Help, Stalling!!

Gave Sir Dracula Dupree 0.75U Prozinc this morning at 925am. His preshoot number is currently 97 at 913pm

 

Do not feed. Test again in 30 minutes to see which way he is headed. Even Prozinc is an in-and-out insulin, sometimes the duration can be a bit longer than 12 hours.
Tagging
@MrWorfMen's Mom

 

I am not feeding, stalling insulin and Okay I will recheck in a bit

 

When did you last feed Sir Dracula Du? Is the preshot number food influenced at all?

Also, from: http://www.felinediabetes.com/FDMB/...ion-for-experienced-prozinc-pzi-users.166057/

“No-Shoot” numbers are individual choices. In the beginning, we suggest setting 200 mg/dL {11 mmol/L} as a No-Shoot number, but as you get more data and understand how the insulin is working in your cat, you can choose to shoot at a lower number. For some people, this is 180 mg/dL {10 mmol/L} and over. For some people, it is 150 mg/dL {8.3 mmol/L}.

 

934pm
106

Should I keep stalling ?
It has been 20 minutes

 

The last time he ate was after his 930 am routine

 

@ 943pm - 110

 

106 is still too low. No shot tonight. It is a recent diagnosis and I do not see any data on the spreadsheet after 11/19.

Is it possible to feed him snacks during the day? It is easier on a cat taking insulin. The food helps counter the drop during the cycle.

 

The default tab may be the shelter info I filled in. On the Nov/dec tab I've been filling it in.
Im home most days, all days someone is home most times so snacks are possible. What should I choose, just his food in more portions? His levels have still been kind of high.
So now tonight I feed him and skip insulin. Then check, etc in the AM?

 

Technically you can shoot any pre-shot of 90 or more BUT I agree with Kel that you should skip because you have limited data and have never shot any pre-shot nearly that low. Best to work your way down to shooting lower pre-shots.

 

I believe I fixed the detail sheet now in google sheet settings

 

Last night thread starting insulin,
MrWorfMen's Mom said: ↑
I'd reduce the dose to 0.75u tonight provided BG is over 200 at pre-shot test. With ProZinc, anytime kitty's BG falls below 90 when you first start out, they earn a dose reduction of 0.25u. You really don't want Sir Dracula Dupree dropping much lower than 90 at this point till you get a little more data.

^does the above mean that tomorrow morning if the preshoot number is higher than 200 and I give him insulin, I should stick with the 0.75 or do 0.50 due to the low number for dosage drop

 

Found the spreadsheet. Thank you.

I still think the 96/106 is too low to shoot. Given meter variance, they are basically the same number.
From: Beginners Guide to Prozinc
In the beginning, if your cat’s BG is not up to at least 200 mg/dL {11 mmol/L}, if your schedule allows, you can stall (without feeding) for 20+minutes, then retest the BG. You are looking for a number that is rising, not falling and up to 200 mg/dL {11 mmol/L}. If you stall once, but can’t do another round of stalling and your cat hasn’t reached a BG of 200 mg/dL {11 mmol/L}, you’ll need to skip the dose and wait until the next cycle.

A full meal at shot time, then say, snacks at +2 and +5. There is no hard and fast rule with snacks other than picking food up at +10 to make sure the preshot number is not food influenced.

@MrWorfMen's Mom
Do you think a dose decrease is called for?

 

Thank you for looking again for it. Im going to obviously withold dose for tonight.

I will absolutely start snacks for him.

Our vet prescribed 2u, we started with 1u, then decreased to 0.75. I was thinking the same about dosage decrease, as I posted the same question above just as you were posting.

 

The numbers on 0.75u aren't bad but the fact that he's so low at the end of the cycle makes it look like perhaps trying 0.5u would be a good idea to see if you can get 2 shootable pre-shots. I'd skip tonight and reduce to 0.5u tomorrow AM (don't worry if pre-shot is higher after skipped shot). It's a bit of toss up right now whether 0.5u will be enough and that late nadir is just a fluke or because dose is too high but dose can always be increased again if need be.

 

Tested him 1023pm @ 167 (1hr after stall)
Fed him 1 can of fancy feast oceanwhitefish+shrimp classic pate
which is under 5% carb content

 

He is now at 216 for the final check I'm doing tonight. 1132pm

 

How much wiggle room do you have in your shot schedule?

I think dropping down to .5 is a good idea too. We know that cats in shelters will almost always run a lot higher just due to the stress of being in the shelter environment.

Now that he's got a home, he can relax and show you what he can really do!

 

I (and my out of this world amazing fiance who is super helpful) am basically running my life around Dupree's medical needs and now our dog who we need to get an eval for a possible heart murmur. We are very fortunate with how much wiggle room we have right now

 

He has been running a bit high as well since coming home last month but luckily I started testing prior to starting insulin so that was good to have the extra data.
He is already settling in and being obviously more comfortable here

 

With ProZinc, there are some options as long as you can change your shot times around. For tonight, I'd go ahead and just skip though. It's so early in his treatment that it's the best option.

STALLING/ SKIPPING/ WAITING
Stalling/Skipping/Waiting are not really considered “advanced dosing” options. But they are worth considering when your cat’s blood glucose numbers are running low at pre-shot test time, which is not likely to be early in your feline diabetes journey. (Although this does sometimes occur early in treatment when the starting dose turns out to be too high.)

• If you cat isn’t in a safe blood glucose range at the scheduled shot time, but is relatively close, you can stall: Wait 20 minutes without feeding to see if the blood glucose rises on its own. (This is because food usually raises blood glucose levels. So if you give food, and then re-test and shoot based on that result you could end up shooting a number that is higher than it would be naturally be). So withhold food, then retest: You want to know the number has risen, and that it is at or above your No-Shoot number. You might also consider shooting a little less insulin for added safety when your cat is very close to your target number (meaning within a few points of the Safe-to-Shoot number).
• Another option is to skip the dose, particularly if you will not be around to monitor afterwards. The next pre-shot test result may well be higher than usual, because it will have been 24 hours since the last shot. This is another situation in which you might consider reducing the dose - even if you’re seeing a higher number. The point is that this higher number is a reflection of the cat having had no insulin for 24 hours and therefore is not “true.”
• One more option is to feed and wait 2 hours, until the effect of the food has worn off. If the number is high enough to shoot, you can give insulin. Just bear in mind that you want to be able to wait 12 hours before shooting again. For many people, this option messes up their 12/12 schedule.
• If you had to stall, skip or wait 2 hours, it may be wise to reduce the next dose by a little bit. The goal is to have two shootable pre-shots in each 24-hour period and not have to skip or stall. A little lower dose might help you achieve that goal..
• “No-Shoot” numbers are individual choices. In the beginning, we suggest setting 200 mg/dL {11 mmol/L} as a No-Shoot number, but as you get more data and understand how the insulin is working in your cat, you can choose to shoot at a lower number. For some people, this is 180 mg/dL {10 mmol/L} and over. For some people, it is 150 mg/dL {8.3 mmol/L}. Whatever your target number, be sure that you can monitor that cycle whenever you choose to lower your “Safe-to-Shoot” number.

 

This morning he is at 290 pre AM shot

 

Not bad given the skipped shot last night. Let's see how Sir Dracula Dupree does on the 0.5u dose.

 

Gave 0.5u at 930am, I'll check him a few times today, I want to start getting more data.

I read through most of the Prozinc forum this morning for beginning and advanced dosing

 

Thank you so much for all of your help. One of our dogs we found out needs a follow up for a possible heart murmur and it caused some issues yesterday so thank you for making my night with Dupree easier!

 

You're quite welcome. Hope your pup is OK. It's hard enough with one animal needing extra care but 2 at once is a lot.

 

Thank you, we are waiting for a second opinion and then ultrasound. Luckily I am so fortunate with my schedule right now and can be where the animals need me to be and be doing what it is they need, but wow is it a lot of work haha

 

Tonight pre shot he is at 352

 

Looking at patterns we think the 0.5u is slightly too little. We are giving him 0.75 and sticking with it for now to see if we can get a goos few pre tests

 

Patience pays off and those highs are just the result of the lower numbers from yesterday. Dosing needs to be based on how low a dose takes kitty not on the pre-shot numbers. Better to have two consistently shootable pre-shots and that is why we recommended lowering the dose to 0.5u. Make sure you monitor him closely with the 0.75u as that low pre-shot the other night suggests he may have dropped lower than what you saw with the testing earlier that day.

 

I have just checked him +1 and he is at 278
I will continue to monitor him. Im thankful for home testing, the script is written for 2u, I feel after the changes in these low doses that he would surely be dead if he was given what he was prescribed.

 

OMG I admit I did not read past Sir Dracula! Love it! great name