Sub Q impact on BG- Grayson 2/26

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Grayson & Lu

Grayson & Lu

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Good morning all -

Woke up at 4 am, about 2.5 hours from AMPS, and Grayson tested at 353.

I tested his ketones and they were moderate AGAIN - up & down since Thursday night. Plugged him into some Sub Q fluids.

I'm tempted to go ahead and shoot him now, rather than wait for the clock to say it's time. Anyone know if the Sub Qs impact the BG... I'll test him another time before shooting, but don't know if they'll skew the number.

THanks,
Lu-Ann
 
Re: Sub Q impact on BG

ECID but many people see a lowering of BG as a result of fluids. Not immediately, but over the current or next cycle. Kim can help because she has seen this with Kitty and I saw it sometimes with Bob.
I think the early shot was okay.
Carl
 
Re: Sub Q impact on BG

Thanks for the reassurance. I've shot early before to preclude the red numbers... that was kinda what I was thinking. Although, having slept through the night, not getting those mid-cycle numbers, AND having had the marathon cycles, I was hesitant to shoot at 4 am in case he still hadn't nadired. Not to mention that I'm back up to 1 full unit. (it still amazes me the kitties that guzzle insulin!).

Thanks for looking.

Lu
 
Re: Sub Q impact on BG

I always saw a lowering of BGs associated with giving sub qs. I would post the topic of sub qs lowering BGs on health-- there are many in the forum that don't visit PZI, but have used sub qs and can share their experiences with you. I didn't always see the impact immediately, but "at least" by the cycle after giving the fluids. I was always "told" that you should not give fluids and insulin at the same time and do not inject them in the same place. It is always advisable to give sub qs AFTER nadir, to avoid them accelerating or increasing your drop. Right now, with your high cycles it is impossible to tell when your nadir is--but, normally you can assume that by +8 Prozinc has nadired (lowest of cycle)-- even if you can't see it on your tests. At this point, with your high cycles, I would not be "real" worried about when I gave the fluids in regards to BGs-- ketones are your main enemy and you MUST give the fluids. You can bring the low BGs up with foods etc. if that happens.

I looked at Grayson's SS and it does not appear you are getting dramatic drop or any drop associated with the fluids. But, that really isn't a fair statement....because, you don't know what the BGs would be without the fluids.

I am glad you increased to 1 unit. I DO NOT like the moderate ketones and would not hesitate to increase his insulin again if the numbers do not start to move downward. I also would inquire about using R on health to get him out of these high flat numbers. When you were just giving .6 or .75 units of PZI, R would be almost impossible to use, but as you see the need for more insulin and are dosing more-- you might can implement R into the regiment now to get the numbers down. You HAVE to find a way to get the numbers down to rid the Ketones. Remember-- insufficient insulin is one of the primary causes of ketones.

For what it is worth-- Kitty was on an antibiotic for an infection and Still went DKA. I just mention that, because sometimes it takes time for the ab to work and it is not a definite alleviation of the infection.

You are doing GREAT using the fluids and checking the ketones, but SOMETHING is causing them to stick around. If you do increase your insulin, be prepared to need to lower the dose when the infection and ketones clear. One more point....and I know ECID, but prior to DKA, Kitty was getting 2 units of PZI once a day (yes, I know--crazy, but I didn't know then!)--- after DKA, she went to 3 units bid and still had high numbers. While the DKA MIGHT have increased Kitty's insulin need....... it goes to show how severly she was underdosed prior to DKA.

Keep a check on the ketones, post on health about Sub Q impacts on bgs and the use of R, and do not hesitate to increase the Prozinc if the ketones remain.

One more thing.....RIGHT now, your biggest concern isn't the BGs or looking for the perfect curve.....it is KETONES.

Just my thoughts.....

Edited to add--- the only reason I mentioned R was to combat the Ketones! If you did not have ketones present, there would be no need to inquire about R, you would just continue to increase your Prozinc dose over time.
 
Re: Sub Q impact on BG

saw your post on Health...
whether or not you see a glucose lowering effect after giving sub-q fluids depends on the cat. it's the old ECID thing. :mrgreen:

fluids never seemed to lower alex's BG numbers so our routine was to give fluids and then immediately test, feed, and shoot. another fdmb member clued me into this interesting little tidbit of info... for some reason, most kitties will want to eat immediately after receiving fluids. this is especially helpful when you have an inappetent kitty and need to get food on board in order to shoot.

hope this helps. good luck keeping those ketones at bay... don't be afraid to get enough insulin into him even if it means feeding wet high carb food to keep him from bottoming out.
 
Re: Sub Q impact on BG

Thank you Carl, Kim & Jill -

Before I posted here, I put the same message on HEALTH and directed them to come to PZI. It seems to have worked, as Jill found her way here!

Fortunately, inappetance is NOT an issue for Grayson. When he peed onto the stick [MODERATE] I fed him and did the fluids immediately. This way he doesn't wiggle - he's too focused on the food. I waited an hour since he was still almost 3 hours from preshot, then fed and shot him anyways... my biggest concern was shooting early. Friday pm/Sat am, per the vet's recommendation, I upped him to .75u; I moved on up to 1.0 last night & this morning on my own, as the flat cycles had continued.

+9 353
MODERATE ketones
FF
SubQs
AMPS 360 (+10)
Shot 1.0
FF
+3.5 336
Clavamox

kse said:
It is always advisable to give sub qs AFTER nadir, to avoid them accelerating or increasing your drop. Right now, with your high cycles it is impossible to tell when your nadir is--but, normally you can assume that by +8 Prozinc has nadired (lowest of cycle)-- even if you can't see it on your tests.
Click to expand...

Although it's not been as obvious where his nadir is, I didn't want to assume, as he was often dancing marathons... sometimes nadir was as late as +11 (2/11, 1/24). For Grayson, it appears the timing of the fluids don't seem to make much difference.

Stay tuned!
 
Beginning at 40 today:
+9 353
MODERATE ketones
FF
SubQs
AMPS 360 (+10)
Shot 1.0
FF
+3.5 336
Clavamox
+4.75 304
+8 323
1/2 can FF snack

Looks like he might actually have broken 300 for his nadir, but unfortunately, I wasn't here to find out! Maybe tonight. It also looked like he pushed out some of the fluids that went in at 4 am... litter box had a larger than his usual sized pee pie. He's not too inclined to go near it when I'm home - apparently he's decided he likes his privacy now!

He's still eating and looking good, behaving normally - just finished 1/2 can FF (snack), and is lounging on the dog bed grooming himself. My! His coat sure does look handsome again!!! (not to mention those teddy bear arms!) ;-)
 
I think right now you should be using the SQ fluids for the ketones, which at this point are your main concern.
Think of moderate ketones like sitting on the edge of a cliff .... with just one other thing happening and you are at the bottom in DKA. SQ fluids help dilute the ketones and I also agree you should think about adding R now that he is up to 1u. With pzi you can add the R at the same time because they nadir at different times, keeping a higher dose of insulin in him all the time. And by the way a big gulper is like Payne and Kitty 9-12u a day. ohmygod_smile

Nancy and Payne ......
 
Nancy -

Thank you for your insight. Sorry I wasn't paying attention - on the phone and not good at multi-tasking while in conversation.

I checked him a short while ago; SMALL ketones - I gave him another 100 ml of sub Qs and a can of Royal Canin - probably when you were responding. Will keep you tuned in.

THanks again!
 
FINALLY a yellow (and after just eating a can of Royal Canin)!!! Lowest number since Wednesday.

Grayson just walked over and pulled a catnip toy out from under the secretary, and is wallering around with it. Earlier he had a fly - and was dancing around the kitchen/dining room chasing it. He clearly feels good, in spite of the roller coaster it's felt like to me. Doing well w/ the SubQs (face in food seems to be a good distraction); the ketones are decreasing, but I see they can inch up w/o much notice... so TEST, TEST, TEST!!!

Although he's eating everything he's offered, he's still dehydrated. The fluids usually make him look like the Hunchback of Notre Dame, but in less than a half hour they've been absorbed. I'm mixing water w/ his food, and he's still drinking a fair amt, so at this point its 100 mL 2x/day, Clavomox and food whenever hungry in addition to shot time. Hopefully I'll see several more hours of his numbers, and will maybe see a nadir! I can only imagine what it would be if he wasn't snarfing down so much food! :smile: Maybe even a blue!!!

Will touch base w/ the vet tomorrow and go over what's transpired this weekend. I'm a little leary to do the R without it being in an IV - as well as the dosing for 1 unit. I'm sure it's probably like the micro-dosing otherwise.

For those of you that use the R - how do you do it? Inject or IV?
 
The people that I am aware of that give R-- give it sub q-- just like Prozinc. You would need someone to advise you as to how much you would give--but it is given in much smaller increments than Prozinc.
 
Much smaller doses. You can PM Nancy, and Deb also has mentioned it in Lydia and Sid's threads. You definitely want to ask someone who has used it before and ask them to post in your thread with any advice or tips.

Carl
 
The theory with using R for ketones is it gives more than an adequate amount of insulin at all times. So if you were shooting 1u pzi adding a small amount of R would give you a nadir at +3-4 and also +5-8 .... that helps keep the ketones lower because an inadequate amount of insulin with ketones is the #1 reason for DKA.

Even though Payne gets 4u pzi TID ..... ALL four times she went into DKA she was on 2-4u insulin a day!! with no R. At her worst with ketones, Payne was off the ketone meter! and she was getting 20u a day pzi and R. Go search giving R or go on health and ask about dose for giving R.

Good luck,
Nancy and Payne .....
(who doesn't like talking about ketones!)
 
I think I get what you're saying, and based on the normal length of his cycles, when I usually didn't see an initial drop until about +4, I'd say I agree with you. Right now, however, it appears nadir is at or before +4.5 (am) or +4.75 - 8 (pm). Isn't that when the R is supposed to kick in?

Maybe his numbers are skewed because of the quantity of food I'm continually giving him? I'm not sure.

PMPS (+9.5) 360 Shot 1.2
+1.75 317
+2.5 306
SMALL ketones
+3.5 SubQs given
fed Royal Canin
+4.5 278
+5.5 305
+6.5 330 fed 1/3 can FF
NEGATIVE-TRACE ketones (although kinda lt. gray on test strip)
+8 372 Shot 1.2

Again, he looks and behaves normally - even playful at times, although he was a little agitated (wiggly) when I gave him his shot tonight. And maybe a little tender in his belly?

In addition to the ketones, is there anything else you can think of that we should be having checked???
 
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