Sam is back at the vet's this morning

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KristenP&Sam

KristenP&Sam

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I called my vet and left a message around 5:45 am, then got up and tested Sam. BG reading was "hi" on the meter. Not happy about that. Anyway, when the vet called at 7:30, I explained what had happened, my concerns about rebound and too much insulin, and they said they wanted me to bring him in so they could monitor him for the day. So, I just got back from dropping him off and hopefully will hear something in a few hours. He's been acting fine, not at all like he doesn't feel well.

I'll post news when I get it.
 
Hi Kristen. I just wanted to tell you my ketone-testing method. Charlie is a very low squatter, too! I tape the test strip to a long, thin stick and wave it around under his rear end while he pees. It let's me get close to the litter but still get a good test sample, without having to keep a spare box, or collect in a cup or ladle. Maybe this'll work for you!
 
Just talked to the vet's office. They gave him his regular dose (2 units) and are monitoring him. His first reading after the shot was 3-something. Sorry, my mind just blanked on the number. 363? Can't remember now. Anyway, they're going to start checking him every hour and if the numbers get too low, they're going to look into lowering his dose or switching the kind of insulin he gets. Not sure how I feel about this. I was hoping they were going to lower his dose to start with. I don't want to get frustrated with them because they've been really good with Sam and seem very open to new ideas, but if he spikes again tonight, I don't know what I can do differently.

They close at 5:30 today, so they're basically watching him through the easiest part of the day. Okay, I am frustrated. When I call at 4:30 about picking him up, I'm going to insist I talk to the vet herself.
 
If they cannot lower the dose then TID [shooting 3 times a day or every 8 hours - and spreading the current 4u per day over 3 shots] would be the option to try hopefully for a short period with ProZinc or the other insulin I would recommend would be Levimir [as supposedly Levimir has some of the flexibility of PZI and is a longer lasting insulin. But the way you use longer acting insulins is very different than ProZinc/PZI.

Technically from the data you have so far, Sam is not going "too low" right now. A nadir in the 100's is technically just fine. It is that the change or "delta" from 500ish to 100ish that is too big. That if anything is what is causing rebound - but this may not be a rebound situation and might be a duration problem. One way to test the rebound issue is to reduce the dose. Since you cat has keytone history then I would hope to do that gently/slowly and maybe have you seek input here from someone with keytone experience first.

They way to handle duration issues [the insulin not lasting long enough] is to shoot TID or change insulin to a longer lasting insulin like Lantus or Levimir. Technically there is a third option of using an "R" [R is an old style short acting insulin] booster but I'm not sure that's something you want to take on but it is a possibility. So on the duration theory the insulin is simply not lasting long enough - it poops about then at the end of the curve [and start of the next] the cat is basically used up all the insulin and thus the BGs go way up. If the duration was longer then there would be time for the insulin to still be in effect at the end [and beginning] of the curves.

The problem with Lantus or Levimir is that they are long acting and take time to build up in the system to be completely effective. So there would be a lag time between when you start the insulin and when Sam "shed" of that insuilin had built up. Normally this is not a problem, but for cats with keytones this can be a problem. And sometimes I've seen recommend again an R booster during that short period that it takes to get going with it.

Anyway, I hope I'm not making you more confused. I'm just kind of talking aloud so when you take to the vet you might have things to ask about.

And lastly Lantus is not a bad insulin by any means so if they want to switch you to that, then that's not the end of the world. But Levimir would be nice and I'm pretty sure it's dosed much like Lantus in the beginning - then I think later you might have more flexibility to make it conform to how you want.
 
Small update. Sam's bg was at 61 at 4pm, so they feed him some Hill's DM. That's really low, in my opinion. Lower than it's ever been for me. I go pick him up at 5:15 so I hope to have his full curve by then. It worries me for tonight tho. Although, I'm sure they didn't free feed him like I do. That's bound to keep his numbers up too. Again, I'll find out exactly what his food schedule was like too. I anticipate another semi-sleepless night.
 
LOL They saw what you have to deal with and said, "Uhmm here lady, you can have this one back." ;-)

At least they got to see a little flavor of what's going on.
 
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