Shaikha - numbers off the charts help

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wombat88

wombat88

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I'm still overseas and my friend has been giving insulin since Thursday PM. She's kept to a good schedule, but Shaikha's numbers continue to be off the charts high. Should we increase her dose again? My friend doesn't have time to go a mid-day test on a regular basis, but will do one on Wednesday. If you have a suggested time after shot for her to do this, please advise. I'm thinking between +4 to +6, but maybe sooner? She can only do one. The other option would be to drop her off at my vet's and have him do a formal curve on Wednesday or Thursday if she's able to get her there. Advice?

My friend says she seems okay despite the high numbers. Good appetite. Stools look good too and no sign of blood. Wish I knew how low she was going during the day but I'm guessing not too much. If we should change the dose, suggestions for how much appreciated.

For recent numbers, please refer to her SS which I've updated. Thanks! I'm at a loss to figure out how to best help her.
 
Wendy when did you leave..so I get an idea how this began
 
I see you left on the 4th.
Man, this is crazy number stuff.
Is she home alone all day and perhaps suffering from missing you and her normal routine???
I see the numbers were all going this direction before you left.
+6 would be the number to get if you can only get 1.
and dear Wendy...if it were me...I'd raise dose.
That's just what I would do.
Your gone for awhile no? when coming home?
My trust of vets is sooo limited...do you trust yours to leave kitty there?
if dose is raised...2.2 on the u100 right? easy enuf to see.
 
lori and tom said:
Wendy when did you leave..so I get an idea how this began
Click to expand...

Left Thursday AM. I forgot her insulin that morning so I gave her only 1.2 units mid-day. The vet gave us a schedule for the next dose 8 hours later based on how high she had gotten. She was over 500, so he said to give 2 units which is what we did. We returned to a normal schedule after that.

Her numbers started spiking though the end of April when she had a flareup of pancreatitis. She's gotten better, but is still on antibiotics (tends to get high fevers when it flares). Her stools also got slightly bloody, but that has resolved. She gets 5mg of prednisolone daily. Less steroids would help, but makes her IBD worse and usually flares up pancreatitis more. Trying to switch food now to canned with me overseas probably isn't a good plan either, as that usually triggers diarrhea. I don't know what to do to get those numbers down.
 
can NOT switch foods if your not testing mid day...too dangerous.
when coming home?
 
lori and tom said:
can NOT switch foods if your not testing mid day...too dangerous.
when coming home?
Click to expand...

That's what I thought. I'm not home until after 5/24, so we have to muddle through doing the same stuff and just adjusting dose until then. We plan to switch insulins when I get back. Most likely will try using Levimir. Just no way to do that before I had to leave. We were too scared to try reducing her steroid dose or do other changes with me gone either, as in the past that also triggered flareups.

My vet is good, but they can get swamped and often aren't great on doing curves (not regular timings). I'm sure she misses me, but the jumps started around the time she developed issues so I think that is the trigger. She is home alone (has another cat companion, though they aren't close like she was with my other cat). I am sure the death of her long-time companion is also an issue. She got sick the day after he died. She's stopped wailing for him and pacing rooms, but she still calls out for him on occasion. They always slept together so I'm sure that she is missing him. My other cat tends to pick on her a little, so that doesn't help but I don't want to confine her to a room. I work anyway so she's usually home alone so that change isn't usual, though our absence is likely not helping.
 
i wish i was closer and could go visit with her :sad:
well i told you what i would do...up to 2.2
is she fully capable of finding that dose on your syringes?
 
lori and tom said:
I see you left on the 4th.
Man, this is crazy number stuff.
Is she home alone all day and perhaps suffering from missing you and her normal routine???
I see the numbers were all going this direction before you left.
+6 would be the number to get if you can only get 1.
and dear Wendy...if it were me...I'd raise dose.
That's just what I would do.
Your gone for awhile no? when coming home?
My trust of vets is sooo limited...do you trust yours to leave kitty there?
if dose is raised...2.2 on the u100 right? easy enuf to see.
Click to expand...

Good. I told my friend to give 2.2 units in the AM and let's see how she reacts to that. If her number drop a little, we might even be able to go further. I also emailed my vet with a link to the spreadsheet to get his opinion. He was also of the opinion before I left that a dose increase this week would be likely as he didn't think her dose was sufficiently high to get good control. The day he did readings in his office the lowest she got was the mid 300s.

Will ask my friend to try to get a mid-day reading around when you suggest.
 
and if that does'nt drop her in a day or 2 raise again to 2.4
 
lori and tom said:
and if that does'nt drop her in a day or 2 raise again to 2.4
Click to expand...

My thought too. Have also emailed the spreadsheet link to my vet and asked what he wants us to do. If we could do three times per day it might control her better but I can't ask my friend to do that.
 
no and it would'nt be good without frequent tests.
hate to see kitty sitting in a cage at vets
better at home.
poor baby.
yeah, just keep upping the dose.
it's all you can do right now.
no one else around to visit with her and love on her a little.
love is healing
 
oh, make sure she has PLENTY of fresh cool water...PLENTY with these numbers. k? dyhydration and DKA warnings.
 
lori and tom said:
oh, make sure she has PLENTY of fresh cool water...PLENTY with these numbers. k? dyhydration and DKA warnings.
Click to expand...

I've got two Drinkwell 360 fountains plus a Drinkwell Platinum running. With my other cat with renal failure (the one that died) and her, they went through water like crazy. She is drinking a lot. I also have an IV bag set and my friend is checking hydration daily. She knows how to give subQ fluids if needed. Pancreatitis alone is dehydrating. I had been giving subQ fluids during the worst of her flareup but she was getting better and so far my friend says hydration seems good.

My friend does give her lots of attention, by the way. She's taken care of them before and Shaikha likes her a lot. She was purring on her lap while glucose testing, for example. She's great with them but has lots of animals herself and loves them. I am sure they miss me, but they will be well cared for. I also prefer to keep her at home (vs. vet clinic) though they do take pretty good care of her too. It is stressful for her though as no separate quiet cat room, so if we can keep her at home it would be best.
 
wow, ok so your set up for that.
and she has a nice kleen litter box?
and familiar surroundings.
and plenty of food.
and insulin.
i guess this is the best we can do at this time.
lot's of cats do worse huh??
 
lori and tom said:
going ni ni now..
you ok?
Click to expand...

I'm good. More relaxed now I got a reply. I was going to increase dose by 0.2 if I didn't hear so it is good to know my thinking was correct. Am 12 hours ahead of US so it is daytime here. Thanks again for your feedback!
 
Glad Lori was able to get to you. Sounds like a good plan. I think she is better off at home than at vet's . I assume there is ketone testing. She is lucky to have such a dedicated and supremely knowledgeable mama bean. Good luck and hope your trip goes well!
 
Last night, middle of the night, I thought....did I mention testing for ketone testing?
HMMMMM>.....And Judy thought of it for me ;-)
Sorry I did'nt bring that up sooner tho'.
 
How can we do that easily? I have strips, but have never tried on my own to use them. Haven't showed her how either. Not sure how she could collect urine easily unless we stick her in a room with an empty plastic box (no pee pad) and hope she uses it in the 12 hours period my friend wouldn't be there. I hate to do that to her though. She has a tendency to hold it if she isn't happy with the "facilities" but as much as she's drinking it is doubtful she could. What I'd worry about more is her using the floor inappropriately, which she has been known to do. Easy to get a sample that way, but I'd hate to have her have to clean up a huge mess.

I saw a link on one of my lists about kit4cat litter that looked like it would be helpful, but I don't have any and not sure how quickly we could get it. Has anyone tried this product? http://kit4cat.com/

Does the sample have to be fresh to measure these? What about blood test strips vs. urine? I think I read a thread somewhere about that as a possibility. Can they be obtained at a place like Walmart without a prescription? And is blood tested the same way? My vet has tested for these previously using urine he collected at his clinic.

Heard back from my vet and he concurs. He wants her at 2.2 units now and try to hold at that for two days, then jump to 2.4 units if that isn't working and try to hold for three days before changing. Am asking him about ketones as well. She's never thrown them but she's not been this high for this long before either.
 
hey wendy...there is a meter that has strips for both ketones and glucose. i used to have one in my nk collection but i'd have to dig around. google it. i don't know the cost.
if i can find it i would be happy to express it to your home.
 
Since your pet sitter may not have time to wait for a sample to test for ketones, you could have her buy the Precision Xtra meter and the specific ketone strips that go with it. It measures ketones using a blood sample. The meter isn't terribly expensive; the strips are - but you shouldn't be using too many. Just a few checks to keep her safe.
 
OK, I HAVE THE BRAND NEW ABBOT PRECISION XTRA.... everything but the strips :YMSIGH:
here's what i'm thinking.
there is an 800 #
i call, order...or ask for sample for the meter.
give them your address.
blah blah blah.
you get this meter with any other newbie kit supply you need right now? lancets...sock? toy?
send me your addy thru the newbie kit link...
shipping fees only
i'll order the strips for you
send me your addy to tell them where to mail them off to?
wdyt?
 
lori and tom said:
OK, I HAVE THE BRAND NEW ABBOT PRECISION XTRA.... everything but the strips :YMSIGH:
here's what i'm thinking.
there is an 800 #
i call, order...or ask for sample for the meter.
give them your address.
blah blah blah.
you get this meter with any other newbie kit supply you need right now? lancets...sock? toy?
send me your addy thru the newbie kit link...
shipping fees only
i'll order the strips for you
send me your addy to tell them where to mail them off to?
wdyt?
Click to expand...

Have PM'd you but you lost me on the newbie kit?? Sorry, very late here and I took benadryl to get to sleep. Still not on the time zone here yet. Need to get to bed soon or I'll be asleep on my laptop keyboard. What newbie link are you talking about?
 
darn it...you must not have pressed sent...no addy. it's coming to my house overnight delivery.
the ketone only strips.
the meter uses two strips.
ketone and bg.
i will send the whole kit when i recieve it
and you can go to the newbie kit link and paypal your shipping fee's there. the kit and supplies are free.

whew!
 
wombat88 said:
lori and tom said:
NOW!!!!! on the line
Click to expand...

Check your PMs. Addy is there.
Click to expand...

Okay, I found the newbie kit location. Sorry I didn't know it existed. I found the store, then took a while to figure out how to find the kit location. Have put in info there plus donation. Hope that was in time. Am falling asleep now so need to sign off as benadryl is kicking in.
 
Wendy I hope you are sleeping like a baby as I write this.
I would have mailed your kit today had we connected in time...I had the strips lady on the phone and had to give her an address to mail the strips to.
So I gave her mine.
It should be here tomorow as she is mailing them overnight delivery...So the absolute latest your meter and strips will go out is Fri.
If you think of anything else you need in the shipment let me know.
Lancets,
u40 syringes
etc.
You will NOT have the glucose strips for the meter....so continue having your friend test with the original meter for bg's.
You will only get the ketone strips. Later if you want you can buy bg strips for it too. I am sending all the packageing instructions blah blah blah...but I think it's pretty basic.
I'll study it before I mail it and let you know if there is any special thing to do to the meter that I feel I should 'splain to you k?
Lori
I do think Shaikha deserves a new toy in the deal...tell me, is she fond of catnip toys? Iz gotz da gud stuf.
 
Eeeks, just peeked at your SS :shock:

I didn't read everything :oops: but my quick reaction is:

- get the mid-cycle check in like you are planning, anywhere +4 - +6 is probably ok - she has had late nadirs and early nadirs so it's kind of a guessing game with only one check

- consider having your friend take her to the vets one day for a curve - normally I'm not a fan, but with little mid-cycle data to go on (can your friend do a mini-curve on the weekend? +3 +6 +9) it might be worth doing

- if the mid-cycle #s do not give you any reason to suspect this is rebound, I would raise in 0.5 increments

I don't think it's rebound b/c you KNOW 1.5 was too low, and there's nothing on 1.8 or 2 that I see to suggest the #s were getting lowish, so it looks likely to me she just needs more insulin. Especially with Pred in the mix, and I would guess that could be causing a worsening effect over time that is driving her insulin needs up.

I'm sure you must be going crazy being half-way across the world and trying to figure out what to do. :YMHUG:
 
Oh, did I get it that she is on dry food? If I read that right, I would be a lot more aggressive with raising the dose, I would definitely move in 0.5 increments and I would raise every third day if possible. Ideally you want your friend to get in at least a nadir check though before each dose increase. If you are on dry food though and steroids, I would not be scared to raise the dose more quickly. If the PSs come down into the pinks I might slow down a little, but with #s like this I would not bother with only raising in 0.2 increments, it's hard to even remotely imagine that will be enough of an increase if you are fighting Pred & dry food.

Not sure I read the food piece right though...
 
You are probably right Joanne. I just don't know this pz anymore. seems sometimes the smallest dose makes a difference.
you know me...i would probably do it. but from 6000 miles away...with kitty sitter just visiting....hmmmmm..yep, i would still do it.
but could not cross the 'safety line' and suggest it.
 
lori and tom said:
Wendy I hope you are sleeping like a baby as I write this.
I would have mailed your kit today had we connected in time...I had the strips lady on the phone and had to give her an address to mail the strips to.
So I gave her mine.
It should be here tomorow as she is mailing them overnight delivery...So the absolute latest your meter and strips will go out is Fri.
If you think of anything else you need in the shipment let me know.
Lancets,
u40 syringes
etc.
You will NOT have the glucose strips for the meter....so continue having your friend test with the original meter for bg's.
You will only get the ketone strips. Later if you want you can buy bg strips for it too. I am sending all the packageing instructions blah blah blah...but I think it's pretty basic.
I'll study it before I mail it and let you know if there is any special thing to do to the meter that I feel I should 'splain to you k?
Lori
I do think Shaikha deserves a new toy in the deal...tell me, is she fond of catnip toys? Iz gotz da gud stuf.
Click to expand...

She loves catnip toys. I can always use syringes. I usually use U100s, but if you have U40s and they allow easy incremental doses fine to put some of those in there.

How many strips come in a package and how many/how often should you test? Am trying to figure out if I should ask a friend to get some at Walmart or if there is a cheaper place to order online since I'll be gone so long.

Thanks again for all your help!
 
Joanna & Bix (GA) said:
Eeeks, just peeked at your SS :shock:
- get the mid-cycle check in like you are planning, anywhere +4 - +6 is probably ok - she has had late nadirs and early nadirs so it's kind of a guessing game with only one check
- consider having your friend take her to the vets one day for a curve - normally I'm not a fan, but with little mid-cycle data to go on (can your friend do a mini-curve on the weekend? +3 +6 +9) it might be worth doing
- if the mid-cycle #s do not give you any reason to suspect this is rebound, I would raise in 0.5 increments
I don't think it's rebound b/c you KNOW 1.5 was too low, and there's nothing on 1.8 or 2 that I see to suggest the #s were getting lowish, so it looks likely to me she just needs more insulin. Especially with Pred in the mix, and I would guess that could be causing a worsening effect over time that is driving her insulin needs up.
I'm sure you must be going crazy being half-way across the world and trying to figure out what to do. :YMHUG:
Click to expand...

That's why I asked about the nadirs. I've no idea where they are because she has been all over the place. When her pancreatitis cranks up she's always like that, though this is the worst it has ever been, at least since her fever episode in February.

Doubt my friend could do a curve this weekend, as she's got some travel obligations. I've got one other person coming into give a shot for her as it is. That person has a dog with diabetes so they should be okay with testing/shots. Will talk to the vet about a curve on Friday. That might give us a few days on the higher dose so we can see how she's adjusting.

Yes, she eats dry food. She seems to be better with it due to her IBD. I do use grain-free but it still has more carbs than canned. We just got her through an episode with bloody stools, so no changes will be happening on diet, at least not with me over here and of course that would also throw off numbers more without good monitoring.

It has been driving me nuts. The reds were bad enough, but all these blacks and >600s worry me. Will ask my friend to increase dose again tonight by the full 0.5 you recommended, especially if she's not lower.

I'm guessing it is the pred driving all of this in addition to inflammation, but unfortunately we can't get her off it. We've tried.
 
Yah, did I already say this? When Bix was on dry he needed over 4u and I still couldn't get him regulated. When he was under 2u it was solid reds & blacks. Sorry I missed that before, I was thinking she was on LC canned, or maybe I would have realized to push for more insulin sooner. Sometimes they have to eat dry for one reason or another, just is what it is. Fwiw, Bix had IBD and did well on Wellness. Everything else I tried that was LC canned made him sick.
 
Joanna & Bix (GA) said:
Yah, did I already say this? When Bix was on dry he needed over 4u and I still couldn't get him regulated. When he was under 2u it was solid reds & blacks. Sorry I missed that before, I was thinking she was on LC canned, or maybe I would have realized to push for more insulin sooner. Sometimes they have to eat dry for one reason or another, just is what it is. Fwiw, Bix had IBD and did well on Wellness. Everything else I tried that was LC canned made him sick.
Click to expand...

Wellness gave her horrible diarrhea. I tried that because it was the on the IBD group's list of foods, but she couldn't tolerate even tiny amounts. ECID, right? Our luck. She's done best on dry, novel protein foods that are grain-free. Green pea or rice seems okay but we avoid everything else. She had done okay on duck, then turned off that after getting sick in February. After a bunch of wet food trials, I finally got her to eat RC hypoallergenic dry. She's on the soy right now which seems to agree with her the best yet, but we have the venison as a backup.

My friend just reported the third reading in a row over 600, and a +4.5 reading of 443. :YMSIGH: She increased dose to 2.2 units, but it has not made any change. I told her to go ahead and shoot 2.8 units tonight (not easy to do 0.5 unit readings on my syringe). I don't think we are at much risk of hypos at this point. Will see how she does with that but hopefully that will nudge her numbers down some.

Will talk to my vet about a curve later this week.
 
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