Clueless since insulin switch..?

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

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  1. Monica & Josie

    Monica & Josie Member

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    Thank you so much Kris and Djamila. It’s interesting how you both moved all around from one insulin to another til found the ‘right’ one..
    I respect your opinion and expertise and really would like to follow your advice to increase the dose further but I’m just feeling quite nervous about it as I am getting really concerned about the constant high ps numbers not budging and the big drop from ps to mid cycle already.
    I hope you understand cos I really don’t mean to be ungrateful, I’m just not comfortable with a further increase esp. as our vet advised against it already and her reasons make sense to me too.
    I will ask our vet as well what would she suggest at this point that we should do and will have a good think about it all.
    Again thank you so much both of you!
     
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  2. Djamila

    Djamila Well-Known Member

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    It's often said around here that "you hold the syringe". We can share from what we've learned, but it is always up to you to decide what you think is best. Please do keep posting with updates though as we all care very much for the beans and kitties around here! :bighug:
     
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  3. Yong

    Yong Well-Known Member

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    Hi Monica, as Djamila stated, Josie's nadir does indicate she might benefit from an increase to 2.0U but it is completely up to you and your Vet :). I just wanted to chime in for your thoughts on switching insulins. I didn't have much luck getting PS's number down with Maury on Prozinc either, it just helped his nadir get lower but then he bounced back. We've had much nicer curves on Lantus and I think the depot insulins tend to do better for bouncy kitties. So I guess I'm just chiming in to give you an example of a successful insulin switch with a slightly bouncy kitty of my own :cat:.

    How is Josie feeling?
     
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  4. Diana&Tom

    Diana&Tom Well-Known Member

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    Well put, Monica! You're right to follow your instincts and common sense, and I'm sure everyone empathises with your comment about the vet... we definitely need to keep on good terms with our vets although the good ones respect our opinions and are willing to discuss. So yes ask her what she advises at this point and also get her opinion on Lantus for a bouncy kitty. I'm sure she respects you already but some vets do a bit of extra research themselves when they see a client is working hard to find out as much as possible about a particular disease - and you're certainly doing that!
    Do let us know when you've had a chat with the vet - as Djamila says, we all care very much here, and remember also that your experiences are forming another FDMB story which others may well be following now or in the future. We worry when people just disappear sometimes, and ultimately it helps all of us to watch the route to a hopefully successful outcome... we all learn something from every "case" and that means we have more to offer to others coming to the board.
    Best of luck Monica!
     
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  5. Monica & Josie

    Monica & Josie Member

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    Thank you so much ladies!
    Don’t worry I have no intention of going anywhere.
    I don’t think kitty and my sanity would’ve made it this far without your support, we owe you big time!:cat:
     
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  6. Rachel

    Rachel Well-Known Member

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    It's tough for sure to follow the advice of folks on the internet...especially when your vet is saying something else! We've all been there. I'm with the others...maybe discuss it with your vet and bring up the points made above on why we think you should increase the dose (you don't have to say you got it from a bunch of crazy cat ladies on the internet though LOL...can just say you did some research) and ask her opinion. Then if she disagrees, as we've said, it's definitely up to you! That way, you'll know for sure what she thinks and she'll be able to give you some insight into her thoughts vs our thoughts.

    My only caveat is to please make sure you keep testing for ketones! And definitely stick around and let us know how things are going...we always like to keep up with the kitties on this forum!
     
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  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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  8. Monica & Josie

    Monica & Josie Member

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    Hello everyone, just a quick update.

    Josie had a surprise yellow amps this morning and in the blues already at +3 so looks like a jolly good day so far...:)

    She is on 1.5u at the moment on the vet’s recommendation.

    Taking Josie to the vet on Thu for check up regarding marble sized lump found in her belly and another pancreas test to see if there’s an improvement. Wish us luck!
    She’s been sneezing for a while now, also started drinking water noticeably a few days ago but otherwise looks fine.
    Hope you’re all well, have a nice wknd:cat:
     
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  9. Diana&Tom

    Diana&Tom Well-Known Member

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    Thanks for the update, Monica! Good to hear you sounding upbeat and positive. Liking that blue this morning!

    Sounds as if she might have a bit of a cold so don't be surprised if her bg goes up - infection is one of the main causes of raised bg, as you know, and increased water intake would also usually point to higher bg. But atm it seems as if she's ignoring the "rules" lol so good for her!

    Keep us posted and yes of course, good luck at the vet on Thursday.
     
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  10. Monica & Josie

    Monica & Josie Member

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    Thank you Diana! Xx
     
  11. Diana&Tom

    Diana&Tom Well-Known Member

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    How are you and Josie doing, Monica? Update please!?!
     
  12. Monica & Josie

    Monica & Josie Member

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    Hello everyone,
    hope you're all well:cat:

    Not posted for a while as things been the same old same old but Josie's been having some very interesting and unexpected readings in the past few days!
    After 6 months we hit a jolly green for the first time and she's been quite low ever since.

    Tried to adjust the dosage according to the ps numbers, hopefully I made some good decisions.. tried to err on the cautious side, can't help it I am a bit of a worrier..:nailbiting::)
    But this morning she shot up again so gave her usual dose. Then someone very helpful pointed out that this mornings high amps could be a sign of bouncing and it got me thinking she might be right..?

    I would love to hear your thoughts of what you think might be happening and could really do with some dosage suggestion and advice as not quite sure where to go from here..

    Thank you so much, really appreciate your input as always!

    Have a lovely wknd x
     
  13. Djamila

    Djamila Well-Known Member

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    Hi Monica!

    We are not very precise with our use of the word "bouncing" around here, so I can't be certain what the someone was pointing out, but in general it means the body's response to a low, lower-than-usual, or faster-than-usual drop between the pre-shot and the nadir. In this case, I don't think that's exactly what's happening since the 11/23 PM cycle showed a rise which means the 0.5u dose was not enough insulin. It's not impossible, but it's unlikely it would be too little on 11/23 and then too much on 11/24. I'm more inclined to think that the erratic PS numbers are because of the frequent dose changes over the past few cycles. Josie will likely settle down a bit as you settle on a dose.

    Also, as a point of clarification: doses are determined by the pre-shot and the nadir. At the most conservative, a reduction might be taken if the BG goes below 90. Usually they are taken if the BG goes below 50. I wouldn't recommend reducing based on the data I can see on your spreadsheet. Anytime our cats are over 200, they are having to over-work their other organs, and that can lead to damage. Providing enough insulin is essential to their long-term health. I wonder if it might be helpful to read through some of the information on the main FDMB page? Here is a link to one article that I have found helpful in understanding the balance between BG and insulin: http://www.felinediabetes.com/diabetes-info.htm
     
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  14. Monica & Josie

    Monica & Josie Member

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    Apr 16, 2017
    Hi Djamila,
    thanks very much for your response.

    I read the article you recommended above thank you.

    Can I just clarify with you using a specific example what you say about dosing if you don't mind please?

    So Josie has an AMPS number of 338 and given 1,5 unit of PZ and she goes down mid cycle to 97 - the next day she has a PMPS reading of 205 you would still give her the same 1.5unit as you did the day before at 338?

    Would the same 1.5u insulin shot given at 205 not push her mid-cycle numbers down much lower than 97 possibly risking a hypo?

    Also she went down more than 50% between amps and mid-cycle so as far as I understand according to the protocol the dosage might be too high and should be reduced?

    Or am I completely wrong here?

    Thank you for your time, I'm just trying to have a better understanding of dosing on various preshot numbers..:banghead:
     
  15. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    @monica, regarding the last couple of days: Nov 23rd looked pretty good and even to me, in both cycles. Then, there was a slightly higher preshot the next day but still a decent run. It just looks like something caused the numbers to rise during the following night or early am.
    Please don't beat yourself up, Monica... You really are doing a great job here. (Hugs, hugs, hugs!!! (And more hugs!))
    ...Managing FD can be particularly challenging (AKA 'frustrating') in kitties who have more erratic numbers, and especially kitties that have concurrent health issues, because it can be SO hard to pinpoint why the numbers are high or low sometimes... :confused:
    .
     
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  16. Monica & Josie

    Monica & Josie Member

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    Apr 16, 2017
    Thank you Eliz you are very kind:)
    I’m just trying to figure out how to respond if Josie goes significantly lower out of the blue like she just did in the past few days.
    It took me by surprise and I thought I was doing the right thing by reducing her dosage accordingly to keep her safe as it made sense to me. I thought on lower ps numbers she won’t need as much insulin since ProZinc is a medium acting insulin but it seems I might be getting it all wrong..?
    Do you reduce the dosage if ps number a lot lower than usual?
    Also I just checked her pmps, it’s 20.4.
    Shall I go back to 1.5 then or start on 1.25 and stick with that for a few cycles as it might suit her better since there was more than 50% drop from amps to mid cycle?
    Thanks very much for your support!
     
    Last edited: Nov 25, 2017
  17. Diana&Tom

    Diana&Tom Well-Known Member

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    I don't think anyone could blame you for reducing the dose when you get a PS of 11 or 12, Monica - we are all so petrified of hypo which as you know is not something we want to see, so it's only natural and not incorrect to reduce the dose in these circumstances. Specifically, you might well reduce the dose if you've been monitoring mid-cycle and kitty's bg isn't rising at pre-shot time... sometimes out of the blue you will get longer duration... and therein lies the challenge of trying to figure out what to do for the best.

    As Elizabeth says, you really are doing a good job and sometimes there is simply no rhyme or reason for the numbers you see. Josie is just being a cat! But also as Eliz says, with other issues such as Josie's pancreatitis, you may just have to expect the unexpected. This doesn't address your question of dosing, I know - I wonder if anyone else can suggest a way forward? @Rachel @Kris & Teasel @Yong

    Keep going! You're doing fine, you should give yourself more credit!
     
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  18. Monica & Josie

    Monica & Josie Member

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    Apr 16, 2017
    Thanks very much Diana!
    Yes I have come to accept to expect the unexpected!:)
    I’m not even trying to figure out why cos it could be a combination of many things and I could be sitting here guessing til the cows come home!;)
    I just want to know how to tackle the dosage if it happens again to assist her joyride the best I can while it lasts!
     
  19. Kris & Teasel

    Kris & Teasel Well-Known Member

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    • Josie is a bouncy girl and that means more weight should be given to the nadir values a dose gives. It might mean looking over a few days' numbers if there's a spell of bouncing going on. The PSs are often too high in a bouncy cat so I wouldn't base dosing solely on them except when they're lower than usual.
    • If a PS is in the 11 or 12 range you can reduce the dose slightly for your own peace of mind but I wouldn't drop it more than 0.25 u. You can also wait 20 minutes without feeding and retest. If BG is rising, give the usual dose. The only way to learn what works best in these situations is to try something and get data.
    • It's worth testing around +2 either in the day or evening to get a forecast for the cycle. If the BG is higher or nearly the same the cycle won't likely be too dramatic. If it's lower at +2 that can be a sign of action to come in the form of a lower nadir.
     
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  20. Djamila

    Djamila Well-Known Member

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    Yes to everything Kris said. It can be scary to dose on lower-than-usual pre-shot numbers. But as Kris said, the only way to figure out what works best for Josie is to try it, collect the data, and then know for the next time.
     
  21. Diana&Tom

    Diana&Tom Well-Known Member

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    I must admit to being baffled about dosing at lower than usual pre-shot numbers. I've never had a "normal" diabetic cat (if there is such a thing!) - my Tom had acromegaly which was a different ballgame. So even though I've been on the board for years, I never give specific dosing advice because I just don't have the day-to-day experience that most people here do, and I haven't seen the "theory" in practice. I read here, of course, but don't feel qualified to offer detailed advice. My posts are quite generalised. Plus, maths and numbers are definitely not my thing! So this is interesting.

    So what puzzles me - and maybe Monica also - is that if the "theory" we learn at the start of our FD journey is that we dose with caution, if at all, on a BG of 11 or so, when is it ok to reduce the normal dose only slightly? Monica gave a token small dose at that number which would also have been my instinct, but Kris and Djamila would have dropped the usual dose by only 0.25u, right? Is this specifc to the Prozinc protocol? I know Caninsulin can have a quickish and steepish drop, and Prozinc is more gentle, so maybe the advice given above (yes I know it's the Prozinc forum!) is based on this insulin alone?

    Sorry to sound daft but it might be important to clarify this, not only for Monica but for future reference. @Elizabeth and Bertie , you've used both insulins, any comments please?
     
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  22. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Great questions, Diana! :) Basically, the no dose or tiny dose at a BG of 11 or 12 is the way to go at the start when you're learning your kitty's responses. That's the safest way to proceed. As time goes on and you accumulate a lot of data then you can push the envelope to learn more about what you can get away with for your kitty. The goal is to not lose ground by dropping /eliminating doses when your data bank tells you it's possible to give a decent dose safely, provided you can monitor of course. The only way to learn where the outer bounds of the envelope are is to try careful dosing experiments when you have a good level of experience and are able to steer with food, etc. should you get a bigger response than you'd like. Eventually you'll be able to lower your "no dose" BG level below 11 or 12 because you have a good feel for what your kitty will do. Make sense?
     
  23. Diana&Tom

    Diana&Tom Well-Known Member

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    Well put, Kris, thank you! Makes complete sense and hopefully Monica will be reassured.
     
  24. Djamila

    Djamila Well-Known Member

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    There aren't a lot of active Prozinc users on the forum right now, but I've found it helpful to go back through old threads and look at others' spreadsheets to start to get an idea of what works for different cats. You'll find lots of folks who were able to consistently shoot on mid and even lower blues because they collected data showing it was safe and learned what worked and what didn't for their cats.

    I do understand the emotional pull to lower the dose on a lower number. I did it myself last night. Sam was ready for a PM reduction from 2 to 1.8, but then his PMPS was even lower than I expected. Logically I knew I should still give the 1.8. I know from his data that he could handle that dose just fine, and that it would even be preferable. But when it came time to shoot I made the decision to lower even more to 1.6 because I was feeling chicken and needed to sleep last night. You can see from his +3 last night, that I should have given him the 1.8. I let my own fear get in the way of doing what was best for him last night. His numbers are low enough at this point that it wasn't terrible that I did that, but as soon as I saw that +3, I wished I had gone through with the intended dose.

    I may have shared this before, but in the time I've been on the board, I've never seen a cat have a serious hypo event if it was being fed low-carb food and had an owner who was monitoring and giving a reasonable dose. The only cats who I've seen have a significant hypo event were either being fed high carb food, or the owner was new to the forum and the vet had recommended a ridiculous dose. There are cats who have had a lime green number, but were still perfectly safe. Cats can handle an occasional lower number because the body stores glucose and dumps it into the blood stream if low BG is detected. In contrast, I've seen far too many cats stay in high numbers for too long, come down with a UTI or some other low-level infection, and end up hospitalized (or worse) with DKA. I think high numbers are far more dangerous than low ones.

    I'm not in any way suggesting that we can be careless about low numbers, but I think we often fear them more than we need to, and don't acknowledge the very real danger of the higher numbers.
     
  25. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Rather depends on what you mean by 'an owner who was monitoring'. We certainly have seen very serious hypos here on the forum. But in those situations where caregivers test before shots, and also during the cycle on a regular basis, such incidents are very rare indeed.
    The ability to do this seems to vary from cat to cat. One cat might tolerate a low number, and another might not. A cat's body may register the low BG, but the body may be too slow to compensate from its own glucose stores. If a cat's BG is really low it needs that glucose now, not in half an hour's time.
    Yes, indeed. I've certainly seen many more DKA deaths here than deaths caused by hypo. ...And it is so important to routinely test our kitty's pee for ketones. But we can get a bit complacent about that...
    .
     
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  26. Monica & Josie

    Monica & Josie Member

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    Thanks so much everyone, lots of great info!

    So Josie has an evening preshot number of 12.4 right now, to be honest I am still not quite sure what dose should be given right now..?

    Same dose of 1.25u as before at 20-24 or reduced dose or no dose as Kris says above for preshot numbers of 11-12 as we are at the beginning of this lowish preshot reading for Josie?

    Thanks very much!
     
  27. Diana&Tom

    Diana&Tom Well-Known Member

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    Monica, if I recall, you gave 0.5u in the week on a similar pre shot number and Josie was fine... so you could be brave and give a teeny bit more this time, BUT is she going up or down? If you don't have that info you might like to stall for half an hour and see if there's a clear direction then.
     
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  28. Rachel

    Rachel Well-Known Member

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    Just jumping in to say I agree with Kris's advice above...Kris knows bouncy kitties!
     
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