+3 223 (.5u) New ProZinc user, Advice appreciated

Hello all,

I've been posting in the Feline Health Main Forum here, but some more expertise from ProZinc users would be very helpful.
(Previous Thread Link Below):
http://www.felinediabetes.com/FDMB/...ed-post-1st-blood-test-x.158275/#post-1686587

My vet told me to give 2 units of ProZinc 2x a day which I now see was way too much! Micah was in the 300s + 200s yesterday. You can look at his SS but his +11 is 48. I will retest at +11.5 to see how he's doing, but I don't think I will be giving him any insulin at his PMshot time. If you have any advice please let me know.

Thank you,
Karen

 

Karen, give him some higher carb food if you have it. If not, rub a teaspoon of honey on his gums. And retest. We need that number to rise, not fall.

 

Karen, you probably just saw what I wrote on the other thread about stress hyperglycemia ...

We want to get Micah's #s up to a reasonable level and make certain it stays there on its own for at least a couple of hours (without any more steering) before you can really relax tonight. No, you definitely do not want to dose him at all this cycle.

And tomorrow, at his usual morning pre-shot test time, you need to post that # here on ProZinc with "AMPS # & Dose Advice Needed" in a brand-new thread at that time. Not only will you not shoot if the number is below 200 tomorrow, but even if it is, I'm wondering whether you'd be much better off starting out at 0.5 unit. As you can always increase a dose next cycle, but you can't "unshoot" a dose of insulin that's too high; at that point all you can do is steer, like you're doing right now.

 

That is a hypo number. So, no insulin. We need to bring the number up. And yes, definitely a reduction in dose.

 

And the small amounts of higher-carb food are important too, because the honey or Karo syrup will bring the BG number up faster, but the food helps the blood glucose stay up longer ... and that's what's needed here: A good, safe BG # that comes up and sticks.

 

Hm is dry food okay then? He prefers the wet but I can give him a small amount of dry before his meal of wet food.

 

Is that all you have on hand for a higher-carb choice?

 

If that is all you have. Best would be gravy off a high carb food. But if not, then a few pieces of dry food. And I think I'd be tempted to add a tiny amount of honey also.

 

I could do dry food with some honey. I don't have any high carb wet food.

 

@Sue and Oliver (GA) - What's your recommendation for the amount of kibble Micah should have right now? (As I've never used kibble to steer, myself ...)

 

Ok so his +11.5 is 56, which is back up a little from 48. Should I still put honey on the kibble? It's Purina One Sensitive Systems kibble.

 

I am glad he is moving back up. Maybe we can skip the kibble and just give him a teaspoon of regular food. Then plan to retest in 20 minutes. (It is most likely at this point in the cycle, he will be going up, but we want to make sure he doesn't drop down again.

 

I would add a few drops of honey to the kibble. Kibble is pretty high-carb, but we do want to make sure he gets up to above 70-75 at least.

Oh, good! Sue's back!!! (And I agree with her post above, btw.)

 

Should I add honey to a teaspoon of regular food?

 

I'm sorry: Has he already had some honey?
Because if he has, maybe just the food this time around to see how he's doing in 20 more minutes ...

 

Since he's risen to 56, I'd be a little more cautious about adding more honey if he's already had some before this; would like to see how the food does.

 

@Robin&BB No I haven't given him any honey yet. Just a tiny bit of wet food and gravy around +11 when he went down.

I'm going to copy&paste what you wrote to respond better here from the other thread.
"The good news is this, Karen: We know that Micah needs significantly LESS insulin than 2 units. One of the things that can happen at the vet visit is "stress hyperglycemia" - some cats really stress out going to see the vet (some cats get really stressed just by riding in a car, like mine does).
It is not unheard of for a cat to spike a BG# more than 100 pts higher during a vet clinic visit than the cat would at home where he or she is more calm and relaxed. This is why home-testing is such a smart thing to do! (And I am SO glad you're doing it.)"

I am debating between going down to .5 or 1 unit of insulin. Micah was actually extremely relaxed and at home at the vet's. It was very peculiar. Meowing nonstop the whole car ride there, but I let him out on the bench while we waited (and we waited for 40 minutes) and he just laid down and relaxed like he was at home. Little dogs barked and walked by and he was totally calm. I don't get him lol!

 

Ok I will just give him a little bit of wet food by itself then and test again around the PMPS time.

 

Well, this drop down into hypo territory is a clear indicator that 2 units is way too much for him. We'll know more when you get that preshot # in the morning ...

As for the steering when he's too low, it's something of a balancing act. You want to bring that # up and keep it up, but you don't want to overload him with carbs to the point that he's spiking a really high BG # from too much added honey or syrup. And although you need a fast-hit like Karo or honey if that # isn't rising enough/ quickly enough, overdoing it can make it difficult to determine later whether it's his own system working or whether it's the effects of too much added glucose.

 

Does that make sense?

 

I was smiling at the irony here, Karen, as I was writing all of the above --- because lately I've been having to steer my own kitty a LOT out of low #s.
(And would you believe she is only on 0.05U of Lantus? And I used to have to steer her on 0.10U of ProZinc when we were on that, too.)

 

How many minutes from now will that be?

 

Wow that seems like nothing! I guess you probably have to use the u100 syringe instead of the u40 one then right?

I won't be able to monitor while I'm at work tomorrow either so if he's high enough by the morning I think I will give him the lower dose of .5u to be safe.

Edit: I was going to give it about 7 more minutes around 7:15EST since I just gave him a little food.

I am also trying grab a bite to eat between tests for myself lol.

 

Assuming that you see a pre-shot # of 200 or more, I'd say that would be the smartest route. But I would also leave out a frozen "puck" of the canned food when you leave for work, so that it's thawed out by the time he night need it. (Is Micah your only kitty in the house?)

 

Ha, yep! U100s. It's a real eyesight-wrecker of a dose, that's for sure!
(Btw, Lantus is always dosed using U100 syringes; ProZinc users need to use a conversion table to dose with the U100 syringes, though.)

 

I agree. Most likely he will be high. After 24 hours since his last shot and probably a bounce, his amps might be high. But I would still reduce the dose. My thinking is that you want less insulin in his body than the dose that gave you a hypo number at the end of the cycle.

A bounce is when his body perceives a lower number than he is used to (like his number tonight) and it releases extra sugar. So his number bounces and is higher than expected.

 

Makes me wish they could TALK to us ... but even "happy" excitement can cause a spike in BG#s; that's the trouble - you just never really know for certain. (Unless it's Bat-Bat. She's so nasty at the vet's office that she has to be stuffed in the "gas box" before anybody can even examine her ... but is as calm as can be here at home. Kinda embarrassing!)

 

Scary numbers! But you are in very good hands here with Sue and Robin!

 

Glad to see you made it over here Karen!!

I'm good for getting people started, but if they're using ProZinc, it's always best to move over to the Insulin support group for that insulin so you get the best advice possible

Just for the future....You should keep some "Fancy Feast Gravy Lovers" food in the house at all times...The "gravy" part is high carb and usually just a teaspoon or two of the gravy is enough to get them back above 50 where we want them (without filling them up so they won't want to eat later if we need them to)

When you use the Gravy Lovers types of food, just pop the lid and press it back down and squeeze the gravy part into another bowl and just feed that gravy part. It's messy but it works!!

I'll be checking in with you and Micah now and then, but mostly, since you're here with the ProZinc experts, I'll leave the dose advice to them!! I do agree the .5 would be safest for Micah at this point too..especially with him going this low, this late in the cycle....especially if you can't be home to test.

Welcome to the Sugardance!!

Edited to add...if you haven't see this Conversion Chart here it is....It's for using U100 syringes instead of the U40 that you usually use with ProZinc so you can give smaller doses

 

Good news! Micah went up to 91 at his PMPS time! That was just giving him a teaspoon of normal food, no honey.

 

Yessssss!!! That's the kind of news we LOVE to hear. So you need to write "skip" in the "U" column on your SS (since he's definitely not getting a dose tonight) and I'd say you should go ahead and feed him what he normally gets for his evening meal. Then as long as he eats it all, check him @ +1 just so you can see that he's staying up there.

(If he doesn't eat it all, check him again in another 1/2 hour. I'm just being extra cautious here ...)

 

Great! Avoiding giving honey is good as it will add to those high bounces. Anytime you can just give regular food and steer the number is good. Chris is exactly right - gravy lovers fancy feast is a necessity for your hypo kit.

Nice job bringing him up. You survived your first hypo!

 

And you will also want to get a +2 before calling it a night on the testing. (And then - woo-hoo! - you'll be able to get a good night's sleep!)

P.S. We're all so proud of how well you did this, btw!

 

Great job getting Micah back up to a nice safe number Hoping for a quiet rest of the evening for you two

 

Yay!! Thank you everyone for the help getting him back to a normal number. If you had told me that I would be getting blood from Micah's ear this many times in a day last week I wouldn't have believed it! I gave him the rest of his can of food with some extra water and will test him again at +1 and +2.

I'll also pick up some of the Gravy Lovers Fancy Feast tomorrow when I go to the pet store.

 

Umm.. is my monitor broken!? Micah just bounced up to 267 at +1, skipping the PM insulin! This is good right?

 

Well, now we get some idea of how fast he bounces. Somehow they bounce right away, sometimes a few hours later, sometimes the next cycle.

Yes, I imagine it's a bounce. To be sure, you might retest and make sure it was a good number.

 

If you get a test that seems out of place try doing another one. Sometimes a strip is off or the blood sample was too small for a correct reading

 

Hi Karen

Great job with catching that low and steering Micah back up to better numbers today. I'm glad to see all is going OK.

Tip:

Make a note of when, how much, and which type of food you gave while Micah was running low in the Remarks column for today's line on your spreadsheet so that you have a record of the effect of the food on Micah's BG. It's always helpful to have information like this to refer back to.


Mogs
.

 

I retested and got a 266 so it looks like it really did bounce back up! Thanks @Critter Mom I will type in some notes right now.

Do you all think I should do .5units or 1 unit for the AM insulin shot if Micah is still above 200?

 

I'd still be inclined to do the 0.5 unit. Because you can always increase the dose later, when you can be home to monitor. Better to "start low, go slow" after an episode like this one.

 

If you were going to be around to monitor, one unit might be okay. If not, it makes me a little nervous.

 

Ok thank you @Robin&BB and @Sue and Oliver (GA) . I'll do the .5u tomorrow if he's 200+ for his AMPS. I have memorial day weekend off so I'll be able to go up to 1u and monitor if needed (for 3 days) after tomorrow's .5u.

 

That sounds like a good, safe plan, Karen. (And now Sue & I won't be sitting around like this tomorrow while you're at work:)

 

Haha! Thanks Robin! I will keep you all posted!

 

P.S. In all the hubbub today, I forgot to tell you ... that I think Micah is a really strikingly handsome boy.

 

Thank you! I quite agree with you!

 

Nice job, Karen - good luck tonight and tomorrow

 

Hi Karen! Sorry I wasn't around today...looks like I missed all the activity! Since Sue and Robin had things well in hand, I pretty much wanted to stop by and welcome you to our forum!

Just to let you know, we are a fairly small forum. If you ever run into an emergency situation, post both here and on Health to be sure some eyes can be on it. We will definitely help if we're here, but we're not always, and there is usually someone on Health.

 

I updated Micah's SS. He stabilized at a 333 at midnight and I gave him the .5 after his AMPS since he was still 333. I'll update again later after work probably around 3 or 4PM EST.

 

Thanks for the update, Karen. Will be watching for you starting around noon-ish my time.

 

So probably his bounce cleared and he "surfed" along at the same level. If this is his pattern (bouncing right after the low and then flattening out) that is good info for you to have.

It will be interesting to see how the dose works this cycle.

 

+8 Micah was at 265 from the .5u dose

 

Actually, that's not bad at all, Karen. He went through a LOT yesterday ... and this yellow you're seeing @ +8 makes me curious as to what his nadir might have been today. (Who knows?)
So I will be interested to see what you get for a PMPS #, and we can all put our heads together then & help you figure out whether you want to hold this 0.5 for another cycle or increase it just a bit. (And you'll be around to monitor this weekend, right?)

 

Yay! That would be great. Should I refrain from feeding him until PMPS then? Also, he threw up that liquid brown vomit again while I was work...

Oh and yes I will be around to monitor

 

Yes, I would refrain from feeding until then. But now I will have a question:

When you say "brown liquid," is this kind of a golden color?

 

Something like the color attached. Maybe a little darker

 

Hmm ... could be mostly bile, if it's just liquid. I'd say he may still be having a bit of tummy upset from the food change & then with the low-drop yesterday & the steering that had to be done. Was his appetite ok this morning for you?

 

Oh yes! He NEVER has an appetite problem. Even if he rejects a certain kind of food he still acts like he's starving. He gobbles up 1 can as fast as he can in one sitting.

 

Oh, that's good to hear. That may even change a little over time ... (Although I must say that my cat's always been a "chow hound"-type kitty, even since her diabetes is well-controlled.)
How much food did you leave out for him while you were at work today?

 

I just left the regular 1 3oz. can of wet food. I need to go stock up on more food today and I think I'm going to wait to look into the timed dispenser before I try frozen food bc I think he would just gnaw at it and eat it in one go.

Oh right, I wasn't able to switch over to this Purina One food slowly because I found out he had Diabetes and he was refusing the Nutro cans he ate before. His other regular food before that was dry and I was told not to feed dry with the Diabetes. Hopefully he will stop throwing up once he gets used to it a little more. I'm surprised his appetite for it hasn't decreased even after he's thrown it up.

 

There have been times that Ms. Bat has tried to eat what she just barfed. (Ick!)

Speaking of that ... if Micah ever does the "scarf & barf" thing, I found that raising my cat's dish up off the floor (using a shoebox is just about the right height) helps because then the head isn't kind of upside-down when kitty is eating (so is not fighting gravity). I also learned that if I give her about a 5-minute "food rest" halfway through her meal, she doesn't scarf it all down so fast. (She used to do that a lot more, back when her diabetes wasn't well-regulated yet, but now she's better about pacing herself ...usually.)

 

Yep that's what I was doing when Micah was drinking water so fast nonstop until he threw up. I made him take several breaks.

However this seems to be a little different than the scarf and barf because he doesn't throw up right away. It's more like hours later. Like when I heard him throwing up in the middle of the night. lol I'm glad he tries to make it to the litter box to throw up though. Kinda cute

 

Aww ... what a little gentleman! Here's another question for you: Does he have his own water dish that he alone drinks out of --- or does he have access to a "community" water dish shared with your roommates' kitties? (I was only asking because I measure Bat's water-drinking every 24 hours; can be a helpful secondary monitoring tool. But maybe that won't work for you ...)

 

Nope he stays in my room and can't stand the other two cats. Being outside my room makes him nervous and crazy. He runs and hides in weird places. I noticed that he did drink more water than yesterday.

 

Bat has a smallish water dish: I measure out 8 oz. fresh water every morning with one of those 1-cup Pyrex measuring cups, then the next morning I pour what's left back into it and that way I can see how much she actually drank in 24 hours. (I do this at AMPS time, but you can always do it at PMPS time if that works better for you. ) Easy enough to do, and it really helps me see how she's doing (especially eases my mind on those days when she throws me a wonky, higher-than-usual pre-shot number). Cats don't naturally have a very high thirst drive; what I discovered was that when she was first diagnosed, she was drinking as much as 7.5 to 8 full ounces of water every 24 hrs! Now she never seems to drink much more than between 0.25-0.5 oz. (Even on the hot summer days, she only drinks, at most, about 3/4ths of an ounce.

Normal water-drinking for a 10-lb. cat on canned food can be as much as 1.5 oz to 3 oz. every 24 hours, however. But when your canned-fed cat starts going significantly beyond that level, it's a good indicator that glucose is out of whack. This is an especially helpful tool once a cat is in remission; it can be something of an early warning flag. And if I had been smart enough to keep on doing it when Bat made remission in 2013, we may not have ended up back on "the juice" for as long as we've been this time around ... (Gah, one of those live & learn things ...)

(Of course, this tool is worthless for most people in a multi-pet household.)

 

Before I forget: Any water you may add to the canned food (I do add a little, because it makes her think she's getting some "gravy") does NOT count as part of the water consumed per day; only the amount a cat actually drinks based on his thirst counts in the daily total.

 

I haven't been as exact with it as you but I give Micah water in a plastic to go pint size container which is 16 oz. Before the insulin he would drink the whole thing in 12 hours. I would refill it and he would be done with it again by the morning.

Edit: update! Micah is doing a 224 at +3 off the .5 u dose this evening. I will test again at +4

 

WOW! He must have been peeing bucketsful of urine. Holy cow, that's a a lot of water.
(Definitely would be worth carefully measuring the amount he takes in daily.)

 

HAHA Yes. I thought there was something wrong with the litter because it would just become gluey clay. But it was just Micah. Should I create a new thread?

 

Yeah, I'd start a new one. ('Cause I'm old and too lazy to keep scrolling down the page.)

 

Micah's new thread:

http://www.felinediabetes.com/FDMB/threads/micahs-new-thread-4-151-6-176-new-to-prozinc.158578/