Discussion in 'Prozinc / PZI' started by christobevii3, May 2, 2017.
273+ 4, hoping for a good AM number. Thanks for guidance on keeping it at 1.5u
248 AMPS, sticking with 1.5u and can check at lunch easily. Had upset stomach at +11 too. Hadn't had issues with the food prior but the dog was sick two days before so maybe pet flu or something?
The yellow says the bouncing has stopped (until next time) so you should get a good idea of what 1.5 u can do today. Hard to say about the tummy upset. Could they both have gotten into something they shouldn't have?
Dog i think just ate too fast but then he didn't eat much for last two feedings so who knows. Rat terrier so very temperamental. Cat i don't think so. Only thing I could see out was bowl that had ice cream in the sink and rinsed out. Shouldn't have been enough in that water to do anything. Just seems odd to throw up that much after 11 hours from eating. Then of course the smaller rat terrier ate it up before my wife could clean it up *gag*.
If Mason's stomach was empty at +11 stomach acidity can irritate and cause clear, foamy vomit. People whose cats have a chronic problem with that will use human Pepcid or similar to help. I don't know enough to advise on its use.
376 at +6. So still high but hopefully will see things drop at PMPS from here. Was hoping to see a high 100 or low 200 today.
381 PMPS so sticking to 1.5u for longer.
Yep, I think that's a good dose for now!
474 at +2 ouch!!! Possibly 1.75u is right and if low a 1.25-1.5 is ok. Maybe being too cautious?
Bouncing and possibly a bit of a food spike. Hang in there.
440 at +3 so right direction. Wife is going to bed so no +4.
430 at +4 so a little better.
I'm sometimes the dissenting opinion, so take this with a grain of salt, but if it was Sam, I would try the 1.75 again. You got a long cycle from it, but only once. If you wanted to try it again, just make sure it's a cycle you can monitor in case I'm wrong .
I'm new to this, but I thought it's bad to keep changing the dosage so often, and especially not more than half units.
At the beginning of Mason's spreadsheet, where you see the 4u and 3u, those were from the vet. Vets often prescribe too much insulin because they base the numbers on in-office BG tests which are stress-inflated, or the fructosamine tests which show an average, but not the actual impact of a dose.
The drop down to 1.5 units was the beginning of using the procotol here. The increase to 1.75 was a small increase based on the pre-shot and nadir numbers that christobevii3 was getting. The reduction back to 1.5 was based on the AM cycle on 4/6 which showed the insulin lasting too long during that cycle. When it lasts too long like that, it sometimes means too much insulin, so we recommended reducing the dose.
christobevii3 is able to make dose changes as often as 3-6 cycles because he is monitoring closely at home - getting consistent pre-shot tests before every dose, and getting frequent mid-cycle tests so we can clearly see the impact of each dose.
I hope that all makes sense. If not, please feel free to ask for clarification.
I tend to agree here...it looks like 1.5 has been given a good run now and when you get a chance, going back up might help. But I would make sure you can monitor..
387 AMPS and already gave 1.5U so after todays +6 if it is still on the upper end of 300's I'll move back to a 1.75u tonight.
I'm convinced. Let's see what 1.75 u can do tonight.
Yes, when Chloe was first diagnosed, she was put on 2 units. The first curve was done a couple weeks later at the vet. I have the scores somewhere. The highest number was in the 500's and I was told that the numbers were very high and the vet was worried, so she increased the dose to 2.5 units. Chloe hasn't been at such a high dose since I found this forum.
385 at +6. Definitely looking at 1.75u for tonight. Looks like a 1.5u dose keeps things averaged around 380 with a few anomalies like the 248 AMPS or the mid 400 areas.
Can't get much flatter than that, huh? Have you tested for ketones yet?
363 PMPS so went to 1.75u. Definitely a predictable reading though with dosage. My alphatrak strips got delayed in shipping and down to two more. So will save for tomorrows AMPS and PMPS unless I can get some at the vet tomorrow or delivery updates for tomorrow instead of thursday. Hadn't got ketone strips yet.
372 AMPS with another 1.75u. So nothing new so far. Strips updated for delivery today so can test at lunch.
Three cycles at 1.75 u and then up to 2.00 u. You'll get there but he's safe along the way.
464 at +6. Wrong direction for raising the does to 1.75. Any thoughts?
Still bouncing I think. He might have gone lower last night. It's best to just look at overall colour trends on the SS instead of trying to figure out individual numbers.
I agree to raise dosage to 2 units after a couple days.
Got the new strips in before leaving for work from lunch. First group were batch 7 and these are batch 38 for cats. Reading of 421 with the new batch so maybe just an oddball reading earlier.
354 PMPS with new strips. Still relatively in the 380 + or - range even with higher does. I'll test the +2 and +4 tonight. Would be feeling a lot better if I was averaging around 300 like the couple of good days earlier on.
I know this is a strange question to ask when you're getting such high numbers, but do you know how to steer a hypo? Do you have a hypo kit?
The reason I'm asking is that I'm thinking you should raise the dose tomorrow evening (since you can monitor more in the evening than you can during the day). And then continue to raise the dose every 3-4 cycles (only on cycles you can monitor!) until you start to get some mid-cycle drops. Right now your cycles are upside down which usually indicates that the dose is too low.
So back to the first question: when you start to raise the dose, there is always the possibility that Mason will react and drop lower, so I want to make sure you're prepared and confident about that before we start messing with things too much.
It is easy to monitor on Friday evening thru Sunday evening. Weekdays I can do pre shot, lunch, pre shot, and 4 hours until bed.
I'm not sure if I have a hypo kit...I've seen references to having honey in case it drops or a high carb food (feral cat outside has dry food). Let me search and see what I need.
Also, rechecked him since I actually checked 20 minutes earlier than feeding. 464 now. I went upto 2u. Guess food stress when his numbers are high and a little more hungry makes him impatient.
Here are the links to the hypo information: http://www.felinediabetes.com/FDMB/threads/hypo-links-be-prepared-just-in-case.48385/
And just to clarify, I do think that holding a dose for three cycles is important to avoid getting weird numbers -- that's why I recommended going up tomorrow instead of tonight. That being said, I think Mason is safe from going up tonight -- it's just that raising quickly without giving enough time for the dose to settle can sometimes causes wonky cycles that make us all scratch our heads and doubt the next step.
Understood. I figured up tonight since he had spent some time at 1.75u and saw good numbers one cycle but not now. Also, it would give us enough cycles to plan something for friday evening or saturday.
423 at +2 so at least a drop from the PMPS.
I really do think Mason's fine with the dose tonight...just wanted to clarify for future dose changes.
Also, setting him up for the weekend cycles makes a lot of sense, so well done!
422 at +4 so not movement really so far. A single visit reference due to the local vets not knowing much about cat diabetes had them write me a prescription for lantus. How long would you stick with prozinc after we go through dose raising before considering it? Could it also be more related to psychological obsession with food? Maybe look at getting a timed feeder with a cold pack to feed mid day or twice during the day?
The how-long-to-stick-with-it question is really hard to answer at this point. I think it depends on response once he gets to a dose that gives some better curves. If he gets drops into the greens, and those show some consistency, then you could stick with it. If he just can't sustain those and the PS numbers don't budge, then I'd say switch. Fingers crossed he responds well to this though!
I'm a fan of several meals or free-feeding, so I vote yes on the feeder. It could be psychological, but at the numbers you're seeing, I'm more inclined to say it's because he can't get the nutrients he needs out of the food right now and he really does need more food than he would if he had regulated BG.
Ok, I'll look at ordering the feeder for him. I could always feed a can at lunch but not everyday without the feeder. His initial issue with eating was obsessing about dry food so the behavior is there and todays test 30 minutes before feeding and at feeding showed that large difference. Also, am asking since I will probably need to get another bottle of prozinc in a few weeks is all. I guess I can order that and give it another bottle and see.
Any thoughts on that oeverpaw meter? Strips look significantly cheaper if the accuracy is ok. May end up getting that. Strips look like they take more blood but shouldn't be too big of an issue. 150 strips for everpaw at the same cost as 100 for the alphatrak
I've only ever used a human meter, so I don't really know what to suggest about that. All I can say is my strips cost way less than either of those!
To be honest, if I was ordering new insulin, I would probably go ahead and get Lantus. Prozinc works great for a lot of cats, but I like the logic of Lantus. I imagine that the longer a kitty spends in healthy numbers, the better they'll feel, and the depot insulins keep their numbers more consistent instead of the smile curves that we get on prozinc. If you look at Sam's numbers right now, he doesn't have much of a curve - so I think he's doing well on prozinc. But I guess if it was me, I'd use the prozinc while you have it, but if you don't see some good responses by the time you need to re-order....then maybe switch at that point?
If you do decide to switch though, the Lantus protocols are written for human meters only, so you might consider switching meters to a human one instead of the Everpaw anyway. Then you can just use the AT2 to give numbers to your vet (if s/he requires them for a new prescription).
442 AMPS and 334 at +6. Gave a can of food to test if that takes pre feeding stress down.
424 PMPS so another 2.0 and slight improvement from yesterday and this morning
Yeah! Great to see that drop mid-cycle today, instead of a rise!
Yes, I'll take anything at this point. He seems happy but I know he can do better. He is growing some hair back on his hind legs too that had been bald on the insides.
430 at +2. I want to see if anything improves then next week take the numbers to the vet and see if I should continue with prozinc or lantus on next refill.
Are you going to increase to 2.25u tomorrow for the PM cycle?
Most likely will unless I start seeing a high 200 to low 300 number.
If you increase tomorrow night, you could probably (assuming no surprising numbers pop up) increase to 2.5 on Sunday morning, and have Sunday AM/PM to monitor a bit and make sure he's safe before going back to work on Monday.
Of course if he suddenly starts dropping or bouncing, all bets are off! I'm just a little worried about him being up in the pinks and reds for too long and would love to see him get some better numbers. It is good to hear that he's seeming happy though!
540 first test at +4 and was so bewildered I tested again and got 488. Any thoughts? Not really sure what to think here besides prozinc may not be ideal for him (he's calm as can be laying on shoes right now) and with slight dose increase going up higher than the previous 1.75 with lower numbers. I did feed a can midday so possibly high food bounce? I'll try to replicate feeding a can with Lilly to share at lunch.
When he was on vetsulin I did not test we saw a weird response. He would not be excessively urinating for a week on a dosage raise and then regress back to same as before.
His behavior, uriniation, and fur though says he is doing better. Just BG says no.
Hmmm....any chance it was a fur shot? And you are feeding fancy feast classic pates? or a different type? Any pets in the house eating a different food that he might have gotten into?
It's likely just an unfortunate cycle, but figured it was worth looking around in case there was another cause....
The dogs and cats are separated for feeding and nothing but fancy feast classic fed. I gave the shot about 10 minutes after feeding (forgot). I think we can just say fur shot then to be safe for now too? I really was careful to be sure it was in though.
As frustrating as it is to do a fur shot, when you get numbers like this, you almost hope it was that and not just that the insulin isn't working!
Another way to look at it though is that you've actually had similar cycles before. On 5/8 AM cycle, he went up 128 points, 5/8 PM cycle, he went up 93 points, 5/10 AM was up 92 points...so this cycle he went up somewhere between 64 and 116 points, depending on which reading is closer to correct. So this time it looks extra ugly because it hit a black number, but in terms of relative response, it's not far out of line with what you've already seen.
It might be a combination of being a bouncy cat and not yet at a high enough dose. The way forward is careful increases every 3 cycles, numbers permitting. You don't want to leave him high any longer than necessary because glucose toxicity (which is reversible at a high enough dose) can impair insulin response.
Sorry for the late response. I have been gone so trying to do some quick check ups on everyone before I head out again today! I did look at Everpaw pet meter because test strip price seemed better than AT2 but decided not to go with it due to less knowledge and it does not seem user friendly. This was just from what I looked at online so no "real" experience. I know we're not suppose to enforce this method, but I use Free Style Lite test strips in my Alpha Trak 2 meter. About half the price of AT2 strips but you have to do multiple comparison tests between AT2 strips and FSL strips. I couldn't just tell you the difference between mine, everyone's is different I can explain more in detail later but I just got a call to get job site
324 PMPS!!! I haven't seen a pre shot number that decent in a long time. I went ahead and went with the 2.25u shot. I didn't make it home for lunch so no mid day test sadly and only did 1 can each for each cat this morning. Was planning on giving a can at lunch.
*paws crossed for yellows*
358 AMPS was decent but back at 445 +4. I'll check again at +6 and probably +8.
Come on, Mason! Down, not up!
Chris, 4 things. 1. Can we clarify your name? lol. I think we just keep adding a letter or two and removing them. 2. Will you be getting a picture of Mason for your avatar? Or at least post one? 3. Either tonight or tomorrow morning, may want to start a new thread. 4. Have you tested for ketones?
We'd definitely love to see a picture of Mason!
YELLOW?!?!? You got a yellow!!!!!! That's awesome! It's a long cycle again, which are always a little perplexing to interpret, but I think your decision to stick with the regular dose was the right choice. I know you'll monitor him to make sure the overlap doesn't mess with him too much. The PM shot should kick in a little after +2, but based on your last long cycle, the AM dose should be gone by then. Post if you get anything weird tonight though.
Name is Alex actually, name is just an online name. Tonight at +3 were at 385 so good sign so far in the right direction after last week. Why a new thread and not continue the current? And no haven't tested for ketones yet. The vet had a handful of times though when they did curves and didn't see anything.
Here's a picture:
284 at +5! Still high enough I think that I can sleep ok but might be looking at a 2u pullback in the morning!
181 AMPS, went ahead with 0.75u since I'll be around today to monitor. So this would be third blue pre shot so guessing 1.75u to 2.25u is the sweet spot when Mason decides to calm down
I think we might just be moving his doses up a little too quickly, and he needs a bit more time to settle in. Although it's great to see that blue!
One trick when you get a lower than normal pre-shot is to stall 20 minutes without feeding and retest to see if the number is rising. You can repeat the stall/re-test for up to an hour without messing up your insulin schedule. Sometimes in that last hour, the insulin will rise over 100 points, so if it's lasting just a bit longer than usual, you can get what looks like a low pre-shot, but 20 minutes later, would be a totally normal pre-shot. So using the stalling trick can end up with him getting a normal dose of insulin instead of being high for a cycle. Of course, sometimes it doesn't work, and the cat really does need a reduced dose, but the stall helps you tell the difference between a real low and a low that's just the result of timing.
When a thread gets up over 100 posts it can be difficult to find info. That's why we suggest starting a new one when yours gets to that length. Your kitty is awfully cute!
What a cutie . Basically, what Kris said. I guess we could call it forum etiquette?
What an adorable kitty!!!!
Bad numbers last night but sticking with the 2.25u dose for now. I think if I see a high blue number like on the 14th I'll look at 1u to 1.25u. I think we're narrowing in on a 1.75u to 2u shot though.
Hopefully he starts giving you some lower numbers soon!
ETA: Stalling and retesting to see where he goes is a good idea if you get those lower preshots.
I'm so sorry he hit those high numbers! Don't worry, you'll get him back on track! If it's possible with your schedule, I would really recommend trying the stalling technique on those low pre-shots. If there's anyway you can safely stick with the regular dose, that will help him, and stalling gives him a chance to rise into safer numbers.
EDIT: Djamila is right, stalling is better if you can do it!
I think you'd be okay to increase the dose again if you feel ready for it.
I actually did and didn't put it in... read my mind
Think I may have a bounce moving to 2.5u. I'll see in the morning but won't be available to test in the afternoon so if low or high I don't want to adjust too much. Still hoping to see an improvement by the end of next week before I decide to get more prozinc or move to lantus.
I think you're still quite safe to do your next increase assuming a typical pre-shot tomorrow. However, it looks like at 1.5, 1.75, and 2.25 it was the third or fourth cycle that ended up being long, so you may end up with a lower-than-normal pre-shot tomorrow. If that does happen and you can stall in the morning then you could shoot the 2.5 again, and then increase in the evening.
306 AMPS, went up to 2.75u despite a decent number. I can't decide if a little premature but the progression has improved in the last few days.
Very nice number...pinks are better than red!
I think the increase was needed and not premature. It's great to see some improvement, but remember that you're aiming from blues and greens, so there is still a ways to go. Keeping the increases coming steadily is important to get him into safer numbers. You're doing a great job!
What?!?!? A yellow mid-cycle?!? Did you do a happy dance? Go Mason!
It's great to see a couple of yellows appearing! If you feel ready for it, I think you can safely raise to 3.0u. His evening cycles are still looking inverted and he has plenty of room to drop still.
206 AMPS!!! I'll see at +3 or +4 tonight. I think I'll go ahead and re-up on prozinc instead of moving to lantus. He was active out in the front all day today. Even swatted at our rat terrier when he got up in his face. Usually he just cowers and runs so good signs. Might be looking at possibly a slightly higher dosage at evenings vs morning with the numbers we seem to get?
What!??! That's awesome!!! I might recommend getting a +2 tonight since you shot the full dose on a 206. His history of long cycles that end up high make it unlikely he'll drop, but since this is the lowest you've shot it would be good to check earlier than later.
It's great to hear he was out and more active today!
You may end up with different doses, but I would wait until we start to see some blues or greens at mid-cycle before you do that. It's not uncommon to spend some time in this journey with an AM dose and a PM dose.
Woohoo! That's a great preshot!!!!
386 +3 tonight so no worries. So possibly look at a 2.75U if sub 300 in the AMPS and in the PMPS look at a .25U higher?
I'm thinking hold the 3.0U unless he gives you another low 200 PS. This might be bounce cycle 2, and they can last up to 6 but we'll see what the others think.
The morning doses are trickier since you aren't home until +6, but at this point, I think you can pretty safely shoot 3u (we'll see after today's dose) into the high 200's, with maybe just a little reduction into the lower-mid 200's.
As far as separating into an AM dose and a PM dose: you don't want the two doses to get too far away from each other as it can cause one of the cycles to become unpredictable, however I've seen being off by 0.25 work pretty well. Again, I would wait until you're seeing a better reaction in at least one of the cycles before you split them, but if you really want to do it now, you'll need to hold both doses at 3.0u for three cycles, and then raise just the PM dose for three cycles, and then go back to raising both doses again. The reason I am suggesting waiting is that doing that slows the overall increase, and right now, I think Mason needs more insulin sooner rather than later. It's really not good for him to be in these high numbers for so long. So I would rather see him continue to do the AM/PM increases until we see some better numbers, and then do the increase on just the PM cycle at that point.
Also consider that we really don't know how low he's getting during the PM cycle right now, nor do we know where he's at during +3 of the AM cycle. That makes it hard to fairly compare the two cycles. It's possible that he's hitting yellows by +6 at night (most cats run lower at night than during the day), and it's possible that if we had +3's during the day, they would look just as inverted as the PM cycle +3's do. So that's another reason I would hold off -- the data isn't all that clear at this point. You could set an alarm for a couple of nights to try to grab a later cycle test during the PM cycle, or wait until there's a day when you can run another curve to get a clearer picture of if those two cycles are really that different.
I just wanted to check in and see how Mason's doing? And also, would it be possible to get a curve sometime this weekend? It looks like there is some bouncing happening based on your last two AMPS's, so might be helpful to get a peek along the curve.
I can try to get one tomorrow. Been busy with a work transfer, buying a house, and getting this house listed. I think I miss shot two nights ago so good to see better numbers today.
Ah! Now that 515 makes perfect sense! Yes, glad he's back in better numbers today. And huge congrats on the new house!!! Hopefully you're old one will go quickly!
Wow! Lots going on for you. Congrats on the move!!!
Yeah, lots! Old house is a trailer home we own out right and lot so no big deal there. Job transfer is great and allows us to grow up some and have to be adults. Mason numbers are starting to get more predictable too. 239 PMPS
That's great on all counts! And two yellow pre-shots in a row is pretty fantastic. You're doing great keeping up with the steady increases too. Hopefully soon you'll hit a dose that will bring those mid-cycles down into healthier ranges.
Been cautious about raising and get a random 71 number tonight PMPS. Any thoughts? I gave food already and no shot, but may check in 30 minutes and do a small 1U if it bounces back up. Such a bizarre reading after testing at lunch at 300.
83 now 10 minutes after eating
It's a good idea to do another test right away when you get a totally unexpected result like that 71. You could go with your plan of giving a small dose.
114 at 45 minutes so went with 1u
137 at +2 so looks ok doubling and not going up like crazy. Hoping to see a 200 at +4 so don't have to worry tonight. Morning numbers will be interesting for dosing. Mason is still acting normal so not too worried right now.
Separate names with a comma.