but you should see an improvement back to the decent numbers and curves you saw a few days ago.
Automatically upping the dose, when you think the problem is "not enough insulin" can have disastrous results if in fact the problem is already that the dose is too high.
The best advice is to err on the side of caution.

Carl
 
Welcome!

We recommend you feed a canned, low carb diet. Some cats may be very, very carb sensitive and it will help if you know the % calories from carbohydrates. This is one source of information: Binky's Page
 
Welcome Avery and Turtle!
I am sorry to hear about Turtles ordeal, that must have been frightening!
I am also in agreement with too much insulin
start over with one unit and go slow.
We are lal here for the 2 of you so ask all the questions youhave!
Oh and as Sue always says, dont forget to breathe!
Looking forward to getting to know the 2 of you!
Denise and Shakes
 
Just thought I'd chime in too, and say welcome!

You're already getting good advice so that's all I wanted to say.
 
Thanks everyone for the great suggestions & welcome!

I was shocked last night to realize that what I have been feeding her the last six months, what I thought was low-carb, was not. I feel like a real idiot. When I shopped for food 6 months ago I had the Janet & Binky charts with me. I got several varieties with low-carb values hoping I'd find one that didn't upset Turtle's tummy, and that she'd eat. Somehow I ended up with the Natural Balance Grain Free Venison and Green Pea in my shopping cart, and that was the one that Turtle liked the most.

Only last night while reading over Dr. Lisa's Cat Info page and looking at the charts again did I realize that the Natural Balance wasn't even on there. Further reading suggested that this food is *not* low-carb (the number I saw was 31%!) and not appropriate for diabetic cats. Somehow I ended up thinking this was one of the "good ones!" So even though I took her off the dry food, I ended up feeding her canned food that had way more carbs than the old canned food I used to feed her (which now I find out had 3% carbs!)

Sheesh! So I'm off to buy a boat-load of Fancy Feast Classic and some other samples from the charts-- this time I'll be more careful! I feel pretty good about changing her diet at this point because I'm cutting her PZI dose in half.

Thanks all!
Avery
 
Welcome to PZI group, Avery & Turtle.
It looks like too much insulin to me from looking at Turtle's curves. Vet trips usually induce higher levels while kitty is at the vet from fear and stress.
When you switch to FF classics, you may get a big drop in bg levels from feeding low carb, so you'll want to closely monitor bg levels after starting FF.
Good luck!
 
Hi Avery,
So, what kind of numbers did you see today?
I agree with the value in Dr. Lisa's site. Great info isn't it? I've got it bookmarked and use it almost daily.

And YAY for FF classics!

Carl
 
Her numbers are very interesting, actually...Mon eve I started the cutback from 2u twice a day to 1u twice a day. Wed eve (last night) her PMST was 197. Gave her 1u then started her on the FF Classic Food (7:00pm). At 10:00pm she was at 200. At 1:30am she was 88! Couldn't believe it so took another sample which read 86. She seemed fine, but this was at 6+ and I'm not sure where her "nadir" is so I gave her a few treats & kept an eye on her for awhile. This AM she was at 90! Again, couldn't believe it, so another sample yielded a 98. I did *not* give her shot and now I'm not sure where to go from here. I'll poke around here & try to get some ideas.

What does it all mean? I dare not hope that she may need no insulin or only a tiny amount. But these low numbers! Right after I started the FF Food! Oh, and I should add that last nite's shot was the first I had given in her flank and not her scruff.

Heady stuff!
Avery
 
Forgot to mention - I gave her her normal amount of food this morning at 7:00 after checking her BGs.
 
I'm at work now, I can't test! Do you think she's in trouble? I thought she'd be OK now since I didn't give her insulin and she had breakfast...! :?
Thanks Carl!!
 
Aver,
This is the routine I was going for....
When you get a 90 or any other non-shoot number..... feed like normal (which you did).
An hour or so later, check the bg to see if it came up. It should from the food.
Then wait another hour or 90 minutes to see if it is still going up or not. Or dropping.
If it is steady or dropping, then she is producing enough of her own insulin to keep things under control.

And THAT is exactly what you hope to see happen!

Carl
 
NO, NO, not the least bit "in trouble". No insulin means she won't go too far down. Her pancreas won't make her go "hypo" or anything bad.
Just wanted to point out the opportunity that exists when you see a nice low number like that.
Carl
 
Whew---that's what I thought but panicked for a second there... :oops:

Yeah, I would *love* to be at home keeping an eye on this! Work really gets in the way of FD management doesn't it! :smile:

Thanks so much!
 
lol, yep, but it puts the insulin on the table though!

Amazes me how many times we see a conversation going on for a couple hours, then one person says "I'm at work right now, gotta go!" Of course, the bosses are probably doing the same sort of thing behind their closed doors.

Sorry, didn't mean to make your BP rise!

Carl
 
No problem! I probably needed waking up a little anyway...

I just called my Vet about getting some more insulin. She was happy to have me contact VPA directly, but said that the VPA told her that PZI is on back order for two weeks! Is this normal? I'm not too worried right now...I have quite a bit left and I don't know if I'll even be using that much for the next few days.

Also, I decided to be bold and tell her right out that I had switched her food and cut her dose and that her BGs were going lower. She was very positive about it...seemed excited at the progress and didn't yell at me for being a loose cannon! So even though she wanted to put Turtle on a higher dose last week thank goodness she's open to alternatives...!

Ooops, here comes boss...back to work! :lol:

Thanks millions.
 
Yesterday I did not give Turtle her shot in the a.m. because her AMPS was 98. Her PMPS was 244 last nite, so I gave her the 1u at 7:00pm.

At 7+ (2:00am) she was 145, and this morning at 12+ (7:00am) she was 138!

I have to say this is something that has seemed consistent with Turtle. Her night-time midrange and AMPS are always very close. My two theories at this point:

One, the nadir seems to be coming so late in the cycle (+6 to +12) that she may only need a once-a-day injection. ?

Two, she needs twice a day but a lower dose. The only thing different in her AM cycle and her PM cycle is that midrange in her AM or daytime cycle she gets 1/3 of her daily allotment of food. I originally did this because I was so afraid she may go too low while I was at work and unable to do anything, and she would at least have that food available to eat (it's on an automatic timed feeder). This may be driving her numbers up during the day, as opposed to the nightime cycle, where she gets no food midrange.

I talked to another Vet yesterday who said that shooting into a number under 200 but higher than 100 was OK, since 1 unit is such a small amount. But I still felt uncomfortable giving Turtle her AM dose when she was at 138, so I did not. I gave her her regular AM meal, but I did not put out her mid-day food, hoping that this will keep her BGs from rising too much during the day.

I couldn't test her after her meal this a.m. because I realized I was out of strips. :oops: They're so thick I thought I had more than I did. I have to get some more after work this eve.

The Vet I talked to cautioned against messing with her dose. It seems to be conventional wisdom that you want to keep her at the same dose for several days. But how can you do this if it means shooting into low numbers? I'm not comfortable doing that yet!

Would it be a bad idea to cut her dose in half again and start with 1/2unit BID tonight instead of 1 unit BID so that the numbers will not be going so low into AM shot time?

Or, should I perhaps trying one shot of 1u in the AM and no PM shot? Based on her feeding schedule (more food in daytime than night), she seems to need the insulin more in the daytime than she does in the nighttime.

Or, should I eliminate this mid-day meal and give her two meals a day to level the playing field between the AM and PM cycles?

Any suggestions? Does my reasoning make any sense? :)

Thanks!
Avery
 
Wow, that's a whole lot of reasoning to sift through! But I'll try, in pieces... ;-)

One, the nadir seems to be coming so late in the cycle (+6 to +12) that she may only need a once-a-day injection. ?
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For now I'll just say not recommended, but not totally out of the question. I did so when Bob was almost at the end of his insulin treatments.
Two, she needs twice a day but a lower dose. The only thing different in her AM cycle and her PM cycle is that midrange in her AM or daytime cycle she gets 1/3 of her daily allotment of food. I originally did this because I was so afraid she may go too low while I was at work and unable to do anything, and she would at least have that food available to eat (it's on an automatic timed feeder). This may be driving her numbers up during the day, as opposed to the nightime cycle, where she gets no food midrange.
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That is, IMO, the most logical choice - BID but smaller doses. I'm thinking that rescheduling food might have a positive effect too, so more later.
I talked to another Vet yesterday who said that shooting into a number under 200 but higher than 100 was OK, since 1 unit is such a small amount. But I still felt uncomfortable giving Turtle her AM dose when she was at 138, so I did not. I gave her her regular AM meal, but I did not put out her mid-day food, hoping that this will keep her BGs from rising too much during the day.
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That vet is correct. We always dispense the advice not to shoot under 200 to "newbies". Two reasons
1- the stress and uncertainty that comes with being a newbie. You don't have a lot of data yet, and haven't collect the numbers to show what a given dose can do, plus things like "settling into a dose" and diet changes can be happening at the same time. Too much going on at once.
2 - dealing with low numbers can be nerve wracking. Nobody wants a new person to be staying up all night worrying about their first "hypo" incident. Most times, it seems kitty is just fine, and it's the people who need the help more than the kitty.
Once I had been dealing with Bob for weeks, I routinely shot doses into low numbers, like even under 100 numbers. But by that time, I had already seen what "X" units would do to his BG, so I didn't worry as much shooting 1 unit into a 90 as I did shooting 2 u into a 350 actually. I was always scared at first. You will reach a point where you will know when to worry, and when to trust your gut. Just not yet. Vets (some) are used to dealing with a crisis, and they have the resources and knowledge from past experiences that lets them "recover" quickly if BG goes too low. At least if they have had to deal with emergency hypo sorts of things.
It is natural for you to feel uncomfortable. First off, it is your baby, and you've got a lot invested in that fact emotionally. Vets can step outside of the "emotional" connection and realize it's just a patient, a problem, and they know a solution. I would think it is easier for a vet to treat your animal than one of their own pets.
1u is a "small amount", but of course, ECID. 1u was "nothing" to Bob, who at one time got 4u BID. But look at Cassie, who has big reactions to adjustments of just 1/10th of a unit at a time. Others do as well, but I use Cass as an example because his regular doses run between .1 and .3 units. THAT'S a small amount!
The Vet I talked to cautioned against messing with her dose. It seems to be conventional wisdom that you want to keep her at the same dose for several days. But how can you do this if it means shooting into low numbers? I'm not comfortable doing that yet!
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Again, until enough history is there to look at, the standard advice is to pick a dose, and stick with it. Kitties take a few cycles to adjust to a dose, and switching doses often confuses us and the kitty. The "trick" is to find a dose that works to keep the numbers more consistent, so you aren't having to deal with "do I or don't I?" questions often. Ideally, you want around the same reading AM and PM so the doubt and uncertainty are taken out of the equation. You'll get there, and fairly soon I think.

Would it be a bad idea to cut her dose in half again and start with 1/2unit BID tonight instead of 1 unit BID so that the numbers will not be going so low into AM shot time?
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Not a bad idea, but I think playing with food and mealtimes would be the first variable to try.
Or, should I perhaps trying one shot of 1u in the AM and no PM shot? Based on her feeding schedule (more food in daytime than night), she seems to need the insulin more in the daytime than she does in the nighttime.
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Not the best choice. Changing the dose would be better if the food thing doesn't work.
Or, should I eliminate this mid-day meal and give her two meals a day to level the playing field between the AM and PM cycles?
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OK, now I'll get to the food thing....
When Bob was on insulin, I only fed him 2x a day. Around 6-7, AM and PM. I actually don't think that was the right thing to do. Especially after I read where people have had success with multiple small feedings throughout the course of the day.
Food raises BG. Insulin makes it drop. I have come to think that spreading that "BG boost" in smaller amounts over the whole day seems like a better idea than giving two big boosts a day.
With Turtle, you are getting low AMPS and higer PMPS, correct? And, you have seen that her middle of the night numbers are pretty much what you see the next morning at AMPS?

You feed her at 7am, then sometime during the day on a timed feeder, then at 7PM?
What time does the timed feeder dump her some food?
I see a couple of possibilities with scheduling the food dispensed by the timed feeder.
One, maybe set it to "open" a little earlier, so that she eats the food well before her PM test. I think the food should only be making her rise for 2 or 3 hours, so if she ate it all before say 3 or 4PM, it should have cleared her system by shot time. The other thing to consider is maybe she is digesting that mid-day feeding right around the time that the insulin is starting to disappear, so there's nothing to push the BG back down?
Two, maybe make it 4 meals a day, and have the timer dispense food around noon and midnight, so that her food intake is the same daytime and nighttime?
When she eats, is she a "grazer", or a "hoover"? Does she nibble, leave and come back and nibble some more? Or does she pretty much vacuum the bowl in a few minutes (like Bob does)? Either way works, but it matters in terms of understanding her cycles and numbers.

The alternative is to shoot .5 AM and PM. That keeps her daily total the same, but might make her numbers more identical AM and PM.

Carl
 
You want to stick with the 12/12 schedule because cats metabolize the insulin fast, shooting only once a day would leave kitty without any insulin for 12 hours and could potentially set her up for DKA or worse. We wouldn't want to risk it.

I like your idea of lowering the dose to .5u twice a day. That way she's not surfing past schedule and should give you shootable bg's at PS's. If you could do a curve on the .5u we would be able to see how the cycle looks.

I will agree with your vet that in the beginning it is a good idea to stay at a dose for several days to let them settle into the dose and insulin, but not if the dose is obviously too high and you were absolutely right not to shoot into a bg of 138.

The reason we say not to shoot if the bg is under 200 in the beginning is because you havn't been testing long enough to start seeing patterns emerge. But once you have gathered enough data and know what to expect you can change that.

I also don't think that 1 unit is a small amount of insulin for a cat, there are some here now, and some who have moved on who have regulated and or gone OTJ never dosing 1 full unit.

ECID, you need to find the right dose for Turtle and so far your instincts have been right on.

I think you could continue feeding her the mid day meals that she's used to, I free feed my crew every day and night. If down the road you think that the food is spiking her bg's then you can experiment with that later.

For right now just let her get used to the insulin and testing, you two have just now put on your dancing shoes and are beginning to learn the dance steps together.

You are doing a great job.
 
With Turtle, you are getting low AMPS and higer PMPS, correct? And, you have seen that her middle of the night numbers are pretty much what you see the next morning at AMPS?
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Yes, exactly.

You feed her at 7am, then sometime during the day on a timed feeder, then at 7PM?
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Yep, it's timed to open at 1:00pm. My husband is usually there to make sure she actually sees the food (her hearing is going, so she doesn't hear it opening) and eats it around the time it opens.

One, maybe set it to "open" a little earlier, so that she eats the food well before her PM test. I think the food should only be making her rise for 2 or 3 hours, so if she ate it all before say 3 or 4PM, it should have cleared her system by shot time. The other thing to consider is maybe she is digesting that mid-day feeding right around the time that the insulin is starting to disappear, so there's nothing to push the BG back down?
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Some days I'm not sure what time she actually eats the food, but when my husband is there is makes sure that she eats about 1:00, when it opens. 12:00 would be even better, as he's almost always still at home then.

Two, maybe make it 4 meals a day, and have the timer dispense food around noon and midnight, so that her food intake is the same daytime and nighttime?
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This I could do. I could easily give her a feeding before I go to bed.

Code: 
When she eats, is she a "grazer", or a "hoover"? Does she nibble, leave and come back and nibble some more?  Or does she pretty much vacuum the bowl in a few minutes (like Bob does)?  Either way works, but it matters in terms of understanding her cycles and numbers.

Hoover all the way!

The alternative is to shoot .5 AM and PM. That keeps her daily total the same, but might make her numbers more identical AM and PM.
Click to expand...

So perhaps an action plan to begin with would be to keep her at 1u twice a day but spread out mealtimes as discussed above, then consider cutting to .5 twice a day if the numbers do not seem to evening out?

Thanks so much for plowing through all that!
Avery
 
Just one comment, on the last thing you said.
Try the midnight snack, but - Continue on 1u BID ONLY if it gives you a shootable number for the AM and PM shots. If you continue to have to skip one shot or the other, then what Robin said applies - reduce to .5 BID, which should bring the numbers closer to "equal", and eliminate what seems to be a longer duration on the 1u dose than what is "normal" right now. It looks like the 1u is lasting longer than the 8-10 hours we would expect it to last.

Carl
 
Thank you all *so* much. I feel so much better about what I'm doing now. I will do a curve this weekend and hopefully be posting some more numbers soon.

Y'all rock!!
Avery
 
I have some new numbers and update on Turtle.

I decided last night to start her on .5u BID (down from 1u BID). I was planning to do a curve and monitor her all weekend and be prepared to test ketones so I thought I should grab the opportunity.

Last nite at 7:00, she got .5u and food. Her PMPS then was 236. These numbers followed:

+1 281
+4 195
+5 midnight snack - 1.5 oz FF
+7 143
+9 137
+12 141

These are very similar to the pattern I was getting the night before, after I had given her 1u for her PM shot. The following morning (yesterday) I didn't give her an AM shot because I didn't want to shoot into her AMPS, which was 138.

I decreased to .5 for last night's shot in the hope that it wouldn't stay so low through this morning, but as you can see her AMPS was 141. So again, I didn't shoot this AM. Here are the numbers for today:

7:00am 141 (which was why I didn't shoot), food
8:00am 161
10:00am 188
12:00pm eat
1:00pm 195
3:30 pm 228
5:00pm 221

Not sure what to make of this. The numbers seem good but I can't seem to get her BID.

The way things are going it doesn't look like the numbers will have gone much higher by 7:00pm, her normal shot time. I was thinking of doing the .5u again then and then seeing what happens in the morning. I'll do a reading at 1:00 or 2:00am but man I've got to get some sleep! :)

By the way, Turtle seems to be feeling great. She's never been the world's most active kitty but she seems more alert, happier. Just like she's feeling better. Eating well, grooming, urinating normally, "talking."

Thanks!
Avery
 
It is a "problem", but not really a bad one to have. And, she might be able to get off the insulin just with one shot a day which wouldn't be a bad thing either.

Stick with the .5 for tonight, and get a test after if you can. Don't push yourself over the line. Sleep is a good thing! Sometimes (usually) any time you make a dose adjustment, it takes several 12 hour cycles until her body adjusts to it. It could be that you'll get the results you are hoping for after another day or two on .5 units. Either she'll adjust and give you a shootable number for both shots, or..... she'll give you a "no shoot number" for both shots.

Things are looking pretty good from where I am sitting!
Carl
 
Carl is right, this is a good problem to have.

You could also drop your dose to .25u bid to try for shootable PS's.

Only shooting once a day makes me nervous, are you able to test for ketones?
 
Yes, shooting once a day makes me a little nervous too...

I just gave her her 7:00pm test and she's at 217! The numbers have been very close together since 3:30 (3:30 228, 5:00 221). This is strange as I thought it would have been rising by more now.

I'm reading that you should test for ketones if no insulin for 12 hours and high numbers. I thought she'd be OK if she was still in the 200s. But I'll definitely test - I have the strips. I tested her the other day when she was over 300 and she was negative for them.

It's shot time. Perhaps she is starting to adjust to the .5 and leveling out some? I am going to stick with the .5u tonight. I have a better idea now of how low she goes in the night now so I'm not too concerned she'll go too low. I will do a 2:00am reading to be sure though.

I don't know if I can even manage .25...I have the 100U syringes. They have half-unit markings and so the .5u was easy to do.

Thanks !
Avery
 
It's the U100. I know you can do smaller increments with U40 syringes, but then you have to also get the U40 insulin, correct? I don't know how quickly I could get it...the U100 is on 2-week back order with VPA as it is according to my Vet. :(

Thanks!
Avery
 
Ok, the conversion chart is only if you are dosing U40 insulin with U100 syringes.

You could eyeball the .25u dose by getting the plunger between the half unit mark and the zero mark.

Strong reading glasses and magnifyers can help with micro dosing.
 
The way I try to get 0.25ish is to position my finger in the angle between the plunger and the syringe, and roll my fingernail down/inward while holding the plunger of the syringe - kind of a rolling/pinching motion that (for me) is more controlled than just pulling on the plunger.
 
I see what you mean...I got a syringe out and practiced. I think I can do this if necessary especially if I use the magnifying glasses too.

Thanks! I'll see what the .5 does for a few days, and I'll be ready to go to .25 if need be.
 
Sigh...Here I am this morning with an AMPS of 148, so I don't feel I can shoot (again!).

Here is what happened after her 7:00pm shot (.5 U) and meal (PMPS 217):
+3 Midnight snack 1.5oz food
+4 245
+6.5 193

then down to 148 this morning.

The 245 number was about 40 points higher than the same time the previous night, but she did have her midnight snack about an hour earlier. I've been stalking this cat all morning waiting for her to pee so I can test for ketones. :)

Again, I'll monitor her throughout the day. Unfortunately it looks like I will have to run her to the Vet today because she has not pooped for a couple of days. The FF gave her some righteous diarrhea so I didn't expect her to be regular for a little while, but now I'm getting worried. The stress will probably drive her BGs up and the rest of the day's readings will be useless. :(

Not sure what to do. If I give her the .5 tonight, I risk another no-shoot number in the AM, then I'm not here all day to monitor her. I could try the .25 tonight in the hopes of getting a shootable number in the AM, but if it's not shootable then she still goes all day with no insulin while I'm at work and even less of it left in her system from the night before.

I'm leaning towards sticking with the.5 tonight, because her numbers have not been going up too much during the day.
Off to call the vet now...
 
I would try the .25 unit to try to even out her bg's and get shootable numbers at PS's.

You have a good chance of getting her regulated and maybe more if you can get her on a 12/12 schedule and keep insulin in her system all day to let her Pancreas heal.

Good luck at the vet, I hope she's ok. Are you adding water to her food?

Please let us know how is goes at the vet.
 
Turtle is home from the Vet. She seems OK - Vet did X-Ray and found nothing scary, just a colon chock full o' stool. She's plenty hydrated and is drinking and peeing normally. He gave an enema which produced a nice amount of poo. She got some Lactulose Oral Laxative before she came home too.

She's acting like she feels fine. Thank goodness. Don't know what Lactulose and stress will do to her BGs but I'll let her rest a little while before I test her.

I think I will try the .25 tonight as you suggest.

Whew. What a weekend....lucky for me I have no social life! :lol:

Avery
 
Turtle returned from the Vet with her BGs at 320. That was at 12:00pm. She had an enema and Lactulose administered at the Vet but she seemed fine. Negative for ketones. Ate at 12:00pm. Just now at 4:30 her BGs were down to 268. Does it seem to be a good sign that they came down on their own (she had no insulin this morning)?

I'll try the .25 BID starting this eve. Since the dose will be so small, what could be considered a shootable number? Still over 200?

Thanks!
Avery
 
Good thing you took her to the vet, I'm glad she's feeling better.

Yes her bg's will come down naturally as the stress level drops.

I'm glad you decided to go with the .25u, Yes I'd stick with 200 as a no shoot number for now until we see some patterns start to immerge. I havn't looked at your ss today though.
 
Turtle has shootable AMPS!

Yay, it's up to 223 this morning so I was able to give her a morning dose for the first time in 4 days (.25u).

Here's how it went last nite-- PMPS 269
+2 285
+4 245
+7 234

Can't test any today because I'll be at work. :(
Avery
 
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