Can someone look at Prudence's spreadsheet. Need advice.

I was really liking the numbers on Thursday, but can't seem to get out of the 300's amps & pmps. Any advice on what to do? Should I stay at 0.80 for a few more days?

 

I've been re-reading again & trying to understand all of this. On Elizabeth Hodgkins DVM, Website...http://www.yourdiabeticcat.com/protocol.html she explains about PZI insulin peak activity. I will have to get more data on Prudence to see where I'm at, but looking now, she seems to start climbing around +8 or +9. But I do not understand what she means by the highlighted paragraph below ohmygod_smile

Does this mean since Prudence was below 150 Thursday after PMPS (+6-+8) I should not have given her the amps shot Friday morning? What's the science behind the PS? I sure hope this make sense in the morning.. I may need some sleep @-)

PZI insulin has a peak activity time in most cats at 6-8 hours after injection. This means that the blood glucose level in the diabetic cat will be at its lowest point 6-8 hours after the last dose of insulin. After this time, it will begin to rise again until another dose of insulin is injected. Because of this, I ask my clients to perform a blood glucose test at 6-8 hours after each dose. If the blood glucose is still above the normal range (greater than 150) then another injection of insulin is warranted. In the beginning days of tight regulation, owners typically test three to four times per day and often give insulin, in doses dictated by the blood glucose reading at each test, this often as well.

I am also trying to understand Tight Regulation. Elizabeth Hodgkins talks about Protamine zinc insulin can be dosed at 6-12 hour intervals. I've seen some folks doing this, but how do you know when (I am guessing when there's a spike) but how much insulin do you shoot? She has this table on her site.

The following is a suggested “sliding scale” for the cat just starting Tight Regulation. The protocol asks the owner to test at least twice daily, but optimally three or four times daily (every 6-8 hours), with doses of insulin given according to the reading at each test:

Blood Glucose mg/dl Units of Insulin to Inject
151-170 .5
171-185 1
186-200 1.5
201-220 2
221-250 2.5
251-290 3
291-350 3.5
351-410 4

I welcome any thoughts @-) I'm going to try and get some sleep.

 

The paragraph you are asking about means that if you test between +6/8 and get a reading of 150 or higher, you shoot (according to your scale). That would put you on a 3 time a day shooting schedule. So on March 12, you would have shot at +6 during the daytime but you wouldn't have given the extra shot in the evening when you got those readings in the 50s.

Dr H provided an initial sliding scale, but you have enough data to know that it would be too high for Prudence. So you will have to develop your own. For example, on the 150 yesterday, you might shoot .6 or .5 instead of .8 units. Then you see how that works and if it's too much, you adjust your scale. It takes a lot of testing and being home to develop a scale. With Lucy, my scale was in increments of .1 unit. So if she was high, she got 1.0 units. Normally she got .9 units. And if she was lower than normal and I needed to shoot, she got .8 units. I did not shoot below 150 unless I knew she was past peak and her numbers were rising and I couldn't wait.

 

Thank you Terry. I will have to re-read your reply in another hour. I wanted to see where Prudence was at @ +10. I was hoping it wouldn't be in the 300's, but it is again. Until I figure out if I can do the sliding scale. I am not sure what to do for her am shoot or no shoot? or try to go to 0.5 or is that too much of a drop? I am using the U40, so I have to eyeball it @-)

Be back soon! I need another hour of sleep :YMSIGH:

 

You kitty responds so well to small doses of insulin that I would run out to the pharmacy and get U100 syringes, and figure out the conversion chart. It looks like it will be really important to you to be able to be accurate in tiny dose variations.

And yes, I would NOT increase any doses when you hit all those green numbers. It looks like the dose is getting more effective as the days go by. I even wonder if you need to decrease the dose. I would guess those high preshots may be a reaction to the new low numbers. Kitties liver can produce sugar as a protection response to low numbers.

Kitty is so newly diagnosed (yes?), I wonder if you could get her pancreas to kick in more by giving frequent small feedings. If you aren't home have you thought about a timed feeder?

I pretty new here myself, so get some more experienced advice, but I'm betting if you move carefully kitty might do really well.
Get as much data as you can.

Also, is she eating any dry food which could be influencing those numbers?

 

Dr. Hodgkins' quote simply says that if peak effectiveness time is past, and the blood sugar numbers are still too high, there's no reason not to add a bit more insulin. Your body does it all the time, shooting out little extra bits of fast-acting insulin whenever it sees the need.

Dr. Hodgkins' sliding scale idea might work for Pru but as Terri says, in much smaller increments since Pru is very responsive to 1 unit even at a high number. I think at this point with the numbers you've already seen, I'd stick with doses between 0.5 and 1.0 at all times, and shoot every 8 hours or so as long as peak time is past. If you can stay within those bounds, then whether you go with a fixed scale or a sliding one is up to you.

 

Thank you Nancy, Terry & Steve :smile: I went out and bought the U-100 syringes. The needle is much smaller than the U-40. I don't think that makes a difference... or does it :?: I actually played around with the two syringes using water just so I had an idea what I shot this morning. I took what I thought I gave Prudy with the U-40 syringe and shot it into a tiny cup -then I sucked it up with the U-100 syringe to see where I was at.. if that makes sense @-) I still have not slept since yesterday... this is crazy. I had a pretty good eye :mrgreen: going by the conversions chart, I was administering about a 0.4 of U-40 insulin.

Times a tickin and I'm a waitn for her next BG.

Thanks :YMHUG:

 

Hey Michelle -- try to move the 'every 8 hours' around so you can do a shot when you retire and another when you wake up. Then get some sleep !

 

Are you talking about me or Prudence... I actually could use a Vodka tonic right about now :lol: J/K