Risky 9/17 curve--+8 surf +10 rising pmps 452

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kse

kse

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Martha is traveling, so she is sending me the test results to post.....

For those that did not read the last thread completely let me restate a few things---she tested him last night +18 (since insulin--7 units) and he was 368. She is feeding him dry and canned tuna and working on trying to transition him to something wet--even if it is Medium carbs. She tested for Ketones this morning and they are negative! She is aware that she must be vigilant with the ketone testing with the reduction in dose.

I advised her to leave the dry out today. Obviously, it needs to go--but...low insulin, and not eating good (doesn't like the wet) can spell trouble. So, we know he needs to eat something.

So here is the curve for today

(an early gut reaction to me is the 1 unit is too low--but, it will be interesting to see what the cycle presents)

Does anyone have any suggestions? Is everyone comfortable with the strategy? Thoughts please!


amps 477--shot 1 unit and fed tuna and dry (more tuna than dry--maybe 3 tbs. of dry)
+2 586
+4 519
+6 444
+8 432
+10 504 eating tuna
pmps 452
 
Re: Risky 9/17 curve---looking advice!

Obvious boost from eating. Remember too that dry food boosts stay around longer than those from wet. About what I would expect so far.
Carl

The drop could be the insulin starting to kick in.
 
Re: Risky 9/17 curve---looking advice!

I don't think the numbers are that bad for 1u .... poor baby, he has been saturated with so much insulin that I think I would stay with this UNLESS his PMPS is HIGH, then I might go to 2u but staying with 1u would be the optimum. All in all I think this looks good.

I would also have her go out and buy many varieties of low-med. carb food and try and see what he might eat but am in agreement that the dry is needed until then. All in all a very good job!
 
Re: Risky 9/17 curve---looking advice!

as we know the dry has to go, its bringing his numbers up.
I would wait to see what the +6 and +8 are, (if she can)
to see how low the one unit will bring Risky down. If he is going to stay on the dry for now
I would up to at least 2 units....how is he acting today? any difference in his behavior?
 
Re: Risky 9/17 curve---looking advice! +6 still dropping!

I wish we had left the insulin up a bit higher, especially since the dry food is still on board. But, now that she is on one unit, I would stay there for another cycle or two, working really hard to get rid of the dry food (Parmesan, tuna juice, heating the wet up to be stinky....all those tricks), testing often for ketones. These numbers are still better than she had before, but too high for my liking.
 
Re: Risky 9/17 curve---looking advice! +6 still dropping!

I was with her yesterday when she was trying the wet food---unless he will eat flaked tuna cat food, I think the dry is going to be around awhile. She is mixing tuna with the wet and he is eating some. He LOVES tuna!

Depending on the pmps, I agree that I think the 1 unit probably is not enough and there is no need to spend a lot of time there (risk reward mentality)...if we increase tonight...assuming the preshot is high...would you increase to 1.5 or 2?
 
Re: Risky 9/17 curve---looking advice! +6 still dropping!

Do you know what dry food she is feeding Risky? I was just looking at Janey & Binky's dry food chart:
http://binkyspage.tripod.com/dryfood.html

I know dry food isn't a fan favorite on this site for good reason, but it looks like the Innova EVO Cat and Kitten is 8% carbs. It would be great to get Risky switched to a wet food diet, but in the mean time can she get him on a lower carb dry food?
 
Re: Risky 9/17 curve---looking advice! +6 still dropping!

He is eating science diet light.
 
Re: Risky 9/17 curve---looking advice! +6 still dropping!

Good idea, Marcy. Science diet is one of the highest carb food. I am convinced it made Oliver diabetic. Even a lower carb dry would help get the numbers down while she works on converting him to wet.

Sometimes tuna juice on wet helps.
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

I talked with Martha about the food...she has some Purina DM and says he will eat most dry foods. It is her intent, to mix the DM (Appears to be 13 % carb) with the Science Diet (40 percent) at a 50/50 blend. That should help reduce the carbs and then she can continue to increase the DM. While 13 perent sounds high--it would be Great if Risky would eat it.

That being said---what dose tonight? I will post the PMPS, but give me some suggestions or ranges.

She is testing for Ketones.

Thanks!
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

What we need to remember is the basic tenet that says to stick to a dose to determine what it does before increasing or decreasing, and we usually say 3 or 4 days minimum.
Think of this a brand new "case", where Risky is newly diagnosed and just starting diet/hometesting/insulin changes.
If Martha had just joined, we'd be telling her to start on 1u BID, change to wet, and home test like crazy....

Yes, we all know he's been on 8u, but try to forget about that for now. This is pretty much a "do-over".

IF we determine that maybe 1u needs to be upped now to 1.5, or 2, then we need to draw a line somewhere, and quickly, otherwise Martha and Risky are going to end up on the same ladder they just crawled down off of. If everyone agreees on a dose in the next day or so, then we need to encourage that she stick with it for at least say 4 days so we can get a clear picture of Risky's reaction. It takes a few cycles to "settle" into a dose. Maybe draw a line in the sand - if Risky stays below 450, 500, whatever, then he stays on 1u BID, or if over that imaginary line, he stays at 1.5 or 2 for 4 days. What is most important to me is that we quickly determine the right dose, and then we live with it for 4 days. I need to see a whole day before trying to figure out what the "right" starting dose needs to be.
We can't be sure right now when he really reaches nadir, for instance. Could be 4, 6, 8 hours. One cycle isn't going to tell us a whole lot. Just MHO :smile:
Carl
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

Actually, I agree with Carl. We are really starting again and unless in goes in the real high range? whatever it is decided, I think we should stick with the 1u unless we start to see ketones, and then it becomes a new ballgame. At least figure out when his nadir is?

I think, IMHO, for what he has been through and what his body has endured, he is doing great!! and new bean Martha is learning so much, so quick .... great job!!
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

Kim
You're our "independent observer" on this, so a couple questions. You've seen Risky. Did you see signs of dehydration? Anything that leads you to feel that he's an immediate DKA risk? Did you poke around his belly and notice any signs of pain like would make you think P-titis? Neuroptathy evident, and would methyl b-12 be a good idea?

Carl
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

agree. stick with one unit for a couple of days unless he starts acting different or sicker
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

Agree. But if he will eat any dry, I think switch immediately to the Purina and quit feeding the Science Diet. At least we get the carb count down a little.
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

Let me be honest with all of you! This is so much harder on me than normal, because I actually feel responsible for someone else's cat. While I always try to give good sound advice, it so different this time. I don't want to put Risky at any risk!

Okay, I feel better getting that out.

In the two hours I was at Martha's house, I saw nothing that would have led me to believe Risky was "sick" or diabetic. While he has lost weight, I would not have noticed it. He did lay around and Martha said he use to be very active--but, he didn't appear in any pain etc. to me. I asked about his hind legs and if she had noticed any weakness and she said, "Yes." She even went as far to say that his legs go out from under him when he is on tile floors. I had some Methyl B 12 and I gave her some pills. I am sure she hasn't started it, she was going to check the dose first. The pillls I gave her were 3 mg. Does anyone know the dose for a 15 pound cat?

My biggest concern is ketones, probably because I have witnessed DKA first hand. Obviously, when he was getting 7 and 8 units he was getting enough insulin to ward off any or most ketones. When dropping back to 1 unit---it is scary to me. Not, that I disagree--just scary. She is testing for Ketones...so, atleast it will not slip up unnoticed. Risky is a very mellow cat---no problem to test, shoot or check for ketones.

So, let me confirm what I "hear" you saying.....unless the pmps is HI....stick with the 1 unit, try to switch to a lower carb dry food (she thinks this is feasible...the DM is 13 carbs and she says he will eat it....time will tell!), test for ketones and continue to get at least a couple of mid cycle test. Is this correct?

Thanks!
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

For the record---+10 at 6 pm est and pmps at 8 pm. I would love for you guys to check the numbers out when I post them!
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

Sounds like the plan. I understand completely. A friend here in town asked for my help with her diabetic cat and I was incredibly nervous. (turned out great - cat off insulin in 3 weeks - basically just needed a diet change. But giving dose advice was scary.) It is harder to feel responsible for someone else's beloved pet. You are doing great, Kim.
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

(((Kim))) I know how you feel. It's great that Martha is on the board and is learning so quickly. She has you to thank for that.

Regarding the lower carb dry food change, just remember that the higher carb influence will take a few cycles to clear.
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

Kim,
Yes to your questions, that sounds like a good plan.
Totally understand you feeling different about this case. To you, this is a real person with a real cat that you have met, seen and touched. That does make it a whole 'nuther thing. I am extremely glad that the way this group interacts is allowing you to toss all this stuff out here and ask for a group consensus. We are ALL learning more by taking part in this "group therapy" advice exercise. It's also different for us, because this is the first time since I started posting here, that someone has been right there seeing things with the sugarcat and the bean. Having you "there" let's us see a view that is somewhat removed from the normal kitty/bean relationship, and not skewed by a personal history of Risky. Make sense?

I know it has to be stressful for Martha, because of course she's worried about her precious baby, but it also has to be a tremendous relief for her to have you close by. You're doing such a wonderful thing here, Kim!

Carl
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

agreed with the one unit and hopefully a less carb dinner

now for the methyl B - Shakes has BAD neuropathy, I was carrying him everywhere!
I started last year on 5 pills a day
and since he started PZI he is getting a little better so I reduced to 4 pills a day
and he isgetting around pretty well, so it really depends on how bad it is
I would start with one pill, 2 times a day and see what happens from there
 
Re: Risky 9/17 curve--+8 surf..let's talk pm dose

I agree Carl, I think it is great we can work together to help someone. We have a great group of people in PZI and it is a pleasure interacting with everyone here.

One thing that just hit me, based on What Marcy said about it taking a few cycles for the dry high carb to clear...that is more reason we probably should hold the dose. If Risky starts eating a different dry food that is lower carb and we raise the dose to quickly, we could get a scary cycle where the higher carb wears off and we have a dose increase. Did that make sense? :lol:

I am waiting for the +10--I told Martha to expect it to be higher. While I would love for Risky to be in better numbers, I actually hope he is surfing or increasing, so we can see the "normal" PZI curve and react.
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

I dont know about you guys but I am ready to break out the wine,
and before you know it the"I love you man!" will start!
(haha)(trying for comic relief, and it is saturday!)
anyway,

it is great that you are there and can help Martha...great job Kim!
/Iwill be looking for your post on numbers and hopefully wont fall asleep before 9
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

I am expecting a mid 500 preshot....are you all sure we should not increase the dose some?
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

did I miss the +10?

Carl
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

+10 is 504

Curve on first post...
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

Your mid-500s is probably right on the money. I still stick with 1u, and lets see where we sit 24 hours from now. Is Martha okay with our strategy?

Carl
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

She knows 8 Units is too much! I am hoping she will pop in and read the conversation before dosing....she said she would be on later, I just am not sure when it will be.

I just don't want Ketones!
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

Did someone say it was wine time????? drinking09

Not only is it going to take a few cycles for the high carb to wear off but I think it will also take 3 to 5 days for the rebound hormones to clear.

I agree with everyone that she try the lower carb dry food like Wellness Core or EVO at least it is a step in the right direction.

I would stick with the 1 unit and keep testing for ketones.

Kim you are doing such a great job for Risky, this group is AWESOME!

drinking24 I love all you guys, man.
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

I read on line today that EVO dry is 6.64% carbs,
which is actually lower than some of the wet food...

and yes I think it might be time to crack open the wine, or perhaps a beer
but it is too cold to sit outside tonight

I wonder how Barbara's daughters wedding is going!
 
pmps 452

I told Martha that the group advised sticking with the 1 unit for another cycle and testing religiously for ketones!
 
Risky ended the cycle just below where he started. That is encouraging due to the low dose, and still eating dry, don't you think? And he had no insulin last night?

Carl
 
Re: Risky 9/17 curve--+8 surf +10 rising..let's talk pm dose

dmartini4 said:
I read on line today that EVO dry is 6.64% carbs,
which is actually lower than some of the wet food...!
Click to expand...

It depends on how it's calculated. The label lists it at 7% nfe & Binky's lists it at 8% as fed. It seems to be the lowest carb dry option for those of us with picky cats who won't touch wet.

It's still dry & will affect bs numbers longer.
 
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