? Help! PM dosage advice needed

Discussion in 'Prozinc / PZI' started by Jena4277, Jan 28, 2018.

  1. Jena4277

    Jena4277 Member

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    Aug 8, 2017
    hi. Cat tested 174 20 Min ago. Today I upped her Insulin by .25. Tested her just now 20 Min later and it is 164. I’m going to feed her dinner and test in an hour or so to see what it is. Last time this happened I didn’t shoot and at +3 she was in the high 300s. I want to shoot tonight so I will see how she’s is doing in a bit. Sound ok?
     
  2. Sarah Smith

    Sarah Smith Member

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    I'm not versed enough for dosing advice sorry :( Hoping to bump this and someone better with prozinc can help you out!
     
  3. Jena4277

    Jena4277 Member

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    THanks. I most likely will give reduced dose if she isnt going up enough. This forum doesn’t get that much traffic compared to them Lantus one...
     
  4. Jena4277

    Jena4277 Member

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    @Rachel @Kris & Teasel what do u think if u have time?

    I want this 1.25 dose to work and on the first day she’s too low...how frustrating. I don’t want to have to stall everyday. Im going to retest her soon
     
  5. Jena4277

    Jena4277 Member

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    It’s 254 an hour and 10 min after the 174. Im going to wait another half hour and shoot the whole 1.25. She didn’t eat very much yet so I think it’s ok.
     
  6. Sarah Smith

    Sarah Smith Member

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    Sorry I'm not more help, will be around tonight though if you need someone to talk to while keeping an eye on her
     
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  7. Jena4277

    Jena4277 Member

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    It went down to 236. I’m going to only give 1u. I will prob regate this decision...
     
  8. Djamila

    Djamila Well-Known Member

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    I know I'm late to the party, but maybe this will be helpful sometime in the future: The 174 was most likely high enough to take the whole dose. It's hard to be certain since there isn't a lot of PM data, but based on the AM data, and the follow-up tests that show she was rising, she most likely would be just fine. When you know that the previous dose has worn off (the numbers are rising), and you are near to 200, it's most often fine to stick with the regular dose.
     
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  9. Sarah Smith

    Sarah Smith Member

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    Its so hard to judge sometimes! Keeping my fingers crossed it works well!
     
  10. Jena4277

    Jena4277 Member

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    Thats what I was thinking. Oh man I missed it.
     
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  11. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Just seeing this now. Did you give 1 u? It shows beside, not in, the dose cell on your SS. I also don't see the 254 and 236 info on your SS.
     
  12. Rachel

    Rachel Well-Known Member

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    Oh so sorry! I'm just seeing this too. I was at the park taking a walk when you posted. Looks like you gave 1 unit. I think that was fine...she probably would have been fine with the whole dose too. But this way you can get some good data on what she does on a 1 unit dose at this number. All data is good data!

    So sorry again...we'll know when to check in on you next time!
     
  13. Jena4277

    Jena4277 Member

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    No prob. I will try to get her twice tonight but I may fall asleep lol.

    @Kris & Teasel Idk how to show the extra shots when they r within the hour on the spreadsheet. I don’t have a pc just my phone so it’s hard to read if the cells are overcrowded.
     
  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Maybe just put them in the "notes" section of the right side of the SS?
     
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  15. Jena4277

    Jena4277 Member

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    OK. also she is at 102 three hours in. She usually rises and she has eaten about half a can already so I am a little worried but not yet. I will check her in an hour
     
  16. Kris & Teasel

    Kris & Teasel Well-Known Member

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    This drop is a sign that you might see dark green at nadir. Maybe try to control her drop by feeding 1-2 tsp regular low carb food every 30 minutes or so.
     
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  17. Jena4277

    Jena4277 Member

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    @Djamila @Kris & Teasel it’s 81 now and she may get lower. She ate a half hour ago a lot of wet with some cheese on it and she still tested 81 25 Min later. I gave her 2 temptations treats as a safety precaution bc I have to go to bed and unless I wake up cannot test her anymore as I get up at 4:45am for school and need some sleep.
     
  18. Djamila

    Djamila Well-Known Member

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    It looks like the 81 was at +5, so she was probably fine at that point, plus the regular food may not have fully kicked in yet. So all that to say, I hope you sleep well! And hooray for a nice safe green!
     
  19. Jena4277

    Jena4277 Member

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    @Rachel @Kris & Teasel @Djamila
    I was able to come home an hour early and grab a 10.75ish test. It is 422. Is this a bounce? I gave her 1.25 this morning on a number in the 300s. Do u think she’s went low today? I think to still shoot the 1.25u later and monitor...what do u think?


    On second look her number this morning might as well have been 400 it was 392. I should stay with this 1.25 dosage still correct?
     
  20. Rachel

    Rachel Well-Known Member

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    I think you’re seeing a bounce. Hard to know for sure but what you’ve got indicates she probably stayed high and flat today after that low last night. Not uncommon or unexpected. I’d stick with your dose for now...don’t want to adjust on a bounce cycle. :)
     
  21. Jena4277

    Jena4277 Member

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    Thanks!
     
  22. Kris & Teasel

    Kris & Teasel Well-Known Member

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    My opinion is that it's a bounce. Keep the 1.25 u dose. :)
     
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  23. Jena4277

    Jena4277 Member

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    Hi! So this morning she was in yellow and I just tested her and she is yellow again. My only concern is that she might be going too low during the day but I won’t be able to tell until Saturday when I can curve. If I see a high number tomorrow it’s probably another bounce right? How does the bouncing game work - if she keeps showing numbers all over the place like she’s has been I will have to reconsider the dose? Hopefully today’s data stays consistent and I don’t have to worry!
    She had some diahrea today. I have been sprinkling cheese on her food. Perhaps too much. I will keep an eye on it. I don’t want her getting another UTI
     
  24. Kris & Teasel

    Kris & Teasel Well-Known Member

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    The two yellow PSs are good. If you can get a +2 and a +4 this evening that would be good data for today. Stay with this 1.25 u dose for now. Chances are if she had dipped low mid day today her PMPS would be quite a bit higher.
     
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  25. Jena4277

    Jena4277 Member

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  26. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, she's a bit erratic. She's only been on ProZinc for 2 weeks though so I suggest you stick to the 1.25 u dose for now.
     
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  27. Rachel

    Rachel Well-Known Member

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    She sure is! I do think you're seeing some minor bouncing...and as Kris says, it's only been 2 weeks. She might need some time to settle into the new insulin before she calms down. The good news is you're seeing some beautiful and healing numbers mid cycle, which means her pancreas has time to rest and heal. I know it's tough, but be patient! I think you'll see things get better soon.
     
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  28. Jena4277

    Jena4277 Member

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    THANKS! Just wanted to make sure I was kind of on the right track. She must not feel so hot bc of the bouncing :confused:
     
  29. Djamila

    Djamila Well-Known Member

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    Please forgive me if we've already talked about this, but which type of Fancy Feast are you feeding her? Also, what kind of treats does she get, if any? Are there other pets in the house that eat anything different? And is she taking any meds for the arthritis or any other health issues? Anything for the neuropathy? Just looking for any factors that might be contributing to the bouncing. It's most likely just as Kris and Rachel said - she's new to the insulin and needs some time to settle - but might as well check on everything else while we're at it! :)
     
  30. Jena4277

    Jena4277 Member

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    Fancy feast classics
    Never treats
    No other pets
    No meds

    I’m staying the course! :D
     
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  31. Djamila

    Djamila Well-Known Member

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    It is okay to give treats - as long as they're low carbs! ;) You also might consider giving her some zobaline to help with the neuropathy. Many cats see quite an improvement after a few weeks on it. How much does the arthritis effect her? Inflammation can increase BG numbers, so I'm wondering if some meds for that might help her?
     
  32. Jena4277

    Jena4277 Member

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    I used to give freeze dried but she turned her head to those after a couple of weeks. She’s doing fine without treats . I mean sometimes she gets table scraps (purely meat only) so she is doing just fine lol.
    Her arthritis is severe, she has carpal hyperextension to the nth degree and has hip and joint issues. I tried meds but she just won’t take any and I stopped forcing her. She has slowed down plenty so although there may be some daily pain, her body is not requiring her to do more than lay around in her elder years so she is not making it worse by a huge amount of activity. It is a huge deal getting Meds in her and in her frail senior state, I really don’t want to put her through a daily fight/struggle. She is better just left alone as much as possible. The neuropathy has improved. She used to drag her leg around and slip around when she ate , now she can put weight on it a bit more and looks much more comfortable. Not sure why. Anyway, I think she will just always be a high kitty and I will do my best to keep her low in the time I have left with her. Thanks again.
     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Some people have found Adequan injections help a lot with arthritis pain. Have you ever investigated that? @JanetNJ has used it I believe.
     
  34. JanetNJ

    JanetNJ Well-Known Member

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    Definitly try adequan shots for the arthritis!!! No pill to force in. Easy shots 2x a week for 8 weeks, then once every 2-4 weeks to maintain.
     
  35. Jena4277

    Jena4277 Member

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    The bouncing is insane! :nailbiting: I wasn’t able to get a number last night but boy i am curious ...
     
  36. Jena4277

    Jena4277 Member

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    @JanetNJ @Djamila @Kris & Teasel blood work came back. Dx today pancreatitis and hyperthyroid. Starting cream Rx tomorrow on ears. Told me prednisone steroids for pancreatitis. I told them no. She was on prednisone and it gave her DKA with seizures that summer 2016. No thanks. She had bad reaction. It started all of this diabetes mess. Treating thyroid first then will explore other options for pancreas.
     
  37. JanetNJ

    JanetNJ Well-Known Member

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    Pancratitis is treated with cerenia for nausea, sub q fluids, and bupe for pain.
     
  38. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Pancreatitis attacks tend to be self limiting but can come and go over time. Janet is right - and my vet told me this too - treatment is aimed at relieving symptoms: cerenia for nausea (and vomiting if it's happening), pain meds and fluids.
     
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  39. Djamila

    Djamila Well-Known Member

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    Here is a great place to start in learning about pancreatitis: http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

    Unfortunately, a lot of our sugar-cats suffer from both. Steroids are a possible treatment depending on severity and frequency, but in general, if the kitty is eating and keeping food down, it is managed with pain meds, nausea control, fluids, and time.

    The pain meds will likely help with her arthritis as well. Bupe is pretty easy to administer and seems to work fairly quickly to bring some relief for the pancreatitis.
     
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  40. Jena4277

    Jena4277 Member

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    I am at my wits end. :(
    She has been great with her sugar for weeks and now this weekend it’s been in 200 or 300(today) at +6 when it’s usually less than 100!
    Can all this stuff going on with her affect her sugar? I can’t believe this. Why isn’t the insulin working? These were not fur shots. I don’t know anymore....so much money, so much stress. :(
     
  41. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Pancreatitis can raise BG because it an inflammation. Also she might be bouncing on the 1.25 u dose. I'm basing that on the fairly recent 54 and 44. As hard as it might to get more data through the middle section of a cycle and/or in the evening would be very helpful. Insulin doses usually have to be tweaked up and down a little to keep BG under control. By that I mean after a few days, not AM and PM.
     
    Last edited: Mar 4, 2018
  42. Jena4277

    Jena4277 Member

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    I wasn’t pricking her bc she didn’t feel well and i was giving her and me a break. She hasn’t really bounced for several weeks. The 1.25 has held her in healing numbers. I don’t think the 40 and 50 is that alarming bc she was behaving just the same and her preshot numbers have been consistent. The last time she’s had pancreatitis this didn’t happen. I really don’t want to increase it when I am not home to test. What a mess. It’s a hard day for me emotionally. Thanks for your reply.
     
  43. JanetNJ

    JanetNJ Well-Known Member

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    300's down to 50 is A HUGE difference... Your cat may be bouncing from the steep drops. I know you said your cat is not having symptoms of hypoglycemia, but mine didn't either. She was 44 on a pet meter (under 68 is hypo). No symptoms. I rushed her to the er. Cats can go from seemingly fine to seizure or coma. So just be careful. If you lower the dose just slightly you may find her preshots come down a little as she won't be bouncing as much.
     
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  44. Djamila

    Djamila Well-Known Member

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    Yes, pancreatitis definitely raises their numbers, and when my kitty is having a flare up, I have to increase his dose in order to stay on top of it. However, I don't know that that's what's happening here. I agree with Kris, that there is evidence of the 1.25u possibly causing some rebound. A cat acting normally doesn't mean the cat is safe. They generally act just fine right up until the point that they fall over and have a seizure. I'm not one for panicking at a lower number as many healthy cats can handle the occasional low number just fine, however I also don't think it's good to ignore them. That lime green should have resulted in an insulin reduction.

    The two high numbers recently could be rebound, or they could be pancreatitis. I do understand the desire to avoid testing- I hate testing my kitty and I've been at this for a long time, but you can't know what's going on with this many gaps in the data. Any advice we give would be nothing more than a guess, and any change you elect is again nothing more than a guess without filling in some of the gaps for a few days. The current dose isn't doing what Abby needs, increasing could drop her too low based on the low numbers you're already seen, and decreasing could help, or it could hurt if she's rising from inflammation - and that can lead to ketones. So for now I'm afraid we're a bit stuck. If you can get some mid-cycle numbers today and a before bed test tonight, having data from two consecutive cycles will help sort out what's happening.

    What meds/doses is she taking for the pancreatitis right now?
     
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  45. Jena4277

    Jena4277 Member

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    I am at work and cannot test unless it is weekends and the week like
    I said has been pretty unbearable.

    It was my assumption by our last conversation that 1.25 was a good number to keep her at. Now I am confused. What number should she be in at her nadir to keep her ok? My Vet said I was doing a good job. I really am confused. You’re telling me for weeks I have had her on the wrong dosage? I thought it was doing what she needs because of the way she curves to the blues and greens and rises when it wears off. She was on 1.0 and it wasn’t dropping her low enough.
    I can reduce the dose but I have no idea what her numbers will be until this weekend.
    I am in shock right now.
     
  46. Jena4277

    Jena4277 Member

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    Cerenia last day for nausea for pancreatitis.
    Just picked up the transdermal gel for hyperthyroid and it’s been two applications so far, last night and this morning.
    She is due at 5pm est for Insulin, second cream application, and last 1/4 of cerenia.
     
  47. Jena4277

    Jena4277 Member

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    I also am trying to balance the war testing and cream application bc apparently if I am exposed to it on my skin I can get thyroid or health issues myself bc that stuff is potent. I am calling the Vet tomorrow for more specific instructions.
     
  48. Jena4277

    Jena4277 Member

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    Just tested now. 323.
     
  49. JanetNJ

    JanetNJ Well-Known Member

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    does she seem to be feeling better? Does she seem to be in pain? is she eating ok? Once she's feeling better, maybe try a fat 1... meaning JUUUUUST over the line of the 1, but not quite a 1.25 to see if the bouncing settles a bit. Her mid day numbers right now may be a bounce, or they may be a response to pain from the pancreatitis. She's not getting any pain killers? Does she seem comfortable?
     
  50. JanetNJ

    JanetNJ Well-Known Member

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    Maybe start a new thread asking about prozinc dosing. I'm just going by what I see as a steep drop, but truth be told I've never used prozinc, so if prozinc users would chime in, that would be helpful.
     
  51. Jena4277

    Jena4277 Member

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    She is def eating better due to cerenia I’m sure. I guess tomorrow will tell if she’s vomits or doesn’t eat since today is her last dose. I will try the reduction today. She isn’t showing signs of pain but of course who can tell in cats. Shes not doing anything alarmingly like
    hiding and she is jumping up and down sofas and beds so...I think it’s managed.
    I heard pancreatitis can last any range of days or months. Yikes.

    Ok so I will move to a fat 1 this week get evening numbers and curve Saturday. If my evening nadir numbers are high I’ll post for advice. Do you know any experiences ProZinc users?
     
  52. Kris & Teasel

    Kris & Teasel Well-Known Member

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    @Djamila is very experienced as is @Rachel. I’ve used ProZinc too. We’ve all offered feedback, Djamila just this morning. As frustrating as it is, there’s no “set and forget” for insulin dosing. What worked even a week ago might not work today. As we say, this is a dance : kitty sets the steps and you follow. The BG testing routine we recommend and keep coming back to is the best way we know to see what kitty’s steps are and we follow by assessing insulin dose and adjusting as needed.
     
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  53. Djamila

    Djamila Well-Known Member

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    Oh gosh, Jena, I'm so sorry! I didn't in any way mean to make you feel like you aren't doing a good job. You are doing a good job - this is just complicated, and there are so many "if this....then that....except when it's this other thing....." that it really takes a lot of minds to figure out some of the more complicated steps of this dance.

    If I remember right, you're dealing with hyperthyroid, pancreatitis, diabetes, and arthritis at least - and I might be forgetting something...?

    Because of the inflammation in the arthritis and the pancreatitis, your numbers are probably not going to be all pretty blues and greens. Inflammation impacts BG, and it can be unpredictable and variable at times. Which means you may need to lower the dose for a few days here, raise it for a few days there....this isn't going to be a super easy case to manage.

    So yes, if you get a lime green, you lower the dose. But it might just be for a few cycles and then you may need to raise it again. Or you might not need to lower after a lime green - but it will take a few times of seeing one, collecting data on what she does in the hour or two after that, and what she does during the cycle or two after that - and then that data helps figure out how to respond the next time.

    Okay, so that's the ideal way to manage it. However, please know that we all understand how crazy-making this can all be. The constant stress of trying to manage all of these health issues can sometimes be more than we can handle, and if that's the case, it's okay to say that and we can help you manage it with your current level of testing - our approach is to make sure you have all of the information about how to manage FD in a very hands-on way. But we also respect and understand that it isn't always possible - both from a schedule standpoint and from an anxiety/stress one. We care about the people here as much as we care about the kitties.

    Here is what I would suggest at this point - As I mentioned, we aren't sure exactly what's going on right now, so I wouldn't lower the dose tonight. These high numbers could be bouncing or pancreatitis - and I would lean toward the latter. That lime green was a few days ago, so I wouldn't use that as the decision maker today. Do you have numbers from today that you can share? My gut is that she is rising from being sick, but I'd love to confirm that before tomorrow morning if we can.

    If you lower it while she's sick and needs more, it can lead to ketones and as you know from first hand experience, that's to be avoided. So when you get a chance, put your numbers from today into the spreadsheet and then we can try to make a better decision about dosing as you head into the week.

    It looks like you opened a second thread asking for input, so after this, I'll post on your new thread instead, and if you have questions from this, maybe post over there so we can just move the discussion onto the new thread. And again, I'm so so sorry if I made you feel bad with the earlier post. You are managing a lot here and we want to support you as you move through this journey! :bighug:
     
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  54. Rachel

    Rachel Well-Known Member

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    Posting here in the Prozinc forum as you've been doing will get you experienced Prozinc users. I spend almost all my available time here instead of Main because I only have so much time...and I know I can be helpful to Prozinc users far more than to other insulin users.

    This is definitely not easy...having a kitty with lots of health issues is hard on you as well as them. And having some emotional moments is fine (sometime let me tell you about the complete breakdowns I have had...trust me we ALL do it). Just remember that unfortunately with diabetes, there is no way to just set an insulin dose and go with it. The needs change over time...that's why we advocate testing so much. Because you'll need to change dosages as the numbers change. The good news is that you can really help control how she is doing! And while that's stressful as heck, it's also nice because it means you can adjust things as needed due to other illnesses or any factors that affect things. That really helps me because it means I can control SOMETHING...and hopefully help her feel better.

    I'm with Djamila on this. I'd not lower the dose just yet...get mid cycle tests in WHEN YOU CAN...we totally get that you can't do that while at work. And as Djamila said above, you do have to regulate what you're doing for kitty with what you have to do for YOURSELF. Sometimes you need a break...we've had plenty of folks who focus on helping their kitty feel good without worrying too much about trying to hit remission. The goal is to help both of you deal with this...and that doesn't have to mean going crazy with testing and trying to walk that fine line of getting green numbers that aren't too low. It just means doing the best you can and letting us know what factors are in play so we can help you figure out how to both help your kitty without completely driving you insane. :bighug:
     
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  55. Jena4277

    Jena4277 Member

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    SORRY I use my little phone and put them in the wrong date bc the screen is tiny lol. It’s updated now.
     
  56. Djamila

    Djamila Well-Known Member

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    Ah-ha! Those pinks are today! Got it. And yes, it's tricky on the phones since you can only see such a small section at a time.

    How many hours from PM shot time until bed?
     

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