Shaikha 7/28 TID - PM dose suggestions?

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wombat88

wombat88

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I only gave 0.4U of insulin last night after her hypo episode yesterday morning. Her blood glucose was pretty high this morning, though, so the combination of lower dose and higher carb dry food isn't a good thing. I increased her to 0.5U and we'll see how it goes. I was able to get her to eat a bowl of canned food with crushed dry food sprinkled on top this morning, thankfully. She wasn't interested otherwise. At first it seemed she'd only pick off the dry, but eventually nibbled away until she finished most of the bowl. I'll take it, since last night she had a bowl of dry food only as she wouldn't touch the canned at all so this was progress. I will continue to give her a higher dose of anzemet, in addition to fluids and bupe. She's now having puddle poo on top of the other symptoms, so the Fancy Feast and her overall condition are kicking in. They were rather "fragrant" offerings, which means IBD is kicking up which is pretty typical in bad flareups. Hopefully we'll have a good day and can find an insulin dose that works better for her.

7/27 PMPS = 300, gave 0.4U

7/28 AMPS = 397, gave 0.5U
+3 = 334
+6 = 414 (yuck -- doubt we had much of a nadir today)
MDPS = 414, gave 0.6U
+3.5 = 315 (ugh -- not much of a nadir again I think)
+5 = 297
+6 = 339
PMPS = 407, gave 0.7U (would barely touch her wet food though, even sprinkled with dry, so I gave up and gave her dry)
+7.5 = 252 (finally! and after dry food no less)
 
Re: Shaikha 7/28 TID

Poor Shaikha :( sorry she is having some potty problems. Hopefully she can get back on track quickly. You are one awesome kitty momma bean with a lot to deal with!
Good on both of ya!
 
Re: Shaikha 7/28 TID

Wendy, you do so well with Shaikha and all her problems ..... you are a super Mama bean!

I keep a journal on Payne that looks like a book in progress :roll: I keep everything in it, I draw graphs, make comparisons, wonder if this, if that .... I think if she has one more thing! I don't know how I'd do it and you do it! I think you second guess yourself when you shouldn't because you are doing great! :thumbup
 
Re: Shaikha 7/28 TID

donnahc said:
Poor Shaikha :( sorry she is having some potty problems. Hopefully she can get back on track quickly. You are one awesome kitty momma bean with a lot to deal with!
Good on both of ya!
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So far it hasn't been bad diarrhea. I'm hoping we can avoid that because diarrhea and Persian cats don't mix well. She's got enough to contend with, poor little girl, without that. :-|
 
Re: Shaikha 7/28 TID

Nancy and Payne said:
Wendy, you do so well with Shaikha and all her problems ..... you are a super Mama bean! I keep a journal on Payne that looks like a book in progress :roll: I keep everything in it, I draw graphs, make comparisons, wonder if this, if that .... I think if she has one more thing! I don't know how I'd do it and you do it! I think you second guess yourself when you shouldn't because you are doing great! :thumbup
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LOL, Nancy, you sound like me! When Tabriz was still alive I had enough to contend with, since he had multiple health conditions (severe anemia requiring frequent blood transfusions, chronic renal failure, liver problems, and pancreatitis, though milder than Shaikha's, and I suspect IBD too). When Shaikha got sick, I thought I was running a cat hospital. Heck, I was! I had two cats needing fluid therapy, medication lists a mile long, and scheduling treatments and shots was a nightmare. I did/do pretty well balancing it all, but I know that "if she gets one more thing" worry! I think her list is long enough, you know?

I'm definitely going to have to ramp up her insulin dose, because she's zooming. I know part of that may be a reaction to yesterday, but with as sick as she is from the pancreatitis, that's the majority of the problem. I think the problem yesterday wasn't so much a dose issue as the fact that her pancreas is sputtering. When she gets like this, she's just VERY unpredictable. Mostly bad, but sometimes unexpectedly good. The only thing I can think of is that all that inflammation just makes it difficult for what is left of the pancreas to function. Sometimes it wins the upper hand and some extra insulin leaks out, adding to what you give. Other times, what insulin is there is nullified due to resistance, I'd guess. That's my theory. I don't know how else to explain her variability in needs. I know the steroids play a role, but she gets them at the same times daily. That said, I think the reason cats develop diabetes is because the steroids contribute to insulin resistance. I think I read that somewhere. Just musing out loud. She probably would not have hypo'd though had the strips not given the wrong reading -- I just would have skipped or delayed the dose had I known she was as low as she was. The longer duration could have been momentum building combined with a sputtering pancreas. My usual response when we get longer duration like that is to cut back dose a little, though I think at times I've reacted too quickly before I verify a trend exists and it isn't a one-time occurrence.

Will test her again in 45 min and we'll know where we stand, but I'm guessing we'll go up to 0.6U. I may have to increase that again before it is all said and done, but will try not to do it too fast so we don't have the yo-yo we had yesterday. I saw a book advertised called "How to think like a pancreas" -- don't we wish we had a direct line! LOL. Though in the case of pancreatitis cats, I'm not sure the message we'd get could be shared in polite company! :shock:
 
Awwww, I hope she is feeling better soon. Keep in mind that you totally know what to do if you get unexpected lows again, so the risk of overshooting a little is not the same risk as someone who isn't testing, or doesn't know what to do. Assuming of course that you are home to monitor. So I wouldn't let that one cycle freak you out, she really looks to need the insulin. You might pull back a little more if you get another blue PS like that, but I wouldn't worry too much about the higher ones.
 
Thanks, Joanna. I was sort of scared to increase too much after the other day, but today it looks like 0.5U or 0.6U is WAY too low. She's barely got a curve and nadirs near 300 are not a good thing. I plan to increase her to 0.7U tonight and we'll see how that goes. I honestly think we'll end up even higher than that though because she's so sick right now. I think she's starting to feel a little better with the fluids and painkillers, but her appetite is definitely off. The other day really was an aberration, I think. I want to get her out of these higher numbers though because that combined with her other problems makes me worry about ketones, and of course the higher numbers are also harder on her body in general. She's drinking and peeing a lot more than she had been.
 
It might help you if you don't call it a hypo, lol. It was actually a surf in perfect numbers. Now I realize you gave her HC to keep her in good numbers, so in that sense it is scary, but in terms of the numbers themselves, as long as she was acting fine I don't think she was actually in hypo numbers (slap me if I'm wrong though, it drove me nuts when people said stuff like that to me with Bix!).

Overreducing is everyone's bane. I did it, and I have seen virtually everyone on the board do it. Those who *don't* have been the ones that I have seen get regulated the fastest. Hard not to be gun shy though, and a lot of the time those who don't overreduce don't actually know what the numbers mean, and that is why.

You will find the right balance, you are doing great, and with each shot you will keep learning more, that's how you get it nailed down eventually (if that is even possible).
 
LOL! She so rarely sees green I sort of panic when she gets to normal ranges, I guess. So is 40 then the number you need to worry about? The lowest I've seen was 41, but even then she was acting like nothing was wrong. That was after she'd come home after hospitalization and had gotten a larger than usual dose of insulin because her numbers were high due to a bad fever.

Will increase her to 0.7U tonight and see how she looks in the AM. If she's still running high I'll get her up to 0.8U because she can't stay where she is right now.
 
Do you have a civie you can test to see how your meter runs? I know in Lantus they say 50 or 40 depending, but 40 makes me pretty nervous. I know some people though get a low 40 on a civie test, so then it's not scary. I do think it depends a lot on the meter - some run lower than others.
 
Mentally I add 30 points to the low numbers, b/c I have read they intentionally make the meters run low at the low end so that people won't get complacent and hypo. And then cat blood is actually different than people blood in terms of the test strips, I think it's something like the cat sugar clumps are bigger than people ones (? I could have that totally wrong) and so the human test strips don't always pick up all of the kitty clumps and so the readings can be lower than actual.

Not to stir up any controversy - it is FINE for everyone to use human meters, in fact I think that is better b/c that is what most use and that is the frame of reference.

But to say that in my mind, a 50 isn't actually a 50, it's likely more like an 80 in reality. That is very disputed, and you can find plenty of people who would disagree with me on that, just that's how I see it, and why those numbers don't scare me the way they used to.
 
Joanna & Bix (GA) said:
Do you have a civie you can test to see how your meter runs? I know in Lantus they say 50 or 40 depending, but 40 makes me pretty nervous. I know some people though get a low 40 on a civie test, so then it's not scary. I do think it depends a lot on the meter - some run lower than others.
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That's a good idea. I'll test her brother tomorrow and see what my meter says "normal" is. :)
 
Joanna & Bix (GA) said:
Mentally I add 30 points to the low numbers, b/c I have read they intentionally make the meters run low at the low end so that people won't get complacent and hypo. And then cat blood is actually different than people blood in terms of the test strips, I think it's something like the cat sugar clumps are bigger than people ones (? I could have that totally wrong) and so the human test strips don't always pick up all of the kitty clumps and so the readings can be lower than actual. Not to stir up any controversy - it is FINE for everyone to use human meters, in fact I think that is better b/c that is what most use and that is the frame of reference.But to say that in my mind, a 50 isn't actually a 50, it's likely more like an 80 in reality. That is very disputed, and you can find plenty of people who would disagree with me on that, just that's how I see it, and why those numbers don't scare me the way they used to.
Click to expand...

I've heard/read the same thing, actually, that cat blood is different so human strips read levels differently. When I first started testing, my vet gave me an Alpha-Trak to try. The strips were horribly expensive so I started looking for alternatives. The Alpha-Trak needed coding, but the coding was done by species, I think. I decided to buy a Relion meter after researching a bit more. Since I had the Alpha-Trak and strips, I decided to run a parallel comparison so I could get a feel for how the Relion compared. The Alpha-Trak consistently was 30-40 points above the Relion at the levels she ran at the time. So, it may be that she is higher than what my meter shows. The point really is the trend, not the actual numbers, so even if you use a human meter you will still have the same idea as to the trend even if numbers are a bit off. I have another meter that I use to read ketones and that one also shows higher than my Relion does -- usually around 30 points though I haven't used it that much. I keep strips on hand in case my Relion conks out or if I need to do a sanity check on a reading, but know now that it reads higher so I mentally subtract numbers if I'm comparing it with my Relion.

Thanks for reminding me of this. She may really be higher than my meter shows. I'd forgotten that.
 
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