? HELP - ProZinc PMPS 193 after stalling - 3rd night no shot, do I decrease dose in the AM?

Hi,
Tonight is the 3rd night in a row that I will be skipping Chia's insulin shot. Today I wasn't able to come home to get a mid-cycle BG so I don't know how low Chia's BG got during the day. Will I be able to drop Chia's insulin dose to 1.5 units tomorrow or is it too soon to change dose? Also, tomorrow I should be able to cone home during lunch to get a mid-cycle BG reading.
Thank you!

*NOTE - Also, I had been giving Chia 2 units per his vet. Last Wednesday 2/5/20, she wanted me to up his dose to 3 units. I was hesitant about raising it so much, so I changed it to 2.25 units only. Then I came across the FDMB and well, here I am giving him 1.75 units and 3 no shot evenings later and trying to figure this out with the kindness of people on here.
My original newbie thread
http://www.felinediabetes.com/FDMB/...ried-that-it-is-too-much.225444/#post-2524358

 

That is a really good question. I hope someone who is more familiar with the ins and outs of Prozinc can answer more specifically than I can. With some other insulins, it's possible to gradually relax the "no-shoot" number once you have some data, but I'm not comfortable advising too specifically on this, particularly since you're using an AT2 and my instincts are more trained to human meters.

I do like your idea of reducing down to 1.5U (again, pending input from a prozinc user!). However you do it (lower dose or pushing the no-shoot number down gradually), you want to find a way to be able to shoot twice a day-- it's pretty clear from the spreadsheet that Chia can't make one shot a day stretch past the expected 12 hours!

It really is nice to see him in those blue numbers, though!

 

I am not a Prozinc user, but if you are having to skip three evening doses because the BG level is too low to shoot, I would reduce the dose to see if you can find a dose that lets you shoot both cycles.
You could try 1.5 U and see if that works.
Are you leaving food out for Chia while you are at work?

ETA
Try and get some tests in during the PM cycle when cats often drop lower at night. Try and routinely get a before bed test in to see if the number is lower than the preshot....you may need to test again later to keep your kitty safe.

 

You've shot before on low pre-shots. How about 180 as your new threshold number for stall and ask. If still less than this 180, then give a reduced dose, 0.5U. (1/3 of the normal dose)
If 180 or higher, give a 1.5U dose. The current 1.75U dose is too high.

I do recommend that you try to get more than the PMPS test for the night cycle, on a regular basis. I'd like to see a +2 for each night. Then a test somewhere in the +4 to +7 range. In a few days, try to get a +8 to a +10 test at night. Vary the times you do the nighttime testing. a +4 one night and a +10 another. A +6 one night and a +8. Not sure what your schedule will allow you to do. Push back if these suggestions don't work for you.

We're having you look for the nadir that Chia gets on the Prozinc.

I'm wondering to myself as I look at the SS if Chia is getting a longer than normal duration with the Prozinc. Some cats do get 14 hour duration and Chia may be one of those cats. So you may be seeing a bit of overlap from one dosing cycle to the next. I'm not sure of that quite yet, so let's put that thought on the back burner for later consideration.

Then I'm wondering if Chia has a later nadir than normal. Not sure on that either, but the thought is percolating in my mind. We'll have to see with more testing, if either of those theories is correct.

 

Yes, I leave food out for him. I just don't know how quickly he eats it when I am not home. I am looking into getting a timed feeder so I have a better idea. I should be able to get PM shots. I haven't been able to give him his PM shot these past three nights though because is PMPS has been below 200.

 

When I shot on low pre-shot, that was before finding FDMB. I was just doing what the vet told me which was to give him 2 units every 12 hours. I tested his BG to give her numbers. The fructosamine results prompted her to recommend 3 units. I came across FDMB on Sunday 2/9/20 and that is when I started following the tips and advice here, and I created Chia's SS that same day. It took me a while to input all the data I had collected before but I am glad I did it because this SS is so useful. All data from before 2/9/20 was from when I was clueless and following the vet's recommendations blindly. I look back at all the times I gave him insulin at such low pre-shot and no wonder he had another bout of pancreatitis in mid-January! Too much insulin being given to my poor boy!

I will do more night testing so we can have a better idea of where his nadir may be. Wow, so some cats get 14 hour duration? And interesting theory about a later nadir! It all comes down to needing more mid-cycle numbers. I will take your suggestions. Night time is actually easier for me because I am home. I should be able to do that. On my days off I can make sure to get the daytime mid-cycle numbers.

Thank you for your help @Deb & Wink! I think I will try for 1.5 units tomorrow and see if that will allow me to give him an evening shot tomorrow.

 

Yes it is nice to see him getting blue numbers! I will try 1.5 tomorrow and see if that gets me back to shooting twice a day.

 

Not just getting all mid-cycle tests, but some tests at the +10 and +11 times could be informative. Especially if the later nadir theory pans out and the longer duration idea too.

We'll see.

 

I will try what you suggested about taking one at +6 one night, one at +10 another, one at +7, etc. To get a better picture of what the insulin is doing within the entire cycle and see if later nadir or longer duration ideas pan out.

 

Yes a timed feeder is a very good idea as you will know that Chia is getting food when it's needed. If he is anything like Sheba was, he would eat it all in the beginning!
Each time you reduce the no shot number, I would do it on cycles that you can monitor.

 

Yes, I think he eats most of his food in the beginning, too! Good tip about reducing no shot number only during cycles when I can monitor.

 

So happy you found this site too. I agree you should reduce the dose. Deb is giving you great advice. Next time his BGL is high enough to shoot, try the 1.5 unit. And get those mid-cycle BGL readings when you can. I know with my Billy, I did some alarm setting during the night. Got pretty good at waking up, doing a test, and going back to sleep, but it was exhausting.

Don't be concerned about those high morning numbers. You're probably getting some bounce from the skipped shots. It should even out as you continue, especially if you get a dose low enough to do twice a day. Sometimes, doses need to be adjusted fairly quickly. If you click on Billy's Spreadsheet in my signature, you can see how fast we had to drop his dose. Our vet had Billy on one unit if he was eating, and two if he wasn't. It turned out to be too strong for him.

You are doing an awesome job taking care of Chia!