Shaikha 6/13 t.i.d. + midcycles

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wombat88

wombat88

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After her bounce last afternoon, I gave her a lower dose and she was doing okay this AM. Did a rising number check, but she was still in the upper blues. Will see how today goes. She seems to be getting some more duration, but she still is having fairly early nadirs so not sure how to handle that best. Still plan to use t.i.d. for now. Should I think about b.i.d. or are her numbers where we want them to be (other than the bounces, of course). I know we need to get her into the greens during nadir. Just not sure how to get her there.

6/12 PMPS = 321, gave 0.6U (shot about 45 min. early)
6/13 numbers:
AMPS = 162/178, gave 0.6U (rising number check)
+3.5 = 124
MDPS= 156, gave 0.5U (cut back a little just to see if we can avoid a bounce PM)
+5 = 194
PMPS = 294, gave 0.6U
 
HI Wendy!

No advice--just wishing you a good day! It looks like she is getting in much better numbers.


Good luck if you make the vet visit today for the anemia!

Kim
 
Unfortunately, because she is still going into the 300's if you go back to b.i.d. now, she will go back into the 400's because she is still not getting any duration with the early nadir. Give her some time to heal more and get her #'s down steady .... remember the longer she stays in the 100's and 200's, without seeing 300's, she is healing. You are on a really low dose so you are headed in the right direction, patience. Have a good day!

Nancy and Payne
(who NEVER was on a dose that low :)
 
Thanks, Nancy. That's sort of what I was thinking. Though sometimes she's a little later and earlier, she still nadirs usually between 3 and 5 hours after insulin. Sometimes she's later, but only if I've done something unusual like shoot early. I'm sort of thinking w'ell need to increase her dose a little to get her into the greens, but am not sure how much to push it given the occasional bounces. She's definitely improving but I'm not she'll ever be a "normal" diabetic kitty. I was able to lower her dose because the antibiotics are kicking in, but even at our highest I'm afraid your Payne has got us beat. The only time she's taken a lot more was during periods when she had high fevers or was being regulated by my vet, but she was really out of whack then with numbers in black or over 600 continuously.

Do you or anyone else know a good range you usually want the pre-shot to be and what nadir should be so I know whether I'm getting close? I'm monitoring her more carefully so I know I can shoot if she's in the upper 100s without it causing problems but wasn't sure what the ultimate goal is with PZI or what is realistic. I know you don't want to swing too much, just not sure how much of a "swing" is what you want. Still trying to sort this stuff out some.
 
Re: update on anemia / vet visit

I just talked to my vet. He wants me to bring her in tomorrow so we can do a number of blood tests and smears that we'll send off to a lab for analysis. The plan is to determine whether her anemia is regenerative or not, as well as to see whether there is an issue like a parasite or virus that could be causing these problems. We'll also retest her PCV to ensure she's not getting too low. If she is, we may need to do a blood transfusion just to tide her over until the test results come back, but I'm hoping that won't be necessary. Her appetite is getting poor and she's not that active, so I am worried about how low she's getting, plus her blood is awfully thin, so those aren't good signs. We'll also retest her stools to ensure she's not losing blood there. At this point we really aren't sure what is going on with her. It could be nonregenerative anemia, though since her kidney function isn't that bad it seems unlikely, but it also could be a type of aplasia caused by an adverse reaction to medications she'd taken that makes her kill off red blood cells before they mature. Or it could be regenerative anemia caused by blood loss we simply aren't detecting. If it is nonregenerative, that can be fixed with drugs. If it is regenerative, then we've got some digging to do to find out where she's losing blood. I'll be on pins and needles waiting for these tests to come back, that's for sure. Whatever it is, I hope we can fix it. Some warm thoughts and prayers for her would be appreciated. I'm pretty worried about her.
 
Wendy, hopefully this is something you can treat.

Definitely keeping you and Shaikha in my thoughts and prayers.
 
My prayers are coming your way .... as far as the pre-shoot #, on t.i.d. you have the luxury of being able to wait for a better number, although Payne rarely goes low. Also pzi is very forgiving time wise. ProZinc "should" nadir at between +6-7 hours but remember ECID .... hit a nice 3-4 hour low, then gradually start going slowly up. It should work this way but different things happening, (food, illness, etc.) can change that. When you have early nadirs, like Payne, it becomes too long between shots, then you start living in the 400's which is very bad on regulation. (and the kitty) I think with everything that is going on you are doing great!

Nancy and Payne
Once again as the old timers say ..... breathe.
 
Warm thoughts & prayers for both of you! If anyone can handle all she has going on it's you! You never cease to amaze me with your knowledge. :YMHUG:
 
ECID, but the ideal is sort of PS 150 - 180, nadir 50 - 80, something close to that. When I got Bix regulated he seemed to hit those numbers pretty nicely on BID, and if his PS crept up past maybe 170 I would raise the dose a hair and vice versa if it went the other way. But ECID definitely applies, and you can't push the nadir lower than about 50, so that dictates some of it.

A couple thoughts I have are:

1) Stay TID unless she starts getting PSs below 150. If the PSs prove she is getting longer duration, then you wait til you get a 150 (moving more to as needed dosing than strict TID) and shoot then.

2) If you want to go for the greens, you can do that and again take more of an as needed approach. If you get green nadirs and she is below 150 at the next +8, then you wait to shoot, otherwise you stay at +8 shots.

Really though her #s are SO much better I would be tempted to stick with what you are doing if the schedule is working for you. The problems that I see with taking a more aggressive approach towards the nadirs and then considering as needed dosing are that she's been doing this bouncing thing and then doing better on a lower dose, so I'm worried if you really try to shoot for a green you may just get her in a bouncy pattern (not liver training, that is fine, but real bounces). Also shooting as needed can really wreak havoc with your schedule, and it's hard to keep up with when it turns out the next dose is needed at 3 am for example. What happened with me is you get some great cycles, but then you end up missing some opportunities due to scheduling, and then shooting later than ideal.

So I guess my gut is don't fix what isn't broken, and keep going with what seems to suit her pretty well. Of course if you can't manage TID, or you are seeing signs this isn't fitting her that well, or you gut is telling you it's time to change things or she needs more greens, then ignore me. :-D
 
Joanna & Bix (GA) said:
ECID, but the ideal is sort of PS 150 - 180, nadir 50 - 80, something close to that. When I got Bix regulated he seemed to hit those numbers pretty nicely on BID, and if his PS crept up past maybe 170 I would raise the dose a hair and vice versa if it went the other way. But ECID definitely applies, and you can't push the nadir lower than about 50, so that dictates some of it.

A couple thoughts I have are:

1) Stay TID unless she starts getting PSs below 150. If the PSs prove she is getting longer duration, then you wait til you get a 150 (moving more to as needed dosing than strict TID) and shoot then.

2) If you want to go for the greens, you can do that and again take more of an as needed approach. If you get green nadirs and she is below 150 at the next +8, then you wait to shoot, otherwise you stay at +8 shots.

Really though her #s are SO much better I would be tempted to stick with what you are doing if the schedule is working for you. The problems that I see with taking a more aggressive approach towards the nadirs and then considering as needed dosing are that she's been doing this bouncing thing and then doing better on a lower dose, so I'm worried if you really try to shoot for a green you may just get her in a bouncy pattern (not liver training, that is fine, but real bounces). Also shooting as needed can really wreak havoc with your schedule, and it's hard to keep up with when it turns out the next dose is needed at 3 am for example. What happened with me is you get some great cycles, but then you end up missing some opportunities due to scheduling, and then shooting later than ideal.

So I guess my gut is don't fix what isn't broken, and keep going with what seems to suit her pretty well. Of course if you can't manage TID, or you are seeing signs this isn't fitting her that well, or you gut is telling you it's time to change things or she needs more greens, then ignore me. :-D
Click to expand...

Thanks, Joanna. This helps a lot. I can manage t.i.d. if it works for her. I tried using 0.5 last afternoon and she went up to 294, but she's been going high in the evenings anyway. It seems that 0.6U was working pretty well, so maybe I'll just stick with that and hope the bouncing stuff stops soon. She's got some liver stuff going on now (more in another thread on that) so I'm not sure how all these conditions are impacting things too. UGH.
 
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