Shaikha 7/24 - higher dose given

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wombat88

wombat88

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Shaikha is having a tough time. I lowered her dose in an effort to reset things, thinking she may be getting too much insulin. She did okay initially, but started rising and is up to reds and blacks today. I did increase her dose a tiny amount last night because she was so flat. I'm not sure what is going on with her, but I think the 0.5U dose will work better than the lower one. She's still got some sort of flareup going on I think. I wasn't able to give SQ fluids each day because I discovered on Friday that the fluid bags I got from my vet didn't have a drip chamber and I didn't have a sterile large syringe to use. I had one SQ dose left so I gave it to her after the black reading at +2.5 this AM. She has dropped a little, but we'll see how it goes. She feels warm to me, but I haven't taken her temp. If her BG stays high that's next on the agenda. Ideas? She's on the last of the ABs and will likely finish them today. I really don't know what to do on dose with her. One day she's great, the next not so good. Could it be that her dose is actually too low?

7/23 PMPS = 336, gave 0.5U

7/24 AMPS = 447, gave 0.5U
+2.75 = 506 (gave 100ml. SQ fluids)
+4 = 476
+5.5 = 475
+7.5 = 414
+8 = 437
MDPS = 516, gave 0.6U (given food & insulin at +8.5)
+2 = 368 (also tested ketones - 0.0 so negative -- whew!)
+4 = 371
+5.5 = 358
+7 =332
PMPS =366, gave 0.7U (increased again; plan to hold here until I can see how she does in AM)
 
Re: Shaikha 7/24 - need eyes on SS

:shock: Well there's definitely a difference from .4 to .5. Could it simply be new dose wonkiness? I almost wonder if she's getting to much insulin and you should drop back to .4, but I don't know TID. Just thinking out loud....
 
Re: Shaikha 7/24 - need eyes on SS

Marcy & Klinger said:
:shock: Well there's definitely a difference from .4 to .5. Could it simply be new dose wonkiness? I almost wonder if she's getting to much insulin and you should drop back to .4, but I don't know TID. Just thinking out loud....
Click to expand...

I've no clue! She's had other periods where she shot a sudden spike but usually that's related to pancreatitis or an infection. I'm not sure what is going on here, but she is having some issues with nausea and inappetance, so I've suspected a flareup of pancreatitis. She's also peeing like mad, but the higher numbers are likely responsible. She's got me totally confused right now. She's got no immune system so she gets infections easily, so that might be an explanation, but we checked her last week and her urine was clear though there was a tiny bit of blood and TONS of sugar. A UTI is possible, I suppose, given the amount of sugar she's throwing but she's still on amoxycillin and has been, unless another bug that isn't susceptible to that has taken hold. She's on so little insulin now I am trying to figure out what is happening. Do I cut her back more? She's also on steroids which complicate matters. Bleah!
 
Re: Shaikha 7/24 - need eyes on SS

My first reaction was too much insulin, but then when I looked at how small the dose was....I said, "no way .1 per cycle would make that much difference". I am not use to dosing such small amounts, so I have no idea.

But, something is obviously different.
 
Re: Shaikha 7/24 - need eyes on SS

kse said:
My first reaction was too much insulin, but then when I looked at how small the dose was....I said, "no way .1 per cycle would make that much difference". I am not use to dosing such small amounts, so I have no idea.

But, something is obviously different.
Click to expand...

What concerns me is that I think this change actually started BEFORE I upped the dose. If you look at the SS for the day before I made the change, it seems she may have been trending upward even then. Unfortunately I don't have midcycles for the period I was gone, so it is hard to tell what was happening then. Since I've gotten home though it has been a strong uphill climb. :?
 
Re: Shaikha 7/24 - need eyes on SS

Wendy, she is so complicated! have you taken her temp? could she be having a CP flare-up? Is she in pain? I know a lot of questions but if she is in pain that would make her #'s go up .... she takes so little insulin but I think, IMHO you are now at too little.

If she's not on pain meds. maybe you want to see if that will help? she has so many things going on at the same time but if she's running a fever while taking amoxycillin, then she could be having a flare up. Even though Payne doesn't seem to be in pain when her CP flares .... I give her a couple of doses of bupe and it seems to help.

I think you are doing a great job!
 
Re: Shaikha 7/24 - need eyes on SS

Too much insulin was my first reaction too. She was doing so well on .4u and things have gotten worse with every increase.
 
Re: Shaikha 7/24 - need advice now if you are online!!

I just tried to get blood to test both ketones and glucose, but could only get enough for a glucose reading. I've poked her too many times so will wait on the other for a while.

Based on a test at +7.5, I was considering not shooting and waiting as it appeared she was falling. But when I tested at +8, she was up to 437. Decided to wait another 1/2 hour and at +8.5 she's up to 516. I don't think I can wait to give insulin now or she'll be off the charts. She's definitely rising, and fast.

The question is... what do I shoot? I was thinking too much insulin, but given her pattern now I'm not really sure that's the case. I think something is going on with her. I've given her bupe.

What do you think? I was considering trying to do BID again to see if she could do it. Her patterns have been so weird after returning to TID but she's also not showing the duration needed to do BID usually. That said, she also didn't do that great on BID either the few days I tried it again. It would be much easier if I could figure out what is going on with her -- if it were just insulin and we didn't have the curve balls of pancreatitis and infections to always sort out. I do think she's in some pain so I did give bupe.

Should I shoot 0.4U or 0.5U? More?
 
Re: Shaikha 7/24 - need advice now if you are online!

Oh Wendy, I wish I could help. I don"'t know what to say. I do think you should shoot something , I don't know that a .1 difference at this time is going to make such a big difference
 
Re: Shaikha 7/24 - need advice now if you are online!

I'm going to just throw this out there. I posted in Lev today to get advise on Harley's rising bg's, the advise so far is to lower the dose.
 
Re: Shaikha 7/24 - need advice now if you are online!

Wendy, I am concerned that something else is going on with Shaikha. If there is an infection going on, she may need a little more insulin to get her into better numbers. Hopefully you'll be able to get a ketone test in soon!
I think I would go with .5 or even .6 tonight.
 
Re: Shaikha 7/24 - need advice now if you are online!

I am undecided..........I could defend increasing or decreasing....
 
Re: Shaikha 7/24 - need advice now if you are online!

Go with your gut. You know her the best. If you feel there is something else going on to cause this spike then increase. If she seems more "her normal" then decrease.
 
Re: Shaikha 7/24 - need advice now if you are online!

Okay, my Shaikha radar is going off. I do think something is going on, an infection or else pain from pancreatitis. Evidence for a problem is that:

1) she's been unwilling to eat unless she's getting a very strong anti-nausea medication (ondansetron isn't even enough),
2) she won't eat unless I make her food like soup (usually needed only in pancreatitis attacks in the past)
3) I have to do a lot of encouraging to get her to finish (to include assist feeding),
4) she's lost weight due to not eating enough -- I've been trying to get another 1/2 pound on her as a result,
5) blood glucose numbers are unpredictable at best.

She's a little skittish, but she's grunting if I palpate her abdomen, which also isn't a good sign. She's not yelping in pain, but she's obviously uncomfortable with me mashing on it. I've given her bupe to see if we can get a change in her reaction.

I've decided to take a chance and INCREASE her dose. I gave her 0.6U this time. We'll know whether that was a bad idea soon enough, but my radar says we've got a problem, Houston. I will try to get a ketone test in about an hour. I want to give her ears a rest. I tried poking all of them and could not get anything. Even tried her back paw pad in desperation, but she was very unhappy with that. I got some blood, but she kicked it off before I could get the strip on it.
 
Re: Shaikha 7/24 - need advice now if you are online!

Hi Wendy,
I looked at her chart And I would think something is definately not right today
Go with your gut and do whatever you think is right..
Good luck and I hope she feels better soon

Dneise and Shakes
 
Re: Shaikha 7/24 - need advice now if you are online!

Something seems to be going on; it sounds like she is in pain?
Sometimes when Henry has had a UTI the Clavomox and Amoxicillin don't clear it up, Cipro worked for him when Clavomox didn't clear it up.
Hope she will come down on the .06.
 
At +2ish we are out of the reds and blacks! Thank goodness. She is acting like she's feeling better. More relaxed, so I think the bupe has helped. I was able to get a ketone test in and it was negative, thank goodness. She purred the whole time on my lap too. Will continue to monitor her at two hour intervals to ensure the extra insulin was what she really needed, but I think it may have been. Here's hoping we are on the right track! This girls is way too much of a puzzle sometimes! ohmygod_smile
 
Re: Shaikha 7/24 - need advice now if you are online!

It scares the heck out of me when a number of people on the board look at a series of higher numbers in a cat on a low dose, eating higher carb food, and with a history of health complications, and have an initial reaction that it is too much insulin. It was my first reaction too, which scares me even more! :shock:

The most common cause of high numbers is too little insulin. I can't get my mind around imagining that going up to 0.5 on a high PS would give her enough drop or low number that today would be a rebound cycle. I mean sure, the numbers look like rebound b/c we are not used to them, but she's been nowhere close to a low number on 0.4, and I can't see that 0.5 would cause that. You were shooting 0.9 and 1u TID a few weeks ago and she responded well to that, so it's hard to imagine that 0.5 would cause rebound.

It does look too like what you said - she started running higher yesterday midday before you increased, and now you are playing catch-up. I'm glad you are trying a higher dose - I think back to when her vet took her in and shot a heck of a lot of insulin to get her numbers back down, so that is my reaction - she is a cat who needs more insulin when she runs high, unless she gets to a point where you can truly see she is getting too much insulin.

Wendy I hope you are both doing ok. You must be freaked out with such a dramatic change. :YMHUG:

Also just throwing ideas out, do you think her low eating correlates with the higher numbers? Could be when she eats that is what is triggering her pancreas to pitch in (and there's no way it isn't sputtering with her on higher carb food and a low dose), and so if she isn't eating well she isn't making her own insulin like she normally would? Just speculating.
 
Re: Shaikha 7/24 - need advice now if you are online!

Joanna & Bix (GA) said:
It scares the heck out of me when a number of people on the board look at a series of higher numbers in a cat on a low dose, eating higher carb food, and with a history of health complications, and have an initial reaction that it is too much insulin. It was my first reaction too, which scares me even more! :shock:

The most common cause of high numbers is too little insulin. I can't get my mind around imagining that going up to 0.5 on a high PS would give her enough drop or low number that today would be a rebound cycle. I mean sure, the numbers look like rebound b/c we are not used to them, but she's been nowhere close to a low number on 0.4, and I can't see that 0.5 would cause that. You were shooting 0.9 and 1u TID a few weeks ago and she responded well to that, so it's hard to imagine that 0.5 would cause rebound.

It does look too like what you said - she started running higher yesterday midday before you increased, and now you are playing catch-up. I'm glad you are trying a higher dose - I think back to when her vet took her in and shot a heck of a lot of insulin to get her numbers back down, so that is my reaction - she is a cat who needs more insulin when she runs high, unless she gets to a point where you can truly see she is getting too much insulin.

Wendy I hope you are both doing ok. You must be freaked out with such a dramatic change. :YMHUG:

Also just throwing ideas out, do you think her low eating correlates with the higher numbers? Could be when she eats that is what is triggering her pancreas to pitch in (and there's no way it isn't sputtering with her on higher carb food and a low dose), and so if she isn't eating well she isn't making her own insulin like she normally would? Just speculating.
Click to expand...

I was freaked out, but it was the right decision to increase her dose. She's still around 371, but she's no longer in the reds and the bupe definitely helped. She just displayed a different pattern this time than usual, but that's Shaikha for you. I think she probably is going to need more insulin than what she's getting, but I'll try to make changes slowly since she'll get some overlap with TID.

Will post as I can tonight. I just set my new computer and don't have everything installed yet, to include my email client. Am downloading tons of stuff now but priority is anti-virus and firewall. Got the AV on now need to work on something stronger than Windows' version.

Thanks for holding my hands today! She scared the heck out of me. We're not where we need to be yet, but we'll get her there. Joanna, though, you are right. When these episodes kick up she needs a lot more insulin than she did previously because as Nancy said, she just goes through it like jet fuel.

I don't think it is what she's eating that is triggering this. With her, when her pancreatitis kicks up, she stops eating because it hurts and she's nauseated. I am diligent about getting food in, but sometimes she doesn't scrape the bowl and just a little of that over time adds up in terms of weight loss. More than likely part of that weight loss though is dehydration due to the pancreatitis, so I'll have to get with my vet tomorrow AM to get normal IV bags of lactated ringers to give her. I do have her on the lowest carb food right now that she can tolerate so we are about at 20% carbs. I know it isn't as low as some things, but it is hypoallergic and it doesn't give her puddle poo along with the other problems.

Will check in later and let you know how she's doing.
 
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