Looking for guidance...difficulty regulating

Discussion in 'Prozinc / PZI' started by abrudney, Oct 14, 2019.

  1. abrudney

    abrudney New Member

    Joined:
    Sep 4, 2019
    I am having difficulty regulating my cat. Diagnosed in June but I have only been doing daily monitoring for the past month. He responds to the insulin but the pre-meal values can get very high at times. For example, today AMPS was 716. +6 was 71. PMPS was "hi" (over 750). He does get a snack midday. 1.5U Prozinc twice daily. New bottle. He is raw fed + supplements. Recent chemistry was fine. No CBC done unfortunately. A few red blood cells in his urine, but no infection or ketones.

    What am I missing??? Should I try a different type of insulin? I have concerns about these dramatic swings. They aren't always as crazy as today but his pre-meal values are mostly in the black, especially in the evenings.

    Anyone have any thoughts or experiences with this?

    Thanks
    Allison
     
  2. Jenna Josie

    Jenna Josie Member

    Joined:
    Jun 30, 2018
    Hi Allison. I'm sorry that you're having so much trouble regulating your little munchkin! Tbh, I've not seen such dramatic swings before (not that I have all that much experience), but my first thought is that "bouncing" may be a *contributing* factor: he has such dramatic drops that his little body panics and releases stored sugars, which then makes his numbers skyrocket, so you give him his 1.5, he drops precipitously, rinse, repeat. He probably feels crummy, poor boy.

    That is a *guess,* but if he's eating raw (what are the supplements, btw?), then I don't know what else could be contributing to such spikes and drops. :confused:

    My thoughts are 1) try lowering the insulin to see if you can create less dramatic drops and their (possibly) consequent spikes; and 2) it may very well be that ProZiinc is just not a good insulin for him. Lantus and Levemir are supposed to create much flatter cycles, and perhaps a switch would be a good call for him *even if* his spikes are in part a "bounce." Frankly, I'd probably go with #2 . . . Those swings are too dramatic, imo.

    I am tagging @FurBabiesMama since she is a) very wise and b) has had experience with both ProZinc and the L-insulins. Hopefully she will be able to reply soon with some better wisdom.

    P.S. Are you testing for ketones? With those high numbers, that is important.
     
  3. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You've had several readings that were far too low and 2 of them were very dangerous (Sept 30th, Oct 2nd and Oct 3rd) and the dose of insulin should have been reduced when those low readings occurred. You do not want your cat's BG dropping below 68 on your AT2 meter.

    When BG drops a lot, drops quickly or drops to levels kitty is no longer use to, the cat's defense system goes into action and dumps stored glucose into the bloodstream causing elevated BG. What the cat recognizes as low BG is relative. On the 14th you gave insulin at a BG of 716 and BG dropped to 71 which is still a safe BG but far less than 50% of what BG was before insulin was given. That drop of 600+ points set off another bounce resulting in yet another high BG at night.

    I would strongly suggest you reduce the dose to 1u and hold it for a period of 3 to 5 days barring any readings below 68 mid cycle to see if numbers improve. It looks like what you are seeing is likely a case of too much insulin creating a vicious circle of bounces from the huge drops in BG. It may be that a longer acting insulin would work better for your cat but right now it's not clear that a longer duration insulin is needed. Some cats are bouncier than others and a longer lasting insulin isn't necessarily going to solve that problem.

    It would be helpful if you would add some info to your signature like your kitty's name, the type of insulin, type of glucometer, and any other health concerns. You can also include your name and general location or time zone.
     
    Diane Tyler's Mom likes this.
  4. Lisa and little

    Lisa and little Member

    Joined:
    Sep 24, 2018
    If you drop the dose as recommended above and still see these big swings you may in fact want to try Lantus or Levemir. Take a look at the difference in my Prozinc #s vs my Lantus #s. While I didn’t have nearly the swings you are experiencing, I couldn’t get Little regulated on Prozinc and Lantus has been a much better choice for Her. I feel I left my girl on prozinc too long with no regulation and while the change was scary, I wish I did it sooner. Keep in mind every cat is different and hopefully you can in fact regulate using the advice above. Hugs to you both!!
     
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  5. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    A dose reduction to 1.25 should have been done after that drop to 38 on Sept 30. That is a very dangerous number, especially on an AlphaTrak. Then, on Oct 2, you dropped to 1.25, and he went to 20 - an even more dangerous number. That same evening, you went back up to 1.5 though there had been two clear indications that he was probably getting too much insulin. (I am not saying these things to make you feel bad or to criticize you, but I want to explain what I am seeing. Those red flags obviously were not clear to you at the time, but having them brought to your attention may help you see them if they occur in the future.)

    I agree with Linda. I think that I would drop to 1 unit at this point. Things need to be 'calmed down'. You should not see such huge swings. Giving too much insulin will continue to feed the volatility. Hold the 1 unit dose for a few days. Do not adjust based on pre-shot test results UNLESS you get a low enough number that giving insulin would be unsafe. If you get a mid-cycle reading that is too low, another drop may be needed. Otherwise, a dose increase can always be done after you have held the dose a few days. Being very systematic about dosing changes and keeping things as consistent as possible is very important. Feel free to post again for input.

    I would give ProZinc a little more time - with proper dosing adjustments - before deciding to change insulins. I see that you just opened a new vial, so I would say that by the time you are finished with that one, you will know whether to change or not. (I usually got about 3 months out of a vial before I saw a drop in effectiveness though some people say they use their for longer.)

    What is the carb percentage of his food? Besides the meals at shot times, what times does he receive meals or snacks? (For example, does he get one at +5 or something like that?)
     
    MrWorfMen's Mom likes this.
  6. abrudney

    abrudney New Member

    Joined:
    Sep 4, 2019
    Thank you for your response! Yes. I am checking urine for ketones.

    His supplements: fish oil, digestive enzymes & probiotics, feline renal support, psyllium. For urinary support: Tinkle Tonic & Cranberry Comfort For Diabetes: chromium, Ecosulin (herbal blend), DB7 (gymnema & Vanadium) -- Seems like a lot, but the herbal ones he gets just a dusting as he won't eat more than that.
     
  7. abrudney

    abrudney New Member

    Joined:
    Sep 4, 2019
    Thank you for your reply! I agree with going to 1U. Looking at his spreadsheet, his pmps was at its lowest when he was at 1U. If I am understanding you correctly, I should be looking for a 50% decrease, not necessarily a nadir in the 80-120 range? What about symptoms? At 1U he is still drinking like a fish, which is partly why I increased. (Of course, he is drinking like crazy with the bouncing too.)

    I will update my signature. :)
     
  8. abrudney

    abrudney New Member

    Joined:
    Sep 4, 2019
    Thank you!!! I appreciate the feedback. Feel free to critique me! Trying to learn what is best!

    Definitely going back to 1U tonight. He was drinking a ton of water at 1U, which is why I increased. Do you base any of your dose adjustments on symptoms?

    Zero carbs in his food. Raw fed. I am using a couple of herbs but he doesn't get more than a tiny pinch of those. He is a grazer, even though he is raw fed. I make sure he eats at least half of his meal with his supplements in the morning before I give his insulin. Then, on days I work, he will graze over the next few hours. If there is still food when I come home for lunch (+5 or +6) I make sure he eats again. I realize this can contribute to our wacky midday values. On days where I am home, I pick up the food after 2 hours and give him the rest after the next reading so that I know my readings are more accurate. I am not comfortable doing this if I am not home. Would rather he have food available. Treats are 100% protein. Given minimally and usually only when he is ravenous.

    Thanks again! I am sure I will be back with more questions!
    Allison
     
  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Not exactly. You are aiming for a nadir in roughly that range however if BG drops into that range from a starting point of 700+ it's extremely likely there will be dramatic bouncing from the excessive drop. The goal is find a dose where pre-shots are low enough that when BG drops into the ideal range, the drop is 50% or less thus calming down or eliminating the excessive bouncing. A drop from a pre-shot of 200 with a nadir of 80 is far less likely to cause severe bouncing even though the drop may be slightly more than 50%.

    It's actually better to allow Cherokee to have a main meal with shots as well as snacks in between. I would continue with your work day routine even when you are home. While pre-shot BG testing definitely should not be food influenced, the mid cycle tests can be done without concern of when kitty last ate. Spreading out food intake throughout the 24 hour period actually helps stabilize BG.

    Dose adjustments are based on how low the dose is taking BG. Pre-shots tell you whether it's safe to give insulin as well as providing a starting point to determine how much a particular dose is likely to drop BG. Monitoring symptoms like hunger, peeing etc. is definitely needed but those symptoms can change from day to day and are not accurate for determining dose requirements. Those symptoms are more telling when you notice less peeing over a longer period of time along with daily BG testing.
     
    abrudney likes this.
  10. abrudney

    abrudney New Member

    Joined:
    Sep 4, 2019
    I dropped the insulin to 1U Tuesday night. I thought we were headed in the right direction, but bouncing again today. Yesterday our pre-shots were in the 400's (yay) but I think he may have had a little bounce last night as our midcycle was lower than the previous days. This morning, he went from 603 to 85 in 5hrs. Thoughts on how much to give tonight? Stick with the 1U?

    Thanks!!!!!
     
  11. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I think it might be a good idea to drop the dose back to 0.75u for a few cycles to see if that stops some major bouncing. 85 is safe but heading low enough you really don't want Cherokee dropping any lower.
     
    Jenna Josie likes this.

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