Beenie's dose

Happy Friday...although I'm not very happy. I tested twice for ketones yesterday, tests were negative. Will do it today once I catch her in the act.
I'm coming to the end of the third cycle on 4.8 units. Safe to go to 5 tonight? I know we typically do it in the mornings but I'm so worried about not getting her numbers down. I can't imagine she would dip overnight to low numbers with a .2 increase. What do you think??

 

I think 5.0u would be fine.

 

It's frustrating but keep at it. You WILL get to a good dose range eventually.

 

Thank you!! I'll keep increasing .2 every 3 cycles until we see something.
You guys are so supportive and I truly appreciate it

Have a great weekend all

 

Just keep pushing through...it's tough, but usually when you hit that breakthrough dose, things start to happen fast!

 

Good lord! I let my hair down and went out with my friend for dinner and drinks. So I left instructions for the hubby about the 5 unit increase. He texts me PMPS of 298 after he gave her the shot. That was the lowest she has been PMPS. So I panic and tell him to test at 9:30Pm which is +3 after and the reading was 326. Phew!!

Geez, can a girl relax for one day?!? So I'm home and will test her at +5 and I'm sure its all good. What roller coaster ride

 

LOL...oh my, we have all been there! Most of the time, when a kitty is in higher numbers like this, a lower pre-shot is just a matter of timing. If you stalled without food and tested even 15-20 minutes later, she probably would have been in "normal" numbers. That last hour between +11 and +12 many cats will rise more than 100 points! But when you don't have weeks and weeks of data yet, panicking is the right response. Glad it all worked out though!

 

It ALWAYS happens the one time you finally decide to go out!

 

Good morning! Just checking in. Increased Beenie this morning to 5.2 units. Will test for ketones again today. Tested negative Saturday. Hope to get my U100 syringes in soon so I can increase half units. Fingers crossed to see more "yellows"

 

How are you measuring 0.2 units right now? This is a fraction that you can measure with a U100 syringe but not easily with a U40 syringe. It's fairly easy to eyeball a half unit on a U40 syringe if it doesn't have half unit marks.

It's possible that Beenie will be a higher dose kitty. The other possibility is that she's become insulin resistant from being high for a while. In that case, you'll eventually get to a breakthrough dose and her insulin need will drop.

Hurray for negative ketones!

 

Oh we just started with 0.2 unit increases and was at 5 units which I was using the U40 syringe for (just because I have them still). The 5.2 unit is equal to 13 units on the U100, its just that when I up her to 5.4 units I'll need those new syringes. Should have them in by then

 

Just re-iterating when the U-100's come in, put those U-40's in a completely different place

 

I hear that. I was thinking the same thing the other day. I have three different boxes of syringes and I'm going to put them all away or donate so that there is no confusion on dose. We'll always use the conversion chart, its safer than going back and forth. My original plan was to use the U40 syringes when I was at a whole dose and use the U100's when I was anywhere in between. Not a good practice, will keep it consistent

 

I'd tape the conversion chart to the fridge or something, and then definitely HIDE the u-40s from yourself!

 

Conversion chart taped to the wall, check
U40's hidden in closet, check

So glad you guys suggested. My gut told me I shouldn't keep them both around. I told my husband last night we'll just always convert. I was going to use the U40's for when we were at whole units just to use them up. Don't want to ever be confused and use the U40 with the U100 dose

 

So were past 3 cycles but I wasn't around to get any data during the day today. Should we go to 5.4 tomorrow morning? I can monitor Beenie tomorrow and Friday.
Just not sure if you guys see something I don't based on the numbers I do have. I'm trying as much as possible to test for Ketones. I note in now in the SS, last column.

 

Yes, I'd go to 5.4 u tomorrow AM. Good idea to do those ketone tests when numbers are high.

 

I think you can safely go forward with the increase.

 

ARG! Jinx again, Kris! LOL...we keep posting at the same time.

 

Thank you!!! Will do

 

Good morning!

Sorry to bother you ladies yet again but I'm wondering if I'm not doing Beenie any good with her feeding schedule with regards to shot times. I asked my vet about this in the beginning and he said it was fine but I never asked you guys

So standard protocol is test/feed/shoot. I always test now before shooting but feeding schedule doesn't coincide with this. Beenie gets her shots at 6:30am/6:30pm. Feeding schedule is 12:00am, 3:00am, 11:00am, and dinner depends if I'm working from home. Its either 4:00 pm or as late as 5:45 pm. So yesterday I was in my office and when I got home I tested her at 5:40pm and then all the kitties got fed. I then gave her her shot at 6:30 pm. Since I do work from home most days she's fed around 4 and doesn't get her shot until 2-1/2 hrs later. The mornings are similar, 3:00 am feeding and test/shot at 6:30 am.

Should I be worried that this is not a good routine/plan? I always test at least 2 hours after she eats so I don't get food influenced numbers but is it dangerous to give insulin without any food with or immediately after even though she is running high?

I'm trying to rule out any mistakes I'm making. I discovered the other day her treats (deli turkey) had trace amounts of sugar even though the packaging said 0 sugars. That's out of the picture now.

 

It's safest if she has a meal before you give her insulin. It doesn't have to be a lot of food (1/4 of a 5 oz. can should do) because ProZinc is slower in onset than, say, Vetsulin. However, she could surprise you with a quick drop one cycle and you want food in her to soften that blow.

 

Here are the important things to keep in mind:
The shots need to be 12 hours apart, and as close to the same times as possible. Consistency matters. Prozinc has some flexibility in terms of being safe, but works best when it's consistent. So shooting as close to 6:30 each cycle as you can.

The tests also need to be consistent, and as close to shot time as possible. In the last hour between +11 and +12, many cats, especially cats in higher numbers, can rise over 100 points. So if you test at 5:45 one day, and 6:15 another day, and 5:30 another day, your data is going to be kind of messed up. It also messes up your mid-cycles since +4 might actually be +4.5 or +3.75 if the test/shot times were varied.

Now as for the feeding: it's totally fine to feed multiple times per day. You already know about the 2 hour fast before shot times, so as long as you're keeping to that, the feeding times aren't that important, although they do influence the curve, so again, consistency is important. It doesn't matter so much when or how many times you feed, as long as it's as close to the same every day as you can make it. Whenever a cat (or human) eats, the body releases chemicals and hormones and keeping those consistent helps with everything else in this process. It's less critical than the tests and shot times, but still very helpful in getting the cat regulated.

As far as eating right at shot time, the reason for that "rule" is to make sure that the kitty is willing to eat that day in case they start to drop low and you need them to eat something. Sometimes a kitty will stop eating for whatever reason (infection, ketones, pancreatitis, etc.), and no food + insulin is bad. However, if the kitty is eating that day, but maybe not right at that minute, it's usually okay. If you can even get him to eat a tablespoon of food at shot time, it's a good little guarantee that he's okay. My cat grazes, so he doesn't usually eat a meal at shot time. He just eats a bit of his food and then I shoot and he goes and takes a nap.

It sounds like maybe what' happening is that your kitties are hungry before shot time? It can take some training to get them onto the needed food schedule, but it is possible to get them adjusted to waiting a bit until it's time. Just slowly keep pushing back their dinner time until it's closer to when you need it for the test/shot time. There may be some vocal complaining for a while as you make the shift, but they really will be okay. I sometimes had to go for a walk during the 30 minutes before dinner time because I'm such a softie it was hard to listen to them complain and not give in!

 

Ok thanks Kris!

 

You also want to know, as Djamila said, that your kitty is willing to eat that day. She gave you a lot of good info.

 

I see. Yes they are hungry well before shot time, when I am home, they all start bothering me for food starting around 3:10pm!!!

So what I need to work on is the days I am home I need to hold off feeding until 6:30 ish right before test/shot time. Then I can keep this schedule when I am at the office. This will give me more consistency and as far as Beenie's 6:30am shot I will give her a tablespoon of food just so she has something in her belly. To date Beenie has NEVER passed up food or treats!! When that does happen it will be crystal clear something is wrong. My other kitties, and I just learned they're referred to as civvies , will pass on treats occasionally, will eat most of their food and then walk away. Not Beenie. Never passed up a treat, comes charging in the kitchen for them, doesn't look up from her food bowl until its licked clean!

I had read somewhere on here that some kitties do better with a slightly higher food carb content. Like 5-6%. I'll try and find where I read it but have you ever experienced that? I give FF classics 0-2% only. Could a few more carbs do her good? How would one know?

Thank you, thank you

 

Having a kitty who's a good eater is such a bonus! Teasel and his siblings are all great eaters and, like for you, any sign of not wanting to eat is a huge warning that something isn't right.

Re carb %: some kitties do better on slightly higher carbs (still under 10%). The only way to know is to try a few different carb levels to see the effect on BG. Some kitties are very carb sensitive, some not so much. Teasel isn't that carb sensitive so I don't worry too much about carb % in the pates he's fed. However, I know that when I have to steer his BG upward, food alone isn't that effective. I add honey to his regular LC food. He doesn't tolerate the gravy food very well - GI upset.

 

Thanks Kris. I'm going to give the new dose of 5.4 a chance to see any changes then I may try a slightly higher carb content pate still under 10%. I'm so curious if it will have a positive effect. Like you all have said most kitties don't need very much insulin and we just keep going higher and higher. Does a high dose mean that remission would be unattainable? I see so many SS where doses are 0.5, 1.5, 0.25...

Or does insulin resistance mean that once you "break through" dosing usually comes down?

 

Not necessarily. It depends on the reason for the high dose. If it's a high dose condition like acromegaly, then remission isn't going to happen. If it's insulin antibodies, I suppose it's theoretically possible that kitty's body could stop producing them and maybe remission could happen. If it's insulin resistance caused by prolonged exposure to the toxic effect of high glucose level then yes, remission could happen once the resistance is overcome, kitty becomes responsive to insulin, doses drop over time and so on.

Once you break through resistance the dose might well come down or, if not, the dose level that gave you only pink/red/black starts giving yellow/blue and, eventually, dark green. That is, kitty is responding to the dose. Time spent in good numbers like low blue and dark green can allow some healing of the pancreas and that can result in less insulin being needed or even remission.

 

Thanks Kris. So then I will continue with the small increases every 3 cycles. Should I consider .5 increases instead of .2?

I just tested for ketones, neg
I just want her out of danger with these consistently high numbers. I'd be happy to see some more yellows

 

I'd stick with 0.2 u increases for now but no more than 3 cycles at an ineffective dose.

 

Ok, sounds good to me! Thanks Kris

 

Just to add my 2 cents, I can't always stick to <10% carbs because most of those varieties are pate. Maury is not a fan lol . I did some experiments with him though and found for a while his MC (medium carb) wet food didn't have the same impact as MC dry. To get him off his old dry food, I did use Purina DM for a while before switching to YAZ. Nothing official but the MC range I use is 10-14%. I'm trying to sneak some more LC foods back in

 

Thanks Yong. I'm going to stay the course with the really low pates and see what the increase in insulin dose. I wished for a yellow yesterday and I got it
Luckily my rascals seem to love pate . That's the bright side. This morning woke up to one of my civvies badly constipated. He even threw up which he tends to do when he is that uncomfortable. Tried giving him a little Miralax laced FF naturals and he only took a few licks. Wouldn't be the first time we've had to go to the vet to have a poop removed
I actually have a vet appointment today for the other guy to get his nails clipped. He's new to the household and was outside for quite some time. Haven't had time to focus on him and train him to let me clips his nails which are more like talons now . Everyone is keeping me quite busy today, perhaps a family trip to the vet?!?

 

Will your constipated kitty eat pumpkin? A little bit a day helps keep them regular.

 

I never tried pumpkin with him before. I just always used the Miralax. I will try it for sure. How much do you recommend per day to keep them regular?

 

1/2 teaspoon of plain pumpkin twice a day, no sugar, spices, additives

 

Thanks Yong

 

Can I give 1/2 tsp to Beenie too without affecting her BG? It does have natural sugars but since its so little just wondering?? I think everyone in the house can use a little "help"

I gave it to my kitty and at first he just kept smelling it and then took a lick, licked again then finally, finally he LOVED it! Funny to watch all the dramatics leading up to it

 

I give it to Sam every other day and it doesn't seem to impact his numbers. I used to give him closer to a tablespoon because he loves it so much, and that did impact his numbers, so it's important to limit it a bit. I open a can and put it into this mini ice cube tray I have a freeze it into little cubes so it lasts longer. Then just pull out of the freezer and give him a little pumpkin Popsicle

 

Most don't see any impact from the natural sugar/sweetness in fruits and vegetables . Kind of like our own bodies process the "sugar" from them better than artificial.

 

Great idea to freeze it into little cubes!!
Was wondering how to stretch it out. I bought some organic baby food, only ingredient is organic pumpkin. Label says use within 2 days of opening

Thank you!!

 

Makes sense. Thanks Yong

 

Best AMPS number we've gotten to date! I have a good feeling about the SS and the direction we're going. Can't wait to see some blues!

 

!

 

Should I keep increasing? Just wondering if its advisable to go longer than 3 cycles at any point? Just want to make sure I should increase again .2 tomorrow morning?
Just a little nervous about the high dose.

 

When you get a response where the drop between the pre-shot and the nadir is significant, or at least enough to cause a bounce, then you would want to hold that dose for a few extra cycles to give the kitty time to stabilize. Right now, you're still getting consistent numbers with just a small drop. The good news is that the pre-shot and the mid-cycle numbers are slowly moving downward and your spreadsheet is getting a lot more yellow. So HOORAY for progress!

 

Oh good! Thank you so much. Definitely seeing some improvement in the form of bright sunny yellow

 

Seems a little less bouncy too, which as Kris has stated can mean you are getting closer to the ideal dose. The ideal dose can still move around a bit, it'd be too easy if it was find it and done

 

Going in the right direction!

 

Good morning!
I am happy to report our first blue number last night . I actually set the alarm to get a 2:00am reading just to keep an eye on it and it went back up slightly not down like I was almost worried about.
My question is this mornings AMPS number. What the heck?

Just the wonkiness of the sugar dance or something else??

No contraband food was left out anywhere. Can't be a bounce, can it?

 

Hooray for the first blue!!! Today's numbers are unfortunately totally normal. After a kitty hits a new "low" number, they will usually follow that up with a few high flat cycles. Even though 192 isn't particularly low, it's low for Beenie, so his body panics a little and floods his system with stored glucose giving you the numbers you're seeing today. It's nothing to worry about, and is a very normal, predictable part of the sugar dance. It's also the part that we all kind of hate. We usually refer to it as bouncing. or vets usually call in somogyi effect.

 

Yay for first blue! and everything Djamila said

 

!!!

 

Ah so it is bouncing. Just tested again and was able to get ketone test in too. Also have the strips ready to go!

Thank you so much!

 

I'm going to hold the 6.4 unit dose for a few more cycles since we had our first bounce. Typical is 6 cycles or is there something in her numbers I should be looking for before we increase again??

Where are my manners......GOOD MORNING!!

 

Good morning Michelle!
Even though that blue set off a bounce, if her PMPS is still pink, I think you could safely increase to 6.6U tonight or tomorrow morning if you prefer increases in the mornings . There's still room for improvement . Just my thought

LOL just read your note from yesterday's ketone test

 

Yes, we usually recommend 6 cycles to get enough data to assess a dose's effectiveness. If it doesn't give you better numbers, then it's time to raise the dose. If there's been a lower than usual number a cycle or two earlier the inflated numbers (at that same dose) are bounce numbers. Unfortunately, bouncing complicates everything. If the earlier low was not very low (such as your blue) then a dose increase isn't likely to suddenly produce a lime green.

A lot of this is decided based on your SS data, knowledge of Beenie's responses and your instincts. That last part is important and it develops over time.

 

Know thy cat . Has definitely helped me with my boy, and I'm sure many other members

 

Since she has never dropped low I'm comfortable with an increase tonight. Beenie agrees! Thanks!!


Yong- I didn't think anyone would catch that ketone note. Figured we were there had the strips, why not?!?

 

So pretty!

 

Such a lovely kitty!

 

Beautiful!

 

PMPS was yellow so I held the dose. Always surprises!!

That posted weird

 

Morning!
Ah don't worry about the weird post, it happens . Looks like another bounce . I think you're getting close to his working dose (of course that can change again too )

 

I like the yellow PSs you're starting to see.

 

Yes, another yellow this morning!! Just updated spreadsheet.

 

Great example of what happens when you get close to the "good dose range"!! Keep in mind that things can get a bit ... exciting ... when you're there and that the good range can move around a bit. Nothing is ever set in stone with FD.

 

Since AMPS was yellow too I'll hold this does if my PMPS is yellow again. I think I'm getting this

 

You're getting a lot of good test data, Michelle, so you'll be fine!

 

How confident do you think you could measure 6.5U if you get a yellow for PMPS?

 

I'm using the U100 syringes that have .2 increments. I can go to 6.6U on the next increase, no problem.

 

Oh no, you can get a 0.1 increment . I'm going to get an old syringe and try to post pictures for you . I've been thinking about doing this anyways, I like visual aids . You are drawing to line 16 for the 6.4U, correct?

 

Yes I've been drawing to 16. So the half unit markers are .1? Maybe I'm saying this incorrectly. I'm using the U40 to U100 dosing chart and the increments are 6.0, 6.2, 6.4, 6.6, 6.8... So that's were I'm getting the .2 from. Yikes am I doing something wrong?

 

This chart
http://www.felinediabetes.com/insulin-conversions.htm

 

No, you're right , the half unit marks are 0.2U. OH fiddle sticks, I am supposed to be leaving . I have to get the pictures together anyway. Don't fret about it right now .

 

Ok have a great day! See you guys on line later

 

Hi Michelle,

What Yong meant was that the half unit marks on a U100 syringe correspond to 0.2 u if you're using them for ProZinc. Then, if you eyeball between those half unit intervals, you have a 0.1 u fraction. Does that make sense?

 

I don't think I can I eyeball that. It would be a crap shoot. I can barely just see the half unit markers. I went to CVS a month ago and had to get readers Got them all over the house now!!!
Good lord I can't see close up anymore...I need longer arms

 

I still got the pictures done, finally . If it's too frustrating, don't worry about it but I said I would do them for you

 

Ah I see now I get it! Thank you!!! I actually just gave Beenie her new dose of 6.8 U. I will try for 6.9 after we get through the next cycle. I had to be in my office all day today and I feel so guilty for not getting numbers today. I'm starting to get a bit obsessive
I just set my alarm to get a +3 and +5 reading tonight to see what's happening. Thanks so much Yong for the pics

 

It happens . I realized I was going through 50 strips in less than a week . Had to remind myself, heyyy we're kind of unemployed, should probably slow down .
Glad the pics helped

 

Mornin'

I missed the +5 shot last night but was able to get +8 instead. We're not bouncing still, right? Just seems to be still running flat? Looks like another increase tomorrow morning unless you guys say its bouncing and I should hold. I can try for the .1 increase if that's advisable now that Yong sent me the pics of the syringe I know what I'm going for.
My patience pants are at the cleaners I'll pick them up today

 

I don't really see any reason to just do a 0.1u increase right now. It's a great trick to know when it's time to fine tune the dose though! I think you could keep going with the 0.2u increases. It's nice that the pre-shots are starting to wiggle their way down!

 

Ok so I will go with the 7.0 U next round. I think we're getting closer to the right dose since her numbers are certainly getting better than when we started this journey! Guess I'm perplexed on why I haven't gotten another blue since 7/6/2017 if the bounce cleared. Or maybe I missed it?!?

 

We got our first yellow AMPS and yellow PMPS today!! Progress feels good

 

Woohoo!!! Go Beenie!

 

Sunshine!!!!

 

!!!

 

Posting reply over here:

Like Steph said, the advantage is smaller increments which is working well for Beenie . Towards the end of our Prozinc journey, I was using the U-100s with conversion chart too

 

Hello!
I feel like we're still running so flat. Do you guys see any bouncing? I can't believe how high of a dose we're on especially when I see so many other ProZincers at such tiny doses. I'm at the next increase tonight. Could there be any underlying issues? Just keep going with the .2U increases every 3 cycles until we see a real nadir?

Is Beenie getting any nutrients at these numbers? Should I consider meds for the neuropathy or wait until she's regulated and see if that improves it alone?

Sorry so many questions this Monday morning

 

Hi Michelle,
It's possible that Beenie is a high dose kitty because of insulin antibodies or a condition like acromegaly. There are tests to verify that but many who find out don't/can't treat so they keep increasing the dose until the numbers come down. @StephG is in that position with her guy and it's one reason she's now using Lantus.

Another possibility is that Beenie has become insulin resistant from glucose toxicity that high numbers causes. The way around that is through it. Continue the careful dose increases every 3 cycles, maybe increasing the increment to 0.4 u or 0.6 u because she's getting a substantial dose.

If you can hang in there without getting too discouraged you WILL get somewhere eventually. The proliferating yellows on your SS are telling you that.

 

Chuck got up to 8.2 units before I switched to Lantus. In my area, lantus is cheaper per unit than ProZinc. At higher doses it was mostly a financial decision. He was and is still bouncy but he is doing much better on lantus. 3 months on lantus and we are up to 15 units twice a day.
I haven't tested for high dose conditions but it's pretty obvious he has at least one of them.

 

Thanks Kris! I have a call into my vet for his two cents. In your opinion would it be safe to do the .4 or .6 u increase as opposed to the .2 u? I'm monitoring so I feel comfortable as I do keep an eye on things. Just want to take the best course of action. I just always worry about the high numbers for so long. God knows how long it went on before the Dx.

The yellows do make me happy as at least we're not seeing black or reds

I'm reading up on Lantus now just to familiarize myself with the differences. Just so in case we go that route in the future I know what its all about.

 

Thanks Steph!! Wow Chuck is a high dose kitty. So if it was strictly a financial decision then I will stick with ProZinc for a while to see what happens. I will speak to my vet later today to see if he thinks its worth any testing to confirm no underlying conditions that would impact her resistance. I'm fortunate that our pet insurance covers 80% of the insulin and ProZinc has the flexibility I would like to keep. I'm usually on the money with our dose times but there will be circumstances where I may run late and at least I have peace of mind I have a little wiggle room on timing.

 

You can certainly stick to the 0.2 u increases but I wouldn't hold a dose longer than 3 cycles if it's not doing the job. You're right about ProZinc's flexibility, though - scheduling, dose changing, etc. Big plus.

 

Hi Kris. I'm going to have to be in my office a few days next week so I won't be able to test during the day nearly as much. Other than leaving food out (timed feeder) do I need to be worried? Not that I'm expecting this to happen next week but once we "break through" could Beenie drop really low or is it typical for small decrease

Hi Kris
In your opinion would it help if I changed my increases .6 U? I just went up to .4 U this last increase, all previous were .2 U, but I feel like I'm seeing more pink than yellow and wonder if your suggested .4 u or .6 u increases every 3 cycles would help break through quicker. I'm worried I'll need larger capacity syringes at this rate. Have to get more insulin this week too.

 

Sorry first comment was a thought that I didn't finish.