GA High preshot numbers

Hello everyone! I haven't posted in awhile so I started a new thread for an update on Sookie. She was pretty upset with me for goong on vacation a couple weeks ago and her numbers have been reflecting that. Could someone please explain to me how to get the pre shot numbers down? I know the typical prozinc curve is like a smile but eventually shouldn't it even out a little bit? Sookie is almost always in the 300s before her shot (unless she's bouncing then its in the 400s) and I can usually get her down into the blues sometimes greens but it always jumps back up. I'm wondering if eventually we'll have to switch insulins to something with a longer duration like lantus, unless I'm just not understanding how the prozinc is supposed to work. I'm starting a new vial this weekend so I'm in no rush to switch, just a thought.

I have another question about bouncing. Sookie seems to be bounce anytime she hits a dark green number and a lot of times with the blues as well. Sometimes her BG drop is sort of fast and steep which also triggers a bounce. I noticed that when I give her 2.25 units she goes nicely into the blues, but when I give her 2.5 she will go into dark greens. However when I give her the 2.5 she bounces like crazy the next couple cycles compared to much less on the 2.25. I'm wondering which is better in her case, let her be in lower numbers with the 2.5 and bounce around until it evens out, or take a more modest approach with the 2.25 and not have her bounce so much. I'm trying so hard to understand all of this. Any advice anyone has would be so greatly appreciated!

 

Hey Case! As to your first question, getting the numbers down is something that just happens over time. Usually, what we say is kitties in higher numbers hang out there, and we keep increasing the dose until we hit a breakthrough dose and they head down the scale. As for Lantus...I don't know if that would help bring the preshots down or not. I do know that it helps reduce bouncing some, but I'm not sure if it would be easier to bring the numbers down with it or not... @Kris & Teasel @Djamila do you guys know?

As for the second question, I think I'm missing the dark greens you're seeing. I don't see any recently on your SS...which isn't to say she isn't hitting them, just I'm not sure when. As for bouncing, well, unfortunately some cats just bounce. I think that it's worth it to keep going up in dose in hopes of getting better numbers. The sooner you can get into nicer lower numbers, the better.

 

I can share my observations with my bouncy guy. Teasel was on ProZinc for 10 months and he's been on Lantus now for over 7 months. He's still bouncy but less so than when he was on Lantus. You can definitely shoot on much lower PSs on Lantus and they don't generally drop much in those situations so they coast along at low numbers for a bit within a cycle. I find that Teasel has patterns that I can see on Lantus whereas he was much more erratic on ProZinc.

 

I agree with Rachel about considering an increase. If you increase, one of two things is likely to happen: Some cats will flatten, and that might start to bring the pre-shots down. But the other possibility is that she would dive and you'd need to be around to monitor and steer, so just make sure increases are on cycles you can monitor. As you mentioned, when you've tried increasing the dose, she bounces. Bouncing is just part of the process in getting towards regulation. We hate seeing those cycles, but try not to worry about them too much. They are pretty much unavoidable. The trick is figuring out when the bounces clear, and what to do next.

It does look like soon after two of her greens you reduced the dose. There are different schools of thought on this, but I think it's more effective to hold the dose (unless the green is below 50). Your greens have been quite safe, and indicated that those were workable doses at those times, so maybe should have been maintained to see if the greens reappear. She's been high for long enough now that she'll likely need a bit more than she did earlier.

The other option would be, as you suggested, possibly trying a different insulin like Levemir and see if she responds better to it. The L insulins do seem to help kitties bounce a bit less and get flatter curves, so if you don't see improvement before the end of your new bottle, it may be something to consider.

 

Thank you Rachel. You're right in that we haven't had any dark greens lately. I think it's because like Djamila said I reduced the dose after the few we've had. I did that because I was thinking she was dropping too fast/far. To go from a pink preshot to a dark green made me nervous, especially because I'm only home on the weekend to monitor. I was also thinking the numbers would work their way down slowly and eventually we could get to the dark greens when her preshots get into the 200s, but I see that they aren't coming down at all yet. I suppose I need to be a bit more patient.

 

Thanks Kris, it's definitely something I'm going to consider depending on what happens after this new vial. I want to give prozinc a fair chance to work. But I really like the idea of shooting on lower numbers to stay lower longer without such a sharp drop.

 

This is exactly what I've been trying to figure out. At the time I reduced the dose based off those greens I was so torn on whether to stick with it and push through or be a little safer by reducing to prevent bouncing. I read somewhere that when they bounce it usually means the dose is too high. Well now I realize she bounces anyway and in hindsight you're right, I should've held the dose. I've been conservative in her dosing because I'm scared of her going hypo while I'm at work. I kept thinking that if her bouncing suddenly stopped on a dose that brought her into double digits that she would go too low, if that makes any sense. Now we've been doing it long enough that I just want to get the numbers down, I feel bad that they've been so high for so long.

As far as increasing, I'd love if it would flatten her out but I do think she'll be a nosediver for sure. I have no problem increasing when I'm home and steering with food if I have to. But what if the dose is okay the 2 days I'm home and then the next day I'm at work and she decides to have a more active cycle? If I'm at work I can only leave out food and hope for the best which is what makes me nervous. I'm starting to think that I have to let that fear go a little bit in order to make progress. I'm such a worrier, especially about Sookie because she's my baby! Thank you for clearing that up for me, it's so helpful and something I've been thinking about a lot.

 

I think we all share those fears. My kitty doesn't really dive and has been in the same numbers for months, but I still get nervous if I have to leave before I can get a mid-cycle test to be sure he's okay. Which is silly since he's just fine! Kitties are pretty good at steering themselves when they have access to food and water, so as long as you're doing small, careful increase on cycles you can monitor, odds are in your favor that she'll be just fine on the cycles you can't monitor.

 

I did the same thing before switching to Lantus so I gave Prozinc about 7 months. One thing I will chime in about is that Sookie's bounces don't seem to be for an idiopathic reason, it's almost classic bouncing . If her nadir drops her more than 50% of her pre-shot test, then she bounces. You don't want to increase a dose on a bounce number (I'm pretty sure you haven't ) and a bounce can take an average of 3-6 cycles to "clear", or settle back down. Are you still using the AT2 meter? And have you been able to get another ketone test? As long as Sookie has not been DKA or highly prone to developing ketones, you should try your best to test weekly while she's still in those higher PS numbers.

As Rachel said above, they do gradually come down so feel free to throw on a few pairs of patience pants . The more time Sookie can spend getting into the high dark green numbers and lower blues, her body should start getting re-trained, if you will, to seeing normal BG numbers again and calm down on the physiological response that sends her on the trampoline . I think your first goal should be to see her nadir in mid blue - low yellow so the drop isn't too dramatic on her body .

Lastly, keep in mind Prozinc isn't typically known for keeping kitties flat but they produce the smile curve. So using your most recent data:
AMPS 416,
+2 Mid to high 300's
+4 Lower 300's to High 200's
Between +5 and +7: Nadir, ideal nadir High 100's to Low 200's
+8 Mid 200's to High 200's
+10 Low 300's to Mid 300's
PMPS High 300's to 407.
With meter variance, a 350 could also read as 407. I know this didn't actually happen but just as a guideline example of what a textbook Prozinc curve might look like to help . One of the other ladies can clarify if I made a mistake, I've only been awake for like 30 minutes

 

I'm glad you say that Djamila. It's reassuring to hear that we all have those feelings no matter where we are in our journey and it's not just me!

Hi Yong! I am still using the AT2 with FSL strips but when I start running low I am considering switching to a human meter. No history of DKA but I'll work on getting some more ketone tests, hopefully tonight. I know I'm not doing it often enough, it's hard to catch her sometimes but she is eating very well and actually has already gained a lot of weight back (probably too much). Isn't that a little strange considering she's not anywhere near regulated? Anyway, thanks for clarifying the typical prozinc curve, I suppose its mostly working how it should then minus her bounces.

I noticed the last few cycles with the 2.5 I've been giving her the preshots have gone up into the 400s which I think means she's been going much lower than she's used to. I'm running a curve today (hopefully it won't be on a bounce cycle) but if she goes into dark greens should I back off on the dose or hold it hoping her body will adjust? I know it sets off bouncing but it seems like some people say it's better to push through it and others say to back off. It also seems like when I raise her dose the nadir gets lower and the preshots get higher. It can be confusing and I'm not sure what is best for her. Thanks for bearing with me as I figure this out lol

 

Oh I know it can be hard to catch that ketone test sometimes. I've been telling Maury for a while that I needed him to stop peeing when I leave the room after waiting for an hour or so . Went to walk away, again, last night after waiting and heard him jump in his box! When I got the test and made a note, I realized he had been averting me for over 2 weeks! .

As for gaining some weight back, personally, I don't think it's strange because Maury started gaining his weight back when he wasn't anywhere near regulated either . Now I'm just trying to maintain him since he's at a good weight now and got his muscle back.

For dosage, once again this is just my opinion , I would hold the dose if she gives a high dark green like 80-99 for nadir. My thoughts behind it was that they were safe nadir numbers and if I held the dose I might see more .

 

Haha yup as soon as you walk away they run right to the box! They're smart little stinkers! I'm so glad to hear Maury has his muscle back and is looking good. Also happy it's normal Sookie gained some weight but I definitely need to keep an eye on it because she's starting to look a little too plump lol. Thanks for the dosing advice Yong, makes perfect sense and I think I understand what to do for now. That is until she throws me for another loop!

 

Does anyone have any ideas about what's going on with Sookie's latest numbers? She's been higher than ever and I thought maybe she was hitting a few lower ones and bouncing, but I haven't caught any at all. She's also had diarrhea so maybe she's just not feeling well, could that be contributing? I think she needs more insulin but we just upped the dose and my vet told me I have to hold it for at least 5 days to settle. Not really sure and feeling really frustrated. I'd be interested in what everyone else sees.

 

Sam always runs high when he has diarrhea too, so that could be a factor. Prozinc does have a little adjustment period, but we usually say 3-6 cycles is enough to judge a dose. Most people prefer to raise during an AM cycle since it's easier to monitor, so maybe try the increase in the morning if you want to go up a bit?

As for the diarrhea, a pre/probiotic can really help with that as a daily addition to her food. Fortiflora doesn't seem to work nearly as well as some of the other ones, although it's the only one with that flavor that kitties love. Slippery Elm Bark (SEB) works more quickly - usually within a day - so when Sam gets it I usually start him on the SEB, and then give him a probiotic every day to spread out the time between bouts.

 

Ok so we're on our 4th cycle today and I can wait until the 6th to see for sure. Didn't want to raise too quickly but also hate seeing her so high. I did her last increase on a pm cycle because it seems every time I raise the dose the first cycle always stays high and flat. But I do see how it's safer to raise on an am cycle and can definitely do that on the next one.

Good to know about SEB, is it in powder form and used the same way as Forti Flora? Also what kind of probiotic can I use?

 

There was just a conversation about this on this thread: http://www.felinediabetes.com/FDMB/threads/spicoli-pt4.184135/
Starting on post #57, so you don't have to read through the whole thread.

I've also used this one: https://www.chewy.com/animal-essentials-plant-enzyme/dp/49372 which seemed to help, though I don't honestly know any of the research around it, so I'm hesitant to recommend it even though it worked for Sam. I've heard and read the best results from the s. boulardii, and that's what we use now.

There's good info about SEB on Tanya's site: http://felinecrf.org/holistic_treatments.htm#SEB_cautions

I bought this one when I was in a hurry to get it. Then I just open the capsule and mix the powder into food. One of my cats doesn't mind the taste at all, the other one really doesn't like it and I have to mix it with crushed treats and a little coaxing to get him to eat it.
https://www.amazon.com/Natures-Way-...8&qid=1506886545&sr=8-4&keywords=slippery elm

You certainly don't need to raise doses in the morning! Since you know Sookie's patterns, go with what you know. The morning thing is just generic advice. Knowing your own cat always trumps that!

 

Amazing amount of info Djamila, thank you so much!! She's never had an issue before without a reason like food change or something, so I was totally caught off guard today. I appreciate all the help

 

Hope she feels better soon!

 

Poor thing! I hope she feels better soon. It could just be a bit of a bug that she's got. It happens to all of us every now and then.

 

Thanks I hope so too!

 

I have to say thank you to all who have helped me along this crazy journey. I had to let Sookie go today and I think it was the hardest thing I've ever had to do. She had stopped eating so I brought her to the vet yesterday to find out she had a fever. After an x ray we saw that she had mysterious fluid in her abdomen which called for a night in the er. After hours of not knowing, she had an ultrasound that determined she had a tumor and colon cancer that had spread. I had no idea because she hid it from me for so long. I feel so stupid and guilty for not knowing and boy do they mean it when they say cats hide it well. She was suffering and I had to make the call. Hopefully the right one, but the vet seems to think so. She was only 7 years old and I can't believe how fast this happened. They asked if I wanted to be there and as hard as it was I couldn't let her go in a room with strangers. She didn't want to go but I couldn't let her be in pain anymore. She was comfortably on my lap just as she always had been since she was 4 weeks old. She was such a special girl.

Devastated and heartbroken doesn't begin to describe how I feel. I don't think I'll ever get over what has happened, I wasn't ready to let her go but in the end I don't feel like I actually had much a choice. I hope I did the right thing, it's just hard because she would not let me see her pain for a second. But the knots in my stomach yesterday told me otherwise. I am so grateful this board exists because I've learned and grown so much with all of your help. It's truly amazing to see such compassion around here, it restores some faith in humanity. Thank you again.

 

Oh Case, I am so so sorry to hear this! You DID make the right decision. Sue told me once that whatever decision I made would be the right one as it was made out of love. I firmly believe that to be true. You made the hard, loving decision to let her go and be free of pain. I would have done the same absolutely in your place. It's a hard decision too to be there with her when she passes, I know, but I did the same for my Gypsy and the memory of how peaceful it was has been a comfort to me ever since. She was peaceful and I know she had me right there with her to keep her calm and let her have loving arms around her as she went. It's so hard, but what a blessing for me to have been there. In time, your memories of her will bring a smile again, and you'll know you did everything right for her.

Fly free, sweet Sookie! Land softly.

 

Oh no! I'm so sorry! I know how that goes. A long time ago I had to say goodbye to our cat Nikki at 7 for kidney cancer. I had no idea until the last few weeks.

 

I am so sorry to hear this news. Many, many years ago I had to make the same decision for my Buzzie kitty, when it was found that he had cancer. I knew something was wrong but never suspected that it was so serious until the diagnosis was finally made. You made the right choice to let Sookie go before the suffering was too hard to bear.

 

Oh Case, we are heartbroken with you. I am crying as I read your post, and wish there was a way to reach through the computer screen and across the miles to give you a hug. Sookie will always be your guardian angel. As Rachel said, it was absolutely the right decision. You made the decision out of your deep love for Sookie, and I am certain she knew that.

 

Case, you made a loving decision to not let her suffer with the cancer and you did EVERYTHING you could for her . No more hiding, Sookie .
May fond memories of your beloved, Sookie, warm your heart always

 

Thank you all for the kind words. It's a comfort to me to hear your stories of other kitties who have been through it. Love to all of you and your fur babies.

 

I'm so sorry you've lost your kitty.

 

This is how I get Chloe's urine: I put her in a closed room with a clean, empty litter box. I make sure she has water and wait a few hours.

 

I am so sorry for your loss. Our cats look so much alike. Big hugs .