? Help this newbie understand these numbers - where to go from here?

Discussion in 'Prozinc / PZI' started by Kelsey L, May 13, 2019.

  1. Kelsey L

    Kelsey L New Member

    Joined:
    Mar 23, 2019
    [Cross-posted from the main forum]
    Hi all, I'm relatively new to this -- only about 6 weeks in. About a week ago, my girl Lilly's post-PM numbers dipped pretty low. She displayed no "hypo" symptoms whatsoever, but with some help of some in the Facebook group, I gave some honey, wet food, and HI-carb dry kibble to bring her back up. Of course I wanted to update the vet about the dip, and she and the members on Fb all definitely suggested a dose reduction. So, we did that, and the vet wanted to use caution and not shoot below 300 for a bit. Sometimes, I'll get a perfectly normal pre-shot number. Effectively, that has amounted to skipping almost every other dose, and we even got a 105 after 48 hours without a shot. Of course she bounced right back up, though. The vet (and I) think her dose was clearly maybe too high at 2.5 units. We've climbed all the way down to 0.5 units, now. I will talk to the vet tomorrow, but I also wanted some input from you all about how to make sense of Lilly's numbers right now and where we should go from here? (SS should be linked below.)
     
  2. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hi there, and welcome. Can you tell us a little about what Lilly is eating for food and for treats. Are there any other pets in the house? Do they eat the same foods? What is her feeding schedule? Does Lilly go outside? Does she have any other health issues?

    I think the skips and the moving dose are causing some issues with the numbers that make it hard to know right now, and I'm wondering what other factors we should keep in mind as we read the spreadsheet, so any other information you can share would be great. And if you've already shared all of that in your other post, you can just share a link to that thread. :)
     
  3. Kelsey L

    Kelsey L New Member

    Joined:
    Mar 23, 2019
    Sorry, I guess I should add all that to my signature.
    Food: FF pate
    Treats: Freeze-dried meats
    She eats two meals per day, at shot times: 7am and 7pm. But, if she doesn't eat all the serving in one meal, I'll leave the rest of it out for her to finish.
    No other health issues that I'm aware of, except she injured her knee or possibly hip a while back but doesn't seem to cause her any issues now.
    No other cats, and she's indoor only.
     
  4. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Great. She's on good foods, and I'm a big fan of leaving food out for kitties to graze instead of trying to make them eat a huge meal and then wait 12 hours for the next food. Especially in diabetics, going hours and hours without a snack can mess with their numbers.

    So in that case, it's most likely just the dosing that's causing the numbers. Are you home during the days, or are you away for work? Based on the data, it looks like you're home (or sneaking home at lunch?) fairly often, so if that's accurate, I would suggest is that you give two doses/day of 0.5u for a couple of days. If she's too low, then you'll need to stall. So you give a test. If it's too low you wait 30 minutes without feeding and give another test. If the number is rising then you go ahead with the dose and monitor. If the number is flat or falling, you stall another 30 minutes. Kitties don't like it because it messes with their meal time, but it allows you to give two doses/day which is really important, and will hopefully start to level things out a little.

    You'll also want to keep the testing time as consistent as you possibly can. Prozinc has some flexibility in some cats, but when you have a cat whose numbers swing up and down a lot, the more consistent you can be with timing, the better. So you'll really want to be testing right at at +12, and not at +11

    Lilly isn't ready to be off insulin yet because she's still getting too many high numbers. So I would say let's try to stabilize her a little by keeping a low, steady dose for a few days, and then we can start seeing what to do about the dose from there.

    Vets often say things like "don't shoot under 300" because they aren't as familiar with BG patterns in cats and need to err on the side of caution and keeping a kitty safe. You are testing enough to keep her safe, so you can shoot on lower numbers than that.

    You could also try 0.25u if 0.5u seems like too much to you right now. The important thing is to be consistent. You'll have to eyeball 0.25u, so if you go that route, I would draw some colored liquid (food coloring, tea, juice, etc.) into a syringe and use that syringe as a "ruler" to measure against so that whatever you decide is 0.25, you'll be giving the same amount every day. Even a little variation can make a big difference, so consistency and precision is really important.
     
  5. Kelsey L

    Kelsey L New Member

    Joined:
    Mar 23, 2019
    Thanks for your advice! I had a feeling I needed to really try to be giving two doses per day (as opposed to skipping every other shot), but I didn't know how to do that safely. Unfortunately, I am not at home often (I work 40-50 hours per week), and the only days I'm able to test mid-day are weekends. I've been able to rarely sneak away at lunchtime to double check on her if anything was off in the morning -- but honestly I can't keep doing that (I have to take leave time). Related to that, it really is very difficult for me to stall shots in the morning. I've tried a couple different shot times, so far, and this has been what works to be most assured I'm home by shot time, so I can't go much earlier, and I absolutely can't go later because the time I have to be at work. *sigh*
    Just for sake of explanation, I've been testing at the +11 mark because I've been discussing her numbers with the vet nearly every day, and the vet wants a number to discuss when she calls, but she leaves for the day before my PMPS test.

    Another question I have is how do I determine my "don't shoot below" number, at this point? I know I can shoot below 300, but and as we've gotten further away from that night of lows, I'm more comfortable doing so.
     
  6. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    So if you're not able to monitor as much as you have been then I would suggest only giving 0.25u. 0.5u might be too much without being around to check.
     
  7. Yong

    Yong Well-Known Member

    Joined:
    Jan 11, 2017
    Hi Kelsey and Lily!
    Just from my observation, it looks like Lily is a relatively low dose kitty right now :). I understand your work schedule too! My last job I was working almost 50 hours a week so I was gone for 11 hours a day. I only had time to stall once for like 15-20 minutes if I needed so it's do-able depending on your commute, of course too. As for the No-Shoot number, we typically recommend new members don't shoot below 200 to start but you will eventually. I agree on the reduction and trying 0.25U. If you have syringes with half unit markings they make those tiny doses a little easier :cat:. A starting dose of 2.0U is very high as well. We're not sure why Vets do that :(.

    If she's eaten all of her meal and she received a shot, you can make some catfoodsickles. I put like 1T of wet food with some water in a silicone ice cube mold and if I think my boy is going to spend some time in green while I'm away, I'll drop a foodsickle in his bowl as I walk out the door that will thaw between +1 and +3 depending on the house temperature for him to eat later. Although lately, he's been licking it as I leave, lol.

    She has a very sweet face :cat:.
     
  8. Kelsey L

    Kelsey L New Member

    Joined:
    Mar 23, 2019
    Thanks for your input! I appreciate that! I was hoping she was inching toward remission, but alas *sigh*
    Just to clarify -- she didn't actually start on 2 units, that was just what were were at around the time i put the spreadsheet together and was able to start home testing (that was a process in itself!). She started on 1u, eventually creeped up to 2.5u, and then that one night she went into the 40s and has been bouncing ever since, so we've been reducing and skipping, some. The vet is equally confused by her numbers, and I actually learned today she is referring me to an internist/specialist. So hopeful that will help, too.

    Tonight I tried the "stall and shoot," which is much easier for me to do in the evenings. So, I suppose if I'm able to do it at least half the time, that's better than not at all. I appreciate your suggestions!
     
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  9. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hi Kelsey- First of all, thanks so much for the info in your signature. It really helps my poor memory!

    Part of the bouncing around is because of how inconsistent the doses are right now. The other part is that Lilly is young, and I've noticed that younger cats either go into remission very quickly, or they go the opposite way and can be a little harder to regulate.

    A couple of things to keep in mind: consistency matters with dosing. Sometimes we do need to adjust the dose to keep a kitty safe, but you want to do that as little as you can. Second, dosing is based on the mid-cycle numbers, not the pre-shot numbers. We consider the PS numbers but they aren't weighted as heavily.

    So let's walk through the last few days a little bit. Even without you being home during the day, there are a few things we can still make strong guesses at:
    On 5/13PM, the 0.5u was likely a little too much insulin. We can tell because she hit 77 so early. I see in the notes that you gave gravy and went to sleep. Not ideal, but I absolutely understand. Some nights there's just no way to stay awake. That brings us to....

    5/14AM It was red because Lilly dove early which means she also ran out of insulin early. She got gravy the night before which obviously raises numbers. And since she was lower than she was used to, her liver likely dumped stored glucose into her blood to bring her up. Between those three, she was destined for a high number. In general in that case I would recommend ignoring it and sticking with the lower dose. It's a temporary rise, and the goal is to get her steady, not to chase the numbers.

    So then onto 5/14PM - while the 1u in the morning was more than was ideal, she had enough extra glucose in her system that she was probably okay, and ended up with a yellow PS. Not bad. It can take a couple of cycles to get over things like the 5/13PM cycle, so we can kind of ignore this cycle too. The 1u during this cycle probably caused her body to push back a little which kept her fairly flat through morning. (the other option is that she dove while you were sleeping, but let's not think about that option for now).

    So by 5/15AM she was at a nice blue PS number, but the dose got dropped pretty dramatically. And from this cycle we can make a guess that 0.25u isn't quite enough. Although that's only a guess right now. So the lower insulin dose left her with that high number for 5/15PM, and into this morning.

    So This morning she got another full unit, which left her a little lower for PMPS because 1u is a little too much, and she likely dipped a little too much today.

    So all of the numbers have reasons. They follow pretty typical responses, even though those responses are complex and hard to make sense of with just a glance.

    Each cycle isn't it's own independent thing. What happens in one cycle influences not just the next cycle, but sometimes several other cycles. And it can be really hard to figure out, especially at first.

    So here's what I would propose: if at all possible, plan on sticking close to home this weekend and getting some extra tests. And try giving her either 0.5u or a skinny 0.5u (so not quite 0.5, but not as low as 0.25) as consistently as possible. I usually draw almost to the line, but not quite. And if the numbers allow, keep the dose consistent and let's see if we can even her out a little and settle down the big swings. The data in the mid-cycle will help us to know if that is too much (in which case we'll lower right away), or too little (in which case we will slowly start to raise her after she's had a chance to settle out for a couple of days.

    Towards the end of the weekend, if you're able to get 203 mid-cycle tests each day, we should have a better idea of what's going on and what might make sense for next steps.

    And I absolulutely agree with Yong about the catfoodsickles. They can really help!
     
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  10. Kelsey L

    Kelsey L New Member

    Joined:
    Mar 23, 2019
    Wow, thank you so much for walking me through those examples! That was very helpful, and along the lines of what I was already thinking about her numbers/cycles, so I'm relieved to know I'm beginning to learn and understand things a bit better. I haven't felt quite comfortable determining how/when to shoot, especially with the fear of her going low (which is maybe a bit more of my own anxiety than reality?). I've been relying on my vet, and she kept telling me to give her 1u dose when I could, and adjust it when I couldn't, so that's what led to the dosing being all over the place. I am going to try to hold the 0.5u dose all weekend, with some more testing mid-cycle, and see where that leaves us. Unfortunately, we are traveling together this weekend, and she hates car rides/the carrier. So, I know her numbers are going to be high from the trips on Friday (today) and Sunday. I am feeling so discouraged with all this, and how much it necessarily interferes on both our lives! I want my spunky girl back :(
     
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  11. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    It's going to get better, I promise. :bighug:

    And yay for traveling with kitty! I always laugh that I have to pack more for Sam than I do for myself. While neither of my cats like car travel, they have learned to handle it better since I drag them along with me so often these days. It's either that or I never get to go anywhere since it's so hard to find a sitter who can handle Sam's health issues.

    Sam's numbers oddly seem to always be lower when we are traveling. I think he kind of enjoys the adventures. It's too late for this trip, but if you can order some CBD oil it can help with their anxiety in the car. I really like Charlotte's Web these days. It's legal in all 50 states, and you can buy it through their website if you can't find it locally.

    You can also talk to your vet about some gabapentin. That didn't seem to work as well for Sam as it did for Atticus (my other cat), but lots of folks around here have had it work well for their cats.

    I hope you all have a great trip and enjoy the time away!
     

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