Spicoli pt1

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You might consider waiting for the increase until tomorrow. Last time you did 1.25, he hit green (6/23 PM cycle). Either that, or I would stay up past +3 to monitor. It's always better to err on the side of caution.
 
So we've been at 1.25 for 4 cycles and I've not seen any real improvement in the numbers. Should I hold here for a few more cycles or bump him up to 1.5?
 
Just a little update -
So after a little over a week since our vet visit, still no changes. We went back to the today. Looks like he has an ear infection and an upper respiratory infection. The scope Dr. A used to look in his ear was covered in gunk when he withdrew it from the ear, so doing a culture on that. I know his blood panels last week were unremarkable but I feel like the vet we saw just didn't do a thorough physical examination. He was also dehydrated from his numbers being up so high for so long. So we're doing another blood panel, urinalysis and some IV fluids. He's staying over night tonight but hopefully once we get these things taken care of his numbers will start to go back to normal.
 
Oh, I'm so glad to hear he's getting a better exam! Sorry to hear about the possible infections, but maybe those will help to get some traction on the BG levels. Please keep us posted on what you find out. Why is he staying overnight? Is it to get the fluids?
 
It sucks that he could have a few infections going on, but I'd rather those be the cause of his high BG readings than other possibilities. I think Dr. A wanted to keep him for the fluids and to probably try different insulin doses. His vet has never kept him except for when his tummy ulcer was bleeding and the kitty was vomiting blood. He even let me take him when he had pancreatitis. So when he wants to keep him I don't really object. But I should find out something this afternoon and will update.
 
Well just got off the phone.. Vet had left already and the techs couldn't tell me much. They gave spicoli 2u of insulin and he came down to 176!! Made me so happy to hear that. They did a culture on the puss from his ear but the tech didn't know what was found out about it. So far he hasn't been put on antibiotics. So he's staying for iv fluids and a recheck in the AM. I'll know more once I get to talk to his vet tomorrow...

But it makes me wonder why he didn't come down for me on 2u and he did at the vets when usually his BG would be elevated. Our sugar cats are odd creatures.
 
Hmmm...who knows why he came down? He could be feeling better from the fluids he's been getting. Looking forward to hearing the update tomorrow!
 
Djamila said:
Is there any chance your insulin is old/has gone bad? Floaties?
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I wish. I bought a new vial to check them against each other, got the same results. The "old" bottle is almost gone, but no floaties. They both look the same. Even got my pharmacist dad to check them. Busted out the control solution and tested the meter - was in appropriate range. I went through all the steps to find error on my part (or insulin) and really came up empty handed.

Talked to our vet this AM, and Spicoli has been doing much better. He's been eating (never does this when he stays), drinking, talking, going to the potty, and acting like a happy kitty from what I've been told. Vet wants to try 2u AM 1u PM. They were running a curve today since he's still there and still on IV fluids. He had about 1/3 of a liter left the vet wanted to get in him. Dr A suspects that the infection could have been stressing his little body and keeping his numbers up. I'll be monitoring him closely with this new dose of course.

I do have a question on earned reduction. At what point do you guys reduce? Before, if he hit a hypo number I reduced by .25u. Is this correct?
 
In Prozinc we usually reduce if they hot lime green during the cycle.

Glad to hear he's feeling better! Hope it continues.
 
Glad he's doing well but I'm still leary of the varied doses; 2.0U for AM dose and 1.0U for PM dose. I was going to say, why not 1.5U for both but you've been doing that :smuggrin:. Next step would be to try 1.75U for both but it's totally your decision! :bighug: If it helps him and works, then that's great!

And Rachel clarified when to reduce ;)
 
I don't mind the varied AM/PM dose. My kitty was on slightly different doses quite often, though never quite a whole unit. If it doesn't work, you can always re-balance them, and who knows, it might help!

Is he taking anything for the infection, or just hydrating and letting it run its course? Hoping he feels all better soon!
 
I just picked him up and wow! He seems so much better!! Went right to eating once I opened a can of duck for him. I know he's not "well" yet, but seems much improved.

I guess after they finished the curve today the vet changed his mind - 2u bid. But either way for the next several days I'm going to do my own partial curves during the day and try for +4 pm.

Djamila said:
Is he taking anything for the infection
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We do have drops for his ear - Tresaderm 5 drops bid for 7 days.

And thanks Rachel! That's how I had done reductions in the past just wanted to make sure I was doing it properly :)
 
We had our recheck today. Vet wants to up his dose to 3/3. While I agree another increase is needed, a whole unit not so much. If you go by the math - for every 1u he drops ~100 pts. it makes sense -
but i feel like that might be too much.

I know protocol says .25u increments. On the same hand I don't think a .25u is going to take us very far. What do you guys think about 2.5u? Or should I just stick to the .25u increment?

I guess I'm being a little aggressive regarding his insulin, but he's been hanging out in these high numbers for soooo long.
 
While in general we preach slow and steady in the interest of keeping cats safe, there are times when aggressive dosing is appropriate. Looking at your spreadsheet and the insulin responses so far, I think this is one of those times, as long as you are able and willing to monitor. You do a great job of that during the AM cycle, but I would encourage you to be vigilant during the PM cycle since many cats run lower at night.

The protocol at the top of the Prozinc page actually advocates for 0.5u increases for cats who are high and flat, with flat being less than a 50% drop. It looks like Spicoli qualifies.
 
Djamila said:
The protocol at the top of the Prozinc page actually advocates for 0.5u increases for cats who are high and flat, with flat being less than a 50% drop.
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I guess I forgot about this, haven't looked at the protocol page in a few days.
Thanks for the reminder :)

I'll try to stay up a little extra late tonight and get a +3 +5 since I don't have work tomorrow and we're increasing.
 
No worries at all about the protocol! I've been on here off and on since 2015 and I still find things in there that I've missed or forgotten! I just looked now because I like to double check before suggesting something out of the ordinary. And to clarify about the evening cycle: please make sure you are getting enough sleep. I never want someone to miss sleep (so essential to our physical and emotional health!) unless it's absolutely necessary (kitty dropping quickly, for example). I just meant to try to grab a test as late as possible before you go to sleep. But please go to sleep whenever you need to! :)
 
Djamila said:
please make sure you are getting enough sleep.
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Don't worry I do :) I've been home alot lately due to some medical issues/new medications so I've been seriously catching up on sleep. I'm the type that will push everything to the side to get my 7-8 hrs. I turn into a grumpy 3 year old if I've been up too long. But I'll be up anyways till at least +4 and can make a decision then if I should set an alarm. His nadir is usually around +5 so a +4 should give me a good idea where he's headed.
 
I'm inclined to agree with Djamila for this instance, especially since you'll be monitoring him. Hope the 2.5U at least shows you some blue :cool:. Hope your new meds are helping you as well :)
 
No blues yet, but we've had a much better curve today.
He still isn't coming down 50% so should I stick with the 2.5 for a few more cycles or go ahead and bump him up to 3?
 
Hooray for yellow! I would hold the dose tonight, and if nothing dramatic happens, increase tomorrow. At that point you may get some bouncing and need to hold the 3u for a couple of extra cycles.
 
...mmm....actually, I'm starting to rethink that. Those yellows are lower than he's been in quite awhile, and kind of by a lot. You may get a bounce tonight. Let's hang on and see what happens before making a decision...
 
Djamila said:
hose yellows are lower than he's been in quite awhile
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I know right! It's so hopeful for me I just want to get him lower...but I know these things take time. I guess I'm a bit impatient.
I was really nice to see him acting more "normal" today with these lower numbers.

And his ear seems to be doing much better. The only time I see him pawing at it is right after we do drops :) So maybe as that heals his numbers will continue to go lower.
 
I agree that we should wait and see. Those yellows are a good 100 points lower than you've been getting...let's see what happens before deciding. :)
 
So it doesn't look like he's bouncing - at least to me. I didn't get any tests last night...fell asleep early. I managed to snag a +6 today and it's pretty much the same as before. Unless you guys think I should hold off I plan on going to 3 tonight since he still isn't quite dropping by 50% at nadir.
 
Nice cycle today! Yup, I would go for it. You're getting some good insulin responses now, which is great, but you're right that those nadirs still need to go lower.
 
My kitty is mysteriously climbing right now too, though not as dramatically as Spicoli. :( Fingers crossed we can both get out kitties headed back in the right direction!
 
Aww I really hate to hear that. Did you just switch over to Lantus?
Gotta say I'm pretty envious of his SS!! Looks like you 2 have really made alot progress over the last few months. Hope Sam comes back down :)
 
Yes, just switched. I was blaming the Lantus for the climbing numbers the first few days, but now I think it was just an unfortunate coincidence that I switched just as he started rising. Although I do kind of wish I had just stuck with the prozinc. I felt a lot more in control with that, and right now, i could really use a little control!
 
We had to shoot late last night, so I have to shoot 2 hrs early today (have to be at work early and he escaped last night). However he's at 234!!! Yay!!
But what should I shoot?
 
If you have time to get in one more test before you shoot to make sure he's rising, then you could probably hold the dose. His nadirs haven't been very low, so even if he drops lower than normal, he should be fine. Do you still free feed wtih EVO? As long as he has access to food, he'll most likely just go eat if he starts to drop too fast.
 
Or maybe a little less, like 2.25? You are catching him at a much lower PS right now since it's early. How many hours since last night's shot?
 
He isn't even really rising yet. I would go with the lower dose. He'll probably be higher tonight, but you'll get him back on track this evening.
 
Got home earlier than expected and at +6.5 he was 431. So I'm not sure if this is from the reduced dose or if he's bouncing a little, but either way he was alive :)
 
My guess is that it's the reduced dose. Most likely onset of the morning dose hit at about the same time he spiked at the end of the cycle. With less insulin to help him out, he's going to run high. But here's the thing: it could have gone the other way. Some cats would have taken that and tanked. So this is data, and next time we'll have a better guess on the amount of the reduction. It seems like most of the time with this dance, we only know in hind sight...

And hooray for making it through Day 10 in the Busy Days Countdown 2017! :D
 
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