Discussion in 'Prozinc / PZI' started by Goose, Dec 21, 2019.
SS Updated. Thoughts? 6u seems to be ok at the moment....
He’s definitely looking better but, IMHO, he could use more insulin. If it were me, because you are no longer seeing any green at all, I’d increase the dose to 6.25u and see what that does for him.
Ok. We'll try 6.25u for 3 days. I just seemed that 6.5u was to much for him, at least the swings were rough.
Par of the reason he had the swings was because you weren’t using food to manage the curve and even them out. And while he’s doing much better, the goal is to get him into normal numbers (50-120) for the most part of the cycle and he’s not there.
He eats something at almost every single test we take and have taken, he's extremely lucky to have someone here to do that. The only time he isn't managed by us is overnight when he eats his dry food until 630am. I'm not sure how to manage the curve and even them out more than that as I can't force him to eat other than the needless syringe we have, and I'm sure that wouldn't last long for a feeding method. If he ends up not responding well to a higher dose, I'm apprehensive to keep going up.
SS Updated. There was a 47 at 2pm.
The 6.25u given is a 'best guess' on the syringe.
That 47 yesterday earned Do Daa a reduction in dose back to 6.0u. I'd start reducing tomorrow AM. That is too low. Any reading below 50 is a definite reduction of 0.25u. Make sure you get a couple of tests in tonight starting at +3 and see where he's heading. Looks like he bounced after that low yesterday but he also dropped a lot today, albeit to much safer levels and may be in another bounce tonight.
Oh goodness!!!! I never got that tag. Sometimes the system is quirky and we were out so I wasn’t on the board much to check on you all.
Remember, that any time he drops below 70, you want to reduce the dose by 0.25u the next cycle.
Because insulin syringes are so inaccurate, I developed Dosing with Calipers. It really made a big difference in Gracie’s cycles when I got more accurate with dosing. You might want to consider it.
There was a bit of a panic yesterday. 47 was a surprise. We'll start him on 6u tomorrow AM for the next 3 days (3 cycles).
The red bounce yesterday was probably due to over-feeding him with HC stuff. He had quite a bit of Temptations (20 pieces) because we wanted his numbers up fast. Another bounce like that might not occur tonight because he's just had his regular food and only a couple Temptations, but we're new at this and it's only a guess. We'll have to watch more closely and see how many of the Temptations he can have to try and control these ups and downs to get to a desired level.
No problem, everyone has lives outside of FD. I'm pretty sure I hit reply to your last quote, but quarks happen.
I wrote down that tidbit of info and we'll reduce to 6u starting tomorrow for 3 days and see how it goes. I'll take a look at that link and ask questions, thanks.
Very nice start to the evening. I would not wait too long to test. The goal is to try and hold him at a dose, that is getting him into better numbers, safely forays long as possible.
Is this at any time during the day/night what so ever? He hit a 63 this afternoon at 3pm (+6) does this qualify for a decrease of .25u?
Any time he drops below 70 once in a cycle, you should reduce his dose by 0.25u. Normally, I’d say by 0.5u because that’s how we took him up but, in the past, he didn’t hold the reduction.
I’m not really sure how to say this but as long as you are not willing to try and manage his curve with food and test at times to slow or stop his drop, I’m not sure what further I can tell you.
He’s been clearing bounces quickly; I had hoped you would know that you should not wait four hours this morning after a black number to test, see such an enormous drop, and wait two more hours.
What happens when you get into this kind of dive/bounce cycle that you don’t control is that they drop below the reduction point and they earn reductions too fast but still see high numbers due to the bounce part of the pattern. If you controlled the drop so that he doesn’t go so low but he flattens out and he can hold onto a dose longer that is getting him into better numbers, it’s better for him over the long-term. His body starts to get used to better numbers.
I suggest you all sit down and decide what your goal is: any regulation at all even if he’s bouncy? All numbers below 300? 200? Tightly regulated in normal numbers? Without knowing your goal and what you are willing to put into it, it’s hard to give you advice.
The goal is, and has always been, to save or extend his life as anyone would want to do coming to this forum or going to the vets. One has to be relatively committed based on the expense it took to get to were we are currently and to keep going forward.
We've done virtually everything we have been asked to do on this forum. He has been tested 466 times since we started. If we had been testing in his ears and not his pads, we would have collapsed his veins by now. As it is, one of his pads has toughened up and is much harder to draw blood.
He's getting tested up to 6 times a day, everyday, 7 days a week... and as depicted in the Spread Sheet, 12 time in one day! The only times he doesn't get tested heavily is the middle
of the night. We can't sacrifice our own health as that doesn't do any good at all in the long run. Few have the time to do any of this to this extent, this issue isn't the only issue that demands our attention and must be balanced with all other demands that we have. There are 7 other cats in our care, and some of those have other health issues we are dealing with. ALL of theses animals were orphans no one wanted that ended up in some way, on our door step.
Honestly, how much more testing can we do in a day? Manage the curve? Micro-manage the curve? Control the drop? He eats at every test and when he's not hungry, we aren't going to force him to eat unless there are super low numbers. The food he eats in 24hr is one can of FF (100kcal+/-) and 1/3 of 1 cup of Dr. Elseys Clean Protein 59% protein, 4.7% carbs. That is it, guaranteed. That is his regiment.
What was I suppose to do after his 528? Test earlier? If it's low at +2 or +3 and he's just eaten less than 2hrs before and his not hungry, what then?
At 145 (+4) he was fed and he ate some HC temptations and we waited for the food to do it's job, maybe more HC was necessary, but to much and he goes higher. 10-20 pieces can boost him 100-150 points. 4 pieces plus regular food will bump him up from a low number to a comfortable number. He's greatly effected by the minimal amount of food he eats, as noted above. We are trying to regulate those low numbers with Temptations only as needed and given at no other time. These numbers are moving targets.
We take um-bridge at the insinuation that we haven't been doing enough, haven't managed, or we don't have a direction. After all, in 3 months, we've gone from a whisper to a scream and have been drinking from a firehose of information. We are after all neophytes that have come here to this forum for help and guidance, receiving none of that from the vets.
As the saying goes, "Patience is a virtue" and it maybe a long row to hoe before we can stand on own two feet.
I understand but that’s such a broad goal that it does not give me anything specific to work with. For example, some people want their cat tightly regulated as that will definitely help extend life and reduce impacts to kidneys and other organs. Other members, are fine with their cats being in the 200-300 range due to their own schedules, lives, health issues, children, etc. That puts a cat almost constantly above renal threshold. Dosing advice is going to be very different. I’ve seen cats that are horrific bouncers be diabetic for over ten years and pass away at 20 from a heart issue. I lost my own darling baby at 9.5 years and she was extremely well regulated but IBD/lymphoma got her. So....you all have to decide what range you want to keep him in based on all you’ve got going on with several special needs cats. I completely understand the need for sleep and we’ve discussed that before.
I did not say you hadn’t. I appreciate your cooperation and working with us to help Da. Testing his ears 466 times would not have resulted in collapsing his veins because you don’t hit the vein. If you haven’t ever looked at Gracie’s SS, you really should. We had to test alot with her because she could be going along fine and then drop into low numbers like crazy. She was diabetic 5.5 years and at the end, you still could not tell she had ever been poked on her ears. The vets at the ER clinic thought we hadn’t been home testing and couldn’t believe how much we tested, based on her ears, when we showed them her SS. Once the ears learn to bleed, which doesn’t take long, you can barely touch a warmed ear with a 31g lancet and it bleeds. It’s not common here to test the pads because of the issues you are finding out now. The cat I referenced above that had been diabetic ten years....ear tested and his ears looked fine and still bled well after all that time.
I’m not even sure how to respond to this statement as I do not want to get into an argumentative discussion with you. I’ve linked the information before and I feel you haven’t read it because if you had, you would see that he still gets the same amount of food, you just portion it differently so that he is hungry and learns to eat at specific times. You don’t feed him more on a cycle-to-cycle basis unless his numbers are dropping and then you’ve got the Temptations.
With his patterns of dropping, I would have tested at +2. If he was on a minimeal feeding schedule, he could have eaten at that point.
I’m very glad to see you know this about him. It’s very important that you figure out what works to keep his BG flatter, what brings up low BGs, what skyrockets him.
Yes....he’s doing much, much better. Yes, you have listened to dosing advice and tested when we asked. Yes, the learning curve to FD is very steep. Yes, we are here to teach so that you can, hopefully, within six months, handle the day to day on your own and ask for dosing advice, etc when things get a little murky. Even very experienced members need to step back occasionally and let someone more experienced help them because sometimes you can’t see the forest for the trees.
FDMB is a community. We learn from each other and part of that is looking at other member’s posts, looking at their cat’s SSs, asking questions in other threads, etc. That’s one way you can learn here because Da’s dose might be higher but his cycles are not different from other cats. We have new members pouring into FDMB by the day and brand new members need alot of extra help. As members are here 3-6 months, they have really started learning alot and can be supportive of new members (not with dosing advice but moral support). While I do not usually post on the PZ forum, I’ve happily continued to help you all and will be happy to continue but I urge you to get out into the FDMB community more, read more, look at SSs, etc. I know you are busy with other cats and life; but, hey, most members also are. We have single parents who work and juggle the needs of their diabetic cat, members in your same situation with multiple cats with needs plus working full-time jobs, on and on. I know your situation is unique to you but everyone here has a unique situation and still manage to reach out to others and learn from them. Heck, you might see something on another cat’s SS that you think might help Da and you could ask about it.
We say here that FD is a marathon not a sprint. We understand, about patience; believe me my Gracie taught it to me in spades. I don’t expect you to stand on your own two feet right now but I do expect you to start “pulling up”; having an idea when to increase and decrease. I was very happy to see you shoot a 100 something number without asking....great progress!!!! And I know you are very appreciative and respectful of the time I spend helping you all.
edited to add (eta): It’s not that I’m asking you to manage the curve with food if you are completely against it. I just want you to be aware that he’s likely to continue this kind of a dive/bounce pattern. That’s your decision to make and there’s no judgment here. I’m just offering an option that might help with those big dive/bounces.
And managing the curve with food doesn’t mean they will completely stop bouncing but it does help to level the numbers out a bit. The higher the bounce is, the bigger, and potentially faster, the drop is. The faster the drop is, the harder the next bounce.
I’m going to be off the board until 1/20. Linda said she’d keep an eye out for you all. I’ll check in when I get back.
SS Updated. 6u for 5 days now.
I'd continue the 6u dose for another couple of days and see what Do Daa does. It seems to be dropping BG to decent levels but then Do Daa is bouncing up to higher numbers. As Do Daa gets more used to being in decent numbers again, the bounces should ease off. I wonder too if a little less of the Temptations when he does get down into the green numbers would extend the duration of those lower BG periods. It would take a bit more monitoring to ensure he stays in safe numbers but worth it to get Do Daa into better numbers for longer periods.
Ok, we'll continue with 6u for 3 more days and see what's up.
I agree that his numbers as a whole are looking better. I'm wondering why his am and pm numbers are so high. I know that the insulin is waning at that point, they just seem too high for the 6u am/pm that he has in his system.
Yes about the temptations. We are trying to find a better balance with them when his numbers drop like a rock. It seems like an easy way to Up his numbers.
Like the 80 early this morning. (Staring at +3 thru +6 he was given 30 individual pieces, 1/2 of which was given to him when he hit 80.) We called it a night at 3AM when he hit 127, knowing that at that point, up was likely. This will take more monitoring with the temptation, but we only use them when he has really low numbers.
The overall goal for Do Daa is eventually remission. However, in the in-term, we would be happy with a Consistent 100-200 range as we work towards that goal. Getting a grip on these numbers is like trying to catch a slippery frog. Frustrating, and oftentimes, you fall flat.
Those higher numbers at AMPS and PMPS can in part be attributed to bounces especially when BG has dropped to the greens or dropped more than 100 points by +3 (today's day cycle). I am also questioning the duration Do Daa is getting from the insulin. ProZinc usually lasts about 12 hours but there are kitties who don't get quite that long. Is there any way during the day, you can grab a test even later in the cycle , around +10 to get an idea of how quickly he is rising at the end of the cycle?
Getting a kitty regulated can be very frustrating and it takes a bit of experimenting to find that magic bullet combination of food and insulin. Do Daa is making progress and the more we learn about how he processes the insulin, the less "slippery" things will become.
On using food to steer the curve, I am wondering if you could feed Do Daa a little less at his pre-shot meal and then offer the remainder around +1.5 to +2 post shot to see if you can slow down the initial drop. If you leave him just a little bit hungry initially, he'd be more likely to welcome a snack in those early hours.
Also when you can monitor (we all wish they'd hit those lows during the day) and Do Daa drops to green, try giving him low carb food initially instead of the Temptations and retest in 30 minutes to see if that boosts him up enough to help him surf along in those healing numbers or at least limit the Temptations to 5 or so and retest. It really helps to know just how carbs affect your cat so you can steer then but not send their BG skyrocketing.
I gave him some food (CP) about an hour ago, and he's at 230 compared to last night same time (12am +3) he was at 129. Maybe the food slowed down the drop...
Question: Since we are making him wait for food at almost each test we take, are we helping create the bouncing he's experiencing? Is the fasting at those times too much for him...? and as you mentioned, level out the numbers with more food more often?
We'll take some 7pm (+10) numbers tomorrow and Monday.
As for the food, he never eats a lot at any one meal, and minimal to no food before each and every test. By the time he gets to amps, pmps he is usually pretty hungry. It is sometimes really hard to get him to re-eat any food after his tests because he's just not hungry. i.e - (+1.5 or +2)
Being a grazer, he doesn't eat a lot at one time, eats almost every two hours, and is quite stubborn and has to have food on his paws even to eat at other times during the day. So it would be hard to limit his food at these testing times because he eats so little at each test. He makes it difficult and it's been a real chore to get his to eat up to his 1 Can of FF a day with 1/3 of 1 cup of CP. So I don't know how exactly to cut back on the minimal food he's getting now.....
The food may very well have slowed him down or he's still in a bounce from last night. You 'd have to try it for a few nights to really see if it works for Do Daa. I hear you on a grazer who nibbles rather than eats a decent meal at any given time. Does Do Daa prefer the CP or the FF? If he has a favorite, maybe changing up when he gets whichever food would entice him to eat when you want him to. Just throwing that out there as food for thought. I have 3 of the furballs here and 2 are grazers and the other inhales her food and then tries to pilfer her brothers. I really do understand the frustration of getting them to eat on cue but with time and insistence and perhaps a little hunger when it's safe to do so, they do tend to learn when it's meal time and take advantage of it.
He most defiantly prefers the Clean Protein over the FF, hands down. He's a dry food lifer and only started eating Any wet food about 2 months ago. Unfortunately for us, at the moment, the only way he eats the wet food is to be Bribed with the dry food. The dry food has to be given a few at a time and he has to lick them into the wet food in order to even eat the wet food. Rarely will he only eat the wet food by itself. He is only being fed by himself so there is no fighting or sneaking other food.
He was tested at +10 tonight. He had some food then and was tested at 9pm pmps.
Da Daa is getting a nice drop in the mid/late mid cycles but he is bouncing a lot. The only way to deal with bounces is to try to slow down those drops and otherwise, they stop when they stop. I seriously wonder if a longer lasting insulin like Lantus might work better for Do Daa. It won't stop the bouncing completely but it does produce a gentler drop which helps with bouncing to some extent.
Looks like Do Daa is bouncing yet again. Stay the course. Hopefully he will start clearing the bounces faster.
SS Updated. Still at 6u.
SS Updated. Hit a 48 this afternoon, we've reduced his insulin to 5.75u for the next 3 days.
SS Updated. Hit a 48 this afternoon, we've reduced his insulin to 5.75u for the next 3 days. (Best guess on the syringe).
I’ve been sneaking peeks at his SS while our guests were here. He’s been doing better and you all have been doing great. I’m sure that 48 gave you a jolt but superb job reducing the dose.
I’m just getting back on the board so I’ll have to take a few moments to read through his thread in a bit.
Just one comment......we don’t necessarily hold a reduced dose six cycles (3 days) if we see the reduction isn’t working. There’s no benefit to keeping the dose where it doesn’t help him. But, for now, let’s take it a cycle at a time and see how he does.
Hope you had a good time with your guests.
Yes, he seems to be doing better overall and acting like himself. Thank you for saying we're doing well at this, it's appreciated. It was a little unnerving seeing those low numbers for sure and Yes, 48 was a jolt. He's only been that low twice now, the other was a 47.
We figured that lowering the does for a bit might be helpful. I didn't remember the part about about there being no benefit... I thought that you'd have to go roughly 3 days to see if a dose change would take hold.... So, will only 1 day at 5.75u determine if it's an appropriate level?
Three days is often mentioned by members but it’s not for the reasons they think. It can take up to six cycles or three days for a bounce to clear. But it might only take two cycles. If the bounce clears and the BG does not come back down to normal numbers, why leave the kitty at a dose that isn’t working for four more cycles? You wouldn’t want to so we call it a failed reduction and increase the dose (but if a kitty got into the 30s with the reduction, we don’t want to go back to that dose; we just fatten the dose a bit).
Doses don’t “take hold” on reductions and really, the only insulins where you really need to give an increase time to settle is the depot insulins (eg lantus, basalgar, Levemir). However, we also hold the increases six cycles with PZ for consistency. There is no requirement to do it with decreases for any of the insulins.
Ok. That makes more sense. So as you mentioned, we'll take it one day at a time and see how he does.
It’s great to see him in normal numbers and you are doing a good job of controlling the numbers when they fall. Can you share with me what you are doing please?
We’ve been using a drop below 70 as a reduction point for him and he got there again today. PZ can be a bit “volatile” and so we can see an occasional lower number here and there. If we are conservative, you would drop the dose to 5.5u tomorrow knowing we can increase if he fizzles out.
Yes, it's nice to see normal numbers. We are using the last bit of the 2nd bottle, maybe 2 shots left.
Between +6 and +10 he had 45 individual pieces of temptations, some FF gravy lovers food - small amounts (teaspoon), and at 630pm had .3ml of syrup (when we felt he wasn't rising fast enough)
It's still unnerving when he gets these low numbers, we just don't want him to fall to low and not catch it. We're still trying to get the food amounts down pat to try and control these swings.
Thanks for the info. So he’s getting quite a bit of HC when he drops lower.
Any thought to switching to one of the insulin that work a little better for cats like Lantus or Levemir? I really like Levemir a lot and found my kitty did much better on it. With those insulins, we dose on the nadir instead of preshots.
Yes, at the moment he's getting quite a bit of HC only when his numbers get low. Should we try 5.5u tomorrow?
We just purchased a 3rd bottle of Prozinc last week so we will be on that for the foreseeable future. Other insulins like Lantus are much more expensive. I know it can be purchased in Canada cheaper, but the current Vet is unlikely to write a script for another insulin and we have not yet looked for another Vet. We had issues initially with the Vet and they have followed up with us exactly 1 time since we started this process in late September '19.
The Vet felt too challenged by "people on the internet" (forums like this with people who think they know what they are doing) and hasn't been helpful since. Luckily we are still able to get the Prozinc from them, just on days when most of them are not there. When I started posting on here, I PM'd Linda initially and she knows about it.
SS Updated. We'll shoot 5.5u tomorrow.
Got it on the PZ and I understand.
For safety, because he’s still at a relatively high dose, it’s smart to reduce. We can always take the dose back up.
SS Updated. He was shot with 5.5u am/pm.
Not a bad bounce at all considering how much time he spent in green. Glad to see that blue but let’s hope he can get to green on this dose.
No greens, just blacks and reds. I guess that would be called a insulin Reduction failure. We upped him to 5.75u at pmps.
He hasn’t cleared the bounce from the greens yet. When you see that they look like they are going to clear and then the BG goes up a lot higher....as in today....you want to be prepared that it might be the “high before the break”. That means he might very well clear the bounce tonight and you’ve got a bit of extra insulin in him so don’t wait too long to test him.
We should test him at +2? or 3 or 4?
Should we go with 5.5u tomorrow instead?
I thought that the blacks meant the decrease had failed, so didn't hesitate to increase. So if a situation like this happens again, just let it happen, keep the dose the same?
Black means he is bouncing. He started the bounce the pm cycle of 1/21. He looked like he was about to clear yesterday but then popped back up, wobbled a bit, and then hit black. That is very characteristic of a high before the break. Obviously, I don’t have a crystal ball but it is a pattern we see frequently and it sends up a red flag as he was high at those numbers at mid-cycle. Again, no crystal ball here but I would test by +2 or +3 at the absolute latest since he was already headed down.
Let’s see how he does tonight before you reduce the dose tomorrow. Sometimes, that green was just a bit of an anomaly and he might actually need 5.75u.
You will eventually get a feel for when you should take the dose back up and when you should wait. Not every instance will look like this one or have the same outcome.
Generally, we do not want to take the dose back up if it is evident the bounce is starting to clear. We want to let it clear and then increase if we need to do so.
So much for command decisions on my part with dosage.
SS Updated. +2 at 444, so hasn't fallen yet. Should we test at +4?
Actually, I thought it was great that you made a command decision!!! I’m proud
He seems to often onset closer to +3 so perhaps a +4 and if he’s still flat, you could probably call it a night.
We'll test at +4 and if he's stable, the rest sounds good.
Where, in your opinion, should the numbers be at amps for him to stay at 5.75u or to lower to 5.5u? I'd much rather him be in blues and greens.
If you are going to be there tomorrow, I’d suggest shooting 5.75u unless you wake up to 100 or less. If you get a blue number, just be sure you can test by +2.
Ok. I'm going to log out. Thank you for your help.
You’re welcome. Good night.
Good job increasing! My crystal ball with him was fuzzy. Looks like he did not like that reduction.
SS Updated. He didn't like that reduction, at least for now.
Let’s see how he does back at 5.75u.
Goose....can I ask you to please start a new thread? We are going to be asking all PZ ISG members to limit one thread to 50 posts unless there is an immediate issue going on like a low number. Thank you!
ETA: I’d hold the 5.75u dose a bit longer than six cycles since you are seeing blue. Let’s see what he does with 8 cycles.
I’m not sure when/if you started that new bottle of Prozinc (I don’t think it’s noted on the spreadsheet?), but I would sometimes see some difference in BG values when starting a new bottle. Not everyone does, but it’s something to keep in mind.
New thread making in progress...
More blues today and some greens. We'll hold 5.75u for 4 more days.
The new bottle was started on Jan. 24th. and this has crossed my mind before. I updated the SS for the 24th with this addition.
Separate names with a comma.