Sam +8 166, +10 581

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What was the story behind the AMPS of "354/473 "?

473 to 144 is almost 70% drop/change [or "delta"] which is pretty big.

But if he was at 354 then the slight rise to 371 might indicate just a hair not enough insulin.

That quick of a rise from 166 to 581 almost seems like rebound. But I would have expected it to happen earlier after the 143 than when it did.

It looks like you are getting lower nadirs over the past couple days - maybe because of the food situation.

You said you are free feeding which makes getting a bunch of food at +9 less of a possibility.

The only other possibility is that it's looking like maybe currently the duration of the insulin is not lasting long enough. And that's a whole 'nother can of worms. The way to attempt to fix that with ProZinc is shooting TID [sometimes for a short period] to attempt to get things under control. TID is three times a day or every 8 hours...

And we are still in that zone where things are changing from the food so it's hard to really make any conclusions.

I'm hoping other might chime on on you for some input. If not I'll try to drum up some eyeballs for you - but be patient. :smile:
 
well i can guess what it is. Rebound. gator you always say when a # takes a sudden jump...
and sam (who is so freakin cute!) is not accustomed to those blues.
 
The 354/473 was because I normally test him as soon as I get up, around 7 am, then again preshot around 9am. I need to go read about rebounding, that's something I'm not familiar with yet. Ugh. I thought we were having such a good day.
 
the 143 could have been followed by a yet lower number and the 167 just the beginning of the spike?
 
Any thoughts on what I should do? I can call the vet at the hospital, they're open 24 hours. Does one day a rebound make? Could this be him still getting regulated with the new low carb food and all?
 
Kristen you did have a good day. these types of things happen when you start having good days after many many bad days. it is not unusual or bad. sometimes we just call it a bounce as sam becomes accustomed to lower number his body won't feel the need to protect itself against them.
 
Thanks, Lori. That's somewhat reassuring. I've got the animal hospital on the phone now to see what they say. Will report back.
 
don't let them talk you into anything drastic...nothing is wrong. unless you are seeing other symptoms of an ill cat. has he been tested for ketones?
 
KristenP&Sam said:
Any thoughts on what I should do? I can call the vet at the hospital, they're open 24 hours. Does one day a rebound make? Could this be him still getting regulated with the new low carb food and all?
Click to expand...

First it is wise that you at least read about rebound for yourself:
http://petdiabetes.wikia.com/wiki/Rebound
and maybe a little here too: http://www.felinediabetes.com/FDMB/view ... 93#p318393

Rebound is not some emergency type thing. And some people don't even believe cats can do it. I'm actually not a strong believer in it but I'm not about to say it doesn't happen or is not happening here. For me it's more just something to consider as a path to potential solutions.

What could be happening is that now that you are on the low carb the numbers are not being inflated in the middle of the curve. So now you are getting more normal looking curves. And it's looking like they are getting deeper too - maybe from the continuing effects of the diet change.

Yea, beyond a duration issue, this cat could just not be used to seeing the lower/good numbers. She could increase just a hair and try to shoot though this. But I would encourage the use of U100 syringes to get the increments small enough. But again the diet change may still be ongoing which makes raising at this point more complicated and potentially more risky.

BTW this kitty was DKA.

Kristen answered some of the basic questions about her kitty here too:
viewtopic.php?p=334229#p334229

Kristen, you are still testing for keytones in the urine right?

Yea, this cat is gorgeous!
 
Talked to the animal hospital and gave them all of Sam's numbers starting with the 7 am one. They asked a bunch of questions, then said I should go ahead and give him his insulin early if I retested and he was still high. I retested and it came up on the meter as "hi", so I gave him his shot. One hour early. I'll be sure to check him early in the morning too, and will retest his bgs at 10 pm as well.

No, I'm not testing for ketones in his urine. I don't know how to get a sample because he squats down so low. I'm willing to try if someone has a method.

You know, every time he gets a high reading, I feel like I'm on the verge of a panic attack. I wish we could get regulated! I know it takes time. I really do know that. I guess the stress of Christmas and deadlines and everything else going on is making me a little thinner skinned than usual.
 
all of us were like that. welcome to the club. it get's easier. much easier.
this really is'nt anything i have'nt seen dozens and dozens of times.
take a deep breath and know your doing the 'sugar dance' :lol:
 
When I test for ketones I take away the litter and just put a little cut up newspaper in the pan. I keep watch on my cat, so I know as soon as she urinates. There is usually more than enough urine to put a strip into (the paper doesn't absorb it).
 
I could try to bring in another litter box. We have four cats altogether, so isolating one's pee over another isn't the easiest thing in the world... :-D
 
Kristen,
Please keep in mind that this DM thing is a marathon and not a sprint. So you need to pace yourself. And it come easier for some cats than others.

Not that a 500 is something to ignore or underestimate.

You do need to be testing the urine for keytone especially since your kitty was DKA. There are strips at the drug store that you can do this with. You can read this and this should help:
http://petdiabetes.wikia.com/wiki/Ketoacidosis

I know many here get a big cooking spoon and slide it under then when they go then stick the stick in that.

If that's impossible then you can just put a little fish thank gravel in the bottom of an empty litter box and then they will use that and the gravel will not sop it up. Keep in mind I'm not a keytone expert so if you want to get the mist tips on that you would probably do well to post something in the Health forum with a very descriptive subject like "testing for keytones tips/help"

Also I thought I would note that usually when I've seen cats that have other issues goings ons [like pain/stress/inflamation/infection/etc.] the numbers go high but the pattern is fairly erratic. Solely based on the very small sample of the two great curves you have achieved the patter looks currently fairly consistent. Just thought I would mention that, not really making any hard conclusions at the moment.
 
ooooooooo, ok, i missed the fact that sam was dka.
well, since i kinda do think it's rebound...is this idea sensible?
shoot less and go for a weaker curve until body becomes used to these somewhat lower numbers and gradually up dose?
or it that totally out of the box?
 
Hi all,

My 2 cents, looks just like rebound to me. It's probably been awhile since Sam has seen those pretty blue numbers and that was a pretty steep drop. It will clear.

But the 70% drop suggests a little too much insulin. I'm with Lori on this, I would reduce the insulin and let him get used to lower bg's gradually so he doesn't get into the habit of bouncing around. Once they start bouncing around it's hard to even them out again, you're always playing catch up.
 
lori and tom said:
ooooooooo, ok, i missed the fact that sam was dka.
well, since i kinda do think it's rebound...is this idea sensible?
shoot less and go for a weaker curve until body becomes used to these somewhat lower numbers and gradually up dose?
or it that totally out of the box?
Click to expand...
I think dangerous currently, especially until Kristen gets the keytone testing thing reliably under her belt. Which probably won't occur until the diet change thing is fairly complete/though the system soooo. I think Kristen should also have a convo with the vet about what levels of ketones are acceptable [or not] and what to do at those levels.

I don't know how diet change can effect keytones in newbies. I think that's a good question. Can diet change to LC lower the keytone danger point for cats? If it does then that would lower the [eventual] danger.

Kristen, please hop on the keytone testing thing OK? I think it's not only important but is going to be important very important if you need to potentially need to lower the dose because of the diet change. And the U100s will help you lower in smaller than .5u increments making any lowering potentially safer from a keytone perspective.
 
I have a feeling I'm not going to be sleeping well tonight. Just tested Sam's bg, approximately 2:40 after his shot. 216 - now I'm worried he's going to drop too low and possibly get hypo. I'm feeding him and he seems to be eating well, so I hope that evens him out a little.

What a rollercoaster of emotions this is. And now I'm second guessing giving him that shot early. I hate not being able to control this.
 
OK so approx +3 you are down from 581 to 216 - a lot. But you still have quite far to go until you are into danger zone. I think you are going to be OK.

Test again in .5- 1 hour and post.

Do you have any of the older high carb food around?

The testing IS your way to control this. So you actually have more control than you realize.

If you are doing rebound as we have been talking about then this would be a pattern of that. So the good news is that his little liver is fighting back and really doesn't like the low numbers. So it is trying to protect itself from low numbers and will most likely do so now.
 
I just fed him and he ate pretty well, so I feel a little better about that. Also, Gator, you're right about being able to control this somewhat with testing. Thank you for reminding me of that. I have some of the dry food left - not sure of the carb count or if Sam would eat it. Dry food was never his thing.

I plan on testing him at midnight. I figure that will give the food a little time to process. Will post again when I have the new bg.
 
Hi there, just wanted to tell you not to panic. I have been there several times with my cat, she has gone as low as 35, but as long as your cat is eating, the liklihood is everything will be fine. It's just a pain that you have to stay awake to test and figure out what food to give. I now have cans with various levels of carbs and I mark the number with a magic marker on the can so if we go low I know just which food has how many carbs. Iam wishing you luck and an easy night!
 
After tonight, I'm thinking dose decrease. And we'll just have to see what happens tonight. But I want to do it safely so that keytones do not become an issue. So we'll just have to get that keytone testing going.
 
Just tested - bg is 163. Also, tested once for ketones, but couldn't tell if it was normal or between normal and the faintest pink. What do you think of the bg? Should I feed him some more?
 
Especially since you free feed you should always have food available. It's looking like you are going to be OK. It looks like your drop is slowing.

The keytones might be an issue if you decreased the dose which I'm kind of wishing could happen. Maybe even to 1.5 like you want. I would have wanted to do it a little slower but if you are testing keytones then I might be comfortable with that. As I said call your vet tomorrow and ask about what level of keytones they are comfortable with and what they suggest keytone wise. I've seen cats here go along with trace ketones OK but the owners were doing SuqQ fluids too. How often are you doing fluids and how much?
 
Sub-q: Sam gets 75-100 ml (I shoot for 100, but sometimes he gets too squirmy) every day.

I'm calling the vet at 7:30 am when they open.
 
OK that's a good amount of fluids - and on a regular basis. Good.

What time do you do the SubQ? Any time around +9 during the day?
 
Kristen...

Beth, the other newbie here...

You're doing great, gal! I went through this 2 nights ago. Bud got down to 35. Rob, Lori, and Gator are THE best. Walked me right on through it. She was on 2.0, also, and the concenus was to decress her dose to 0.5. And, for now, it seems to be doing well.

I know it's hard to keep in mind that this is "the long haul" and bumps along the way will happen, but we're all doing what needs to be done and working through the bumps.

RE the U-100 syringes: GET THE ones with the 1/3 marks on 'em! not the increments of 10.

You really are doing great hon.
 
Update here: viewtopic.php?f=24&t=32208

Gator, I normally give Sam his sub-q's in the afternoon, so any time between +2 - +5.

Beth, thanks for the words of encouragement. I really hope the vet can figure out this dosing soon. (Yes, I understand I could be doing it, but honestly, that freaks me out a little) I also made sure to tell them not to feed him anything that wasn't low carb. I don't want his diet undone.

I plan on talking to the vet about the U100 needles when she calls later.
 
Vets sometime [most times in my experience] really do not like the idea of doing the conversion with U100 needles. So be prepared for feedback on that :roll: . Let them know you have a conversion chart [print it out right now and have it in from of you for the call and get used to using it before the call] and that you will triple check the conversion chart before every shot. Be prepared to do the conversion with them over the phone to make them comfortable you are up for it.

I just started using U100 syringes and doing the conversion without even asking my vet. So... And evey time I was in there he would be like "how to you measure 0.1u increments of insulin?" and I'd be like "with U100 syringes and doing the conversion" and he would say "really?!!" and I would say "yup, and I can 1000% tell the difference in H's BGs between increments that small." And he would just kind of look at me like I was crazy. Hehe, on a personal level for some strange reason I really liked that vet - he really DID care about kitties.
 
I've printed it out. Thanks for that tip. I like my vet, I really do. She knows that I'm one of those clients who is always willing to go the extra mile, so she seems to try to present every option when something arises. I don't think she'll fight me on this, but I do wonder about what she'll think of me changing the dose at home on my own. Honestly, it seems scary to me to do that. Like if I screw up, I'm the one to blame then. Make sense?
 
It is your responsibility to make them comfortable.

The biggest way to screw up here would be to a) give too much insulin and go into super major hypo which you can avoid by testing and not making doing increases that are too big [or not decreasing the dose if necessary when their BGs start to go lower]. and b) decreasing the dose too much and having the keytones return in a serious way.

This is why I wanted you to have a talk with your vet about what level of ketones are acceptable. And what the plan would be if you got say "trace" keytones on the urine stick [or more]. Even if you kept the dose at 2u what would be the plan if keytones showed back up? Ride the trace out or increase back up to where there were no keytones? If you reduce a little and get the return of the keytones then [it is my assumption since I'm not a ketone expert] that we would want to put the dose back up to a level that you did not have keytones before [right now that seems to be 2u twice per day].

The keytones really put you between a rock and a hard place. I've often seen here commented that keytones are a problem with too little insulin. So when they show up it is an indicator of too little insulin.
 
Okay, that's good to know. I'll ask about ketones when I go in this afternoon also. So much to remember! Time to start a list.
 
More questions for the vet:
1) what do you think about this being an issue with the duration of the insulin?

2) what do you think about Somogyi rebound's influence in her big swings?

3) what do you think about the current doses influence in this?

4) what do you think about shooting ProZInc TID or three times a day or every 8 hours - spreading the current 4u per day over 3 doses - at least for a few weeks trial]?


Of course shooting TID may not be possible humanly based on what you are able to do. You would max be getting 8 hours [and likely less] of sleep for instance. TID is every 8 hours not every 12 hours so you would have to think about how your would schedule that if at all. Ultimately if you thought duration was the issue then a change of insulin [to Levimir or even Lantus] might be a reasonable choice too.
 
Shooting three times a day wouldn't be that big an issue for me, because I work from home, but both my husband and I travel enough that it might make things really hard if we're both away at the same time. If it were just for a few weeks, that would be doable. I'll see what she says about the other questions.
 
If you think TID might be an option. You should check Hope & Aria's SS and info to give you an idea of what I'm talking about and what you might be doing:

memberlist.php?mode=viewprofile&u=1328

There was another TID though here about the same time It might have been Michelle & Prudence?

memberlist.php?mode=viewprofile&u=1283

And there might be some other resources I could see if they would get involved. I've not done TID myself so I would want you to have a "consult" here with someone who had done it before you engage in that.
 
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