Hi everyone, I'm new this group. My cat Max has been on Prozinc for about 2 years now, but about a month ago I found this group and decided to change his diet (he is now on wet food Merrick and Dr. Elsey's dry kibble). I've been testing his glucose levels since then and they have been all over the place. I talked to my vet before we made the food change and he gave me some guidelines for dosing based on his BG numbers. I was hoping they would have become more stable by now and wondering if anyone has any feedback or suggestions. Thanks, Hettie https://docs.google.com/spreadsheet...LmNcnkHl8Cduf5ONKQ_3R51cI/edit#gid=1182885903
Hi Hettie and Max! Welcome to our group! We're a smaller group than many others on this board, so it can take a bit to get a response sometimes...that's why you didn't get one earlier. It's great that you changed his diet and have been home testing! Those are some of the first steps to help Max feel better. With him being diabetic for 2 years, it might take some time to stabilize things, but we can definitely help. I can't see your spreadsheet right now. It says Access Denied. Try this to see if that makes it visible: Go to File and choose Share Choose Anyone with the Link Can View Copy the link they give you Paste that here It's been a long time since I did my SS, so let me know if that doesn't work...it could be wrong. Once we can get a look at your SS and see what kind of numbers you're getting, we'll be able to help figure out what's going on. In the meantime, does Max have any other health issues? Is he on any other medications or has he been on any recently? Does he eat fine? Please do ask any questions you have! We're happy to help and although you're not new to the journey, you're new here and we know it can be a bit overwhelming when you first join us!
Hi Rachel! Here is the link again, I hope it works: https://docs.google.com/spreadsheets/d/1jKgMMpqRRdkidAOftTLmNcnkHl8Cduf5ONKQ_3R51cI/edit?usp=sharing Max is healthy otherwise, eating fine for the most part and his usual self. He doesn't take any other medications. Thanks for your help!
Hi Hettie, and welcome! Looks like your link is working now. Great job! It also looks like you're getting a pretty good response on the 3.5u -- a little too good in fact. It looks like that may be too high of a dose. You really want to aim for two even doses (AM and PM) that you can hold fairly consistently, and right now you aren't able to do that. We also say that when a cat hits a lime green number, they get a reduction. So when you got that 65 the other day, by our dosing method, you would have lowered to 3.25u. Except my hunch is that even 3.25u might be too much right now. Did you get to this dose by in-office tests at the vet? Does Max have any history of DKA? Does he get any treats, and if so, what kind? Which Merrick food is he eating, and in what proportion with the dry food? I know there are a lot of questions at the beginning, but the more we know, the better we can help. I think lowering the dose right now is going to be important, but want to make sure I understand what he's eating and his history before we make a first guess for the dose change.
PS You might want to edit your thread title if you can. We use the "GA" prefix for Guardian Angel - meaning a kitty who has passed on.
Hi Djamila! I've actually been trying a few different wet foods over the past month to find out which one he likes. I tried Tiki but that was a No. He's been eating the Merrick wet food (turkey pate and beef pate varieties) for the past week now so I'll likely stick to that. He's a nibbler (as are my other cats), and I leave out the dry food all the time, so it's hard to say exactly the percentage of dry vs wet food but I'd estimate 50/50. His current dosing is a result of tests at the vets office. We've done several curves at the vet's office over course of two years as well as fructosamine tests. His numbers were high even factoring for the elevated numbers due to stress. I'd have to double check with my vet, but when they did the last curve, his lowest number was still around 220. When I told the vet I was changing his diet fairly dramatically, he give me the following guidelines: skip for readings of 60-120; 2 units for 120-250; 3.5 units if greater than 250. I've been sticking to this for the most part, unless he had a borderline number I adjusted it slightly. No history of DKA. No treats. Also, the day he had a reading of 65, he wasn't acting his normal self (didn't eat much that morning and antisocial), which is what prompted me to take the readings. The next day he was back to his normal social self. So I think that may have contributed to the unusually low number? Thanks!
This will give you a good idea of how we approach ProZinc dosing here: http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/
Hi Djamila! I've actually been trying a few different wet foods over the past month to find out which one he likes. I tried Tiki but that was a No. He's been eating the Merrick wet food (turkey pate and beef pate varieties) for the past week now so I'll likely stick to that. He's a nibbler (as are my other cats), and I leave out the dry food all the time, so it's hard to say exactly the percentage of dry vs wet food but I'd estimate 50/50. His current dosing is a result of tests at the vets office. We've done several curves at the vet's office over course of two years as well as fructosamine tests. His numbers were high even factoring for the elevated numbers due to stress. I'd have to double check with my vet, but when they did the last curve, his lowest number was still around 220. When I told the vet I was changing his diet fairly dramatically, he give me the following guidelines: skip for readings of 60-120; 2 units for 120-250; 3.5 units if greater than 250. I've been sticking to this for the most part, unless he had a borderline number I adjusted it slightly. No history of DKA. No treats. Also, the day he had a reading of 65, he wasn't acting his normal self (didn't eat much that morning and antisocial), which is what prompted me to take the readings. The next day he was back to his normal social self. So I think that may have contributed to the unusually low number? Thanks!
Hi Rachel! Here is the link again, I hope it works: https://docs.google.com/spreadsheets/d/1jKgMMpqRRdkidAOftTLmNcnkHl8Cduf5ONKQ_3R51cI/edit?usp=sharing Max is healthy otherwise, eating fine for the most part and his usual self. He doesn't take any other medications. Thanks for your help!
So dosing based on the PS numbers alone is often the recommendation from vets because they don't have experience with regular BG testing. They can't keep cats indefinitely in clinic, so they use the tools they have and do the best they can. When there is a caregiver who is willing to actively manage the disease however, you can do much better. We definitely consider the PS numbers and use those when we need to, but you really want to look at the nadir numbers, and at several cycles together, in order to determine a dose. When the dosing uses just the PS numbers and moves up and down with a sliding scale like that, you end up setting off bouncing and really inconsistent readings, which is what you're seeing. For example, on 2/2, you had a really great cycle, but then it lasted too long, and you weren't able to give a dose that night. Skipping the evening dose altogether left Max with no insulin support and ended up at 420 the next morning (2/3 AMPS). That number is high enough to be damaging. If the 2/2 AM dose had been lower, you would have been able to shoot the 2/2 PM dose, and most likely ended up with a healthier 2/3 AM number....and on and on.... And as for the 65, he likely wasn't acting like himself because he was dropping so fast and not feeling well. Plus, since there aren't any PM cycle numbers, who knows what he had done during the night that might have contributed to the malaise. Most (though not all) cats run lower at night than they do during the day. I know this is a lot all at once. It takes some time to really get a feel for managing feline diabetes, and every cat is different, so there is always an element of trial-and-error since hindsight is really all we have. It's great that you're willing to home test and take on the management of this. We are here to help if you want to consider an alternative to the sliding scale dosing approach. Just let us know how you'd like to move forward, and we can all put our heads together and see what might be a good next step.
I'm definitely open to other suggestions/recommendations. I would certainly like to see some more regularity in the numbers. note: I just realized that the numbers for 2/2 weren't entered correctly and I just updated those.
@Rachel @Kris & Teasel @Jenna Josie @Lisa and little and anyone else who wants to chime in...Even if I didn't tag you, anyone is welcome to share thoughts. This is where peer review really comes in handy. Lowering the dose is going to be a shot in the dark right now. So the question is, how much lower? Given that Max is a long term diabetic, I don't think dropping back to 1u and starting over is a good idea. However, I think 3.5 is too much, and my hunch is that 3.25u is too much as well (feel free to disagree though). Looking at the 2/5 cycle, 3u still left a low PMPS number, however giving 2u on the PMPS that night wasn't enough if we look at the AMPS on 2/6. So even 3u might be too much, however given all of the dose changes, 3u might also be just fine if it was held steady. So I think I would try 3u for a couple of cycles and see what happens. However, since this is a guess, I'd really like some other folks to take a look and see what they think. @Hettie, are able to monitor at all during the week? Or are you at work the full 12 hours? Knowing how much you can monitor will help us with next steps as well. Monitoring doesn't mean doing a full curve like you did today. Sometimes just one or two tests during the cycle can give enough information.
Hi Djamila! Thanks for the input. When you say 3u for a couple of cycles, do you mean that I should give him 3u only if he's above 250 instead of the 3.5 that I've been doing? And adjust the other ranges? During the week, I would be able to get a +2 reading, but I generally work all day so I wouldn't be able to get another one until the +10 mark.
We recommend not doing any dose changing in response to pre shot BG unless it's too low. You give the same dose both AM and PM if BG is high enough (even if they're different AM versus PM) and get middle of cycle data at that dose for a couple of days. How low the BG drops on that same dose is used as the main determinant of the dose's effectiveness. So, that means your dose isn't governed by a certain BG range he's in at AM or PM pre shot but by how low it drops the BG at its peak action mid cycle. The erratic BGs you're getting are partly the result of the AM - PM dose changing you've been doing. Djamila has suggested trying 3 u as your dose for a couple of days. That *could* work. I tend to be a little more cautious with dosing so I'd try 2.5 u for a couple of days. It might have a slightly bigger cushion if you're away all day at work. I agree that this is guessing right now. You could also eyeball 2.75 u. Whether you try 2.5 u, 2.75 u or 3 u keep that same dose both AM and PM unless the pre shot number is under, say, 180. This is also a guesstimate cut off number. If he's below 180 post here for help. Rather than skipping we can help you figure out a reduced dose.
Hi -- sorry to be late to the party! I see that you have shot 3u tonight, which seems like a good start. I have the same "hunch" as @Djamila based on the low PMPS's on 1/31 and 2/5 (my *guess* is that Max when that didn't happen on 2/8, it was because he was still clearing the high BG from the previous night's 2u) that 3 may still be too high, but I think it was a good place to start, and the data you gather -- even if it's +2 and +10, will help decide going forward. I definitely agree to hold the shot for maybe 4 cycles before changing (unless, of course, the data convincingly tell say that's too high as well). That way, we can see how he is reacting to the dose rather than to the changes in dose. Keep us posted!
I see you went with 3 last night. I think since you went with that last night, I'd stick with it for several cycles. Let's see what it does and just get whatever extra tests in that you can. It's hard to know for sure what's the right amount to drop by...it's really mostly a guess based on whatever data you have. But with testing, you can keep your kitty safe while working on figuring out what the right dose is.
Thank you everyone! This Friday through Sunday I can get some mid-cycle readings so hopefully that will provide some additional data to determine if I need to reduce his dose further.
Hi everyone! Hoping you all can weigh in again...as suggested, I kept his dose at 3u (except for one time) over the past week and it seems like I'm getting more consistent numbers in the AM and PM. I also spent the last three days getting lots of mid-cycle readings, but I'm not sure if the numbers are 'good' or how to interpret those. Does it seem like 3u is the correct dose for now?
I like how the consistent dose AM and PM has settled him. I think you can try 3.25 u both AM and PM for the next few days. You'll have to eyeball that. Aim to be as consistent in your eyeballed estimate as you can dose to dose. I see that you dropped the dose a whole unit on Feb 14 because he was under 200. I think you could have reduced by 0.25 u or 0.5 u instead of a whole unit. Maybe try that next time you get a blue PS.
Thanks, I'll try that and see how he does at 3.25. Is the goal to get nadir numbers between 70-99? Also, based on what I've read on here, his PS numbers still seem quite high, even though his nadir is less than 50% of that, and so "bouncing" might be what's causing this...what can I do to determine if this is due to "bouncing"?
Generally your goal is to get yellows or blues at preshot and dark greens at nadir. That is usually the sign of a well regulated cat. You could be seeing some bouncing. Usually following a bounce, a cat will have some high, flat cycles. Is it possible to get any nighttime numbers? Anything you can get would be helpful. I'm not seeing the high flat cycles but it could be that he has those at night and just clears them in one cycle.
A +2 will give you a hint if the cycle will be stable, or if the kitty is getting ready to dive. Usually if the +2 is similar to the PS or higher, the cat will stay steady. If the +2 is notably lower than the PS, it means they are going to need a little more monitoring or steering. Every cat is different, but that's a general guideline.
Oh, I should add that many cats run lower at night, sometimes significantly so, so that is why it's a good idea to get some nighttime data. It's hard because we need to sleep, but if you can get a test before bed every night, or right away when you wake up, it helps. Or grab a test if you get up to use the bathroom during the night....any data you can get is helpful.
Well I got a reading in the middle of the night last night. He seemed to be doing pretty well with 2.5u - we were getting yellow PS numbers. He was at 214 PMPS then at +5, he was at 235, and this morning at 464! I know it's just one day, but I definitely didn't expect the 235 at +5. Does this look like a "bounce." I'm wondering if the new low-carb food is finally starting to have an effect. Also, I'm wondering if I should keep him at 2.5 for couple of more cycles and see how it goes?
So it looks like you lowered the dose because of the lower PMPS the other night, but then you didn't raise the dose back up again. So my hunch is that it's not a bounce, but instead just that he hasn't been getting enough insulin the past few days.
Yes, that's why I lowered it. When I was getting the AMPS around 200 I was nervous about giving him 3.25 since I knew I wouldn't be able to monitor him during the day and was worried that 3.25 would make him go too low during the day. I was hoping he would stay on that pattern until the weekend when I could get more mid-cycle readings. I just got one at +8 and he's at 110....this cat is gonna drive me crazy
We had our first hypo scare today. I just don't understand how he's responding to the dosage. 2.5u clearly isn't enough, 3u doesn't seem like enough either (based on the curves from 2/15-2/17), yesterday 3.25u seemed just ok, and now today down to 53! He wasn't showing any symptoms, but I administered kyro syrup and a tablespoon of high carb food - he was back up to 94 30 minutes later.
Good job catching and handling that low reading today. That low reading means you need to reduce the dose down to 3.0u tonight providing your pre-shot reading is high enough to shoot (180 or higher). If he is below 180 tonight, stall without feeding Max and retest him in 30 minutes and please post for assistance. A low reading can make kitty a bit more sensitive to insulin so make sure to get a test before bed to see if his BG has dropped or staying steady as that can suggest an active cycle in which case you may need to set an alarm to get another test and/or leave some food out for Max to eat during the night should he need it.
So right now (at +10) he is at 78. I doubt he will get to 180 or higher. I'm really nervous about giving 3u even if he does get to 180 - that seems so low already compared to his 'normal' numbers. What do you recommend if he doesn't get to 180 tonight?
Let's see where he is in 2 hours. Although it doesn't seem likely he might be high enough at PMPS. Here's a very general guide: if close to 200 (maybe 180 and above), stall without feeding for 30 minutes and retest. If BG has risen try the 3.0 u dose. if in the 150 to 180 range, try stalling up to an hour and if rising do the above. If BG isn't rising much give a reduced dose. How much to reduce is always a conundrum. Maybe try a 2/3 dose. if BG is much lower (say, 100 to 150) give token dose - size depends on what the normal dose is. It's best to avoid skipping if you can.
Please set up your signature and be sure to include in it the type of meter you're using. The signature gives us key info at a glance that we check before giving advice. Here's how to do it: click on your name in the upper right corner of this page click on "signature" in the men that drops down type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
Well, he's at 115 now. I've never given him anything at this number so I'm not sure how much to give. Does 1u seem appropriate?
Hi Hettie -- are you in your "stall"? It's really hard to say because there's not a lot of nighttime data, and the cycle can be different at night, but I see that you shot 2.5u on a 144 PMPS on 2/18, and he was in good numbers the next morning. The daytime data that day suggests he probably went into the greens during that daytime cycle. Compare that to 2u on a 190 PMPS on 2/14, when he went into the reds by morning . . . perhaps b/c the 2u wasn't enough. Just thinking aloud. My cat doesn't have nice, normal curves like Max does, so I'm not comfortable advising on a specific dose. If you're stalling, though, and those numbers start coming up in the next, say, 30 minutes, if it were me, I'd try more than 1u.
Thanks. Yes, I'm stalling to see where he is in 30 min. I kinda had the same thought- that if his numbers are increasing, I'd give him 2u based on previous numbers. I've been trying to get more +2 PM but several nights in the past, he's been hiding under the bed and wouldn't come out...
Treats!! @Djamila taught us about these minnows, and Josie is crazy about them. We cut them up into little bite-sized pieces and put them in -- yes, an empty gelato jar lol. We shake, shake, shake the jar when it's time to test her, and she comes running to her testing spot. She gets those treats (and we shake the jar) only at test time. She's completely trained. (about that, anyway . . . )
I'll have to try that. I bought several different kinds of freeze-dried meats for treats, but he's just never been into treats of any kind. Most of them always come running when they hear the treat bag, but not Max...
. . . because of course the one you need to bribe is bribe-resistant! Cats Were you able to get the +30 minutes?
Sounds good! The +2 and the AMPS will let you know if the 2u was too much of a reduction (like 2/14) or just right (more like 2/18). It is scary scary to shoot a full dose (or close to one: I see you were planning on a small reduction anyway due to the lime greens) on a low'ish PS until you know how Max is likely to respond to it. In either case, it will be great data for the next time he throws something like this. It does look like Max was just having a reallllllly long cycle, likely due to 3.25 being too much. In general, getting the dose to last 14 hours is a very good thing, allowing for "overlap" where the PS tests stay relatively low, but here it's probably too-high of of a dose. Point being: it's great to keep an eye on cycle length and try these controlled experiments (when you can monitor, of course) to see what your "no shot"/"reduced shot" number should be. Kris gave you some terrific rule-of-thumb ranges earlier in this thread. It took me forever to be brave enough to shoot full doses on low PS numbers (the "is the number rising?" tests were crucial to getting comfortable with it), and I really think it held Josie back, so good for you!
P.S. Also, you might want to put the 142 number in the PS slot as well so that you have a reference for next time. If you put in two numbers -- 115/142 -- it will turn the cell white, but you can then manually change the box color/font color using the tool bar at the top. The font color is the double-underlined "A," and the box color is the one to the right of that . . . maybe spilling-paint icon? EDIT: OMG, that avatar is precious! Look at his little face!
