Dose too high??

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Adam Flowers

Adam Flowers

Member Since 2017
Hi everyone..

Mogee has been doing great and I have many of you to thank for that..

These past few preshots however have been extremely high. In fact, some of his highest ever.

He is eating normal, litter habits are normal, etc..

I am lost as I test enough during the cycle to see that he is not going too low and bouncing, so am confused as to why his preshots have been so high?

He has pretty much gone into the green every day since the beginning of August and even so with these high preshots.

I guess I am wondering if the dose of 2.5 units, twice a day is too much? He goes down to below 100 with that dose when his preshot is around 250 as well as if it is as high as 350+...

Maybe he may be going even lower after +6, etc. causing a bounce?

Or too big of a drop during the cycle? For instance, he was 380 PS tonight and is 134 @ +4. A drop of 246 in 4 hours?

Any input and/or advice would be helpful. Please check out Mogee's spreadsheet. And as always, Mogee and I appreciate it!!
 

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I'm not a Prozinc user so I will leave the dosing issue with Linda.
But maybe you could feed the curve a bit to let Mogee down more gently in the first half of the cycle. He will certainly bounce if he drops too quickly. I found if Sheba dropped more than 50-75 in an hour she would bounce.
He's getting beautiful numbers mid cycles
 
Have you been using ProZinc since diagnosis?

I wonder if he might do better on a different insulin like Lantus, Basaglar or Levemir

Those big drops can definitely be causing the huge bounces
 
Might be worth considering to try a different insulin then....Usually if you've tried one at least 6 months, if you're not getting the results you're trying for, it can't hurt to try something that works totally differently.

If you do decide to try one of the other human insulins, don't forget to save some money by buying it from Canada
 
Hi, Adam! You left me hanging on this: http://www.felinediabetes.com/FDMB/threads/advice-please-high-alt.208529/#post-2316102 What ever happened with that???

I'm a big believer in consistent dosing (meaning the same dose AM and PM and held for at least 3 or 4 days). When you have to start 'messing with' the dose on a shot by shot basis, that can be an indicator that the dosing is a bit high. Giving different doses can create a bit of volatility, the more the numbers start swinging around, the harder it gets to understand what is happening or to calm it down. It looks to me that 2.25 MAY be about the right dose right now. It looks like when you are giving 2.5, you end up having a lower pre-shot, and you reduce the dose, then you go back up on the next shot. Since you already dropped to 2 this morning, you could go ahead and hold that for at least 6 cycles (3 days) then go up to 2.25 if the numbers warrant it. Or, you could go to 2.25 and try holding that for at least 6 cycles then evaluate. Try not to be so quick to change dose based on the pre-shot. Obviously, you don't want to cause him to go too low, so I understand that in some cases a reduced dose is a safety measure if the pre-shot is super low (and that is usually an indication that you need to lower the regular dose you were giving by .25 going forward), but don't be too quick to lower, and don't up a dose when you get a little higher than normal pre-shot. You want to base dose changes not only pre-shot but also on how things have been going during the cycles... always keeping in mind the importance of keeping things consistent and 'calm'.

It's a shame that you just started a new vial of ProZinc. With Mogee's pre-shot numbers still in the pink and yellow consistently after two years (and with these numbers being from a human meter, the actual glucose levels are a bit higher), I think it may be time to consider an insulin change. My research led me to choose Levemir, and I love it. Mia is a 'hardcore' diabetic and may never make it to remission, but with Levemir, she is very well regulated on a very small dose. (Her spreadsheet is all blue and green (these are AlphaTrak numbers); it no longer looks like someone spilled Skittles on it.) Levemir has a later onset and much 'smoother' action, so we don't get the same ups and downs as we did with ProZinc. It is also safe to give on much lower pre-shot numbers, so the stress of that is gone. Lantus is another long-lasting option.
 
@FurBabiesMama I understand not changing the dose etc. But if you look at 9/5 PM with that low PMPS if I would have given his full 2.5 units instead of 2, I would hate to know how low he would have actually gone. I feel that I test enough to know exactly how much insulin he needs to go into the green based on his PS. I guess it is just hard for me to give that same dose if he is that low PS and I am not going to be home to test for awhile. That night I was able so I gave 2 units but I think of it was AM and I had to work and unable to be home, I would have gave even less..

I agree with you that he should be about 2.25 units, twice a day and that is what I am going to try..

In regards to "leaving you hanging" I apologize but at that time I was overly stressed and I feel my stress in turn only contributes to Mogee not doing so well as a result. I have been given amazing advice of here but sometimes I have to take a step back, breathe, and trust that it will all work out. Sometimes being on here, hearing 50 different opinions can do more harm to my psychy than good.

You have been nothing but helpful on here and Mogee and I appreciate all your help you have given from the very start. You were the very first to actually be there and help and give me great advice and I will always love you for that and I will never forget..

I guess I just took a step back from FDMB altogether during that time as I thought it was almost the end of the road for Mogee and was having a hard time trying to cope...and everyone is telling me I need to do this and I need to do that and I felt like my head was on a swivel..

Since that post.. the bumps on Mogee aren't there anymore.. I don't know if they just went away or if I was just crazy like as the vet thought they weren't much of anything, just fatty deposits if that.

Mogee is currently not on any medications and is eating well, and seems to be doing great lately with the exception of these past few preshot hiccups in the road.

He never did get his dental done as for whatever reason his ALT still runs high but the last check of that, the vet appointment in question, his ALT was down to 233. So it had went from 400+ to 1000+ and then down to 233 with the Prohepatic supplement. I have not taken him back to his ALT checked again (I know I probably should) but hearing that it had went down from what it was along with his bumps going away and his numbers coming around, I hated the thought of taking him back to the vet as he appeared to be doing so well.
 
I'm glad to hear his bump issue is doing okay. I understand stepping away from here, I was just worried about him, especially when you didn't let us know the outcome... I was afraid of something bad. I'm relieved to know that is not the case.

I understand why you dropped for PM on 9/5. I was not commenting specifically on that. I was referring to a few different things over a range of time. For example, he was getting 2.5 for several cycles, then on 8/25, you had a low AMPS that made you drop - probably an indication that the 2.5 was a little too high. That PM, you went back to 2.5 rather than dropping to 2.25. Then, the next AM, you gave only 1.25 but went back to 2.5 that PM. From there the doses were 2.5 in AM and 2.25 in PM. Another example, was when you were back to giving 2.5 then had a low PMPS on 9/6 that made you reduce, but the next AM, you went right back to 2.5 rather than reducing to 2.25.

Though ProZinc is an in-and-out insulin, there is some overlap, and it can take a few cycles for the true impact of a dose to be evident. Frequent dose changes based on pre-shot 'may' accomplish the goal of making it into greens most cycles, but it may not accomplish the overall goal of bringing his numbers down and keeping things calm and smooth. Wide up and down swings probably don't feel great for him.

I really hope you will be open to considering a different insulin once you are nearing the end of this vial. It would be great if Mogee did not have to yo-yo so much and could always at least stay below the renal threshold (about 250 on AlphaTrak so even lower on human meter).
 
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It is possible there could be something going on with him. I think you mentioned dental work being needed? Pain, infection and stress can all affect glucose levels. Mia's numbers ran higher when she needed a dental extraction. They were more evenly higher, meaning not only were her pre-shots higher but she did not go as low during the cycles either. That pattern may not have jumped out as quickly for you with the adjusted dosing based on pre-shots, but you may start to see it if you are going to try holding the dose at least 6 cycles. I had to raise her dose by a quarter unit every few days trying to counteract the higher glucose. I knew something had to be wrong. So, I took her to the vet, and the only thing she found was some pinkness on her gums. I took her to the dental specialist. After the work was done, her numbers settled back down and I was able to lower her dose.

I hope you know you are not alone in these feelings of not knowing what to do, worrying that something is wrong or you are doing something wrong, being exhausted with it all.. the worry and stress. There is an overwhelmed and scared, almost panicked feeling that comes when you first get the diagnosis - I think almost everyone feels that - but that fades once you get a better handle on things. But, there is a different kind of worry that comes over time for those of us who end up having to live this for YEARS. Maybe it is from the prolonged worry and stress, from watching so many cats quickly go into remission often because they just needed a better diet while watching our cat continue to need insulin. Every time you settle into it, it throws you a curve ball. You feel like it will never end, and you can never relax. Exhausting. I know I am so tired of it. I am tired of having to stick needles in my poor, sweet, good girl. I am tired of wondering and worrying every time something is even slightly out of the ordinary with either of my girls. Why is she scratching? Do I see redness around her eye? Did she just limp? Why didn't she eat as much as normal the last couple of meals? Why did she throw up? Should I put her through the stress of the vet? Will the vet even figure it out or be able to help? AAAAAAAHHHHH! :eek: Anyway, sorry to go on so long, but I just wanted you to know that I think I understand how you may be feeling. It's easy to come here and see people throwing around advice and to think everyone has this all under control, and you are the only one who struggles, but that is not true at all. It's hard.
 
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