Dosing input, please

Discussion in 'Prozinc / PZI' started by FurBabiesMama, Dec 7, 2017.

  1. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Hi. I'll be as concise as I can, but it will be long, sorry. Mia stared at 1u dose and got up to 2.5u, but we started having some pretty low nadirs then low pre-shots, so her dose was reduced. It got to a point where she was dropping pretty far on just 1.75 (example, 341 down to 69) and even on 1.5 (408 to 89). She has been a bouncy girl from the beginning, so the drops kept us in a cycle of low then high, then flat, and so on.

    We got a new vial, dosing was 1.75 then but was gradually increased. She started staying high regardless of dose, and when I got to 2.75, I was concerned that something might be going on to keep her so high (as in staying over 250 pretty much all the time). So, we went to the vet. Bloodwork and urinalysis were okay (except for +3 glucose in urine.. no surprise). She had gingivitis, so we scheduled dental cleaning/exam, and she ended up having 5 extractions. Vet asked that I just stay at 2.5u dose for at least two weeks to see how things went.

    Started new vial 11/28. Started getting better nadirs.. finally blues! But, she was still saying too high too much of the time. So, talked to vet about it being time to up dose. He seemed almost hesitant, especially since she has not been urinating or drinking excessively, but I pointed out that she is staying above the renal threshold the majority of the time and her urine is still full of glucose.. not good. He said to 'be careful' but that to go ahead and go to 3u. I mentioned maybe doing 2.75, but he was concerned about the dosing not being exactly accurate since I have to eye it (which bothers me some, too, even w/the syringes w/1/2 u markings). Still, I just could not bring myself to jump that far with her, so I did 2.75 but just for a day (2 cycles). She certainly did not drop hard from it, and I did not want to linger at that dose based on his concern and someone here commenting that dose increases that are too gradual can also cause issues.

    That brings me to yesterday. I gave her 3u in the AM, and it was a weird cycle. By +6, only down to 278 from 384 PS. So, in light of that and the history of her numbers staying high no matter what for what seems like forever, I went ahead with the 3u dose in PM even though PS was only 276. By +3, she was 109; 30 mins later, 82, 20 mins later 78. The dropping was scaring me since I had already started introducing carbs after the +3 to slow things down. So, I brought out the big guns and gave her a good bit of Karo syrup for fast impact and some 18% carb kibble for longer-lasting impact - I knew I was probably over-doing it but we were hours from mid-cycle, and I was not going to risk hypo. By +4 she was 135, +5 205, +6 181.

    So, what in the world am I supposed to do with her dosing. I have been very gradual, very patient. 2.5 clearly is not enough, but 3 seems to be too much. This morning, she was 335 and I gave a skinny 3. (I am expecting a bad bounce after last night.) At this point, I would love your input. I am not sure if her good dose is somewhere between 2.5 and 3 or if Prozinc is just not her insulin.
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    This is similar to Teasel's responses on ProZinc. He'd dip and spike and responded unpredictably to even tiny dose changes. He was on ProZinc for 10 months and I just couldn't make it work. I switched to Lantus and got better results - not perfect but better. He had some flatter runs of numbers and less bouncing. He didn't feel well on it so after 8 months I moved him to Levemir at the end of September this year. He feels a lot better but still bounces and dives occasionally. He'll always be challenging.

    It might be time to consider a different insulin for Mia.
     
    Last edited: Dec 7, 2017
  3. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Bouncy kitties CAN go into regulation and remission on prozinc but it’s harder...and I can imagine those highs and lows don’t feel good. Maybe back off to 2.75 or a skinny 3 if that works for now. Then you might want to look at the L insulin’s like Kris suggested. Sometimes they do a better job smoothing out those bounces to help bring kitties gradually lower. Might read some stickies on their forum and maybe ask for advice then discuss with your vet if you want to switch?
     
  4. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Thanks, @Kris & Teasel and @Rachel . Around mid-September, I started wondering if another insulin would be better, but the vet seems to think that because she does respond to Prozinc, it should work fine for her and that her chances of remission are just as good on it as they would be on Lantus. (He did say that if we switched, it should be Lantus. He made a comment about Levemir being some 'potent stuff', and told me some stories about the impact of tiny doses on a couple of cats. ?!?) I was so excited when I found this vet because he was the first one I dealt with who seemed to really know this stuff. Everything he said was in harmony with what I had learned here and elsewhere. BUT, lately, when I have discussed Mia's high numbers with him, I have gotten the impression that he is not too concerned about how high she has been staying. I do not understand that. I think he is more 'scared' of the risk of hypo, which I get, but surely we can do better than we have been with her numbers. I have lowered my expectations to where I would be thrilled if she just stayed under 250 the majority of the time, but I cannot even achieve that. After this week, he is leaving to do national consulting, so here we go with someone else.. it will be #4 since the beginning of July. I have not pushed the issue of an insulin change yet because, frankly, I am a little scared. I have read some info on the others, and some things concern me. But, SOMETHING has to be done.
     
  5. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Very surprisingly, Mia did not bounce after last night.

    AMPS 335 - gave skinny 3u
    +3.25 246
    +6 145
    +9 145

    This blows my mind. It's great, but it also makes me wonder what the results are going to be at PMPS and what in the world I am going to do with the dosing at that point. @Rachel , @Kris & Teasel, and/or others please share any thoughts on this. (Maybe, just maybe this is a good sign? I mean she has been SO bouncy all along and last night was the lowest she has gone in over two months; that should have triggered a horrible bounce but did not.)

    Thank you!
     
  6. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Have you shared your name, or are you comfortable doing so? I'm afraid I don't remember and I feel funny calling you FurBabiesMama (unless that's your preference).

    Would you mind adding the extra numbers into the grid part of your spreadsheet? When I look at yesterdays' cycle, it looks perfectly fine since it just shows the 109. I want to make sure when I'm looking for patterns I'm not missing important pieces like that. You don't have to, but it never hurts to ask ;):)

    As I look through, I'm noticing that a number of the lime greens were most likely caused by rapid changes in dose. When you move the dose a lot, some cats will start to spike and dive. It doesn't mean the dose was wrong, just that their body is so confused that it overreacts. Then that makes you think the dose was wrong, when really in a few cycles it would have been good.

    Another thing to consider is that when you introduce carbs, it also contributes to instability. So if you give high carb food or Karo, the kitty is more volatile for a few cycles afterwards. You may have heard people say that a kitty is insulin sensitive after a hypo - that's because of the carbs, not because of the insulin itself.

    It looks like Mia's nadir moves a bit, though it's hard to exactly nail down at this point, so I would suggest that when you're getting a lower number anytime between +3 and +7, you try watchful waiting instead of administering carbs as long as Mia seems okay. Many cats will drop and then surf along for a number of hours. Prozinc does (for some cats, though not all) flatten out. So a cat might drop steeply to +3, and then skate along there until +7 or +8 or so with no problem at all. So a drop at +3 doesn't necessarily mean the kitty is in danger. That's where the watchful waiting comes in. You want to collect the data and be careful, not careless. But also not jumping in to carb them up if they are really doing fine on their own. Try giving regular low-carb food to keep her from dropping instead of giving high carb food.

    Doing it that way can be nerve wracking :nailbiting:, and I'm not saying there might not be a point where you'll need to intervene, but I would suggest trying to intervene with as low carb an option as you can unless you really have to do more. Of course the hope is that we can help you find a dose that will keep her nadir closer to....I don't know...the 80's?..... so you don't have to even worry about all of this!
     
  7. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    I have not. :cool:

    I was not sure how to add those extra two in. I could type them in the same cell with the one done on the hour, but the color coding still would not show the green since the test done on the hour was blue.. or should I code it green even though the test on the hour was not in that range?

    She has had only 4 occasions over a 5 month period when her number was in the lime green range, and the last was almost 3 months ago.
    8/26 - It was her 11th cycle on 2.5 when she went to 67
    8/31 - She had been on 2.25 for 7 cycles but her PMPS was only 196 so it was reduced to 2; she went to 67
    9/5 - PMPS was 134 so 1.75 dose was given; she went to 56
    9/12 - Was during a short period when modified dosing based on PS values was being tried since it was becoming difficult to hold a dose for long with the varying PS numbers; PMPS was 381, 2u was given, she went to 64

    Her nadir has occurred anywhere from +4 to +8. So, when I saw a 109 at +3, I knew I was in trouble. She had been eating her regular food which is only 2% carbs, so I did not think more of that would make a difference. I gave her a spoon of 12% carb food hoping to steer her just enough that she would not go too low, and I would not have to give her even higher carbs. When she was down to 82 30 minutes after the last test and the food (that should have brought her up some), I was getting more concerned, so I gave her a spoon of 15% carb with just a drop of syrup in it. Even with that, she was 78 20 minutes later, about the time the food should have started to kick in and bring her up. So, I went for more syrup and some 18% carb kibble. At that point is probably when I did too much. :oops: I probably should have just given her more of the moderate carb wet food (although she does not love it so she will not eat much of it), but 78 is way too close to 65 (hypo on AlphaTrak) for my comfort, and it was still so early in the cycle. Also, I was thinking about what the vet had just said about 'being careful' if I raised her dose. He told me this story of someone who brought their cat in that same day having seizures because of hypo. I told him I would NOT let that happen to her because I would be monitoring her and would take action before we were any where near that point.

    So, at this point, I will be testing her in just under an hour and having to decide whether to stay with the skinny 3 or not. Her day has not gone like I expected at all. It has been good, but her PMPS may be fairly low. I do not want a repeat of last night, but I also want to be able to hold a consistent dose to the extent possible. So, any thoughts on what the 'magic' number is that you think should make me drop the dose, would be helpful. :nailbiting:
     
    Last edited: Dec 7, 2017
  8. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Well, it is not an issue. PMPS is 396, going to stay w/skinny 3.
     
  9. Yong

    Yong Well-Known Member

    Joined:
    Jan 11, 2017
    Bouncy kitties seem to like those fine tuning doses so if you're eyes are good, or you have a nice magnifying glass ;), there are quite a few doses in between 2.5U and 3.0U. Do your syringes have half unit markings? They help a lot! :)

    As for your Vet thinking Prozinc should work fine for her because she is responding to it isn't necessarily true. Maury responded to Prozinc as well but I don't think he'd be where he is today if I hadn't switched him to Lantus. Just my two cents and personal experience obviously :D.

    Great job holding the dose. Head bumps for Mia! And hugs for you :bighug:.
     
  10. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I agree with Yong. Teasel responded to ProZinc too but was far too volatile.
     
  11. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Yes, I have the ones with 1/2 unit markings. It is hard to be very exact when doing the doses between the halves, but I am trying!

    I definitely see where different insulins would be better for different cats since they do work differently. Right now, for the first time in a long time, I am seeing some lower numbers, so I am going to keep 'playing' with the Prozinc for now, but if we end up where we were before or if I just cannot get it to 'settle' into some type of sane regulation, I am going to push for a change.

    Thank you for sharing your experience with me. I really appreciate it.:bighug:
     
    Yong and Kris & Teasel like this.

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