Thumper 7/15 PMPS 528 should I still stay @ .6?
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Sue and Oliver (GA)
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Re: Thumper 7/15 more questions
It is your decision to make, Barbara. As Joanna said last night, we are not that confident about the way the insulin is working and we are giving you our best guess. You could continue with one unit for a few cycles, getting in those nadirs and see if things improve.
When I look at your spreadsheet, I see your best numbers in the .5, .6 range when she was in the 200s preshot and going down into the blues at nadir. It might be that going back there will not produce those numbers again. I don't know.
It is your decision to make, Barbara. As Joanna said last night, we are not that confident about the way the insulin is working and we are giving you our best guess. You could continue with one unit for a few cycles, getting in those nadirs and see if things improve.
When I look at your spreadsheet, I see your best numbers in the .5, .6 range when she was in the 200s preshot and going down into the blues at nadir. It might be that going back there will not produce those numbers again. I don't know.
wombat88
Active Member
Re: Thumper 7/15 more questions
I don't think so. I responded to your other thread, but though there is confusing data in there, it does appear to me at least there has been some sort of a change the past few days that is increasing her glucose and causing her to throw off trace ketones. You are still below your ketone meter's "worry" zone, but the change in glucose numbers concerns me. I suggested in the other thread that you have her checked for an infection, like a UTI. They can be there in diabetic cats with no symptoms.
It does appear that you need to give her a higher dose. What was the lowest she went yesterday? If you want to shoot a higher dose for today I don't think that will hurt at all. But get good data for in between to ensure she's having a good curve and that she does not show signs of rebound. I think that 0.8U or even 1U is worth a try to see how she does. I'm going to bet that you will not see a decent curve this AM given the lower dose, but we'll see. Test every four hours if you can this cycle, or every three if you can. Then increase the dose this PM if she stays high or flat this AM and do a few tests before you head to bed.
But I would make an appointment to have her seen, at least to get an urinalysis done. If they tell you it is "just the diabetes" tell them that's exactly the point -- diabetics get a lot of UTIs!
I don't think so. I responded to your other thread, but though there is confusing data in there, it does appear to me at least there has been some sort of a change the past few days that is increasing her glucose and causing her to throw off trace ketones. You are still below your ketone meter's "worry" zone, but the change in glucose numbers concerns me. I suggested in the other thread that you have her checked for an infection, like a UTI. They can be there in diabetic cats with no symptoms.
It does appear that you need to give her a higher dose. What was the lowest she went yesterday? If you want to shoot a higher dose for today I don't think that will hurt at all. But get good data for in between to ensure she's having a good curve and that she does not show signs of rebound. I think that 0.8U or even 1U is worth a try to see how she does. I'm going to bet that you will not see a decent curve this AM given the lower dose, but we'll see. Test every four hours if you can this cycle, or every three if you can. Then increase the dose this PM if she stays high or flat this AM and do a few tests before you head to bed.
But I would make an appointment to have her seen, at least to get an urinalysis done. If they tell you it is "just the diabetes" tell them that's exactly the point -- diabetics get a lot of UTIs!
Sue and Oliver (GA)
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Re: Thumper 7/15 more questions
I am sure this is frustrating, Barbara. Wendy and I have opposite advice. The truth is, I am not sure. I don't know about the ketones. It will be interesting to see if the .6 gives you a decent curve today. If not, you can sure move back up.
You said she was feeling better, right?
I am sure this is frustrating, Barbara. Wendy and I have opposite advice. The truth is, I am not sure. I don't know about the ketones. It will be interesting to see if the .6 gives you a decent curve today. If not, you can sure move back up.
You said she was feeling better, right?
wombat88
Active Member
Re: Thumper 7/15 more questions
HA! I noticed that too. You must have been typing while I was. It won't hurt to see if a lower dose gets her a good curve. As Sue said, you can always move up. My advice was driven in part by patterns I've seen in Shaikha with infections or pancreatitis flares. Thumper's BG levels just seem to be following a similar pattern, not the zooming you normally see with doses too high. But since you already shot 0.6U, no harm in trying the same dose all day to see if it makes a change. If she seems to get worse then then bump it up a notch to say 0.8U to see if it improves things.
You said in one post she was more lethargic than usual. Any other symptoms? Appetite okay? Any litterbox problems?
EDIT: I went back and studied her SS for a longer period. One thing I commented on before is that you are increasing dose quickly a lot of times. Sue is correct in that you got pretty good numbers on a lower dose in the past. Thumper also seems to react to insulin a lot -- small dose changes produce big changes, so the more even you can keep dosing the better I'd think. Make dose changes slowly and only after a few days of trying the new dose. It still does look like something is going on these past few days to me but you also kept increasing her insulin too so that could be part of it. She did get a decent curve on this last dose increase though, which is the puzzling thing. That suggests she needs more, not less but you need more data.
Could you do a couple of curves this weekend on a lower dose to see what the pattern is over the whole cycle? Not every hour, but every 2-3 hours? If you aren't seeing a good curve on the lower dose, then go up, but a SMALL amount at a time (maybe 0.1U even if your syringes have enough gradations to do that) and hold that dose for a few days.
Sue and Oliver (GA) said:
HA! I noticed that too. You must have been typing while I was. It won't hurt to see if a lower dose gets her a good curve. As Sue said, you can always move up. My advice was driven in part by patterns I've seen in Shaikha with infections or pancreatitis flares. Thumper's BG levels just seem to be following a similar pattern, not the zooming you normally see with doses too high. But since you already shot 0.6U, no harm in trying the same dose all day to see if it makes a change. If she seems to get worse then then bump it up a notch to say 0.8U to see if it improves things.
You said in one post she was more lethargic than usual. Any other symptoms? Appetite okay? Any litterbox problems?
EDIT: I went back and studied her SS for a longer period. One thing I commented on before is that you are increasing dose quickly a lot of times. Sue is correct in that you got pretty good numbers on a lower dose in the past. Thumper also seems to react to insulin a lot -- small dose changes produce big changes, so the more even you can keep dosing the better I'd think. Make dose changes slowly and only after a few days of trying the new dose. It still does look like something is going on these past few days to me but you also kept increasing her insulin too so that could be part of it. She did get a decent curve on this last dose increase though, which is the puzzling thing. That suggests she needs more, not less but you need more data.
Could you do a couple of curves this weekend on a lower dose to see what the pattern is over the whole cycle? Not every hour, but every 2-3 hours? If you aren't seeing a good curve on the lower dose, then go up, but a SMALL amount at a time (maybe 0.1U even if your syringes have enough gradations to do that) and hold that dose for a few days.
Barbara
Very Active Member
Re: Thumper 7/15 more questions
Wendy, I have really developed a vet phobia when it comes to her I think. Maybe I can get a urine sample myself & take it in. The lowest reading I got yesterday was last night @ +6 - 244 that was after I sort of panicked & shot 1 Unit. I'm not home today but I'm trying to get in touch with DH to see if he can get any #'s for me. I will post if I get any.
I barely remember all of what Joanna was saying last night, I'm going to go back to read it again. Just wanted to let everyone know I really appreciate all the help, I'm just a little confused. I do tend to look at only what happened the last cycle & I guess I need to look more at the whole picture. If it wasn't for you guys I would have been in trouble a long time ago!
Wendy, I have really developed a vet phobia when it comes to her I think. Maybe I can get a urine sample myself & take it in. The lowest reading I got yesterday was last night @ +6 - 244 that was after I sort of panicked & shot 1 Unit. I'm not home today but I'm trying to get in touch with DH to see if he can get any #'s for me. I will post if I get any.
I barely remember all of what Joanna was saying last night, I'm going to go back to read it again. Just wanted to let everyone know I really appreciate all the help, I'm just a little confused. I do tend to look at only what happened the last cycle & I guess I need to look more at the whole picture. If it wasn't for you guys I would have been in trouble a long time ago!
Barbara
Very Active Member
Re: Thumper 7/15 more questions
And I didn't see either of your responses till after I posted! LOL!
She did seem more lethargic I think it was on Wednesday but then I got a report from my daughter that she had been playing some that day when I wasn't home. She seemed better yesterday & she actually went outside last night to lay on the patio & she barely does that anymore. I see no other signs of anything being wrong. When she has had UTI's before she ends up peeing on my bed for some odd reason. That hasn't happened so far lately. The biggest thing I have picked up on is her appetite has increased.
And I didn't see either of your responses till after I posted! LOL!
She did seem more lethargic I think it was on Wednesday but then I got a report from my daughter that she had been playing some that day when I wasn't home. She seemed better yesterday & she actually went outside last night to lay on the patio & she barely does that anymore. I see no other signs of anything being wrong. When she has had UTI's before she ends up peeing on my bed for some odd reason. That hasn't happened so far lately. The biggest thing I have picked up on is her appetite has increased.
wombat88
Active Member
Re: Thumper 7/15 more questions
Shaikha has also peed on the bed when she's had one. Not an uncommon symptom, actually! Given what you've said it sounds like she's doing well, actually, so no reason to take her to the vet. If that's the case then stick with the lower dose as Sue suggested. Get some curves in but grit your teeth and hold the dose at that lower level. You do seem to have a hair trigger on dose changes, and looking at Thumper's SS she reacts a lot to them. If after a few days on 0.6U she just keeps climbing or stays flat, you know that rebounding should have cleared and a higher dose would be warranted then. I'd suggest a tiny dose change though at the most if you do end up having to do that -- 0.7U if you can. I got Relion syringes at Walmart that have half unit markings and they have really helped with tiny dose changes.
Sorry if I confused you any. I do think it would be a good idea to try lower doses for a few days just in case there is some rebound. If she were lethargic or not eating, then I'd worry more about the infection. What you may be seeing is simply the result of too much, vs. too little, insulin.
Don't you love complex kitties????
Shaikha has also peed on the bed when she's had one. Not an uncommon symptom, actually! Given what you've said it sounds like she's doing well, actually, so no reason to take her to the vet. If that's the case then stick with the lower dose as Sue suggested. Get some curves in but grit your teeth and hold the dose at that lower level. You do seem to have a hair trigger on dose changes, and looking at Thumper's SS she reacts a lot to them. If after a few days on 0.6U she just keeps climbing or stays flat, you know that rebounding should have cleared and a higher dose would be warranted then. I'd suggest a tiny dose change though at the most if you do end up having to do that -- 0.7U if you can. I got Relion syringes at Walmart that have half unit markings and they have really helped with tiny dose changes.
Sorry if I confused you any. I do think it would be a good idea to try lower doses for a few days just in case there is some rebound. If she were lethargic or not eating, then I'd worry more about the infection. What you may be seeing is simply the result of too much, vs. too little, insulin.
Don't you love complex kitties????
Ginny & Alex
Very Active Member
Re: Thumper 7/15 more questions
Barbara,
I read thru yesterday's and today's Thumper posts and I can't begin to imagine why you might be confused. ;-)
Good luck on the increase or the decrease or staying the same!
Barbara,
I read thru yesterday's and today's Thumper posts and I can't begin to imagine why you might be confused. ;-)
Good luck on the increase or the decrease or staying the same!
Marcy & Klinger (GA)
Very Active Member
Re: Thumper 7/15 more questions
I agree with what Wendy wrote above. Something has changed with Thumper and may have a UTI or something that is causing her numbers to spike....and you might want to try a new vial. ;-)
wombat88 said:I don't think so. I responded to your other thread, but though there is confusing data in there, it does appear to me at least there has been some sort of a change the past few days that is increasing her glucose and causing her to throw off trace ketones. You are still below your ketone meter's "worry" zone, but the change in glucose numbers concerns me. I suggested in the other thread that you have her checked for an infection, like a UTI. They can be there in diabetic cats with no symptoms.
It does appear that you need to give her a higher dose. What was the lowest she went yesterday? If you want to shoot a higher dose for today I don't think that will hurt at all. But get good data for in between to ensure she's having a good curve and that she does not show signs of rebound. I think that 0.8U or even 1U is worth a try to see how she does. I'm going to bet that you will not see a decent curve this AM given the lower dose, but we'll see. Test every four hours if you can this cycle, or every three if you can. Then increase the dose this PM if she stays high or flat this AM and do a few tests before you head to bed.
But I would make an appointment to have her seen, at least to get an urinalysis done. If they tell you it is "just the diabetes" tell them that's exactly the point -- diabetics get a lot of UTIs!
I agree with what Wendy wrote above. Something has changed with Thumper and may have a UTI or something that is causing her numbers to spike....and you might want to try a new vial. ;-)
Sue and Oliver (GA)
Very Active Member
Replied on Health. I would try the one unit again. But I do think there must be something else. How old is the PZI?
kse
Very Active Member
My thoughts of an inverse curve are like that of a speedbump--- A low preshot that gets higher in the middle and then comes back down at the second preshot--because the insulin has run out. My idea of a flat curve is just that--flat--and I would expect the second preshot to be higher, because the insulin has pooped out.
If this ananlogy is correct----today was flat. And, a flat curve means too little insulin.
I see no reason to expect bounce in the last few cycles--there are no readings low enough to create a bounce. And, Thumper as surfed Greens and Blues without bouncing in the past. I really don't think this is a bounce.
I really don't know--but, these are my thoughts.
I think something is going on with Thurmper--a vet visit is maybe needed.
If this ananlogy is correct----today was flat. And, a flat curve means too little insulin.
I see no reason to expect bounce in the last few cycles--there are no readings low enough to create a bounce. And, Thumper as surfed Greens and Blues without bouncing in the past. I really don't think this is a bounce.
I really don't know--but, these are my thoughts.
I think something is going on with Thurmper--a vet visit is maybe needed.
Sue and Oliver (GA)
Very Active Member
It may be that the one unit is too high. But I don't like that high number with a kitty who is ketone prone.
Barbara
Very Active Member
kse said:
I really think it's the same problem as last time & you know where that vet visit got me...the ER. I really suspect that lasix injection was the cause of her weakness that night & the spike in BG. I went ahead & shot 1 unit...Sue answered me on the Health thread.
Sue and Oliver (GA)
Very Active Member
It really liked the idea of trying the lower dose, but am too uncomfortable with that number.
wombat88
Active Member
Yikes! I'm so sorry, Barbara. I was hoping a lower dose might work and that you were only seeing a bounce, but given how high she's gone I'm glad you shot a higher number. Something else does seem to be going on. You may need to consider taking her in again to the vet to get checked. An infection is a definite possibility and is the only thing I can think of that would come on so quickly. I don't know enough about ketones to know whether the sudden appearance of even a tiny amount is a concern. :sad:
Rob & Harley (GA)
Very Active Member
Well that little experiment gave you an immediate answer. I'm glad you raised back up to 1 unit.
Like everyone else said, I would have her checked for some kind of infection.
Like everyone else said, I would have her checked for some kind of infection.
Barbara
Very Active Member
+2 - 359
Looking a lot better! I think I'm gonna call tomorrow to see which vet is working, with any luck it will be the one I like the best. I'm not sure we totally agree on the diabetes but I'm pretty scared to take her back if the one that gave her the lasix injection is there. If she's not in hopefully we will be okay till she's there next week. I really have a vet phobia now. I'm gonna be able to get at least a +4 tonight. She was eating a lot...tried to get in my plate at dinner! She's sleeping now but seems to be fine. Thanks everyone!
Looking a lot better! I think I'm gonna call tomorrow to see which vet is working, with any luck it will be the one I like the best. I'm not sure we totally agree on the diabetes but I'm pretty scared to take her back if the one that gave her the lasix injection is there. If she's not in hopefully we will be okay till she's there next week. I really have a vet phobia now. I'm gonna be able to get at least a +4 tonight. She was eating a lot...tried to get in my plate at dinner! She's sleeping now but seems to be fine. Thanks everyone!
Rob & Harley (GA)
Very Active Member
Much better. I would think that any vet can do the labs for an infection but you know them best. There has to be something else going on here that we havn't thought of yet.
Joanna & Bix (GA)
Very Active Member
Barbara you are doing great, and I think your instincts are telling you what to do and you are doing it, so YAY! You may not feel like it, but I think you have a much better handle on knowing what to do than you realize. If you figure that we collectively would have confused the h*eck out of *anyone* yesterday 
and not only did you digest all of that and decide what to do, but you are reacting quickly to what you are seeing in the data, and it seems to me your instincts are serving you well.
The benefit of having tried out the 0.6 is that now you know that wasn't the answer, and so can raise with confidence. Normally with dose increases I recommend people wait 3-4 cycles to allow for the build-up/overlap between doses, but there *are* other strategies! (Like you need MORE information and choices right now, LOL ohmygod_smile )
So one thing you can do is raise the dose more quickly, but then as soon as you get good results, pull it back immediately (this is NOT recommended for anyone who is really new here, or if you don't have any particular reason to need to be a little more aggressive with dosing). So for instance instead of holding 1u for 4 cycles and then deciding on cycle 4 if it is giving you a good enough nadir or not, you could shoot say 1.2 for a shot or two, and then pull back to 1u and see where you are. A little extra oomph to kind of get things going, but then pulling back so you don't get the full effect of overlap on 1.2 when you aren't sure what the overlap might give you on 1u.
Lots of variations on that theme. The important thing I think is monitoring - if you can't monitor you shoot on the safe side, if you are there to monitor you can try a higher dose more quickly that you might otherwise. If you did something like that and got greens, then I would pull back a hair so you don't get increased momentum off that.
Anyhow, just throwing all that out so you won't feel scared of raising the dose more if she needs it, and won't feel like you have to stick with a dose a certain number of cycles if you don't like her numbers or if she starts acting like something is off. I wouldn't panic and raise every cycle, but I think it may help you to know you have tools in your arsenal, like shooting a little more on a cycle when you can monitor, and knowing then you can back off that if it actually works.
Given how much better her PS was this morning vs. last night on the 1u, I am hopeful that with 2 or 3 cycles on 1u you will see her PSs coming down nicely. It looks like last time she had an "episode" or whatever it is of needing more insulin, you got results around 1u to 1.2u, so hopefully that will be her range again, and you will see some better numbers soon.
and not only did you digest all of that and decide what to do, but you are reacting quickly to what you are seeing in the data, and it seems to me your instincts are serving you well.The benefit of having tried out the 0.6 is that now you know that wasn't the answer, and so can raise with confidence. Normally with dose increases I recommend people wait 3-4 cycles to allow for the build-up/overlap between doses, but there *are* other strategies! (Like you need MORE information and choices right now, LOL ohmygod_smile )
So one thing you can do is raise the dose more quickly, but then as soon as you get good results, pull it back immediately (this is NOT recommended for anyone who is really new here, or if you don't have any particular reason to need to be a little more aggressive with dosing). So for instance instead of holding 1u for 4 cycles and then deciding on cycle 4 if it is giving you a good enough nadir or not, you could shoot say 1.2 for a shot or two, and then pull back to 1u and see where you are. A little extra oomph to kind of get things going, but then pulling back so you don't get the full effect of overlap on 1.2 when you aren't sure what the overlap might give you on 1u.
Lots of variations on that theme. The important thing I think is monitoring - if you can't monitor you shoot on the safe side, if you are there to monitor you can try a higher dose more quickly that you might otherwise. If you did something like that and got greens, then I would pull back a hair so you don't get increased momentum off that.
Anyhow, just throwing all that out so you won't feel scared of raising the dose more if she needs it, and won't feel like you have to stick with a dose a certain number of cycles if you don't like her numbers or if she starts acting like something is off. I wouldn't panic and raise every cycle, but I think it may help you to know you have tools in your arsenal, like shooting a little more on a cycle when you can monitor, and knowing then you can back off that if it actually works.
Given how much better her PS was this morning vs. last night on the 1u, I am hopeful that with 2 or 3 cycles on 1u you will see her PSs coming down nicely. It looks like last time she had an "episode" or whatever it is of needing more insulin, you got results around 1u to 1.2u, so hopefully that will be her range again, and you will see some better numbers soon.
Barbara
Very Active Member
Joanna & Bix (GA) said:Barbara you are doing great, and I think your instincts are telling you what to do and you are doing it, so YAY! You may not feel like it, but I think you have a much better handle on knowing what to do than you realize. If you figure that we collectively would have confused the h*eck out of *anyone* yesterday
Thanks for the encouragement & compliment but you didn't see me pacing around here this afternoon. I posted on health, posted here, kept refreshing to see if anyone was on and made 2 phone calls! :lol: FINALLY, Sue answered on health, I was wanting to shoot 1 unit but was chicken until someone confirmed it!
Joanna & Bix (GA) said:
Glad you commented on that cause I had wondered about when to raise again assuming we're still getting PS's in the mid 300's.
I have a headache and I think I'm gonna go watch some TV! Thanks everyone!
Marcy & Klinger (GA)
Very Active Member
Barbara, How's Thumper today???? Did you take her to the vet???
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