Clueless since insulin switch..?

Discussion in 'Prozinc / PZI' started by Monica Lewis, Oct 4, 2017.

  1. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Hello everyone,
    we finally switched Josie to ProZinc 4 days ago and I didn't expect immediate miracles but her readings are even more confusing now than when she was on Caninsulin..?!:banghead:

    Numbers don't seem to go down much mid cycle or not at all.. How long do you think before we will see some response? Vet suggested 0.75u as starting dose but maybe we should up the dose asap?

    I just feel so bad every time I get a high reading and really sorry for poor Josie for having to run on high numbers for so long now :(

    Amazingly otherwise she is very happy, cuddly, playful and eating very well with no visible symptoms of FD.
    She's also been diagnosed with Chronic Pancreatitis but again showing no visible symptoms of that either..

    I am totally clueless as of what we should do now or whether these numbers were normal at the beginning of an insulin switch and I am just being impatient...?
    I've been wearing my heavy-duty sugar dance pants for a little while now but it just doesn't feel like I am getting anywhere..:(

    Please advise, any opinion would be much appreciated - many thanks!
     
  2. Djamila

    Djamila Well-Known Member

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    Hi Monica, and welcome to Prozinc! You can change the dose every three to six cycles on prozinc. It looks like you're on the 9th cycle, so yes, raise the dose to 1 unit. It looks like Josie is going to need more insulin. I'm curious why you didn't try more than one unit while on Caninsulin? Was that on vet advice?
     
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  3. Monica Lewis

    Monica Lewis Member

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    Thank you Djamila!
    I'm waiting to hear back from the vet re. dosage increase but if she doesn't get back to me today I think I might just do it anyway tonight as I agree that it is needed.

    As for Caninsulin we went though a few waves with dosage, found that lately she responded almost the same to lower dosage as to higher but she had bigger dives when given higher dose.
    At the end it would've been an option to go 1.25u and above but feedback from board and vet suggested we might be better off trying a less harsh acting insulin and take it from there instead of increasing dosage giving Josie more abrupt curves.. hope that makes sense..?
    Besides after her 2 scary hypos I think I turned very cautious and wanted to keep her relatively safe as I can't be there to check on her all the time and catch if happens..
     
  4. Djamila

    Djamila Well-Known Member

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    It looks like you are feeding her a good, low carb diet if the foods in your signature are current. The odds of her having a dangerous, clinical hypo are really quite low (though not impossible). You are monitoring her well, and dosing carefully, so you are doing the right things to keep her safe.

    In these numbers, I would be more concerned about ketones than a hypo episode. That's why I would encourage you to do the increase. From your original post, it sounds like you're also concerned about the long time in higher numbers.

    Some small, steady increases should help bring her numbers down into safer territory.
     
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  5. Monica Lewis

    Monica Lewis Member

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    Yes she is on 1% carb single source protein wet food, was not easy to find something that suits her needs esp. with the pancreatitis but we got there..

    That you so much for your reassurance, yes I do try to stay on top of things. Sometimes I feel like a helicopter just hovering over her all the time trying to make sure she's ok!:rolleyes:

    Again thank you for your reply!
     
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  6. Monica Lewis

    Monica Lewis Member

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    @Djamila Hello, we gave Josie 1 unit last night but this morning her readings were higher than ever since she was diagnosed at 27.1!? Do I continue with the 1unit or take it back to 0.75?? Many thanks!
     
  7. Monica Lewis

    Monica Lewis Member

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    @Yong @Tuxedo Mom @Kris & Teasel would you have any thoughts on these numbers please if you don't mind?

    I just feel so bad constantly these days for being unable to get her out of the high numbers and every time I test her and the numbers are the same or even higher I feel even worse and more clueless..:( I can't help it.

    I know it's a marathon not a sprint but it just doesn't seem like we are getting anywhere..
     
  8. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Monica

    I feel your frustration :bighug:

    Is Josie acting normally over all...eating, pooping, peeing, activity? As well doing regular ketone checks would be advisable. If she shows no signs of any problems at this point then the increase in dose would seem to be the best approach. You have enough tests in that she does not appear to be dropping low and doing any major bouncing. I would hold the 1.0 unit a few days and see where the numbers go. If you can try to get tests around +5 or +6 this should show whether the 1.0 unit is working better or whether a further increase might be in order. The longer a kitty stays in higher numbers, the more their body "thinks" this is the "normal" range that it should be in.
     
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  9. Yong

    Yong Well-Known Member

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    I agree with what Mary Ann suggested. Keep in mind she might not need the higher dose forever once her numbers start improving and she spends more time in healing numbers. Slow increases of 0.25U every couple days will also help prevent glucose toxicity. Maury got to 3.0U and that was kind of his "breakthrough" and we started backing down the scale. A similar thing happened when I switched him to Lantus but I'll still have to tweak his dose some :smuggrin:. The 1.0U is getting her to yellows but she still has plenty of room to drop. Let's see some blue nadirs soon, Josie :cool:
     
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  10. Djamila

    Djamila Well-Known Member

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    Yes, I agree with Mary Ann and Yong. It's hard to see those high numbers, but a lower dose wasn't working for her, so if all other health issues are good, holding the increase, and then continuing upward until she starts to respond is the best route.
     
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  11. Rachel

    Rachel Well-Known Member

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    I also agree with Mary Ann, Yong, and Djamila! I know it's tough, but it will get better. You might have a bit of insulin resistance going on and in that case, increases will help as eventually you'll break through it.

    Remember also to pay attention to how she FEELS. Josie is more than just a number. It's easy for all of us (me included!) to get stuck on what the numbers are, but it's also important that she is happy and acting like herself.
     
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  12. Monica Lewis

    Monica Lewis Member

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    Thank you so much ladies for taking the time to respond, you are all very kind.

    Also you are all making some really good points here.

    Yes otherwise Josie is acting absolutely fine and happy, no excess water drinking, poop, wee, weight loss or any other issues. I just can't help being concerned about what must be happening on the inside with all these numbers.. Her happy behaviour is totally contradicting her nonsense numbers and I know it's silly but sometimes I think it would be better not knowing her BG readings cos that's when I get confused, stressed and worried whenever I see those unexpected high numbers..
    Anyways I'll hold the 1u dose for a few days and let's see what happens.

    On a separate note we noticed that Josie has a flat lump on her right side which seem to be tender to touch, taking her to the vet next week to have a look at it.. She hates her sides being touched anyway so good luck to us..!

    Again thank you all for your support and guidance, as always it is much appreciated.

    Have a lovely weekend everyone :)
     
  13. Yong

    Yong Well-Known Member

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    It might be an insulin lump that can happen. Maury had one for the first time a couple weeks ago and I said, "Oh so that's what it feels like" :smuggrin: It went away in a couple days. Hopefully, nothing serious of course! [​IMG]:cat: healing vines for Josie, just in case ;).
     
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  14. Monica Lewis

    Monica Lewis Member

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    Thank you, let's hope so!
     
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  15. Monica Lewis

    Monica Lewis Member

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    Hello everyone, just wanted to get an opinion on whether it was time again to increase the dosage further from tomorrow?
    Josie finally had some yellow numbers today which was really good to see but nowhere near low enough for mid cycle so thinking of increasing to 1.25u from tomorrow.
    Any thoughts please?
    Thank you!
     
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  16. Djamila

    Djamila Well-Known Member

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    Yes, definitely time for an increase. I would suggest holding a dose no longer than three days if you don't see something dramatic happening. You can increase as often as every three cycles if you are around to monitor. Do keep an eye on that evening cycle though - most cats run lower at night, so that's where you really have to be careful.
     
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  17. Monica Lewis

    Monica Lewis Member

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    Yes that’s great thank you Djamila!
    Will try to keep an eye on the evening cycles although for some reason Josie is much more difficult to test at night and I don’t really want to force her or annoy her too much.
    We made such a fantastic progress with her since started testing and I don’t want to put her off or go back to struggling again.
    But will try and thank you again for your reply!
     
  18. Rachel

    Rachel Well-Known Member

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    Hmmm...is anything different about your evening routine that could make the testing harder? It's interesting that she only is tough to test at night! Maybe something about nighttime tests stress her out?
     
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  19. Yong

    Yong Well-Known Member

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    I feel like sometimes Maury can be more antsy for PM testing but I think it's just him feeling better and he doesn't want to sit still. He'd rather go play before dinner :cat:. I think you are testing enough to increase every 3 days, numbers permitting ;). For an evening test, Maury also knows he has to get his before bed poke before he gets his PM wet lunch. Maybe you can train Josie with a similar "trick" :smuggrin:.
     
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  20. Monica Lewis

    Monica Lewis Member

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    I know it is odd! I don't think anything is different, same spot same treats same method... she sits nicely daytime most of the time but keeps fidgeting in the evening in a bad mood and tries to scratch me.. No idea why. Maybe she can sense I am tired, I must admit I struggle to see straight past 11pm..!:(
    Stayed up til 1am last night for a +5 test and BG didn't even go down.. I felt very frustrated thinking well that was a waste of time...:banghead:
     
  21. Monica Lewis

    Monica Lewis Member

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    Yes now you got me thinking, she must be hungry and very eager to eat her midnight feast so maybe that's why very fidgety right beforehand?
    I usually start prepping her food to show that she's going to eat straight after but maybe I will leave all food prep until after testing so she's not distracted.. It might work, will try out tonight! Ooohh... exciting!:cat:
     
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  22. Djamila

    Djamila Well-Known Member

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    You got a blue!!! Hooray!

    And as for getting that PM test - as Rachel says, "all data is good data", so even though it showed she was flat, that's helpful information to know how she's responding during that cycle, and to confirm that she's safe enough to be increasing right now.

    Here's to more of the those pretty blues!!! :cool::cool::cool:
     
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  23. Monica Lewis

    Monica Lewis Member

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    Aaawww... thank you @Djamila @Yong and @Rachel you all are such sweethearts for rooting for us!:)

    Yes it was such a nice surprise to see those blues today! Although Josie didn't eat much today which isn't like her..

    Sadly the PMPS shot up to 26.3! :(
    It's been quite a steep drop and back up today - I'm just wondering if it was still ok to keep her on 1.25u for next few days and see if bounce will clear or shall take her back to 1u tomorrow morning? Any thoughts please?

    Thanks so much!

    Ps. Yes I suppose you're right above, any data is good data..
     
  24. Djamila

    Djamila Well-Known Member

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    Yes, hold the dose at 1.25 for another cycle or two. She will likely stay high and flat for a few cycles since she isn't used to going into the blues. Are you testing for ketones? The lack of appetite is always worrisome in our FD kitties.
     
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  25. Monica Lewis

    Monica Lewis Member

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    Yes will hold dose then thank you. I thought I should but the big drop got me a bit concerned.
    Appetite is back, she ate very well this morning and asked for seconds..
    Testing for ketones is very tricky for us as she doesn't have a litter tray and always goes far out under the bushes to do her business.. She's been tested a few times whilst at the vet and it's been clear so far.
     
  26. Djamila

    Djamila Well-Known Member

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    Glad her appetite is back! That would be tricky with an outdoor cat. Mine are both captives in my 4th floor condo, so not much way Sam can escape from the ketone sticks!

    Nice to the see the PMPS back down a bit again. Hopefully they'll keep moving in that direction. :)
     
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  27. Rachel

    Rachel Well-Known Member

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    They do make blood ketone monitors...the strips are super expensive, but you could try getting one of those just to use for ketone tests. It might make it easier for ya.
     
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  28. Monica Lewis

    Monica Lewis Member

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    Interesting, didn't realise there was one for blood, thank you Rachel. Just looked it up, yes they are not cheap!
    Will have to justify whether we really need it at this point as can't really afford it right now on top of other everyday essentials she needs..:(
     
  29. Monica Lewis

    Monica Lewis Member

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    Update:
    Vet visit yesterday had good and bad news..
    Larger flat lump on Josie's side disappeared, on the other hand upon having a good feel around in her belly the vet found a marble sized lump but can't be sure what it was so we need to go back in a couple of weeks time for a follow up.. :(
     
  30. Rachel

    Rachel Well-Known Member

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    Oh that's unnerving! Try not to worry too much about it. If it was something the vet was concerned about, she wouldn't have suggested coming back in a few weeks. As long as Josie is acting okay and the vet wasn't worried, I'd try not to worry too (easier said than done I know!).
     
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  31. Djamila

    Djamila Well-Known Member

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    Monica, I'm so sorry to hear that the vet visit added some stress. It does seem like if it was something serious the vet would have pushed for tests instead of just saying come back in a couple weeks for a follow-up. Hopefully it's nothing.

    On a different topic, it looks like it's time for another little increase if you are comfortable with that and there is a cycle you can monitor.
     
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  32. Monica Lewis

    Monica Lewis Member

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    Thanks Rachel and Djamila - let's hope so!
     
  33. Monica Lewis

    Monica Lewis Member

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    Oh @Djamila I must say I am still none the wiser regarding working out Josie's response to ProZinc!:banghead:

    Yes you might be right about a dosage increase and I was thinking the same however today she had a low reading of 12.0 at +8 ( must admit I got a little excited I might be seeing lower pmps..) but by then BG jumped up to 25.0!?

    Would you have a theory why? Could she be still bouncing? Big jump from 12 to 25 within just a few hours or is it not and kinda makes sense to you?

    Any thoughts would be much appreciated!
     
  34. Djamila

    Djamila Well-Known Member

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    Alas, that jump up is totally normal. Prozinc lasts roughly 10 hours in cats, so the last hour or two of the cycle can see huge increases. The good news is that a "good" cycle will show a 50% drop from pre-shot to nadir, and it looks like she did that today. Now it's just a matter of nudging those nadirs down into a healthier range, which is the reason for suggesting the increase. Then she'll most likely start bouncing around for a bit, and then finally the pre-shot numbers should start to come down. This whole process can take awhile. It's often said that it's a marathon, not a sprint. So it's just a matter of continuing to move forward little bits at a time.

    The protocol recommends dose increases every three to six cycles until you get into lower numbers, or until you need to pause to manage the bouncing.
     
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  35. Monica Lewis

    Monica Lewis Member

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    Hello everyone,
    just posted on the main forum an asap post but maybe this will reach someone here sooner...
    Josie's readings gone unusually low for her in this current cycle and seem to be still going lower, she is showing hypo symptoms although her latest +11 readings were only 10.3.
    She's been acting weird in past hour, walking very very slowly with head down, not responding to call, no eye contact and not interested in her favourite treat.
    Last time I saw her like this she was having a hypo.. she's just standing and staring into space
    I know it's not the case now with these readings but I'm supposed to shoot her now with her evening dose of insulin.
    Any suggestions please as I am totally confused as what to do now...

    Thanks so much!
     
  36. Djamila

    Djamila Well-Known Member

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    Those symptoms sound like a number of possibilities. Is she licking her lips or sitting like a meatloaf? That could be nausea. Ketones are also a possibility. I would test again at shot time, and let’s see if she eats. If she won’t eat, you might want to consider a vet visit.
     
  37. Monica Lewis

    Monica Lewis Member

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    She sits in meatloaf most of the time anyway so it's not unusual for her. Not licking lips just sitting in meatloaf now with eyes half closed.. Will test her again soon, thanks!
     
  38. Djamila

    Djamila Well-Known Member

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    Are these symptoms at all similar to how she acts when she’s having a pancreatitis attack?

    Do you have bupe and cerenia that you could give her if it is?
     
  39. Monica Lewis

    Monica Lewis Member

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    She hasn't had a pancreatitis flare up for a while now but when she did she was just off food no funny slow walking.
    I've got nothing at home as been symptom-free for a couple of months now
     
    Last edited: Oct 14, 2017
  40. Yong

    Yong Well-Known Member

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    Hope Josie is ok :bighug:. Another possibility for her behaviour is that her body still isn't used to seeing lower numbers so she feels "weird". My boy did the same when he would get nice numbers in between all the pinks.
     
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  41. Djamila

    Djamila Well-Known Member

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  42. Monica Lewis

    Monica Lewis Member

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    Yes that could be probably the most sensible explanation..
    It was very confusing to see hypo symptoms at 10.3, didn't think it was possible but then here's my girl to show us how it's done!:cat:
     
  43. Monica Lewis

    Monica Lewis Member

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    Hello Djamila,
    Josie's been fine today, seems back to normal and eating for England again..!:)
    Yes will start 1.5u from tomorrow morning, wanted to see how she was today and only increase if she was back to acting normal.

    Must admit I'm getting a little bit out of my comfort zone here as she's never had this 'high' dose before but it makes sense and if you think that this is the way forward I will certainly give it a try.

    Thank you for including the link above ( good thinking! ) and for keeping an eye on us.
    Also most importantly thank you so much for taking the time to give us guidance and such support, myself and wondercat are truly grateful for it!:cat:
     
  44. Rachel

    Rachel Well-Known Member

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    Glad to hear she seems to be feeling better! I agree that it's time to raise the dose and see if we can get those numbers down. As she gets more used to lower numbers, she should feel better at them. :)
     
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  45. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Hi guys,
    Just tested Josie and her PMPS is unusually low 14.0 compared to her usual readings 19-25.
    Can anyone advice what dosage to give her now please??

    Shall I always stick with the same dose regardless ps numbers and if so how low should the ps numbers go before reducing her dosage??

    Many thanks!
     
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  46. Rachel

    Rachel Well-Known Member

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    Hey Monica! I'm so sorry we weren't around to answer earlier...I was at work and it was just one of those days where I couldn't check in much. It looks like you stuck with the 1.5 dose? I would have done that too. Consistency is key and since the number is still high enough to shoot, it's good to be able to give him the same dose and see if you can see some nicer numbers tonight!
     
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  47. Djamila

    Djamila Well-Known Member

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    Nice job holding the dose! That's always so hard when the PS is lower than normal. Generally you can stick with the dose at least to 200, and some of us shoot lower than that if we can monitor through the nadir. Much of that depends too on what type of numbers you're seeing during the mid-cycles. Right now your mid-cycle numbers are still pretty high which gives a bit more of a buffer. Whenever you're shooting a "lowest number so far" you want to monitor though to make sure the reaction is in line with what usually happens.
     
  48. Monica Lewis

    Monica Lewis Member

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    Thank you Rachel and Djamila. And @Diana&Tom @Squalliesmom for your support.
    I said it on the other thread in the main forum that I am getting really frustrated with these random numbers mostly being all over the place ever since we started in April and I feel I have no hope left in me that we will ever get it right.

    Tonight is a typical example of this when I get an unusually low PS reading of 14-15/ 250-280 but I still shoot the same increased dose of 1.5u ( the same dose what I normally shoot at around 25/350-400) , I stay up to test as feeling concerned she might go too low with same dose, I am so very tired and Josie is in a really bad mood for testing but after several attempts and 2 strips I finally manage to get the reading at +4/0:30am only to find out that it is 26.7/ 481!?!? Now I can spend the night worrying about Josie being in HIGH numbers instead of low!:banghead:
    I have actually got tears rolling down my face as I'm writing these lines because I feel so frustrated, tired and fed up with it all.
    It still just doesn't make sense and we are all still just guessing and hoping...
    I honestly feel I would be better off not knowing what her BG readings are at all because that is what really stresses me out with worry as otherwise amazingly the cat is looking very happy and healthy in spite of the constant high numbers and diagnosed pancreatitis..

    I know I will have to continue testing to keep her safe before shooting so I will but I really feel I don't want to know her readings anymore or wanting to try to understand what's happening and why as I am slowly losing my sanity and my spark...

    And this is coming from me who is usually full of beans, got a positive attitude and a good sense of humour!:(

    Ps. Please don't get me wrong I appreciate everyone's help and support here, I really do!
     
    Last edited: Oct 19, 2017
  49. Rachel

    Rachel Well-Known Member

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    Oh Monica, we know how hard this is! Looking over your SS, I think you've got some insulin resistance going on. I'd say continue on as you are...raise the dose every 6 cycles if you don't get those low numbers and you'll break through. I know it seems like this has been going on forever, but for awhile you were holding the dose for a pretty long time...so it's really only recently that you've started treating more aggressively. I think consistently raising the dose and keeping at it will get you there in time. I know that's terrible to hear...you want her better NOW and I totally get that.

    Remember to focus on how she SEEMS. Josie is more than just a number. Is she acting okay? Is she happy and acting like herself? That's important too. It's easy for us to get hung up on numbers (I'm guilty of that) but all of our cats are more than that!

    I prescribe some rest for you. Tomorrow night, depending on the number you get preshot, DON'T stay up to test...get some sleep. If you happen to wake up on your own, you can get a test if you want, but really, she's shown that she will usually stay high enough to be safe. That means you can get some sleep...and you NEED it. It's important to take care of yourself too and if you're exhausted and burnt out, no WONDER you're feeling so down! Seriously, tomorrow, I want you to come home, test Josie, give her her insulin and whatnot, and as long as she didn't hit some strange blue number preshot or something, go to bed early and allow yourself to NOT worry about her and sleep! It'll do wonders, trust me.

    We're here for you, Monica. :bighug::bighug:Vent anytime you need (we've all done it!) and don't worry...we know you appreciate the help! We've all been in your shoes and know how you feel!
     
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  50. Djamila

    Djamila Well-Known Member

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    Oh Monica! I so wish I could give you a hug! It does all seem so hard and confusing at times. Try to hang on to the fact that she's feeling good and is happy. The numbers are just the numbers. And you really will see progress in time, but for many kitties, it takes awhile and lots of adjustments along the way.

    Josie is going to need some more insulin, and the steady increases will get her there. At some point she'll break through and you'll start to see some better numbers, but it's going to take some persistence. Please know that everyone here has had those moments when we were overwhelmed with all of this. In fact, I've shed a few tears myself this week over my kitty's numbers. You are always welcome to come and vent and know that you are not alone in this journey.

    Rachel's post just came through and I can't agree with it enough! Her suggestions to take care of yourself are exactly right. Please do get the sleep you need. Sending you lots of love!!!
     
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  51. Diana&Tom

    Diana&Tom Well-Known Member

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    Great posts here Monica and we are all saying the same thing so believe it! It's only natural to feel tearful and frustrated, FD is such a tricky thing, but keep going and meanwhile remember to look after yourself properly as well... we would hate to see you, Mrs Cheerful & Positive, let all this get the better of you. As I know you say yourself, everything happens for a reason, and maybe treating Josie atm is something you will learn from and take forward in the future in some way.
    So take all the hugs and good advice here - and eat more cake!!!
    Diana xx
     
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  52. Monica Lewis

    Monica Lewis Member

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    Oh now look what you girls have done.
    I just sat down to catch up on here after another night of like 4 hours sleep and you guys are just so nice and kind that you are making me cry all over again!
    I think you are right Rachel I probably do need some rest! This is so not me.
    The saddest thing is that I am following a newbie here struggling with her numbers being all over the place and losing faith, I've been supporting her to stay positive and I wanted to write her something positive yesterday to tell her to hang in there as she's getting really down by it all. I was sitting here thinking what to say but suddenly I realised that I had nothing to offer her.. I just could not find anything positive within me to take from to pass on.. And that was really sad.

    As for holding the dose for so long Rachel yes in hindsight I do have some regrets over the dosing of Caninsulin but Josie was so unwell so often with her pancreatitis flare ups that I was afraid to increase the dosage most of the time throughout those times. She also responded the same way to a lower dosage as well as a higher one so did not make much sense to increase at the time.

    Djamila I'm sorry to hear you also shed some tears over your kitty's numbers, you know I think these tears show how much we care.
    Hopefully we will be able to turn things around and we'll be shedding happy tears of joy soon:)

    Yes I will try to get some rest and not to get too hung up on the numbers.

    Although we have made no progress whatsoever on the SS since we started this journey months ago we made a massive progress with kitty herself looking and eating so well, no symptoms of any illness being happy, cuddly and extra fluffy:cat:

    And thank you so much for your virtual hugs as well they were very well received and very very much appreciated xx
     
  53. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Hi Monica! Wanted to check in on you though I hope you're fast asleep! Looks like Josie is kind of bouncy today...but that was a nice blue to see!

    How are you feeling today?
     
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  54. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Hi Rachel, I'm doing well today thank you for checking on me. Went to bed early and kept away from the BG monitor..
    I've decided not to be so hung up on the numbers anymore. Also gave up trying to make sense of it all and just let all my frustration go.
    These are just numbers..:banghead:

    I even got a little poem out of it..


    Boo for red, yay for blue
    The cat is happy so I should be too:cat:
     
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  55. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Oh my gosh, I love your poem!!! I'm going to start saying that at testing time too! :)
     
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  56. Sue Hammond

    Sue Hammond Member

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    Oct 4, 2017
    I love your poem Monica, I know how frustrated you feel, this is such a hard thing to get to grips with...I'm at the stage where I'm almost tearing my hair out with all the up and down numbers...and feel exhausted with it...but we will get there, I'm sure of that x
     
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  57. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Thank you Sue and Djamila, I am quite proud of my little poem as well!:cat:

    You know Sue the person I mentioned above that I wanted to give my support to the other day was actually you!
    I can so relate to your frustration and it just really got me down the other night.. but I think I bounced back from it.
    I suppose even if we can't help to fix each other's issues at least it might make us feel a little bit better that there is someone else tearing their hair out at the same time somewhere else over the same thing!:banghead:
    So let's hang in there together Bounce Buddy!:):bighug:
     
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  58. Sue Hammond

    Sue Hammond Member

    Joined:
    Oct 4, 2017
    Monica, I'm usually around if you ever wanna chat, not that i can offer much guidance with all this shooting BG tests etc, when I so obviously have no clue myself, but just know that I'm here when you need some support....we are definitely in the same boat here my bounce buddy xxx
     
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  59. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Thank you Sue, I just replied to you on your own thread.. xx
     
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  60. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    @JanetNJ thank you for your suggestion, thought about it as well but I’m actually in two minds about a dosage increase at this point.
    Probably should keep going to break the insulin resistance but the difference is so big with numbers being 10.7 at +7 then jumping up to 23.8 at pmps that it’s making me a bit nervous and concerned what would happen if increased the dosage further..?
    Must admit I still haven’t figured out fully how ProZinc works so I might be wrong but such big difference in ps and mid-cycle numbers and big dive curve surely can’t be good for kitty, can it?
    Any thoughts if you don’t mind please -
    @Djamila @Elizabeth and Bertie @Rachel @Yong @Diana&Tom
    Thanks so much everyone!
     
  61. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Completely understand your dilemma, Monica, and only wish I had some answers... hope the Prozinc experts will have something helpful to say. The good thing is that the insulin is working fine - just not for as long as we'd like. So duration is the issue and how to address that dose-wise is the dilemma. I'm sure you're not the only one to experience this! Hang in there ..,
     
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  62. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    For some reason I'm not seeing a post from Janet, so I'm not sure what you're referencing. From your post though it sounds like you're asking for thoughts on dosing?

    I think it would be helpful if you look at the change from PS to nadir, instead of from nadir to PMPS. Here's the difference: the first part shows you the response to the insulin, and you really want to see a 50% drop at this point. The second part, the change from nadir to PMPS, just shows you that the insulin has worn off, so that change doesn't really give you much info that's helpful - of course it wears off.

    Right now you aren't getting a 50% drop. You are getting close, but still need to nudge the nadir down further, so I would suggest another increase.

    I think you still have a ways to go on the increases. I would encourage you to try to increase every six cycles if you aren't getting there. It's not good to linger at an insufficient dose.
     
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  63. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Thanks Djamila for explaining it further!
    Yes Janet suggested it was time for another increase on the thread I posted the other day when Josie had a low pmps - I just replied here on the wrong thread..
    As for the 50% drop from amps to nadir that we’re looking for - a few days ago from amps 23.9 she’s gone down to 10.3. That is more than 50% though isn’t it?
     
  64. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Yes, that drop was +50% but the fact that the nadir was still high-ish says a little more insulin is needed. You have to look at the relative size of the PS and nadir numbers as well as what they actually are. So - a 50% drop and a nadir that's in the 4 to 7 range (approximately) is a good goal.
     
  65. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Jumping in to say I agree it's time for an increase! :)
     
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  66. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Thank you all!
    So does this mean that the preshot numbers will not actually be coming down? I thought they would and then once they do we would increase the dose to push the nadir even lower..
    But it looks like the preshot number is staying around 20-24.. so we would still be pushing for the nadir to go down below 10 regardless? Is that correct? Does it not matter that it creates an even bigger drop from preshot to nadir?
    I apologise for all the questions I just want to get this right.
    Thanks so much for your time and input!
     
  67. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I do understand your concern about nadir numbers dropping even more steeply on a bigger dose, Monica, and I wonder if the experts here could add a little info so we can all add to our knowledge! I don't really know how Prozinc works but it must have a different action from Caninsulin so presumably its advantage is that it is gentler and gives better duration rather than being used up fast... if that's the case, would I be right in thinking that a slightly bigger dose could mean that Josie might stay in the blues for longer in the cycle so is not zooming up so high as she nears pre-shot and therefore you'd be shooting at a lower than usual number? That's my logic but it may be incorrect of course - would be very interested to see what @Djamila @Rachel @Kris & Teasel say about this.

    Hang in there Monica! I don't think you're too far off... maybe will take a bit more courage on the dosing and careful monitoring, but the ladies here are giving you great advice and I'm sure will hold your hand every step of the way!
     
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  68. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Thank you Diana!
    Yes I’ve been learning a lot about ProZinc as we go along, hopefully I’ll get to understand it better with the guidance of the very supportive ladies here!
     
  69. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    @Diana&Tom, you explained that exactly right! Prozinc tends to flatten along the bottom of the curve instead of diving as deeply as Caninsulin. But like anything around here, Every Cat Is Different (ECID). Monica will need to raise the dose and collect the data to know for sure how Josie is going to progress. And Monica, to be blunt, the pre-shots aren't going to come down if you won't raise the dose. If you're happy with the numbers you're seeing, then continue with the current dose. If you want her in better numbers, then you are simply going to have to start moving the dose up.
     
  70. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    This makes absolute sense, Monica - Djamila has said it like it is! If you want to see better numbers you are going to have to up the dose. Your worry, I know - it would be mine too - is that a higher dose could (and probably would) drop Josie into lower numbers than you're used to seeing. I think we have all been there too - happy to get the occasional blue and somehow more relaxed when our kitty is mostly in the yellows... obviously well out of hypo range, which is what we fear above all else. I know you say Josie is looking and acting as well as she ever has at the moment and that's great but it would benefit her to be a little lower as far as her bg is concerned. I think you might have to take a deep breath and try a small increase one day when you're at home to monitor. Then, if you start seeing lower numbers, you'd have to get used to that and be aware when she's likely to drop a little too low for comfort, and reduce the dose a tad if necessary.

    So the decision is yours - we as care-givers can only do what we're comfortable with, but as much as anything it's a case of getting used to a slightly higher dose again. You've gone through other increases and got your head round those, this is just the next step. If you can even get those pre-shot numbers down from the reds, I think you'd be happier...

    No-one here would put any pressure on you to do anything but think about it, and come back and ask more questions. You have a great bunch of people here who really know their stuff (not me, obvs!) so take advantage of their knowledge and do what feels right for you in your own good time.
     
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  71. Djamila

    Djamila Well-Known Member

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    Monica, I apologize if my post was too harsh. Diana is exactly right, I would never want to pressure someone to do something they aren't comfortable with. My intent was to be clear and concise since sometimes I ramble on a bit in my explanations, but I think it just came across as kind of mean and commanding. I'm really sorry about that. Diana said it much better!
     
  72. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    I don't think you were harsh, Djamila - clear and concise, yes, which is what's needed when someone is trying to make sense of something. If anything mine was the post that rambled on a bit! Hopefully between us though, Monica will see the point being made and decide what to do for the best for both her and Josie.
     
  73. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Thank you Djamila, that's ok don't worry I totally understand. I suppose it just shows that you are 100% sure that raising the dose further should be the way forward!

    And Diana I don't mind seeing lower numbers, in fact the Lord knows I am ready for it!

    My only concern as said before is that with the dosage increase the nadir has been dropping deeper and steeper but the preshot numbers aren't..?!:banghead:

    You guys say that the dosage increase should lower the preshot numbers as well but we started ProZinc 4 weeks ago and went from 0.75 to 1.5u ( double of the starting dose ) yet still the preshot numbers are still quite random varying between 14-27 and don't seem to be 'coming down'..??

    Could it be because we haven't reached the right dose yet?

    Just tested her at +7 and it was a nice blue 10 going down from preshot 23.6! Which is a lot more than 50%..
    You say that ProZinc is less harsh compared to Caninsulin and generally produces a more gentle curve but she's been dropping quite low from the starting preshot numbers which seems like a quite steep drop..

    My vet emailed me a couple of days ago that she had a look at the SS, it's looking good and she would keep Josie on current 1.5u dose for a little longer..:(
    But you are the ProZinc experts here and I respect and value your opinion.

    It's just that steep gap that's concerning me thinking it's only gonna dive in deeper if I increased the dose as looking at the past 4 weeks we haven't really made any progress regarding the PS numbers and it doesn't look like those numbers are going to come down any day soon..
    Do you see my dilemma here?
    But if you say that I shouldn't be concerned about such big dives and it's ok for kitty without causing damage then of course I'm willing to go along with the increase. I just needed some sort of a reassurance that these big gaps are ok as normally big drops in mid cycle and fluctuating numbers are not ideal for kitties..

    Many thanks everyone as always, I really appreciate that you are giving me your time to help!
     
    Last edited: Oct 25, 2017
  74. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi Monica
    I will leave it to Djamila and co to answer your concerns properly, but I'd just say two things: one, the drop from 23.6 to 10 isn't that much more than 50%... 50% of 24 is 12 so 10 is only a little under. And without more data we don't actually know when and what nadir was, do we?
    And two, what I was trying to suggest earlier is IF you increase dose, it should last longer so when Josie starts rising later in the cycle , theoretically you would catch the rise earlier when it's not as high as you've been seeing.
    I know it's tough, believe me! Fluctuating numbers aren't ideal but nor are consistently high ones.

    I don't want to muddy the waters by posting too much as I respect the opinion of the others here who have a lot of experience with Prozinc. Let's see what they say.
     
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  75. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Thank you Diana!
    Yes it is true about the nadir, I know I was thinking the same that it would really help to do a proper curve to see just how low she actually goes.?
    it’s just so tricky as we made such an amazing progress with her willingness to test her since we started but she still gets a bit funny sometimes and fussy if I’m testing her too often so I just don’t really wanna rock the boat..
     
  76. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Sigh... it's a toughie! If you want to give an increase a go, maybe just try a fat 1.5u next time you're home to test... see if you get slightly better duration from that?
     
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  77. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Ironically I just got a surprise PMPS reading of 12.2 / 220 ..!?
     
  78. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Mmmmm! Interesting!
     
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  79. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Could anyone advise please?
    Shall I reduce the dosage or give a skinny 1.5u?
    About to test her again before shooting..
     
  80. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Never mind, 45 mins later BG was 20.5!?
     
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  81. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    So sorry we weren't here earlier Monica! It's been a busy day...

    Yes, the reason you aren't seeing lower preshots could be that you haven't gotten the right dose yet. With Prozinc, you aren't going to see as flat of a curve as with the L insulins...which isn't bad, it's just different. So you'll see more of a smile curve. We've found that as you move up the dose consistently, you'll get to the lower presots. Sometimes it takes a bit of time, but it DOES happen. Take a look at some spreadsheets around here and that might help you see what we're talking about more. :)
     
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  82. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Hi Rachel,
    not to worry, I understand we all have busy lives and I am always grateful for your time whenever it may be.

    Managed to handle the situation, although must say it took me by surprise getting such low pmps then 45 mins later jump back again..
    Still not sure if I should've waited and check again later like I did or give lower dosage on lower preshot numbers?
    Would you be able to advise in case it happens again what's the best approach?
    Could it be that that's how long the 1.5u dose lasted?

    Re. Prozinc curve and dosage, yes thank you that makes sense.
    Josie was looking a bit low this morning and wasn't keen on eating but all being well I will aim to increase the dose tomorrow morning then, I should be around later on to monitor..

    And thank you for suggesting, I will have a look at other SS to get a better idea - should be very useful!
     
  83. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hi Monica - you did exactly the right thing by stalling and doing the second test to see the rise. That last hour before the shot many cats have pretty dramatic rises like that. So if we test even a few minutes early, we can get a lower number, or sometimes the insulin will last just a bit longer than usual and at shot time we'll see that lower number, but waiting 20-30 minutes it will be much higher. The reason the stall is important is that if we just see the lower number and reduce the dose or skip the dose, then the kitty doesn't get enough insulin for that cycle, and not enough insulin can lead to DKA. So you managed that 12.2 perfectly by retesting and then giving the full dose. That was the best way to keep Josie safe.

    And speaking of ketones, you mentioned that Josie wasn't eating and was a bit lethargic this morning. It would be a good idea to grab a ketone test whenever you notice those symptoms.
     
  84. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi Djamila, not wanting to hijack Monica's post but I value your comments here because I'm learning a lot!! Could I ask - what would be your thoughts about Monica giving the usual 1.5u dose at usual shot time when Josie was 12.2? She was rising (had been 10 at +7 I think) so would a shot then have prevented such a steep climb or would it have been ill-advised because bg was so much lower than usual? Just another possibility to add to the mix? Thank you!
     
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  85. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Oh brilliant, I'm glad I made the right call then. I learnt it from you guys last time!:cat:

    Josie seem to be back to normal now and eating well again so it was just early morning when she wasn't interested in any food.
    Happened before and she was eating well later on but still a bit odd.

    Ketone tests are tricky as she has no litter tray and always goes outside through her cat flap to do her business under the bushes all her life. Tried litter tray before and locking her in but she just would not do it. Also tried to follow to catch her mid flow but that didn't go down well either..o_O
    She usually recovers quickly by lunchtime so fingers crossed we'll be ok without ketone tests..
    Was looking into a blood monitor that does ketone tests as well but not found a decent one so far that was affordable for us at the moment..

    Thanks so much for your feedback and support, I'm really glad to have you on board!:)
     
  86. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hopefully her appetite will be back by lunch. I do really worry about DKA with our kitties in higher numbers, but I understand how expensive those meters can be!

    @Diana&Tom, I wasn't totally clear on when the 12.2 happened. It's on the spreadsheet at +11, so I thought it was a bit before the usual shot time? If it was 12.2 at shot time, then yes, she would have been fine to give the dose at that number. When someone is nervous about dosing though, sometimes waiting to see the rise makes them feel safer about giving the full dose. For new folks who aren't quite sure about getting BG tests during the mid-cycle, we say the cut-off on a human meter is 11.2/200. However, once someone is comfortable with getting mid-cycle tests, they can and should shoot below that number. And especially when you have a cat who still has a nadir as high as Josie's. There is a big enough cushion that she could shoot that low and keep her safe. Prozinc is much more stable than Caninsulin.

    If she shot on a lower number, it might hold the numbers down throughout the cycle, however given how high Josie is right now, more likely she would spike during the two hours before onset and it wouldn't make much difference just yet. Once she starts getting into some better numbers in general, then you are exactly right that shooting on the lower PS numbers is how you hold the whole cycle down. So shooting the lower numbers (with monitoring) becomes a very very important part of making progress with all of this.

    Great question! Thanks for asking!

    And just to clarify for anyone lurking: by "lower number" I mean "lower than usual number". I'm not suggesting she give a shot if her kitty is in the greens!
     
  87. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Brilliant answer, Djamila, many thanks!
     
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  88. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Brilliant explanation, thanks so much Djamila! Really!

    Josie's appetite was back to normal by lunchtime.
    We increased the dose to 1.75u this morning. I'll be interested to see how our WonderKitty responds..:)
     
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  89. Monica Lewis

    Monica Lewis Member

    Joined:
    Apr 16, 2017
    Hi everyone,
    I messaged my vet with a quick update this morning that we are increasing her dose as this morning and this is what she replied..
    Any thoughts please?
    I don’t want to go against her advice as she is sensible and very caring towards Josie but she told me on Monday to hold the 1.5u dose longer and doesn’t seem happy about the increase..?

    Many thanks!

    Hi Monica,
    A higher dose won't give a longer duration, it will just push the blood
    glucose levels down further. It is the animal's individual metabolism that
    determines the length of action really. I guess you have to be careful
    you're not just pushing her into a Somogyi over swing because although you
    might be getting low levels at the nadir, she seems to be bouncing back high
    at the end of the effect of the insulin. The flattish line is becoming a
    curve which is not what we want! Bear with it a few more days but if the
    levels are still high at the beginning and end of the day, you'll need to go
    down not up.
    Let me know if there are any questions
    All the best, have a great weekend!
     
    Last edited: Oct 27, 2017
  90. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Oh dear! I do sympathise, Monica. The vet wants you to stick with the dose a while longer and our friends here say increase... this is one of the hardest decisions, working out which way to go. I guess the proof of the pudding is in the eating so as you've given 1.75u this morning we might have a different pattern of numbers today, and that would be at least a starting point. I think though I'd want to ask the vet what she actually thinks of Josie's recent numbers, ie what is her interpretation? She's not really giving you much info, is she, just commenting on your message ref increase.

    Sorry I don't have any insight but hopefully others will...
     
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  91. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Thanks Diana!

    Well last week she said that she checked the SS and it was looking good and not to worry about the occasional high reading as long as the majority was ok.
    Also said 'well done for getting some blues'..

    Interestingly she raised the same point I was making, that the ps numbers will not go down if we increase the dosage only the mid cycle would go lower which was my way of thinking as well..
    But after discussing it above I figured if the experts here are all suggesting that a further dose increase could bring the preshot numbers down as well I was happy to go ahead with the increase and willing hold the 1.75u dose to see if it would make any difference..
    We gotta try eh?:)

    I was just wondering about the opinions here regarding the Somogyi effect concerns the vet raised..
     
    Last edited: Oct 27, 2017
  92. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes it has to be worth a try with the 1.75u today - if numbers go too low and/or she shoots back up even higher at ps, at least it might be a clue as to what's best. You don't know until you try so look at today as an experiment if nothing else. It will certainly be interesting to see what happens - and yes, also to hear what people say here about Somogyi.
     
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  93. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Oh dear...I do understand the stress of trying to decide if you're going to listen to your vet, or to the crazy cat ladies on the internet. It might be helpful to go to the front page of the forum and read through some of the research on a good blood glucose curve for yourself. There are articles out there written by vets and you can see some of the foundational work on which the protocols here were based. It might also be helpful to read through the stickies at the top of the Prozinc forum again to remind yourself of how and why we make the suggestions we do.

    I'm afraid I have to run to work this morning, I'm already quite late, but ultimately, I still think the dose increases are needed right now. It may take more than just this morning's dose to see an impact, so I would encourage you to hold it for three cycles (unless of course you suddenly get a lime green!) before making a decision on next steps.

    Let us know what questions you have as you read through the information.
     
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  94. Monica Lewis

    Monica Lewis Member

    Joined:
    Apr 16, 2017
    Oh yes definitely intended to hold the dose for longer, made a decision of following the ‘crazy cat ladies’ advice of increasing the dose, would be silly and pointless not to see it through now wouldn’t it? Besides I’m pretty sure I’ve become one of them already..:cat:
    I’m not even stressed about it.
    Was just curious to hear opinions if anyone had any regarding Josie and the possibility of the Somogyi effect?

    Yes I already read loads about ProZinc on the board and the internet but will look for more info on front pages about curves and stickies thanks Djamila!

    Have a fab wknd my fellow cat nutters!:cat:
     
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  95. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Yes I'd say you were a fully-fledged crazy cat lady, Monica - a club only open to very nice, caring people so welcome!!
     
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  96. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    I am honoured to be included! :)
     
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  97. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    When I started on this board I thought everyone here was absolutely nutters. And now....:rolleyes::cat::D
     
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  98. Monica Lewis

    Monica Lewis Member

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    Apr 16, 2017
    Hi guys, it's been a while on 1.75u and I am not seeing much change regarding the pre-shot numbers..?

    Which way shall we go now?
    Would you suggest another increase?
    Or maybe decrease as dose could be too much pushing her too low then bounce up again by preshot times?
    Could these big gap numbers be the results of the Somogyi effect overswing?
    Or are we barking up on the wrong tree completely and maybe ProZinc is not the right insulin for Josie?
    Shall we switch insulin again?
    Or should I not be so concerned that Josie's preshot numbers are still in the reds almost constantly?

    As you advised I read up more stickies, front pages which was very useful and I looked at other PZ spreadsheets but I must admit those spreadsheets vary so much with all the colours and odd doses that I am finding it hard to relate to them or see an actual pattern how ProZinc supposed to work so can't see whether the way Josie has been responding is expected or not..

    If you have a little time I would really appreciate if any of you expert eyes could please take a look at Josie's SS and let me know your opinions please?
    Thanks so much!!
     
  99. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Hi Monica,

    When my kitty was on ProZinc I had no success lowering PSs by increasing the dose. As a bouncy cat he just bounced more violently and gave more a lot of red on his SS. I switched him to Lantus and that worked much better to reduce the spread in BG numbers but he didn’t feel really well on Lantus. He’s now on Levemir which is another depot insulin but it doesn’t behave that way for him. His numbers aren’t ideal but he feels good.

    Josie might well do better on a depot insulin like Lantus.
     
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  100. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    His numbers aren't erratic at this point, they are quite consistent. They are just consistently too high. Assuming you are staying with prozinc for a bit longer, then yes, increase to 2u. At some point he will likely start bouncing all over the place, but right now it just looks like too little insulin still. Also, Sam and Josie are now at the same dose, so we can start a little club. ;):cat::cat::)

    You could certainly consider another insulin change. The "rules" for Lantus/Levemir are quite strict and defined, so you may feel more comfortable with that. It's a bit less guess work and a bit more "if this, then that". We've also seen several cats who weren't making a lot of progress on one insulin do much better on the next. Sam started on prozinc, then went to Lantus, then Levemir, and now we're back on Prozinc, so if one doesn't work after some time, you can always switch again. It really is just finding the right match for your cat, and the right match for you.
     

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