Freya's ProZinc Saga, Vol. II

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Patience young grasshopper
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She's back "down" to her usual PMPS range when there hasn't been any activity in the previous cycle. I'm hoping maybe this will mean some nicer numbers rather than the flat cycle this type of PS usually precedes. I'll get up to check her sometime during mid-cycle tonight.
 
Depending on today's cycle, it looks like it might be time for another increase whenever you're ready.

If you scroll back through your data, the beginning PS's were red, then solidly pink, now yellow and pink....she is making progress. It's slow, but headed in the right direction.
 
She did have another fully yellow cycle today, argh. It seems like the yellow pre-shots happen when nothing is happening in the cycle. I'd guess maybe her "baseline" is in the high yellows these days?

Do you think I should go ahead and try 3.75u when I can?

Also, she's under 10 lbs. For future reference, if she keeps resisting and requiring increases, at what dose do I get her checked out for some sort of condition? I thought I'd seen 6u as the "cutoff" number somewhere, but others say it can be less. I just thought I should ask as she's approaching 4u here, and most cats I've noticed seem to be on sub-4u unless there's a comorbid thing going on. I'm not trying to imply that's what I think is the case here, but just to remember for my own reference.
 
I'm thinking you are OK to try 3.75U tonight if she's similar PS numbers. I believe I read 6.0U was the time to ask about something else but it's so weird that when she started on 2.5U she was getting very nice numbers :bookworm:. Which makes me curious to try a lower dose too.
 
Yeah it's very bizarre to me, and I had the same thought. But then when she was on 2.5u a second time recently, it didn't work. :confused:
 
Yong said:
... but it's so weird that when she started on 2.5U she was getting very nice numbers :bookworm:. Which makes me curious to try a lower dose too.
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I keep coming back to this. It's always been interesting to me...

After being off insulin for 24 hours for her switch, her pre-shots were significantly lower, especially when you look and that bad red before. And ALL those pinks. Then she responded almost perfectly to that 2.5u for like, four cycles. Then the dose changed.

But after the dose changes, and when she was on 2.5u again recently, the results weren't the same. She resisted the hell out of it, and we went about two full weeks of almost straight yellow.

Is there a chance I missed something and should start her over? It just seems so odd and I've never been able to shake the idea that I screwed up. What might this be? Could she actually be getting too much insulin? I don't know what that would look like, but I've always heard too much can look like too little.

Anyway, those are just my possibly weird thoughts.
 
Too much can look like too little for a couple of cycles, but not for a couple of weeks. If it was too much, she would be hitting occasional hypos that would tip us off that it was too much. Also, the downward shifting pre-shots look to me like you're going the right direction -- but still have a little ways to go.

A lot of kitties get into higher doses and then break through and start coming down -- or end up getting frustrated and switching to Lantus.

I don't think you've screwed up at all. You're doing a really great job. Just keep pressing forward with the increases. She seems to have a pattern of getting a perfectly responsive cycle, and then settling into the flats again. I've seen that on a number of spreadsheets and the owners just kept increasing until they finally hit a dose where the kitty could have more frequent responsive cycles. Hang in there!
 
Hahah.

Well, that's good to know. It's just perplexing.

I felt too tired to start her on 3.75u last night and monitor, so she got it this morning instead, following a red pre-shot. I tested her last night and she was still yellow at +5 with barely any difference from her PMPS, so that red can't even be attributed to a bounce. :mad: Maybe something will happen today.
 
Yes and no. The numbers are still too high, but the drop was about 50% which is perfect. Hopefully this afternoon you'll get a cycle where he isn't starting from quite so high up!
 
No such luck really. :( Another red AMPS, and she only got as low as 198 (11) last night. The reds coming back concerns me.

If this continues today, should I bump her up to 4u tomorrow?

The last time this happened, she ended up needing a full unit more for any results, however brief.
 
I think you could bump up to 4. She MIGHT need more than that, but I think you want to stick with those smaller increases. I know it seems frustrating, but you;ll get there! She's definitely responding to the insulin, not sticking in the highest numbers all cycle, and that's important too. :)
 
Oh yeah, I definitely didn't mean for it to sound like I wanted to give her a huge increase all at once -- more that since it seems probable that she'll need even more than 4u, I don't want to keep her on ineffective doses for longer than necessary. I hate thinking of organ damage and other such things that can happen. :(
 
I agree about not waiting too long on the increases right now. I would just keep going up every 3-6 cycles until she either starts bouncing around (then slow down), or starts hitting some better numbers.
 
She got 3.75u tonight and had a PMPS of 247 (13.7). After the red AMPSs the past two days, this was a good change. I got out of bed to check her before her +4 meal, and she was at 122 (6.8). So based on the way she sometimes continues to drop a good bit over the next few hours, I've moved out to the couch where I can keep an eye on her and will test her again in about half an hour. I'm hoping she gets some good numbers tonight. :nailbiting: This potentially complicates whether or not to increase. Guess we'll see soon.
 
I tested her every hour last night until she started to come back up. She had a good run of greens, and I stalled her AMPS this morning since it was 180 (10) at first. She was 257 (14.3) when I tested again after twenty minutes. She was pretty pissed about having to wait for her food. I wish she hadn't risen quite that much during the stall, but then I look at last night and how she started only slightly lower than that and got into some ideal greens. So I guess it's for the best rather than shooting her at 180.

I really hope this holds. And if she bounces, I hope it's brief like it was when she first started ProZinc. I don't know what to do if this pattern holds up where she has a good cycle, then goes up to almost two weeks with no results, where at first it looks like it could be a bounce before it turns out to be resistance. :banghead:

Edit: Corrected "PMPS" to "AMPS" (I'm tired okay)
 
Rachel said:
Wow!!! Look at those greens last night!!! :D:D:D:D
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Yeah, I was happy to see those, although I'd have also liked to sleep hahah. But like I said in my post two seconds before yours ;), I just hope this actually holds a decent pattern rather than the "respond for one cycle followed by several unresponsive days." It's hard, because when she gets a cycle like that, I can't feel safe increasing, but then she'll go so long with no response. It's so weird.
 
Blair & Freya said:
Yeah, I was happy to see those, although I'd have also liked to sleep hahah. But like I said in my post two seconds before yours ;), I just hope this actually holds a decent pattern rather than the "respond for one cycle followed by several unresponsive days." It's hard, because when she gets a cycle like that, I can't feel safe increasing, but then she'll go so long with no response. It's so weird.
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This is a typical Teasel pattern, especially when he's at a slightly too low dose. He did it on ProZinc and he still does it on Lantus. Patience Pants are your friend. ;)
 
Kris & Teasel said:
This is a typical Teasel pattern, especially when he's at a slightly too low dose. He did it on ProZinc and he still does it on Lantus. Patience Pants are your friend. ;)
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It is so frustrating. Why can't they be easy? I look at a lot of other spreadsheets and am like... how???

Djamila said:
Oh my goodness, she is adorable! Sam does the swishy tail/stare at the cupboard thing too. But Freya is prettier!
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I don't know, his little white nose is pretty cute. And I see he likes hanging out in sinks like Freya too. Too bad she hates other cats and punches them in the face or I'd suggest a sink date, hahah. That was what actually made her excessive thirst hard to recognise for a while prior to diagnosis. She's always been kind of water obsessed and a sink lurker.
 
I know what you mean about some other spreadsheets. A few dose tweaks and kitty is regulated. I've been at this almost a year and a half with Teasel and have had to accept that he's very tricky. Acceptance brings peace of mind ... sounds trite or "woo woo" but it's true.
 
It's encouraging to see another "tricky" cat who seems to be otherwise healthy. The chance of DKA is what scares me. I see Teasel had a bout of that. What were the circumstances surrounding his DKA, and how did that go?

I need to get more ketone strips and test more regularly.
 
Blair & Freya said:
It's encouraging to see another "tricky" cat who seems to be otherwise healthy. The chance of DKA is what scares me. I see Teasel had a bout of that. What were the circumstances surrounding his DKA, and how did that go?

I need to get more ketone strips and test more regularly.
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Teasel's bout of DKA came after 2 months on Lantus just after his diagnosis in January 2016. I was following the vet's instructions - 1 u twice a day, do a curve after a week, let her assess results and give dosing instructions. Teasel bounced like crazy the first couple of weeks (20+ mmol/L down to 3+ mmol/L and back up again) so his dose was tweaked up to 1.5 u. That was too much at that point in time. It went back down to 1 u and the weekly curves continued but he stopped responding - ie., high and flat all the time. The vet wanted to try an insulin restart so told me to stop insulin for 48 hours. After 24 hours he was in DKA. He spent three very $$$ days in the ER ICU but recovered. It was several weeks before he was back to "normal".

Upshot of all that: Teasel was switched to ProZinc and I continued doing weekly curves for months with no success. Finally, last August 2016 I came here to FDMB and started a SS. I quickly discovered his crazy bouncing patterns and learned why a weekly curve was useless because it captured bounce days most of the time. I worked at finding a good ProZinc dose with only moderate success. I kept my vet in the loop about what I was doing. This past February I felt I had enough experience and knowledge of Teasel's patterns that I thought it was worth trying Lantus again. I decided to make the switch on my own because I can buy insulin over the counter at a pharmacy in Ontario, Canada. I told my vet after the fact. Teasel has felt better on Lantus and I see brief periods of more stability but he's still very tricky as my SS shows.
 
Poor Teasel. That must have been so scary. I have a feeling Freya would've been in the same situation if we'd kept doing only what the vet said. :( They told us the same, infrequent curves (at the office -- home testing was never mentioned) and fructosamine tests, with dosing increased by too much at a time. Ugh.

Looks like Freya is on her high flats again. How long should I allow for this before increasing? This will be her third cycle after her low one. Prior to that low PM cycle on the 25th, more than six cycles had passed before she hit those greens, so that didn't appear to be 100% a bounce from the previous green on the 20th. That was why I was planning to increase her, then she all of a sudden had those greens. This is confusing. And the pinks are creeping back. I was so hopeful when she had that nice PMPS last night, too. :confused:
 
I am curious where she went after the +2 last night though. I really wish they would perfect a continuous glucose monitor for cats! It would make all of this so much easier!

I think you can move up whenever you're ready. It does look like she's hinting at being a bit bouncy though, which maybe, just maybe means that we're getting closer to having some more responsive cycles. I might just be foolishly optimistic this morning though since the sun is shining again.
 
I guess I looked at other times she's been pink at that time (and not a particularly low pink either) and compared it to how much she tends to drop afterwards and figured she probably stayed yellow last night. I could be wrong but blues seemed pretty unlikely, and judging by past cycles, it looks like most blues don't cause her to bounce so bad. There have been a lot of times where she's had pretty regular and consecutive blues, but the greens seem to wreak some serious havoc. o_O Or that's how it looks to me anyway.
 
Last night and 5/17 are virtually identical, but we don't have later data on either of them (that's okay, by the way, I was just curious - I agree with you that blues/greens were probably unlikely). On the days that she's gone lower at nadir, we don't have +2 data to compare with it.

Here's a thought: Is she hungry at the +4 feeding? If not, I wonder if you could bump it later in the cycle, like maybe feed her at +6 instead, and see if the reason she's staying so high mid-cycle is the snack? I'm all for multiple feedings, but it looks like she stays pretty high after the PS numbers and doesn't onset until around +3 or nearly +4 anyway, and gets another bump right around that same time from the snack? I would totally understand if that isn't a viable option at this point given her love affair with the timed feeder and her garbage scrounging and all.
 
Oh, she's definitely hungry! She plops by the feeder from the PS feeding to +4 waiting for it. I don't want to give her more calories though since she seems to be at a good weight now and maintaining it. She's a glutton to start with, so the diabetes exacerbates it. I am not sure what her garbage fascination has been lately!

I can try moving it to +6. I guess I assumed the food wasn't making that much a difference since it seems like she often continues to drop a good amount even after the meal. But I can see if that helps for sure. Another possibility is that maybe it would help if I gave her less food at the pre-shot? That would require a third meal at some point in each cycle, maybe with a little more at the two post-shot meals to make up the difference, but to balance it all out more so she's not getting such a big portion at the beginning. Just a thought. What would folks suggest?
 
Ok Blair, curiosity may be getting a little better of me but can you list the brands/flavours of food you are feeding Ms. Freya? :):bookworm::bookworm:
 
Please don't make her too unhappy if you do try to change the snack time. Sam being hungry is one of my weaknesses. I really can't stand it. If he cries it just breaks my heart (I'm such a pushover)!!! So I would never want someone else's kitty to be hungry just for curiosity!
 
Yong said:
Ok Blair, curiosity may be getting a little better of me but can you list the brands/flavours of food you are feeding Ms. Freya? :):bookworm::bookworm:
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I think right now she gets:
  • Smilla Poultry with Poultry Hearts
  • Smilla Poultry with Fish
  • MAC's Duck, Turkey & Chicken
  • MAC's Salmon & Chicken
  • MAC's Turkey & Blueberry
I also have UK Whiskas 7+ Poultry Selection in Jelly and UK Whiskas 7+ Fish Selection in Jelly (both pouch types) on hand. That's what she was eating when I was still trialling her on other things. It's been quite a while now since she's had it, but there's still some in her cabinet. I have a feeling I encountered a bad pouch of it once, so have been wary.

I had done carb calculations on all of them, and they are all quite low. Smilla's labelling isn't exactly right with things adding up to more than 100%, as the UK food lists note. However, she seems to get some good cycles on it. There also didn't appear to be any questionable ingredients when I was initially researching the food options. They all have similar daily recommended amounts too.

Djamila said:
Please don't make her too unhappy if you do try to change the snack time. Sam being hungry is one of my weaknesses. I really can't stand it. If he cries it just breaks my heart (I'm such a pushover)!!! So I would never want someone else's kitty to be hungry just for curiosity!
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She doesn't seem frantic about it like she used to and doesn't scream for it anymore. Well, she does every morning starting at half an hour before her test/food alarm goes off because she knows it's coming, :rolleyes: but other than that, she's not pushy about it. She just hangs around the feeder and looks pretty relaxed usually. I think maybe she smelled her empty food cans in the garbage lately?! It might help if I rinse them out thoroughly first.
 
I decided to wait until tomorrow to increase her dose if needed since I desperately need sleep and should be around and awake to watch her in the AM. I can also try changing her feeding times around and see if spreading out the portions might help.

Do you guys think it would be alright to feed her at, say... shot time, +4, and +8, to space it out pretty evenly? Or at what hours would you suggest? In any case, a third meal would make the pre-shot feeding a significantly smaller portion, so maybe she wouldn't stay so high for so long at the start of the cycle.

And should I try the meal change prior to increasing to see if that will impact things, or do both at the same time? Just brainstorming here to eliminate as many potential complications as possible.
 
Usually one change at a time. Looking at your data, I could argue either way: dose first or food first. So I think go with whichever works best for your schedule.
 
Alright, she's on six meals as of now and getting about 60% of what she used to at the first feeding, with the difference moved to the third feeding. That might help! My reasoning was maybe it made sense to adjust the food first, as that's pretty easily and quickly done. Food stuff tends to show a pretty immediate effect with her, which I guess is good in a situation like this? The dosing is trickier, but after a couple cycles to see the effects of the meal change, I can just go ahead and increase if she needs it -- which I expect she will.

I do think this AMPS may be a slight bounce from last night. I fell asleep, but I was pretty certain she'd hit blue for at least a little while after the last test of the night being a low yellow. Not 100% though.
 
More yellow preshots = progress, Blair. Just keep up the slow increases as needed. Bouncy, sticky cats (those who bounce to higher numbers and get stuck there) can't stay too long at an ineffective dose. You have to keep nudging them along. Teasel was/is exactly like this. A little nudge will create some downward momentum but if the dose is still a little lower than ideal they get stuck high and flat. Another nudge is needed then. Rinse and repeat. Patience in enormous doses is essential. :)
 
Well, look at that +2! That's the biggest +2 drop you've had. Might be onto something? Might just be a coincidence?
 
Kris & Teasel said:
More yellow preshots = progress, Blair. Just keep up the slow increases as needed. Bouncy, sticky cats (those who bounce to higher numbers and get stuck there) can't stay too long at an ineffective dose. You have to keep nudging them along. Teasel was/is exactly like this. A little nudge will create some downward momentum but if the dose is still a little lower than ideal they get stuck high and flat. Another nudge is needed then. Rinse and repeat. Patience in enormous doses is essential. :)
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Djamila said:
Well, look at that +2! That's the biggest +2 drop you've had. Might be onto something? Might just be a coincidence?
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The good news is that it looks like the meal change may be improving the situation already. I was cautiously optimistic at +2 but wanted to wait to comment until +4, which I just took. We have a blue! Barely, but hey. At this point I'll take what I can get. It's way better than yesterday and some of the other days. Maybe this combined with an increase will get her somewhere. We'll see what happens in the PM, but I somehow doubt it's completely coincidence. She did eat a fair bit less earlier.
 
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