Mauer SS/Dose

Discussion in 'Prozinc / PZI' started by SashaV, May 18, 2020.

  1. SashaV

    SashaV Member

    Joined:
    Apr 25, 2020
    Hi guys!

    How many cycles do we need to do before adjusting the dose?
    Mauer is too high, a bit sleepy otherwise no clinical symptoms.
    I've been testing a lot to see how low she goes, shes doesn't go below the renal threshold.
     
    Deb & Wink likes this.
  2. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Sasha, it depends on which dosing protocol you use, and also what Mauer's BG levels are, as to how many cycles it should be before adjusting the insulin dose.

    Any 12 hour dosing cycle with a BG level <5 mmol/L (<90 mg/dL) is an automatic 0.25U dose reduction, with the SLGS or the MPM dosing protocols we use here.

    With SLGS, which is the only dosing protocol you can use right now with Mauer, the number of cycles to hold a dose is 14 cycles. You have to use the SLGS dosing protocol because you are still feeding Mauer dry food. Plus, you need to give the SLGS dosing protocol a decent chance to work. One month is suggested.

    You need to be a little patient here, with the dose adjustments. And you also need to get some additional testing in during the evening/PM/nighttime dosing cycle. To see how Mauer is doing in the evening cycle. You have good test data in the morning cycle, but have very little data in the evening cycle.
     
  3. SashaV

    SashaV Member

    Joined:
    Apr 25, 2020
    To be specific how many additional testing would you like to see during PM?

    Why do cats drop lower during the night cycle?

    I'll hold the dose, and test more :D:)
     
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  4. SashaV

    SashaV Member

    Joined:
    Apr 25, 2020
    Two identical numbers in a row!
    Wtf?
    I'll give her insulin now and get up in 4 hours to test her again.
     
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  5. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Always the pre-shot test, for every cycle.
    At least one more test in every cycle. 2 tests if you can manage it.
    A test around +2 often gives you an idea of where the BG levels are headed.
    A before bed test let's you know that your cat's BG levels have not dropped too low before you head off to sleep.

    You still don't know when Mauer's onset, nadir or duration is. So testing at +10 and/or +11 can often tell you that type of duration information. Varying the mid-cycle test can help you find the nadir. Try a +5 one cycle, a +6 or a +7 another cycle. To fill in the blank spots on the SS.

    Chris wrote about the +2 test being an indicator of what direction the BG levels are headed some time ago. I modified it and added a lot of notes. Copying it here so you can see what I mean.

    With Prozinc by Deb & Wink

    More than a number range, think of the percentage of the drop at +2, that may tell you if your cat is going to drop much lower. Think of that +2 as being an indicator of what direction the BG levels may be headed.
    With Prozinc, if you see a 40%, 50% or greater drop, between the pre-shot and that +2, that's a serious heads up warning.
    If you see a 20-25%, 30% drop, not quite so worrisome. But still be cautious.

    Your cat drops 2 color ranges between pre-shot and the +2, pull out your hypo kit and plan on staying up to test.
    Your cat drops 2 color ranges between pre-shot and the nadir, that is to be expected. But you don't want the drop to be much more than 50% between pre-shot and nadir with Prozinc.
    Cats tend to bounce high if the drop is 50% or more from pre-shot to nadir.
    So you steer those mid-cycles with food, to slow down the steep drop and stop the bounces from being too high.

    It's a balancing act.

    The +2 is like an "early warning" for most cats!
    If the +2 is about the same as the PS, it's usually a pretty normal cycle...dropping down to nadir and then rising back up again. (About the same means taking meter variance, that 15% variance that hand held glucometers are allowed to have into account)
    If the +2 is higher than the PS, that usually signals a bounce, and those are the cycles when you can usually take a break from testing.
    If the +2 is lower than the PS, that's your "Early warning" that kitty might be going much lower later in the cycle so it's important to plan on getting another test or two (or 6) in.

    It doesn’t work every time or with every cat. But it does hold true most of the time, so keep this in mind for next time.

    It also kind of depends on what BG pre-shot your cat started out the cycle with. Lower than normal, keep a closer eye on the cycle. Lower than you are used to shooting, a number you may not have given insulin before, keep a closer eye on the cycle. Stalled and number rose some, but you did a reduced shot, maybe another test or 2 to see how much the number is rising.

    It makes a big difference if your cat starts the cycle in the pink 300-399 mg/dL range (16.6 - 22.16 mmol/L) then if they are in the blue 150 mg/dL range ( 8.3 mmol/L).

    p.s. Food notes in the Remarks column can be very useful. Helps to interpret what is happening in the cycle. Notes are done on AM and PM cycle basis and notations need to be with the + time format.

    Because they are more active. Cats are nocturnal mammals, so they are up and about at night more than during the day. Extra activity burns up more glucose, so the cat's BG levels drop lower as they use more energy. That is one reason.
     
  6. SashaV

    SashaV Member

    Joined:
    Apr 25, 2020
    I've been testing before bed the last month or so. I go to sleep right after the PMPS shot, witch is why its difficult to test PM cycle. Yeah I need the 10 hours sleep and an hour in each end to sleep and wake up :oops:
    I got up last night to test. And today I may have made a curve although I wasn't planning on it.

    Is it a bounce I saw when she got back in the red? She didn't eat in the meantime but got a small snack, so I can't wrap my head around why she rose that high without any reason.

    I'm planning on being patient and holding the dose, unless anyone with good reason tell me otherwise :D
    In the last 24 hours shes been holding quite fine I think, despite eating a tiny bit dry food.

    This must be my life's challenge. In some way I'd wish it would have been me. Or I had diabetes in the first place, just to being able to relate.. and understanding how it works, feels seeing the signs quicker..
     
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  7. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yes, that was a bounce when Mauer got back into the red BG numbers.

    Answered on your Feline Health thread, about increasing the dose.

    I think you could safely raise the dose before the normal 14 cycle SLGS protocol.
    Mauer was doing a bit better on a slightly higher dose.
     
  8. SashaV

    SashaV Member

    Joined:
    Apr 25, 2020
    Deb, I might have ****ed it up.
    AMPS was 14, so I didn't think she could hold the 1.5U so I gave her 1.2U.
    She went weird on me last night. Wouldn't eat but ate snacks, drank more than usual. Maybe the raw meat was too hot for her liking and the dog was barking.
    But today there's nothing everything is as usual.

    Was it a mistake to give her a smaller dose or should I just have followed the plan?
    To be honest I'm a bit afraid of the "good" numbers and to bump her too low :oops:
     
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  9. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    No worries.
    Live and learn. Our cats are always surprising us with what they do.
    There is no insulin "depot" or storage area with Prozinc insulin.
    So you can increase the dose on the next cycle. I see you already did that.
    Or wait. It's really up to you Sasha. You make the final decisions for Mauer. We simply try to guide you and make recommendations to the best of our abilities.

    You want to see Mauer down in the blue and green numbers. Those green numbers are giving Mauer's pancreas a rest and time to heal. So the low numbers may be scary, but they are what Mauer needs.

    But you don't want to have a BG level that is very low, down into the neon green numbers. You don't want to see Mauer down THAT low. If/When you do, you give some food support to bring the BG levels back up quickly above the 2.7 mmol range (the 40's mg/dL). You test and feed until you see the BG levels above 4.4-5 mmol/L (80-90 mg/dL) for a couple of hours past normal nadir time.

    We have a saying here. "Feed the 40's" that only makes sense when we are talking in mg/dL terms.
    For you that saying would be "Feed the 2's". Doesn't sound as good saying it that way. But hopefully you get the idea.

    It's a holiday weekend here in the US. There will not be as many people around to help.
     
  10. SashaV

    SashaV Member

    Joined:
    Apr 25, 2020
    Thanks Deb!
    I increased the dose PMPS. I realized during the day that she should have had the full dose. But now I know.

    I know it's my decision, that you're not vets and it's only recommendations from your own experience. But I'm so grateful this site exists and you guys use your time to guide us!

    I know the green is the best and blue the next best thing. It's just so scary :oops:

    Thank you again for all your help, and happy holidays :bighug::bighug:
     
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