Charlie: need dosage help please!!

9/23: pmps-555. 1u
9/24: amps-465. 1u
Pmps-456. 1u
9/25: amps-436. 1u

Poor guy's ears are all red and bruisy! That'll get better, right? I'm going to do +6 tests tomorrow, then aim for a +3 curve on Monday or Tuesday depending on his poor ears!

 

Re: Charlie's numbers

Are you holding the ear for 10-15 seconds between a tissue after you test? This can help limit the bruising that happens. Also, kitty's ears get more bruised in the beginning, but that goes away over time as the ear gets used to the testing.

 

Re: Charlie's numbers

Kelly & Oscar are correct...

Don't forget the direct pressure ...

or the low carb treats for being such a good boy!!!!

I hope he starts feeling much better soon and the PZI starts show some improvement for you.

 

Re: Charlie's numbers

9/25- pmps:436. 1u
9/26- amps: 386. 1u
+6: 445 ( this was 1.5 hours after a meal of kibbles, still working on a switch to low-carb kibbles, and gradually adding in wet food, especially for his food that's given between shots)

I like the general downward trend of his ps numbers (except today's +6 numbers- hopefully just a fluke from his recent meal, we will find out in an hour at his next test.)

Also have noticed big improvements in his strength! He's back to jumping up on countertops!

 

9/26: pmps-497. 1.5 u
9/27: amps-549. 1.5 u

Why are his ps numbers going up again? Nothing I'm doing has changed, except for the gradual transition to low-carb kubble and some wet food substitution. What should I do??? I increased him from 1U to 1.5 U. I'm going to attempt a curve today. I'm so worried that I'll never get him regulated!! Please please help!!
Now I'm also worried that i shouldn't have upped his dose- maybe it's that simogyi (sp?) rebound from lower carb food. I don't know what to do!!

 

I don't know if anyone is reading right now. I am in the same boat. New to this only since last week. I have a question that no one has responded to either. Just waiting on the vet to get to the office now. Maybe I will know soon if I have screwed up or not. I am not sure what all these icons mean. Maybe we should put a 911 on the message so someone will respond.

I hope you find out your answers soon.

 

Charlie,

take a breath! Scary, I know, but the best thing to do is proceed logically. This will help us assess if the dose is too high or too low -- or if we need more time to determine which it is.

Can you possibly put together a profile? I'm not sure what insulin you are using, for example. Are you able to test pee to make sure the cat is not having ketones? That is really important when the BG is so high.

If you could get that info together today, I will be onboard tonight and try to help you then.


Underdawg, can you ask your question again so that it comes to the top of the message list? Also put together a profile if you don't have one. I will also look at your situation tonight. I will do my best to help you and Charlie. I'm sorry things have been slow on the board.

laur

 

profile is now in signature. I'm gonna test him again in 1 hour. I hope his numbers are down some! I guess I'll go to the store later for keto-stix. Wouldn't he be showing some symptoms, though? He's not lethargic or acting weird.

 

In case you've not spotted the instruction threads on the TECH forum on how to do what Laur has suggested - here are links to those threads:

How To Create And Publish Your FDMB Profile

How To Create Your Spreadsheet And Publish It In Your SIgnature

Good luck setting these up - it will help everyone give you sound and safe advice Keep up the good work!

Jane

 

It is set up and in my sig.

 

Hi Charlie's bean! I know it really stinks to see those pre shot numbers rising. Have you been testing mid cycle at all? If not, then we have no way of knowing for sure if it is symogi or his body just wanting more insulin. Can you get in a few spot tests around 6 and 8 hours after the shot for the next day or 2?

 

+5: 374...this was 40 minutes after a small meal (1/3 can) of wheat-free fancy feast. I guess going down is good, but I wish it was lower!

 

thanks for the profile. A spreadsheet will be the next thing you'll want to figure out. That will really help people review the dosing/BG history so that they can give you advice. See viewforum.php?f=6 for spreadsheet setup info.

RECAP
-----------------------
9/23: pmps-555. 1u

9/24: amps-465. 1u
Pmps-456. 1u

9/25: amps-436. 1u
9/25- pmps:436. 1u

9/26- amps: 386. 1u
+6: 445 ( this was 1.5 hours after a meal of kibbles, still working on a switch to low-carb kibbles, and gradually adding in wet food, especially for his food that's given between shots)
9/26: pmps-497. 1.5 u

9/27: amps-549. 1.5 u
+5: 374...this was 40 minutes after a small meal (1/3 can) of wheat-free fancy feast.


My thoughts
------------------
Caveat: I haven't used PZI in several years; I use Levemir. My experience with PZI was that it just didn't last the full 12 hours for my cat even when he was at a good dose. Your cat may or may not get 12 hour duration. If not, a longer acting insulin should be considered. There is a PZI group here that obviously has much more recent experience than me. Check out the PZI Stickyif you haven't yet.

1. you're just starting out. This isn't a race. It is going to take some time. Frustrating and scary -- I know. You want to fix things now, but you don't want to increase the insulin too quickly because you can miss the right dose, and get into a rebound situation. Or worse, a sudden hypo! Your cat's body hasn't had a chance to really get used to insulin yet. Also, the body's tissues are still thoroughly saturated with sugar, due to the protracted time that Charlie's had hyperglycemia (high BG). This high BG can actually lead to some insulin resistance -- this is called glucose toxicity. I'd recommend the method of gradual increase of insulin, supported by testing data.

2. mid cycle testing, and a curve (say on the weekend) will provide you more info. If you are working, maybe drink a big glass of water before bed. You'll wake up in the night and you could test the cat then. :lol:

3. can you expedite the transition to wet food? I broke Danny's resistance to dry food by feeding people tuna (in water) for a week or so. You can't do it long term (not nutritionally balanced) but feeding meat will give your cat a diet that is pretty much zero carbs, and this will bring down the BG. Chicken breast simmered in water is also a good option, and is great for hydrating the cat. Not to mention, feeding the tuna or chicken as treats/snacks while testing will definitely get your cat in the mindset that testing means yummy treats.

4. The +5 drop on 9/27 was something like 175 points. That shows the insulin is having a good effect. If the dose goes much higher, my concern is that the drop rate will be steep, and that alone can cause rebound. The body feels the BG dropping rapidly and dumps glucose to try to protect itself. That makes the BG higher, and if the response is to add more and more insulin, you can set yourself up for a sudden hypo.

5. Ketostix are really important during this time to keep an eye out for ketones. Best to catch it early as possible -- less dangerous for the cat, and much cheaper to treat. Ketones can develop in hours. Keeping the cat hydrated is really important. Simmering chicken breast in enough water to cover will make a great no-salt chicken broth. Served warm (like what you'd give a baby), cats just love it.

6. did the vet check to see if the cat has a urinary infection or dental problems? The saturation of glucose in the body also means very sugary saliva and urine, and that is very conducive to infection and to dental plaque. Germs just love sugar. Infection and/or pain can definitely elevate the BG.


hope this helps,
laur

 

9/27- pmps: 524- 1U
9/28- amps: 458- 1U (yay, it's down from yesterday!! Small victories, right?!)

I'll do a curve today and try to set up a spreadsheet.

 

9/28- +4.5- 362
+7.75- 502 (he hadn't eaten in 3 hours, and that was 1/2 can ff)

Vet wants to increase to 2u bid. Any thoughts, tips, or advice??

 

Charlie's ss is now in my sig!

 

question claudia
you are still feeding some dry??
if so then if and when transitioning to wet, insulin doses can change dramatically. usually increases are done in .25 and sometimes .50 increments.
I personally would not increase by whole units

 

I agree that an increase looks to be in order, but slow and steady is the safer way to go (though I used Levemir, not PZI). Re: ears, Donovan's ear went through a brief time where it was a little lumpy/scabby at the pokey site, but it resolved itself and I guarantee you can't tell which ear I poke now.

MJ&Donovan

 

With those high numbers, I'd say you are safe to do a 0.5u increase, but I definitely would not go up by a whole unit at a time. Big differences can been seen in small dose adjustments for some kitties. Keep testing like you have been these past few days. It will take a day or two for the new dose to settle in for PZI. Keep trying to get rid of that dry food - it will only make things easier in the long run, I promise

 

think I posted in your other thread regarding dosage. but ignore what I initially said cause been a while since I used PZI. I thought you were on lev for some reason. sorry

 

Since Charlie eats frequently, keep in mind that if he's eaten within just a couple hours of his pre-shot test (say 1-2 hours), then the test result might include a food spike. The insulin I use is different, but we try not to feed 2 hours before shot time so the pre-shot test isn't influenced by food.

It's more important to test right now than to worry about the timing with food - I just thought I'd mention it because it might help you control his sugars if you can plan his meals to be spaced out through the day.

 

Take your time....you will not get Charlie regulated in a week, or even a month...it's a marathon. Rushing will only cause you to overshoot the mark and have to start over. He hasn't been on insulin long enough to accurately gauge his response to the dose you are shooting.

We held our initial dose for 2 weeks, the vet wanted to increase by a full unit after that....I went up by 0.5 units after reading the recommendations here, and that was too much. ProZinc is not the same as all of the other PZIs, small dose adjustments have big effects. Do yourself a favor and go slow.

If you want to go up, increase by 0.25 units and hold it for several cycles...at least 3 days. ProZinc has a 45 day adjustment period, you will see wonky numbers and the nadir will move around. You should hold the doses long enough to settle and do enough testing to get an idea where his nadir is (most likely early in the beginning, +4-+5). If you keep changing doses, you will get confused and frustrated because you will see inconsistent results....higher numbers instead of lower, flat cycles, etc. You need to let the dose settle for several cycles. I wouldn't try to use a variable dose (sliding scale) until you are past the initial 45 day period.

My 2 cents, from my experience.

(Edited to clarify meaning)

 

So many different opinions! I'm more confused now. I increased by .5 u yesterday am. I'll hold there for a week or so. I'm going to do a curve over the weekend. Thanks for the tips and info. I'm trying to digest it all! We still feed some dry. I'm very worried about more plaque build-up (he has a tartar sensitivity) by cutting out all dry. He a good kibble cruncher, and that along with regular brushing keeps him away from the dentist too frequently (also has a anesthesia sensitivity). It's low-carb though, and for wet we do ff and blue buffalo wilderness.

 

Dry food keeps plaque off teeth as well as potato chips clean your teeth If you are worried about tartar build up, try to snag a chicken neck every now and again from the local butcher. I cut it in 2 inch sections so my cats can easily manage it. The gnawing on raw meat and against bone cleans their teeth better than anything.

 

Sorry if it makes me a bad bean, bur no chicken necks in my house. We are vegetarian and the thought if handling meat makes me want to vomit! The kibbles do work for us. Charlie used to be on all wet till he got too plump, then we went to a lite kibble. His teeth improved, he lost weight, and he got diabetes. You win some, you lose some. So the lo- carb kibbles and low carb wet combo seem like a good middle ground for us. I know most of you won't agree, but that's ok. But I will not be visiting the butcher!

 

The dry food really doesn't help keep tartar off their teeth, that is a myth. I know your vet probably told you that it does, mine did too, but it isn't true. ;-) If you want to keep Charlie's teeth clean, keep brushing his teeth. It's ok if you don't want to handle meat, but brushing is the next best way to help keep his teeth clean. Dry food is not good for ANY cat. It causes many problems, not just the carbs are an issue. Please go to the following link, I am quoting a small excerpt for you. http://catinfo.org/

Please try to get some early cycle tests when you can, +3 to +6, that will give you some data on how the insulin is working and help pin down the nadir. I know you said you will do a curve this weekend, that would be great! But a spot test here and there would be helpful in the meantime. The more testing you can do, the more data you have, the better picture you get. If you can't get tests during the day, maybe you can get a test in before bedtime?

Don't worry too much about the 0.5u increase, it's done and may not be a problem. As long as you hold it for a few days to let it settle and get some tests in, you will see if it is too much. Just keep in mind that increasing by small amounts and giving it some time to settle is the best way to find the right dose. Don't keep changing the dose frequently.