Sam getting regulated Part 2

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sueandsamwise

sueandsamwise

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Well, Sam went to the vet today and they basically did ......nothing. My husband took Sam in and he never asks questions about why his numbers are so weird or anything! I told him some stuff to ask but he forgot. ohmygod_smile Course, he's still sick so that makes him stupid. He said the tech (not vet) said his numbers are fine, the low on the fruit test was 301. Keep doing what you are doing, give the same amount of insulin. We did get a new bottle so we'll be cracking that open soon. I guess I'll just have to make an appointment or find a new vet. This is driving me crazy, he has a good day then a crappy day. His health is fine, no UTI's nothing like that.

Sam was in remission for almost a year. He was on Vetsulin the first time. He is eating low carb food, not getting any illict food since it's been below zero here and he does not go out when it's cold. We'll keep testing and hopefully get some kind of stability in his numbers. I'm going to do another curve this weekend.
 
I think the curve is a great idea. I'm sorry you're struggling with this so much. It's rough, I know. Maybe the curve will help you figure something out.
 
Yeah, disappointing. I thought those 2 lower numbers would be the start of something big! He does seem to react in different patterns than I have seen.

Are you thinking increasing the dose or doing a curve first? Both are possible ideas.
 
Personally, I'd do a curve to see where your true nadir is falling. Might give you some better idea of what to do. Maybe someone else with more experience will chime in shortly.
 
Mmmm......Maybe up his insulin to 2.5. I read the conversion chart wrong and have been giving him 2.4 units not 2.3 the whole time. I am a dummy at times. Anyway, maybe up the dose a couple of days then do the curve. What do you think?

Oh Sam has gained another nine tenths of a pound since the last visit. He was not re-scheduled for another one.
 
I have to say that I agree with an increase. Only because you've been holding doses for good amounts of time, and have dropped back several times--so you can be relatively confident you didn't overshoot your ideal dose. Those freak low numbers are baffling, though. :?
 
Sheeeit! Sam's number at +3 was 32!!!! I am at work and my husband did a test about 10 minutes ago. He said he gave him several high carb treats and fed him. Sam ate it all. Now I am worried as hell. I shouldn't have given him the shot! :shock:
 
Wow! He keeps you hopping! You could tell DH to mix a little Karo in a little food and get another test in 15 minutes.

Does DH know how to get on FDMB? If he wants, we can walk him through it. He has a way to go before he can relax.
 
OKay I am getting ready to leave right now. I'll get back online after we do another test. Thanks gals. I have no idea what it is about Sam's. Sometimes I think they are jinxed!
 
Just curious- what's your no-shoot number? 2u's into a 72 amps seems like a lot of insulin to me. I hope Sam is coming back up, keep us updated.
 
Re: Sam getting regulated Part 2 (hypo)

Sam was 56 when I got home. I fed him and gave him a couple more high carb treats. My DH is going to test him again around 2 or 3. Whew! Next time I will not shot him if he's below 100.
 
So glad he came up. Is it +5 now? Continue to test until you get 2 numbers moving up.

I would have a number higher than 100 for a no shoot number. 100 doesn't give you enough room if he goes down. See what others think, but I would say 180 - 200 or so and then reduce the dose - don't shoot the usual.

Don't be surprised if you get a high number this evening. It can be a bounce or reaction to the high carb snacks. Don't overshoot it.

The thing I am most interested in is the 72 this morning. Where did that come from? He had been back in the 200 - 400s for 2 cycles.
 
I don't know where that low number came from. He was not Hi last night he was about 389. Maybe he was dropping then. I should have checked him last night before I went to bed. I've been exhausted since being sick for the last two weeks so tend to sleep right through which I almost never do. I'll be keeping a good eye on him tonight. nailbite_smile
 
I don't understand his patterns at all, but I think you need a game plan to deal with high and low numbers. I would not have shot this morning at all.

I hope Joanna and Gator can look at your ss tonight and see if they can make any sense of it. I wonder if he has really long duration, and shooting every 12 hours causes overlap until he crashes low?
 
Some cats do get uncharacteristic long duration on PZI. If this is what is going on there are 2 ways to approach it. 1) As Needed dosing [a link about this is in the PZI Sticky links] and 2) Shooting less insulin on the 12/12 [or approx]. I've never done as needed dosing so that will give you a clue what camp I'm in. So usually when I see extra long duration that means *to me* too much insulin. For instance I would get great "duration" [and even sometimes a much lower PS from the following PS] when H would go into a P-flare because he was not eating and thus his insulin needs would drop.

I've always been "overlap agnostic" and never really saw the effects of it with H so I really don't have too much to say on the overlap topic. My gut feeling is that would have to be a one crazy overlap effect though. But I think it is a interesting hypothesis.

I don't know what this pattern means. If we just look at the past 4 days it looks like too much insulin to me with the potential that he is rebounding in between. But clearly this cat has been at this more than 4 days and has only once before in the beginning of December demonstrated a pattern like this. Then is was back to being crazy high for a month. And also I think Sue did a brief "rebound check" at 1u for like 4 cycles? The question is if this past 4 days is a new reality then that's great and it looks like probably too much insulin. If not and Sam goes back to being in those crazy highs then see the next point.

If it turns out Sam does not do well with a modified dosing or we can't come up with any other solutions...
Honestly, to Pam's point, if you just went to the vet and you guys can't come up with anything that is going on with Sam that might cause the numbers to be wonky and we are sure none of the other things that can cause wonky numbers are happening [the winter weather is cooperating with this it seems], then I would be thinking about another insulin [probably Levimir]. My main worry is that whatever is causing the "crashes" that you seem to be having might still happen even with another insulin. But on the other hand just a switch in insulin is a magic arrow for many [and others not - some struggle for quite a while with the other insulins]. The nice thing is that we currently have a couple people from PZI that are working with Levimir and could try to help you through without the added requirement of tight regulation and everything that comes with that. I don't think it would hurt to contact/PM Marcy & Lori and just ask if they have any ideas for you about approaching Levimir "sanely" ;-) .

In the mean time we can see if you are in a new reality with Sam and if he may need less insulin??

Sue can you describe how the remission thing happened again. How did he end up going diabetic again? I'm sorry I did look back in your posts but did not find where you discussed remission.
 
Well, in 2009 Sam was DX'd with diabetes the first time. I found this group and started following the guidelines here. No dry food, low carb canned, etc. Sam was on insulin for one month then got OTJ. He was in remission for over a year. The diet worked. He was on Vetsulin the first time.
Then, I noticed that he was drinking a lot of water and peeing more. I didn't notice the weight loss at first until we had him shaved. He was very matted and the stuff I thought was weight on the cat was mats. We had him shaved and it was such a shock to see him so skinny. He had a vet appointment after Labor day of last year. Well, he didn't make the appointment. He stopped eating completely over the weekend so we got him in on Sunday. His BG was way up and he had full blown diabetes again. Sam was in the clinic for a couple of days, they got him eating and we brought him home. I had a fight in the lobby of the clinic with the vet over the food. I told her in no way was I going to feed Sam the DM dry or canned. After being a total ***** about it, she just turned around and left. They also told me he didn't need to be checked before the shots I was wasting my time. Stupid, stupid woman. Anyway, he was started on .5U of PZI (prozinc) in the morning and .75 at night 12 hours apart. We do not refuse food since he is so skinny so his numbers may be skewed because he eats before his tests.
 
OK thank you Sue for detailing that again. I'm sorry nothing really pops out about that to me to make me have any more recommendations. If I have any more thoughts later I'll post - sometimes when I sit on things and they sink in I get more ideas :smile: .

I was just thinking strange that I was just recommending more insulin a short time ago for you guys and now maybe less. That sort of thing would be indicative of a "break though" type scenario. I'm just hoping for you that the break though sticks this time.

When the numbers are high is seems OK to shoot as much insulin as you have been, but definitely when the PS is lower than 200 or so you do not want to be shooting 2u or more. You have a couple options as to what to do when you get to your "no shoot" that are outlined here:
viewtopic.php?f=24&t=32652
Waiting and testing is probably the preferred thing to do if you can.
 
Sue and Oliver said:
I wonder if he has really long duration, and shooting every 12 hours causes overlap until he crashes low?
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Interesting thought - when I have seen overlap it shows up in lower PSs though, so I wouldn't think that would be what is going on. To me, that would look something like:

Just raised to new dose:
AMPS 400 +6 250 PMPS 300
AMPS 250 +6 150 PMPS 200 +6 50

Totally made up #s of course, but the idea being that the overlap keeps the #s from zooming between PSs. To me if you are seeing regular 400, etc. PSs, you aren't seeing overlap.

I am in drive-by mode (sorry!) and looking at the SS the #s don't make a heck of a lot of sense to me either. Some cycles the dose looks too high, some cycles it looks too low, and some are just mega-wonky. :?

You tried pulling back to 1u and didn't get good results. The only thing I see in there is it looks like there was a jump back to 2u, and there's some chance that maybe there's a good dose between 1u and 2u? I'm not sure that's really the way to go, but I suppose you could try something like 1.5u for a few days and see how things shake out.

Do you feed him at all between shot times, or is he on a 2 meal a day plan? I am a free feeding fan, and especially if he is skinny, I'd let him eat as much as he wants at any time.

I hate to suggest considering another insulin simply because the #s are a puzzle, but I think there is a reality that there are other insulins with fairly straightforward protocols, and a boat-load of people using them and helping out. Sadly in PZI we are more limited in the size of our crowd, and the lack of a super-clear process for how to use the insulin, especially when the #s aren't straightforward. So I wouldn't say that there is no hope getting him regulated on PZI, but I'd say that unless *someone* is able to help you figure out how to use it effectively (and I'm out of ideas beyond what I've just typed - certainly I wouldn't consider raising the dose with wacky-low PSs like this morning's) it might just be reality that continuing on this track may be too much of an uphill battle.[ETA: my apologies to anyone who may be posting who does have some insight & a game plan - I only did a quick read and everyone looked as mystified as me, but I may have misread...]

When it seems like you've hit a wall, I generally recommend that people post on Lev and/or Lantus forums and ask for suggestions - should I switch? Is there hope for PZI? etc. There are former PZI users on both forums, some with extensive experience, and you can potentially get good tips, or more clarity that way.

Sorry not to be more help! Hope things come together better soon. I know I'd be tearing my hair out if I were you! confused_cat
 
His PMPS was hi just like I thought it would be so we are going to try the 2U again for a couple of days or at least a week to see what we get. I called my old vet today just to see if she'd call me back with some kind of advice. I hope to get an appointment or something out of it. She hasn't called back but we'll see, maybe tomorrow. What I need is a competent cat vet familiar with feline diabetes. Wish there was one around.

We are pretty much feeding Sam whenever he want's and that's quite a bit. He ate a lot of food today and he did have a few to many high carb treats. Those have stopped. Man, Joanna you are right I am tearing my hair out. I think I have a bald spot now on the side of my head! :lol:
 
Yes, he will be tested before every shot from now on. I just think it's warranted anyway. His +2 last night after his HI was 567 so it was falling. His number this morning wasn't bad, 344. confused_cat I am still confused about this.
 
Sue, when did you completely stop giving the high carb treats?

I just want to emphasize that there is no safe level of high carb anything for diabetics. Even 1 treat or 1 kibble or 1 anything. High carb food/treats etc. should only be given when they are in a hypo situation.

Thus even the storage of high carb foods have to be taken into consideration - can they sneak high carb treats from trash or unsecured storage places etc.? They are little carb sneaking missiles these diabetic kitties.
 
That's so true, Gator! If we didn't have baby-locks on all of our cupboards we'd never have bread to eat cuz charlie tries to get at it everytime I open the cupboard!
 
He had the high carb treats yesterday during the hypo. He hasn't had any for at least half a day and night. So a full 12 hours at least. His +10 was 192
 
Well, I hesitate to say this, because every time I do, he throws us a curve - but this looks promising. Those greens and blues look great the last few days.
 
Our drive is drifted shut due to blowing snow. Dammit! So, off to fire up the tractor to see if I can clear it. I will post new each day of AMPS and PMPS plus will do a +6 test.
 
BD brand ... at Walmart.

Although Walmart's ReliOn diabetic supplies page (http://relion.com/diabetes/syringes) says, "All three needle gauges are available in three different sizes (1cc, 1/2cc, and 3/10cc)..... NOTE: All 3/10cc syringes feature half unit markings" I've not been so lucky as to get them.
 

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Is that cheaper than Hocks? I found them very reliable and fast to deliver. And this website gets some money back, I believe , if you go to Hocks from the ad on the site.
 
I think the BDs are the same price at both Hock's and Wallyworld.... Wallyworld is quicker for me... we'll if you don't count the 3 trips and 2 wrong boxes and 6 phone calls... so I just made a donation to the site. :D
 
BTW I do not like the BD's. The GNP or Monoject are my favorites [I'm pretty sure they are made my the same manufacturer - Tyco].
 
eeraby said:
I like that I FOUND the 1/2u syringes. ;-)
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They should be 1/3cc, 1/3ml or 3/10cc or 3/10ml syringes. With 1/2u markings just so there is no mixup. :smile: Because it is so easy to get mixed up when one reaches the store.

This is the direct link to the ones from Hocks:
U-100, 31 (or 30) Gauge, 3/10cc or 1/3ml, 5/16 inch short needle, with 1/2 unit markings syringes (GNP Brand) at Hocks.com - example of what type and where to purchase. If you do purchase from Hock's, you can help support this site by clicking on the link at the top of this board and then entering your shopping cart items.
 
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