Do Daa’s PZ Dosing

SS Fixed.

 

Thank you!

 

Goose PMd me that Do Daa was dropping into blue today so I’m commenting here.

Great news on the blue!

When you retest, you put, for example using your numbers, in the +5 column “164 RT 140” and in +6 you would put “141 RT 130”.

Since you are past midcycle, if he’s hungry, I’d be sure it’s LC food. I would also encourage a +8 test so we can see if he’s headed up.

With the +2 tests I suggested, we are just trying to get an idea when he onsets.

 

Spectacular news!

 

SS Updated. Did I do it right? With both of the numbers at the same time? He's been tested 3 hours in a row - all blues.

 

No....the retest numbers go in the same cell as the original test. So if you tested and got a 169 and then retested immediately or within a few minutes and for a 140, it all goes in the same cell. Otherwise it looks like you tested every hour for four hours.

 

Is that better?

 

Awesome seeing this blue numbers on the spreadsheet. You can manually change the colour of the cells with the paintbrush symbols, so it shows as blue. The way you did numbers looks good.

I agree with Marje, a +8 could be interesting.

 

SS Updated. +8 (5pm) 124 / 122

 

Nice and steady.

 

So I need to eat dinner soon.

Should I hold off until PMPS to test again? Should I continue with 6u?

 

You could wait to test, unless you are curious. I would do 6 again tonight.

 

I'll wait until PMPS, his pads are taking a beating.

6u correct?

 

Yes 6u.

 

SS Updated. He's at 100 and I tested the other foot at 71.

He seems to be continuing going down, is it now something to worry about??

 

Excellent! Good job on the SS. I would suggest you not retest him every time. He’s pretty steady but if you get a number that is a lot lower, then you can retest. By a lot lower, I mean 60 or less.

How are you all doing? Is how most members are with their first string of blues but I know you’ve seen lower numbers before.

 

I'm now getting worried about ( SS Updated. He's at 100 and I tested the other foot at 71.) these numbers. He just had something to eat, but not very much.

Cautiously optimistic, as before.

 

SS Updated. 69 first, other foot was 66.

What to do? I don't want to shoot him at all, especially with 6u at this rate..... PMPS is 1.5 hrs away.

 

He’s still at very safe numbers. I found that when I retested with the same meter, it was usually lower. So I bought a second meter of the same kind and if I had to retest, I used it. It was typically within just a few mg/dL of the first.

Edited to add: will he eat a tsp or two of low carb food?

 

See above. This looks like a bounce clearing cycle to me. That means it also looks like he went lower last night and he’s on a mission tonight clearing the bounce.

If it were just the dose, he would have nadired and we’d be seeing a rise by now. But the fact that the BG is continuing to drop is indicative of a bounce clearing cycle.

Instead of just skipping, we might think about a half dose.

 

You/others would know better than us what this is indicative of. So if he's still low at pmps, we should give him 3u?

He's within the 2 hr. no feed window for pmps. Shouldn't we wait or?

 

We are discussing since we have a bit of time. Questions for you:

• Did you feed him and when (+?) and how much
• What is your availability for monitoring tonight and do you have plenty of strips, lancets, high carb food or syrup/honey?

 

(+9) or 6 - 6:15pm he had less than 1/2 can of FF and 12-15 pieces of dry CP.

We can test quite a bit tonight - what is your idea of times within reason.
We have plenty of everything including Karo, real maple syrup and higher carb Temptation Treats.

What is an unsafe BG reading? When should Karo be used? Should he be fed high carb food pmps? and other times tonight based on readings...

 

• The BG is our guide for when and how often to test. If you shoot, you will need to get early tests like +0.5 or +1 depending on where he is;
• With Lantus and Levemir, members with data shoot everything above 50; newly diagnosed cats earn reductions for BGs below 50; the PZ protocol does not address this that I can find but I would certainly reduce his dose if he dropped below 50;
• The use of HC depends on the BG and where it is in the cycle;
• Please be sure he does not get any HC food before you test/shoot; he should also not have any LC food other than when I advised above when he was at about +10 unless we find he’s in the 40s. Then we change our approach.

If he continues to drop or he’s flat at PMPS, we should stall without feeding and see if he comes up. I’d really like to see him up more towards 100 to have you shoot.

 

He hasn't had any food in the 2hr no feed window, since 6pm or (+9)

Are we reducing his does to 3u at or around 50? What's the lowest point cut off for anything higher, I don't want to hurt or kill him.

At PMPS, we are not going to feed or shoot until his reading is above 100, correct? What amount of insulin? How long do we wait after pmps to feed or shoot?

How do we determine when to test? Every 1/2hr to 1 hour throughout the night?

I'd rather error on the side of caution with the insulin amount than give him too much.

 

I know we all want to have a plan but often, we have to see what the BG is doing. Because we have basically no data with him at lower numbers, I’d like to see him above 100 before you give any insulin. If he’s just above 100, I’d opt for a lower dose like 3u unless @MrWorfMen's Mom, @FurBabiesMama, or @Wendy&Neko have other ideas.

If he skyrockets, which he might do because these low numbers are going to cause him to bounce at some point, then we go with 6u.

If, at any time, he drops below 50 (although we might decide to change that number depending on how he responds to carbs; in other words, if he gets to 70 and he doesn’t want to come up much, we should think about that as a reduction number), you would reduce the dose by 0.5u. I’m also looking at another high dose kitty’s SS on PZ to see what she used as a reduction point. I’ll get back to you on that.

I’d suggest you test just a bit before PMPS. If he’s 100-150, I’d go ahead and give him 3u and feed him his regular food. If he’s below 100, don’t feed or shoot and post here.

Once we see where he is and if you shoot or not, then we can discuss testing times, ok?

 

Just tested before PMPS he is at 70.

So we are not feeding or shooting him right now.

Does changing his PMPS insulin shot, change the 12hr window? Or can we go back to 9am/9pm once he gets back to normal numbers?

 

Because PZ has no depot, you can go back to your normal shot time if you delay.

I would retest in 30 mins to see if he wants to start up.

 

We'll test at 930pm and post here.

 

ProZinc allows for up an hour of wiggle room with shot times so stalling for up to an hour is Ok but I wouldn't go beyond that.

 

So should we test at 930pm or 10pm?

 

Retest at 9:30pm. If he's still down you can do one more stall/retest before your shot time would be affected.

 

Thanks, Linda. I was looking at CCs SS and it looked like Janet stalled for a couple hours at times but then seemed to shoot on time the next day or didn’t record it correctly which is always possible.

Let’s hope the next BG is up quite a bit.

 

Janet has been at this for awhile with CC so she knows her cat and how she reacts. With ProZinc potentially lasting up to 14 hours in some cats and being in new territory with Da, I'd stick to the hour for now if shooting early could potentially be needed.

 

Tested just now at 63. He is getting really hungry ( 4 hours without food) and is starting to get list-less.
Do I put that in the +1?

 

You’ll stack the numbers in the PMPS column so it would be 70 @ +12, 63 @ +12.5.

Hold on just a few minutes and don’t feed. We are discussing. I’d like to know how you feel about skipping knowing he’s very likely going to shoot up.

 

What is the safest way? I think that skipping the does completely would be better for him. I assume he'll bounce for days and back where we were before this started? What's a safe does while still giving him something at or around the 100 mark if he reaches it soon to avoid too much bouncing for days?

 

We don’t know how long he will bounce since he hasn’t been here before on this dose.

If he’s hungry and listless, you might just skip and feed him but you’ll still need to test him about 30 minutes after he eats and be sure he heads up.

You can still wait another 30 minutes and see where he is. If he’s not above 100, I’d skip.

 

So I'll feed him and wait 30 minutes and see and skip if not above 100.

 

If you feed him, you’re skipping.

Edited to Add:

here are the options

• Continue to stall without feeding for 30 more minutes and then test; if he’s above 100, give 3u or
• Skip, feed him, and test 30 minutes after he eats to be sure he’s headed up. You then will not shoot until his regular shot time in the morning.

 

You want to know if he is above 100 without feeding. If you feed then test, any rise in numbers might just be the food.

 

So we tested him at 930pm and it's almost 10pm - check to see if above 100 if not skip dose and feed him, correct?

 

Correct. See above.

 

Perfect sense. Will test at 10pm very shortly.

 

10pm reading was 64. So we are skipping the dose completely and will test in a 1/2 hour to make sure he's going up. If for some reason he's not going up fast enough, what should we feed him?

We'll test and shoot him at the regular AMPS regardless of numbers or should we be mindful of a low number in the amps and adjust to 1/2 does or?

 

You still need to make sure the AMPS reading is a shootable number. Let's see what Da does in the morning.

Given how low Do Daa has gone today, he's earned a dose reduction to 5.5u. If BG is below 150 in the AM, stall and see if BG is rising on it's own and post for advice.

 

I’ll be here in 30 minutes so please just post and we will discuss what to feed if he’s not up.

Yes, you will need to be cautious in the morning if he’s low. I doubt he will be but if he is, stall without feeding again to see if he comes up above 100 and then shoot 3u. You can post in this forum or in Main Health if you need help and be sure the thread very clearly states “stalling...need help please”.

Here is what I suggest for a dose for tomorrow. If he’s continuing to stay around 100 or less:

• if he’s at 100-150, shoot 3u and then the next shot, if he’s come back up high, reduce the normal dose from 6u to 5.5u bid
• if he’s lower and you stall, without feeding, and he rises above 100, follow the instructions in the bullet above
• if you can’t shoot again in the morning, we will talk during the day but we will definitely need to lower his normal dose
• if he skyrockets, shoot 6u in the morning at your regular time.

Sound good? Questions? @MrWorfMen's Mom ....anything to add or a different approach to suggest?

We would also appreciate it if, tomorrow, you would start a new thread in this PZ ISG because this one is way longer than we usually run them. You can entitle it however you like as long as his name is in it. Please put the link to this thread in your first post in the new thread in the morning.

To do that, open this thread and copy the browser address. Then start a new thread and put your cursor in the first text box. Type “Previous Thread” and highlight it. Then click on the hyperlink icon (looks like a sideways paperclip) in the toolbar above the text box. Paste the browser address you copied into the box that opens and click “insert”.

Thank you and I’ll be here for the next test.

 

He just at 3/4 of the FF can, 15 or so pieces of Temptations and 20-25 pieces of CP. He was hungry.

So test at 1030pm? Will that be enough time to get into his system?

Will do on the 5.5u in the morning except if it's below 150 will will hold off ( should we feed him anyway?) and see if it rises and post then.

 

edit: just read the above bulleted post.

 

It’s fine to wait 45 minutes after he’s done eating.

 

So it's 45 minutes after he last ate? That will be 11pm.

 

@Marje and Gracie
Post # 247 Looks good to me.

 

Yes.

 

Thanks, Linda!

 

It would actually be at 11pm, he finished eating at 1015pm. sorry

 

Ok. Thank you.

 

SS Updated.
Just tested he is at 70. Up from 64 but barely....

We're still going to give him food if/when he gets hungry. Should we Karo his gums or something if the numbers don't improve?

Should we be testing at +3?

 

Wow. That surprises me given all he’s eaten. When does he eat again normally?

 

If we test at +3 he would eat then and then he would have a 1/3 cup of CP overnight until 630am (usually eats 80-90% of that) which it is then taken up to not effect amps.

He usually eats every 2 hours but overnight while sleeping is the only change.

 

You’ll need to be sure he continues to come up before you quit testing for the night.

I’m confused. If he eats every two hours, won’t he eat again at +2? If so, I’d test again 30 mins after he eats.

 

He would end up self regulating the 1/3 cup of dry food CP overnight until around 630am as he has been doing since we have started this process.

 

Oh...and I wouldn’t give him karo unless he drops into the 40s.

But my question is.....does he eat at+2 since you said he eats every two hours?

 

I'll restate, he eats every 2hrs during the day while someone is up and with him and the other cats. During the nighttime hours, he eats the CP but we can not be 100% sure that he eats every 2 hours at night. He's a grazer and eats when he wants, especially at night.

 

Thanks for clarifying. Then I would test at +14.

 

+14 is what? 11am tomorrow morning? Does that mean hold off on amps until 11am? Food also?

 

No...+14 is fourteen hours after his last injection or at 11 pm but I just realized with his stalling, you’ll be at +15 soon (or what would be +3 if you had shot on time). So I’d test then.

Is it clear how you count time? In the “U” column tonight, put NS for “no shot”. If you shoot on time tomorrow, you’ll put the BG and “@ +24” so we easily know it’s been 24 hours since you last shot.

 

SS Updated. Reading of 114.

We're still learning, even after 3 months, so I'm sure there will be more questions.

"No...+14 is fourteen hours after his last injection or at 11 pm but I just realized with his stalling, you’ll be at +15 soon (or what would be +3 if you had shot on time). So I’d test then."

So test him at 2am? We are about to test him at what would be +3 (12am).

 

He’s on the way up which is great. Yes, if you’d like to grab a couple hours sleep, 2 am is fine. If he’s way up over 200, you can probably just sleep. However, if you get up before shot time (say at 7 or 8), you might want to test so you aren’t surprised at AMPS.

Can you please fix his SS? In the PMPS column, you want to put “70 @ 12; 63 @ 12.5; 64 @ 13”. Then delete the info in the +1 cell. Thanks!

 

Fixed SS. Is it ok?

 

looks good. You can manually color it in using the pitcher and font in the SS toolbar.

ETA: I’m headed to bed now. Great job testing the last several hours. I hope he comes up and you all can rest. Good luck in the morning. I’m two hours behind you so won’t be up at your normal shot time but you can try and tag Linda, if you need help, as she’s on your time zone.

 

Ok.

SS Updated at 2AM. Reading 171.

 

SS Updated. Up to 457. So a 286 point increase. Gave him 6u in the am. Will try to get a +3 or +4 to see were it goes.

I'll try and get to the making of a new thread tonight.

 

Ok but tonight reduce the dose to 5.5u. Da earned the dose reduction with those lovely lower green readings yesterday.

That high AMPS is a bounce which we expected would occur. Bounces can last for several cycles or clear relatively quickly (depends on the cat) so when you test at +3 or 4, that reading will suggest how much and when to test again today.

 

With so many numbers flying around I thought that any 'normal' number to him right now was to be shot at 6u. So tonight he'll get 5.5u. Is that for 3 days?

 

That was quite the excitement last night and there were a lot of numbers getting thrown around so I understand how the reduction got missed. With the higher AMPS the 6u shouldn't be a problem today but definitely reduce tonight.

Yes, hold the new dose of 5.5u for 3 days and then re-evaluate.

 

Thank you! Yes, there was some excitement last night - tempered by reality this morning with a 457.

I'll be back later today/tonight. Earlier if something happens.

 

Not necessarily. If Da bounces, clears it in three cycles, and then only gets to the mid 100s or higher as a nadir, then there is no reason to continue to hold a dose that does not get him back into green numbers. Just as with the depot insulins, a failed reduction is a failed reduction and we don’t keep holding a dose that might not be working after a reduction.

@Goose that means we need to watch him each cycle to see if he’s able to get get to low 100s or 50-100 on the new dose. If he can’t, we need to increase and we’ll decide a that time whether we go back to 6u or we split the difference and just go to 5.75u. Also, even when a cat has earned a reduction, if the next cycle brings high numbers, we can “shoot through the bounce” with the old dose to try and keep the numbers from getting too high. It’s an old, tried and true method.

You are correct that my original instructions stated that if he was high, the normal dose would be 6u. However, Linda and I discussed this and felt that we should perhaps use a higher reduction point for Da than 50. As I did mention earlier in a post, we might want to consider 70 and we both think it’s reasonable for him. Often, PZ users (and even some lantus and levemir users) follow the Start Low Go Slow method of regulation which has the reduction point as numbers below 90.

One last thought, you might want to look at CC’s Spreadsheet. Although CC is an acro cat, she is on PZ and you can get an idea of how Janet has handled her dosing. We can learn alot from others and, that is our goal....to help you learn enough that you can make most decisions on your own as you gain more and more experience and data. Of course, we are always here to help even experienced members because everyone needs a second opinion from time to time.

 

New Thread started to continue this saga.