Pippin 8/5 curve

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Pippin's Team

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Hi. This is the first time we've posted on the PZI board. Our previous update on the main board is here. We're taking care of a recently diagnosed cat who was started on 1.5u of ProZinc. I changed the dose to 0.75 on 8/3 after one day of skipped shots and advice from Sue and Carl, then lowered it further to 0.5u. I did a curve yesterday.

AMPS 203
+2 113
+4 76
+6 108 (fed 1-2 oz at +5.75)
+8 164
+10 157
+11 157
PMPS 148

Today
AMPS 91 (no shot)

He's also drinking and eating less (1/4 can per meal) than he was before. I talked to our vet this morning and she said that she would like to see him stay above 100 mg/dl and mentioned that they'll want to see another curve or do a fructosamine test in 1-2 weeks, since he's only been on this dosage for a few days. Are his numbers are likely to start heading up again on this low a dose?

We would really appreciate any advice from you guys. Another important point is that my cousin and his husband are going to stay with Pippin this week (they are the ones who will be taking him for the long-term.) They are learning how to do blood tests and will focus on getting pre-shot tests, but may not be able to test extensively for a while. I'm planning to do another glucose curve next Sunday.
-Jamie
 
Hi Jamie,
Those are beautiful numbers! And no, I don't think his numbers will be higher on the lower dose. Last night he was at 148, and you skipped. This morning he was more than 50 points lower, with NO insulin. Let's see what you get at PMPS, but I'm very encouraged with his past couple of days. :smile:

Carl
 
Hi Carl,
Yay! That's good to hear! He was at 147 tonight at about 8:30pm. I was thinking it would be okay to shoot a small dose (0.5 or less) at 9pm - assuming he eats a good amount - and leave food out so he can eat more later. What do you think?

We're not quite sure what to do when he's under 200. My feeling is that in this situation, maybe we should check again after a half hour and see if his blood sugar is rising or dropping and decide based on that. Does that make sense? What are the chances he'll hypo if his blood sugar is in the 150-200 range and we're giving him 0.5u?

Sorry I have about a zillion questions. I'm trying to advise my cousin what to do, which is making me extra nervous. Thank you so much for your help!
-Jamie
 
Can you eyeball even less than .5U? I ask because that dose dropped him 125 points yesterday. You only have 147 points to play with...
You could shoot, but only a tiny bit like .25u if you can see that on the syringe.

The standard advice when you get a number below 200 and you don't have a lot of historic data, is to stall without feeding for 30-60 minutes, test again, and then feed and shoot if he's over 200. You want the number to rise, but without food, which indicates that the insulin is worn out.

Carl
 
The other thing you can try is go ahead and feed, then test an hour later to see if the food pushed him up some. Then test an hour or two later and see if the number has come down. This is all without a shot.
If he eats, rises, and then drops again an hour or so later, then his pancreas is what is pushing the BG down, which means he's getting better. :smile:

Carl
 
Can you eyeball even less than .5U? I ask because that dose dropped him 125 points yesterday. You only have 147 points to play with...
You could shoot, but only a tiny bit like .25u if you can see that on the syringe.
Click to expand...

Ah. Yeah, that would be... not good. Fortunately my cousin tested again and it was 94 so he skipped the shot.

I think we can do about 0.25 but there's no marking. Maybe we should get some u100 needles for these smaller amounts.

The other thing you can try is go ahead and feed, then test an hour later to see if the food pushed him up some. Then test an hour or two later and see if the number has come down. This is all without a shot.
Click to expand...

That is what I suggested my cousin to do tomorrow if possible.

Thank you again. Your advice here may have quite literally saved Pippin's life.
 
Looking at where your doses seem to be heading (tiny), I think the U100 syringes and the conversion scale are a great idea. It will let you dose tiny amounts with more accuracy and consistency.

Your advice here may have quite literally saved Pippin's life.
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Well, I wouldn't go that far, but with Pippin's short history, if the dose is in question, (and nobody is around to give you their thoughts), always err on the low side. It's easy to shoot too little and make up for it over the next cycle or cycles. Not so easy to "un-shoot" the insulin though. :smile: You can react to a too high dose if you are testing often and watching closely, and you have past history to look back on. You can say "hey, the last time he had a number like that at +3, he went really low" and you can intervene before the number goes too low.
A lot of what you do will depend on past data, and on your schedule (whether you can be there to test and feed).

I would dose "my cat" differently that I would advise you to dose your cat. Because, well, he's my cat, you know? I'm right here with him, and I "know him" and I know (only because I've done it) what to do when "X" happens. My basic advice to everyone is, even if you've gotten lots of advice, it all comes down to following your gut instincts. Always trust your gut, and your eyes. They can tell you as much or more than the meter can.

ANY time you have a question, please ask. If nobody responds and you need a quick answer, post in Health.

Carl
 
Hi everyone,
This is Tom, Jamie's cousin. I'm so impressed by this community! And glad to know there are people there who can advise us as we try to figure this out.
I'm on my second day of blood testing with Pippin and starting to get the hang of it, but it's always a production. So I'm not doing tons of tests yet, but I hope to get better with it. In the meantime, I'll try to get the crucial numbers.

So, Jamie posted last nights numbers for us. I didn't shoot and I left food out which was gone in the morning. I tested him at 7:10 this morning and got a 74. I'm aiming for feeding and shooting if necessary at 9 am. I'm still struggling to understand how to interpret all these numbers.
Should I be worried that the 74 is low?
He hasn't gotten a shot in 48 hours and his BG has never been above 157 at any reading.
My understanding is that if his numbers stay low, I shouldn't shoot. But if they are too low, should I give him a lower dose shot?
If any one could give me some advice covering best course of action depending on what number I get at 9, I would really appreciate it.
Thanks
Tom
 
If he hasn't had insulin within the last ~12 hours, he can't go too low. Just keep monitor ing. You don't want to shoot unless he's over 200.
 
Ditto what Lisa said. Kitties OFF insulin can go down in the 40s and it represents a normal number. (in the 40s ON insulin is a worrying low number). Yes, confusing.

But as Lisa said, as long as he is under 200 at shot time, skip the insulin. It looks like his pancreas has started to work again and it is keeping him in nice normal ranges without insulin. (this is fantastic news!)

It may be that the pancreas "gets tired" and stops helping out and that he will need a little insulin again. If that happens and you see that preshot number over 200, post and we'll help you figure out a tiny bit of insulin for a shot.
 
I agree. No shot if under 200 this morning.
Carl
 
Great, thanks!
At 8:15 his BG was essentially unchanged, at 73. I fed him, he ate an ounce, and we skipped the shot. Since he didn't eat that much, I'm leaving the food out and won't be around to know exactly when he eats. I will be around this evening and will do another blood test. In general, are there any specific times I should concentrate on getting numbers for other than before feeding?
Thanks for all your help!
Tom
 
For right now, I would just be sure that he hasn't eaten within 2 hours of your preshot test. Food can make the numbers go up or go down if the pancreas is helping out. And it is better for you to be dealing with a number that is not influenced by food either way when determining whether the number is "shootable".

If he were on insulin, we would be interested in a number midcycle, but as he is not on insulin, I would let him have a break today. Just the small frequent meals to support the pancreas.
 
In general, are there any specific times I should concentrate on getting numbers for other than before feeding?
Click to expand...

If you scroll up a ways, you'll see this, which only applies if you don't give him a shot this evening (or any other future scheduled test/shot time) -

The other thing you can try is go ahead and feed, then test an hour later to see if the food pushed him up some. Then test an hour or two later and see if the number has come down. This is all without a shot.

If he eats, rises, and then drops again an hour or so later, then his pancreas is what is pushing the BG down, which means he's getting better.
Click to expand...

Carl
 
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