Shaikha 7/11 - need expert eyes on SS

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wombat88

wombat88

Active Member
This girl is driving me nuts. She seemed to be lasting longer so BID and a reduced dose seemed appropriate, but I may have cut her back too much. After a good first day she has flattened out or is back to getting much higher numbers than I want to see pre-shot and not getting much duration either. Take a look at her SS and see what you think, please. Last night she seemed to go through her insulin like jet fuel again and then started climbing, but her pattern in the AM also didn't have much of a nadir so I think that 0.4U is way too little insulin for her. I don't think we are seeing liver bounces here -- I think it is simply not enough insulin. As of a week ago she was getting over two units per day split over three doses and now she's only getting 0.8U split in two doses. So, this morning I increased her to 0.6U. I will be home at +5 so we'll see how she is doing then, but hopefully it will work a little better without pushing her too low.

7/10 numbers:
PMPS = 247, gave 0.5U
+2 = 218
+4 = 312 (ugh)

7/11 numbers:
AMPS = 354, gave 0.6U
+5 = 280
+6 = 282
+11.5 = 225
+12 = 215 (now what???)
+12.5 = 223
PMPS = 272, gave 0.5U (at +13 after AM insulin)
+3 =
 
Re: Shaikha 7/11 - need some suggestions!

Hi Wendy,
I don't think I've commented on your posts before...I took a look at Shaikha's ss. Very interesting TID numbers - I haven't seen many people try TID, so it's a great learning opp for us. Is Shaikha still on ABs? How's she feeling overall?
No advice on the dose, just wanted to say hello :-D

Marcy & Klinger
 
Re: Shaikha 7/11 - need some suggestions!

Yes, she's got about another week I think left of them. She's been battling a liver/bile duct infection in addition to a very tenacious problem with UTIs, so the specialist recommended a combination of ABs to give a broader spectrum. Since she doesn't have much of an immune system it is tough to keep her straight that way. I think she's feeling better, but her rising numbers are making me nervous. I'm hoping it is just the change up in dose and schedule vs. something trying to creep its way back in. She finished the stronger AB a while back and has been finishing off a milder one (amoxycillin) so I'm hoping we are not looking at a return of problems infection-wise. The only way to know whether we've got the right ones is to do a needle biopsy and my vet doesn't have that type of equipment so I'd need to take her to a vet school most likely. She's definitely gotten better but whether it is enough to keep her healthy is the question.

I've been very happy with how well TID worked for her. If we can't get her balanced on BID, I may have to go back to it. She's a tough cat to manage with all her health issues. Glad you stopped by! :)
 
Re: Shaikha 7/11 - need some suggestions!

She did so well on t.i.d. I was jealous! Maybe she just needed to be on it longer while her infection(s) cleared. She is definitely a card carrying member of the Difficult Feline club!

I would love to shoot Payne b.i.d. but she just can't do it, so I really understand where you are! Decisions, decisions! my good thoughts to both of you ....
 
Re: Shaikha 7/11 - need some suggestions!

No brilliant ideas, just admiration for how well you deal with all her issues.

The +4 and pmps numbers are interesting - not much movement in 8 hours?
 
Re: Shaikha 7/11 - need some suggestions!

Sue and Oliver (GA) said:
No brilliant ideas, just admiration for how well you deal with all her issues. The +4 and pmps numbers are interesting - not much movement in 8 hours?
Click to expand...

No! And look at her numbers today. I was a little scared shooting 0.6U, but at +5 she's at 280 and rising. She's not zooming up, but she's definitely nadiring very early once again and not dipping down much either I'd guess. I will try to get some earlier numbers tonight, say at +3 or +4 to see if we can pin down her low.

If this keeps up I'm afraid this will be a very short-lived experiment in BID dosing for her. :cry: I guess one good thing is I know that TID works fairly well for her. She's always going to be a complex cat, I'm afraid. One part of the TID schedule she seemed to like was more frequent feedings. She's been following me around or on my lap acting like I've forgotten something! She's getting the same amount each day, but since I started her back on anzemet she's definitely more interested in food again.
 
Re: Shaikha 7/11 - need some suggestions!

Hi Wendy, Sorry I dont have any dosing advice..
you are dealing with so much!
I dont know how you do it!

I do admire you though!

Denise and Shakes
 
Re: Shaikha 7/11 - need some suggestions!

The good news is she responds to t.i.d. thank God! with all her other issues .... I know t.i.d. is hard but you have a chance of going back when her other problems are resolved .....
 
Re: Shaikha 7/11 - need some suggestions!

Nancy and Payne said:
The good news is she responds to t.i.d. thank God! with all her other issues .... I know t.i.d. is hard but you have a chance of going back when her other problems are resolved .....
Click to expand...

I wish I could feel confident they will resolve, but I'm afraid she's not every going to be a normal kitty. I guess she's aspiring to be a tough case like Payne -- though without the DKA's please!!! I don't think I could take those. The anemia et al is more than enough to juggle!
 
Re: Shaikha 7/11 - need some suggestions!

I understand your fear of DKA it is truly scary .... we are on the ketone rocket again. She just looked off to me and sure enough going up high, brought out the R insulin again.

In fact we are taking her with us for a short vacation because I don't think anyone else, including my 24/7 vet, can keep her alive day in day out. AND her #'s are in the 200's ..... for those who think you can only get ketones in the high numbers.
 
Re: Shaikha 7/11 - need some suggestions!

Rob & Harley said:
Still praying that the bid settles in and starts to work for you.
Click to expand...

Look at her numbers for +11.5 and +12 -- she's falling! I do NOT know what is going on with her. Maybe my PZI bottle is possessed.

Seriously though, she's starving and has not eaten anything since 7am this morning. I need to feed her. Could the drop I'm seeing be just from not eating since then? I find it hard to believe that insulin is only now kicking in.

What do I do now???
 
Re: Shaikha 7/11 - please look at her SS!!!

Wow, I would try to hold off a bit longer to see if she starts to come up. I know, miserable for her but if she starts to rise then you can shoot her and keep her in better numbers.
 
Re: Shaikha 7/11 - please look at her SS!!!

Okay... she was 225 at +11.5, 215 @ +12, 219 @ +12.5, and 272 @ +13. I'm feeding her now, one hour late. A couple of questions:

1) What dose seems right? I'm not sure what to do. 0.6U led to a late spurt (maybe) but 0.5 didn't carry her at all last night and 0.4U didn't get her down much either. I'm going to give 0.5U but am not convinced that is even enough, but with these patterns I also can't figure out duration either. One day one thing, complete change the next.

2) What do I do in the AM, as I'll need to leave here at +11 at the latest from this shot now. I may have to skip the shot entirely until I get home in the afternoon if she's not where she needs to be before I leave for work.

I don't know if I should just go back to TID or keep trying this. She is so unpredictable!
 
Re: Shaikha 7/11 - please look at her SS!!!

I wouldn't give up on this. She got the duration you wanted today.

As for the dose I think a f.5u might be good on a regular day. Tonight shooting late I think you could go with .6u.

For the early shot tomorrow morning I would shave a .1u off of what you would normally shoot on that PS to compensate.
 
Re: Shaikha 7/11 - please look at her SS!!!

Rob & Harley said:
I wouldn't give up on this. She got the duration you wanted today. As for the dose I think a f.5u might be good on a regular day. Tonight shooting late I think you could go with .6u. For the early shot tomorrow morning I would shave a .1u off of what you would normally shoot on that PS to compensate.
Click to expand...

She got 0.5U tonight since I wasn't sure when I'd get a response and I was afraid to wait too long since I have to leave earlier than normal tomorrow. I'll do what you suggest on dose unless she's really low for some reason (in which case I wouldn't shoot of course). I'm just frustrated because there is nothing that seems very curve-like other than that first day. Since then she's been all over the place. I suppose her body is adjusting to what must seem like very big changes, but her mama bean is getting grayer by the minute. At least I've got an appointment to take care of that problem later this week! :-D
 
I don't have a lot of experience switching back & forth from TID & BID, but I would say your logic on the 24 hour dose makes sense - in theory you would expect her to need something like 1u per shot on BID. I would imagine that seems scary b/c it's a bigger dose than she was on per shot, but you can get quite a lot of overlap shooting at +8, where +12 is closer to starting over every shot (though some cats get decent overlap at +12s).

Given that until that last day or two on TID her dose really was a lot higher - 0.8ish, so more like 2.4 in 24 hours, the 0.4 seems much too low to me. Of course we were all hoping since she got such good results on very little insulin those couple days when you decided to try BID that her needs had gone down, but a lot of times we see that when you reduce rapidly the results don't hold. I think it is due to some mini-shed that PZI has, or maybe it's that their pancreas kicks, but really isn't ready yet to take off the training wheels.

I don't know why she got that 66 nadir the one day, but now it's all up in the yellows. I would increase the dose though. It's curious to me watching along, b/c I have been impressed that you have been quick to increase her dose in the past when it looked needed, so I'm curious why you are hesitating now. Maybe you are just a TID gal at heart. ;-)

In any case my thoughts are:

1) If you can monitor, go ahead and shoot the numbers and raise the dose. If you scroll up just a few lines in the SS you were shooting close to double this dose on TID, and you are on BID now, so I would shoot at minimum the same as what the TID dose was.

2) Go back to TID to get things back under control, if you are more comfortable with that and feel like you can keep on top of things better that way.

3) Try a modified approach, like shooting at +10s. I think when they come off TID and go to BID, it can be easier if you can do it gradually, letting the duration dictate when you shoot - more like As Needed dosing and let them prove to you that they only need the shot every 12 hours. Of course that is hard on one's schedule (but maybe no harder than TID).
 
This is great advice, Joanna. I think I got used to TID so I felt more comfortable increasing because I had enough data on how she'd react. She's been changing so much lately though, I've not been sure what to think or do. I agree that this is too little insulin for her. I am sure we were getting some overlap with the TID dosing and some longer duration, which may account for the less predictable numbers at times. Option #3 would probably make the most sense in terms of getting her adapted to BID, but with my schedule I'm not sure how well I could stick to that. I could work TID if I have to because I know what to expect, though I must admit it has been nice only shooting twice per day and not having to wait for that late PM dose. On Option #1, I can shoot higher numbers, but I'm a little scared about the time I'm at work. I've got a lighter schedule now than I will in another month but can't monitor in the AM so it makes me nervous in case we had another drop like we did that first day. That's really unusual for her though.

I'm probably going to give this another day or two to see if we can get her more under control with a slightly higher dose. If not, then I'll go back to TID. Though I'd love to stay on BID and hope I can do so eventually, I'm afraid that she's just an infection or pancreatitis attack away from having to go back to TID to re-regulate her anyway so maybe it would just be better to keep her on it. Bleah! ohmygod_smile
 
Re: Shaikha 7/11 - need some suggestions!

Nancy and Payne said:
I understand your fear of DKA it is truly scary .... we are on the ketone rocket again. She just looked off to me and sure enough going up high, brought out the R insulin again.

In fact we are taking her with us for a short vacation because I don't think anyone else, including my 24/7 vet, can keep her alive day in day out. AND her #'s are in the 200's ..... for those who think you can only get ketones in the high numbers.
Click to expand...

I don't blame you for taking her with you! We were going to do that with Shaikha until my friend was able to arrange to come. So sorry to hear Payne is throwing ketones again. :sad:
 
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