Need advice on times of injection

Discussion in 'Prozinc / PZI' started by SallyT, Jan 31, 2020.

  1. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Hi, I’ve been trying to stabilise my cat (P) since October. We started on Caninsulin and just went up and up following tests at the vet. She went into hypo a couple of weeks ago which was really scary and she had to spend the night in an emergency vets ( not our own). She has changed to Prozinc and seems to be doing well. We are now home testing but she gets quite stressed by this and doesn’t bleed easily! We did a curve on Monday. 16.2 at 7 before food and jab, 5.4 at 10.30, 9.1 at 1pm, and 13 at 4.30 pm. My vet has got back to me and said this is still too high but rather than changing the dose (1 u) we should change the times to 7am and 9pm ( we were doing 7 and 7 before) I’m a bit cautious of this as it seems different to what I’ve read online. I have also lost a bit of confidence in my vet and nervous since the hypo. Any advice would be really welcome!

    Thanks!
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hi Sally and welcome. What is your cat's name?

    We use a + hours format to express the number of hours in the 12 hour dosing cycle, where the PS (pre-shot) is the non food influenced number before you give your cat a shot of insulin. 1 hour after PS test is the +1 , 2 hours is +2, etc. PMPS is the evening pre-shot test. AMPS is the morning pre-shot test. Got that?

    No food for 2 hours before you give insulin to get a truer picture of what the BG (blood glucose) is like without food propping up the number. Why? to make sure the BG is high enough before the insulin shot to give the insulin in the first place. We recommend a shoot/no shoot threshold of 200 (11.1 mmol) to start.

    Let's put the numbers you gave me into a more understandable format. Everywhere else, the BG readings are in mmol/L. To convert to US mg/dL is multiple by 18. (SS will do this automatically for the separate US tab if you select the World version on setup. All you need to do is enter your data on the World tab. ) So taking your curve numbers, this is what I get. Is that right?
    So AMPS 16.2 (x 18 = 292)
    +3.5 5.4 (97.2)
    +6 9.1 (164)
    +9.5 13 (234)

    If you would set some info up in your signature and a SS, it would help lots. Especially as I have to convert your mmol BG numbers to mg/dL to understand them better where I live.

    US still hasn't converted to metric system and not holding my breath for them to do that. I'll be dead first.

    Are you in Europe by any chance? Clues for me were you started with Caninsulin (called Vetsulin in the US). Insulin of first choice in the UK. Call me psychic.:joyful::joyful::joyful:

    If you would do that setup, while I work on getting you other answers, that would help immensely. Setup instructions are here.
    New? How You Can Help Us Help You!

    You don't have to do any of that, but it makes life so much easier.

    p.s. No, your vet's suggestion of shot times of 7 am and 9 pm make no sense. Insulin is best dosed at 12 hour intervals. Whatever works best with your schedule.

    Would you share your cat's name with us please?
     
  3. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    When using Prozinc, it's not the pre-shot tests that determine the dose. It's the difference between the pre-shot test and the nadir or lowest point this particular dose of insulin takes your cat. You are looking for about a 50% drop between those 2 numbers. You did not get any test points between the +3.5 and the +6 so the BG levels could have been even lower during that time. Nadirs or lows do not always occur at the same time.

    You got a 64% drop from the pre-shot to the lowest test point. 292 to 97. The dose may be a bit too high actually.

    What food are you feeding? Wet, dry, specific flavors and brands of foods you are feeding would be useful information for me to see.

    Your cat could be getting a bit of extended duration with the Prozinc. A bit of overlap in the doses, so that may be why you are seeing the +3.5 so low so soon in the 12 hour cycle. If you switch the dose so the evening dose is at +14 then the AM dose would be at +10 hours after that and may drop the BG levels even lower earlier in the AM cycle. Then your cats self protection mechanism will dump sugars and hormones into the bloodstream to bring the BG levels up to what it considers "safe". And we'll hope your cat does not have another hypo.

    You might try to get some random tests in that +4 to +7 time frame to "flesh out" what is happening during that time frame.

    Many cats also go lower at night, when they are more active, so getting some tests in the PM 12 hour cycle can be informative. A before bed test is a good one to get regularly.

    Read the dosing protocol that was developed here with the knowledge and resources after many years, with all the Prozinc users we have seen over the years. Not formally published, but a good starting point. There are no formal vet journal articles for Prozinc. I wish there were. PROTOCOL FOR PROZINC / PZI

    Still learning more about Prozinc myself, but I have used other in-and-out insulins.

    Cats will be cats. ECID Every Cat is Different. ECID Every Cycle is Different. Every Caregiver is Different.

    Let me know what works with your cat and your work and life responsibilities and we'll try to suggest different things to make this work for you and your cat.

    Remember, we are laypeople that happen to have had a diabetic cat or 2. Consider us to be an adjunct resource. You should continue to work with your vet and question what we say. To see if it makes sense. Most vets don't have the detail we have, and haven't seen hundreds or thousands of cats with diabetes at their practices.

    Another good resource for you. BEGINNER’S GUIDE TO PROZINC/ PZI INSULIN FOR DIABETIC CATS
     
    Elizabeth and Bertie likes this.
  4. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    What were the hypo symptoms?
    How low did kitty go? to show those symptoms?
    BG reading was what at what time in the 12 hour dosing cycle? for that hypo incident?
    Beginning BG was what at Pre-shot test? during that hypo incident?

    When date did you start the Caninsulin?
    When date did you switch to Prozinc?

    I know I've thrown a lot of information and questions at you today. Hope some of it helps. It's a lot to wade through.

    Please ask me any questions if you did not understand something or if I was unclear on any point.
     
  5. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Hello Deb and Wink

    Thanks so much for your replies and all the thought and advice you have put in.

    My cat is called Patches and we are in the UK well worked out!

    The hype was when she was on Caninsulin 4.5 u. It happened in the evening. Very sleepy, wobbly on legs, she perked up a bit with honey but was then sick an pooed at the same time, by the time she was seen at the vets she was twitching. She went down to 1.4 (or25.2) before she was whisked away to be put on a drip.

    She started on Caninsulin in Oct and was moved onto Prozinc a couple of weeks ago after her hypo.

    Her food is another story! She has always been quite picky. When she first moved in she was given felix. I tried to give her better food but she didn’t like it, so I just thought she’s an old cat so leave her with what she likes. When she was diagnosed in October the vet said she had crystals in her urine so we were advised to give her royal cannin moderate urinary. She are this okay.

    We then saw a different vet in the surgery. She said we should move her onto diabetic food as the info about the crystals didn’t make sense. She gave us some Purina diabetic food. patch loved this at first. ( though her BG was quite low). It was that evening she went into the hypo. We were mixed the old food with the new to get her used to it.

    The emergency vet just said to move her completely over to the Purina as she had been eating different food when she was in with them. patch decided she didn’t like Purina! The vet at our local vet said try different things and she is an old cat so in the end give her what she will eat.

    We tried one they gave us from the vet, raw chicken, cooked chicken but at that point she would only eat tun, and only if I followed her around with it.

    We took her back to the emergency vet because her BG was 29 (or 522) and she had been sick ( not surprising I hear you say). By the time she was seen her BG had gone down to 6 (108). The vet gave her an anti nausea jab which seemed to do the trick,

    So now, and for the last 10/days, she has been eating a mixture of 1 sachet of royal cannin diabetic and 2 sachets of Nature’s Menu country hunter. I don’t know if you get that there but it’s good quality, high protein no grains. She loves this and eats it well. The plan was to gradually move her over to the royal cannin, but as she is happy with what she is getting at the moment I think I’ll leave her with this. Her fur is better and she is steadier on her legs.

    I am sticking to 7 am and 7 pm for now as I’m worried about the vets recent advice. I’ll try and fill in the other stuff later, I need to go out in a minute. I am not keen on doing BG too often though. Patches doesn’t bleed from her ear easily and gets stressed and then doesn’t eat. I want to balance this, so just try and do curves once a week.

    Thanks again for your advice!
     
  6. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hi Sally and Patches!

    Would you update your user profile and think (seriously) about creating a spreadsheet to help us see what is going on? We have a standard format SS that we use here, so you don't have to "reinvent the wheel" and create your own version.

    Directions on how to do that are here. New? How You Can Help Us Help You!

    In the meantime, I'm going to tag a couple of our UK members for you, to give you some local advice on the best meters and such. @Elizabeth and Bertie @Georgiana & Perlutz @Diana&Tom

    I know there are other members in the UK, but those 3 are the experienced members that I can think of off the top of my head.

    Quick summary: 2 different insulins, 2 hypos so far, conflicting advice from various vets, this was her first post yesterday, 1/31/20. Directly in the Prozinc forum. Where scarily, I'm the most experienced person helping out right now.

    Another vet that didn't realize the food switch to a lower carb food could DRAMATICALLY drop the BG readings and cause a HYPO!!!! Hypo was severe enough to cause convulsions and rushed to the emergency vet clinic.

    I haven't even begun to address the questions and issues I see.

    Any help would be appreciated.

    Sally, we may be bombarding you with a lot of information. Please, go back and reread through what has been said. Trying to prevent another hypo and stay at the vet clinic/office/practice for your cat Patches.

    Hugs, :bighug::bighug::bighug: we'll help you all we can.
     
    Last edited: Feb 1, 2020
  7. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Hi and thanks again

    I’ve had a look at the spreadsheet and it’s tricky to set up on my iPad. I’m also really not keen to check BG twice a day. Patches gets really stressed by this process and then doesn’t eat which is more worrying. We keep a close eye on her and monitor water intake etc. She seems to be doing okay at the moment. I’m going to do a blood curve tomorrow so we will see what that says.

    I’m still doing 7am and 7pm injections, but not sure whether to take the vets advice to move to 7 and 9 pm. I’ll see what the curve looks like tomorrow and take it from there.

    Thanks again!
     
  8. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi Sally
    I'm not sure what to say about changing shot times but if your instinct is telling you to stick to what you've been doing, it's probably best to do so until you get a slightly better picture of what's going on with Patches. What will fill in the gaps in this picture is some more bg tests - I know you're not keen to test even twice a day but maybe this is something you can try to get your head round as it's the single most important thing you can do to help her and keep her safe. Very many people here have had issues surrounding the testing process but it's often a question of finding ways to keep both kitty and owner relaxed... there are lots of tips we can suggest that will very often do the trick. I'll tag @Elizabeth and Bertie who has posted elsewhere about her experience with testing a reluctant kitty!

    If you can get into a routine with testing you will find it much easier and it will give you invaluable information about what the insulin is doing as well as peace of mind that you're keeping Patches safe.

    Best of luck!
     
    Last edited: Feb 4, 2020
  9. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Sally
    It can be hard in the beginning and very scary when you see a hypo. Im glad
    you were able to get treatment for Patches and she is ok now.

    We can help you with the spreadsheet. I found it difficult too but I have one on my iPad. @Chris & China (GA) can set it up for you in 5 minutes......I know crazy... it took me hours and I still needed help!:joyful:

    Please think about testing before all shots. It is the one thing that you can do to keep Patches safe. Are you warming the ear first and letting her eat a treat as you do the test?. I found it much easier to let Sheba eat something small as I tested.

    I would stick with the 12 hour cycles (7 and 7)... your instincts are correct. Prozinc is meant to be given at 12 hour intervals.
     
    Deb & Wink likes this.
  10. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi @SallyT , I'm also in the UK. (Waving from Surrey! :bighug:)

    I've been dealing with feline diabetes for 13 years now. My first diabetic, Bertie, was diagnosed in Jan 2007 at age 8. Finding this forum was an absolute lifesaver. I learned how to manage my kitty's diabetes, while keeping him safe from hypo. And my boy lived a long and happy life with diabetes, eventually going into remission. He died last year aged 20.
    I adopted my second diabetic, Bonbon, about a year ago. When I adopted her she was on a dry 'prescription' diet recommended by the rescue's vet, and 4 units of Caninsulin. She's now on a low carb wet diet and has been in remission for a few months.
    Long story short, I strongly recommend the advice from the lovely people on this forum! :cat:

    I do understand that it can be a bit of a challenge at first to get comfortable with testing blood glucose at home (for human and for kitty!). But it can almost always be done with a bit of persistence and sometimes a bit of 'thinking outside the box'. Every cat is an individual, and it is so often a matter of finding a method of testing that works for that particular cat.

    When I first heard of 'hometesting' here I thought it would be completely impossible with my boy. He was 6 kilos of 'attitude' at that time. And if he didn't want to do something then it just wasn't going to happen! But people did persuade me that hometesting was important (and quite rightly!). So, I knew that if I was going to do this I'd need to 'sell the idea' to Bertie in a way that he would be OK with. Then, when Bonbon came here a year ago she brought her own new challenges, and I needed to approach testing her in a slightly different way.

    With both cats I spent quite some time just getting them used to having their ears touched, and to the sights and sounds of the test kit. I found this to be SO valuable and really worth spending time and effort on.
    I'd go to wherever they were in the house, stroke them, then hold or massage one of their ears, just for second or two, then give a couple of treats, and just walk away leaving them to enjoy their reward. Similarly, I'd rattle the test strip vial, or click the lancing device near them (using it rather like a training clicker), then give the kitty a treat or two, and walk away...
    I did these kinds of things probably 6 or 7 times a day intially for at least a couple of weeks. It only takes a few seconds each time. But it gets the kitty to associate these new sensations and sounds with positive yummy things.

    My diabetic boy, Bertie, was strongly food motivated. So I found I could pop him up on the table (our testing spot), crumble a few treats for him, and then test his blood glucose while he was hoovering up the crumbs. It wasn't necessary to hold or restrain him in any way (he'd never have tolerated that!). It only required that he kept sufficiently still so that I could quickly prick his ear and do the test. After a while he would come running whenever he heard me rattle the test strip vial!

    My adopted girl, Bonbon, was not particularly food motivated. And she presented the additional challenge of absolutely hating having her ears touched. Even so, by getting her to associate testing with positive things we did manage to establish a routine that worked for us both. I realised that she loved to be brushed. And so in her case I found I could quickly sneak the test into a cuddle and grooming session, and she barely notices the test. She gets a food reward afterwards too. Now, when she hears me get the test kit ready she goes to her favourite armchair (her testing spot) and 'waits' for me to come and test her.

    I feel sure that, with just a little practice, you will be able to find a way of testing that is acceptable (or even pleasurable!) for your cat. You already know 'how' to test. So it's just a matter of managing to do that on a routine basis. It is so important to test before each insulin shot. We never know when our kitty is going to surprise us with a lower than expected number.... ;)

    Eliz
     
  11. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hypos happen when the BG drops too low.
    If you aren't home testing, you don't know if the BG is too low to give a shot of insulin.
    We'd like to help you help keep your kitty safe.
    And not have another hypo and have you driving in a panic to the emergency vet.

    Have you tried being the "cat whisperer" when testing your cat Patches?
    Have you read this?
    Ear Testing Psychology

    Have you seen this? Marje and Gracie's Testing and Shooting Tips Here is an excerpt from that document.
    "We all know the basics:
    • Warm the ear with a rice sock or a warm washcloth wrapped in a plastic bag.
    • Either freehand or use a lancing device; new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed; then progress to a 31g or 33g which are finer.
    • Be sure to poke in the "sweet spot" and not the major vein that runs along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.
    [​IMG]
    But did you also know there is a particular way for the lancet to be used? It has one side that is beveled so the sharpest part goes in first, if used correctly."

    @Chris & China (GA) helps people set up spreadsheets (SS). Hope she sees the tag for her and can get the initial spreadsheet setup done for you. After that, it's simply signing on to your google email account and updating the SS from there.
     
  12. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Thanks everyone, the tips are all really helpful.

    We do use a rice sock but patches ears don’t seem to bleed much. She has black ears, so it’s tricky to find the vein even with a torch.

    We plan to do a curve tomorrow so I’ll see how we get on. I think part of the problem is that I get really stressed by it too. I know that doesn’t help but I can’t help it. She even refuses treats when she is fed up with us mucking about with her ears!

    What level of BG are we aiming for? My vet says between 11(198) before injection and 5 (90) at the lowest. Is that right? What level don’t you inject at? Do you just miss an injection?

    Thanks again for all the advice
     
    Deb & Wink likes this.
  13. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    • Take a safety razor, and very lightly shave a patch on Patches ear. Black eared moggies can be hard to test. I did that ear shave at first with my black eared cat Wink. It really helped in the beginning, then as I got better with the BG testing, I let the fur grow back.
    • Two pokes, very close together in the "sweet spot". You aren't aiming for the vein itself, but on the outer ear edge, where the capillaries are.
    • Firm backing behind where you are poking. so the ear doesn't move around on you and you have something firm to press against.
    • Sing to your cat while you are doing the ear testing. It helps to calm you down, and if you are calmer, then you don't transmit your stress to your cat.
    • Mindfulness breathing. Concentrate on your breath and block out all those random thoughts running through your head. We all do it.
    The minimum BG reading you want to see right now with your PS(pre-shot) test is that 11(198) before injection your vet mentioned. I would not give insulin any lower than that right now, UNLESS your cat has had ketones or DKA(diabetic ketoacidosis). You have not mentioned that to us.

    For now, giving your cat insulin at a BG reading of 5 (90) at the lowest could cause another hypo.

    That low of 5(90 mg/dL) should be what you are striving for at mid-cycle, somewhere in the +4 to +7 hour timeframe. That lowest point is called the nadir. Nadir is how low a particular dose of insulin takes your cat for this dosing cycle.

    p.s. Sally, would you please put some information into your user profile in what we call the Signature? It's really helpful to those of us assisting you to see that information at a glance.

    Pre-shot BG tests need to be uninfluenced by food, so please take away any food 2 hours before your pre-shot tests.

    There are techniques for stalling if the pre-shot BG test is not high enough. Wait 20 minutes without feeding, test again, if BG reading is high enough, above your threshold (your "shoot/no shoot" BG number). If not, stall for another 20 minutes without food, retest BG, give insulin if high enough.

    You can stall for up to one hour and still keep to your regular every 12 hour dosing cycles.

    You also have the option to skip the dose for this cycle and start up the test/feed/shoot 12 hour cycle at your next pre-shot time.
     
  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Sally, have you told us what type is meter you are using? I can’t see it anywhere. A human meter or a pet meter?

    If you get stressed during testing the BG try humming or singing. It really does work and will help relax Patches as well as cats pick up on our feelings.
     
    Deb & Wink likes this.
  15. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Morning

    I’ve updated my signature (I think)- difficult with space, I had cut loads!

    We’ve managed 2 BGs today. 13.4 (241) at 7am pre injection. 3.6 (64) at 10am. I’m worried that this is too low. She’s not eating well today or yesterday, so that’s not helping
     
    Deb & Wink likes this.
  16. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Just spoken to my vet. We are going to do another reading at 11am and take it from there. I’m keeping a close eye on her so no need to worry!
     
    Deb & Wink likes this.
  17. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Hi Sally,

    Have you tested Patches yet? 3.6 at +3 is quite a drop!

    Please update us if you have a moment...
     
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  18. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Hi

    Yes we re tested at 11am and it just said low! We gave her some honey and treats and it went up to 4 at 11.25am. She also ate a bit. I’m going to take it again in a minute. She seems fine though.

    The vet has said we need to stick to her having 2 meals a day and take her food away after half an hour to train her to do this. (And no injection if she doesn’t eat). I’m pretty sure she won’t do this. She’s an old lady set in her ways!

    My feeling is that we should reduce her insulin, though she is only on 1u. What do you think?

    Also could her going too low be why she has been off her food over the last couple of days?

    Thanks for your concern!
     
    Deb & Wink likes this.
  19. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    And the 1.25 (+6.5) is 7.3. Phew!
     
  20. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Wow - that "low" is worrying, definitely not what you want to be seeing so well done for catching it and giving honey etc. She does seem to drop pretty quickly. It's certainly worth trying a lower dose, 0.5u maybe, see how she goes on that. It may not last as long but it may mean the drop is more gradual... it's all trial and error and may take a little time. Knowledge (bg data) is power...
     
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  21. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Honey and treats can wear off quickly.
    Your cat Patches is not past the usual nadir time for Prozinc. (+4 to +8)
    Please test the BG again.
    To make sure Patches has not dropped below 3.8(69 mg/dL)
    Since you are using an Alphatrak meter, you want to keep those mid-cycle levels above 3.8 (69mg/dL)
    Here is what I have for BG readings so far. +1 means 1 hour after insulin shot, +2 means 2 hours after, etc.

    Do I have this correct?
    AMPS 13.4 (241) 7 am
    +3 3.6 (64) 10 am
    +4 LO (LO) 11 am
    +4.5 4 (72) 11:25 am
    + 6.5 7.3 (131.4) 1:25 pm

    You are correct that 3.6 (64) was too low, especially since you are using a pet specific meter. Then you got the LO (LOW) reading on your pet meter. You knew to give some simple sugar, like honey and treats.

    Cats can go much lower as you have found out. It's why we encourage home-testing. You saved your Patches life today, by testing her BG levels at home. By knowing to test again when you got a low BG reading at +3. By getting another BG reading at +4 and at +4.5 after feeding honey and treats.

    Agree with @Diana&Tom that you need to reduce the dose. Dose is too high. Please give no more than 0.5U of the Prozinc insulin.

    Please do not give Patches insulin if she has not eaten at least 1/4 to 1/2 of a pouch of the cat food, before you give her the insulin.
    With an old lady cat, set in her ways about eating, let her eat when she wants to.
    The only exception to that is before your pre-shot BG tests.
    You want that test to be uninfluenced by food.
    So no food for 2 hours before the pre-shot (PS) test.
    Diabetic cats do better with many small meals a day, just like diabetic humans.
    I agree somewhat. with the "no injection" if she does not eat like your vet said.
    The exception is if Patches has ketones.

    Are you using urine ketone test strips to check for Ketones?

    Not eating enough + not enough insulin + infection/inflammation (think bad teeth or gums) can lead to ketones as her body breaks down fat for energy. More than a trace of ketones, than Patches needs some insulin.
    Do you ever hand feed her? Tempt her with some crushed up treats sprinkled on top of her food?
     
    Last edited: Feb 12, 2020
    Georgiana & Perlutz likes this.
  22. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Are you still having trouble setting up the spreadsheet (SS)?
     
  23. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Oh wow so glad you tested and caught that! This is exactly why everyone should test at home!

    Like Diana said, Patches has definitely earned herself a dose reduction. If her PMPS tonight is high enough to give insulin, I would give 0.25 or 0.5 u and definitely test again at least a couple of times before you go to bed. Do you use syringes with half unit markings? They make life so much easier when you need to adjust dosing like this.

    Are you testing for ketones? (sorry if you already mentioned, I haven't managed to read the whole thread, just from where I was tagged). Ketones can lead to diabetic ketoacidosis (DKA) which can be life threatening. Loss of appetite can be a sign of this. I'm not saying it is, but better safe than sorry! You can buy test strips in most pharmacies (Boots, Lloyds etc) or Amazon.

    Feeding wise, I don't see why she should only eat 2 meals a day, most cats do better on smaller meals spread throughout the day (just make sure she doesn't eat 2 h before giving insulin). If you're not at home during the day, automatic feeders are great.

    Again, well done for catching this low number and for acting so promptly!
     
  24. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I know you are using Prozinc, a U40 insulin. These pictures show U100 syringes with the finer doses. The concept is the same using U40 syringes. Where the plunger is placed is the key factor you are trying to achieve. The syringe pictures show syringes with half-unit markings.

    Fine dose gradations:
    • 0.5U = exactly half a unit
    • 0.4U = skinny 0.5 touching the line
    • 0.3U = skinny 0.5 with daylight under the line
    • 0.2U = fat zero with daylight over the line
    • 0.1U = fat zero barely touching the line
    Pictorial guide using a U-100 syringe marked with half units:

    [​IMG] [​IMG]
    [​IMG]
     
  25. Amy and Socks

    Amy and Socks Member

    Joined:
    Sep 30, 2019
    I'd like to echo what several others have said regarding feeding more than twice a day. I was feeding my diabetic 3 times a day previously and recently switched to a total of 6 feedings (two meals and 4 snacks), and I've seen quite an improvement. I can't say for sure it was 100% due to the timed feeder, but it seems quite likely. He's also a tiny bit less crazy begging for food constantly since he gets it more often.
     
  26. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Hi

    I’m going to test again in a bit.

    I don’t test for ketones, though she has been tested in the vets and hasn’t had any.

    I haven’t been able to set up a spreadsheet. I use a tablet at home and don’t have a google account and it’s not letting me set this up for some reason. I can’t use my work computer for this so not sure I’ll be able to.

    I’m struggling a bit with all of this. I will of course do my best for patches but I also have a full on full time job and other stuff going on. The BG testing is a 2 person job at the moment, so it’s all a bit tricky. I’m off today which is lucky
     
  27. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    I think I’ll phone my vet later and talk to him about giving a smaller dose. I’m not sure my eyesight is able to cope with the 100ml syringes. I’m going to order some with the.5 markings!
     
  28. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Some of those magnifying reading glasses from the drugstore/pharmacy/chemist. To see those tiny doses better.

    Sally, Check your Inbox here on FDMB for a message from me.
    Go to the Upper right of the screen.
    The Inbox is just to the right of your user name.
    Click on the word Inbox and you will see a list of messages.
     
  29. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Sally, we completely understand that this is a struggle and really, you're doing very well so give yourself some credit. Working full time, not so good eyesight, using a tablet at home and other stuff going on are issues to sort out, for sure, but take your time and before you know it you've made more progress. It's important to try to stay upbeat - give yourself a few treats along the way! We recommend wine, chocolate or bubble baths (or even all three together ;) )

    I'm sure the techy people here can advise on setting up a spreadsheet on a tablet - would you like us to ask? And meanwhile, going on today's numbers, you might not need to ask the vet what to do about lowering the dose. You don't want to be worrying about what 1u is doing early in the cycle when you're at work.

    We're all rooting for you :)
     
    Deb & Wink likes this.
  30. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    https://www.vetuk.co.uk/veterinary-...nsulin-syringe-with-needle-box-of-100-p-11335 These are some of the cheapest syringes with .5 markings and they're used by many UK-ers, myself included.

    I know this can feel like having a 2nd job, but it's doable for most. Both myself and my boyfriend have full time jobs but with some planning, we've been managing it for a little over a year now. I bought an automatic feeder for his midday snack, they're inexpensive, easy to use and really useful. Even if you can't test during the day, you can get some readings in the PM cycle, before going to bed. And testing does generally get easier, so much easier! At the beginning I wasn't able to do it at all, I would feel nauseated just from holding him while my bf would test him (I had a blood and syringes phobia). Now? I can probably test him with my eyes closed :D
     
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  31. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Thank you all for your support. It’s also nice to hear others found it difficult to start.

    I have spoken with my vet. He is adamant that we should leave the dose the same for now and to feed her only twice a day. I kind of get what he is saying. He thinks she went too low today because she didn’t have enough food in her. He also says her high is too high and her low too low. I am going to give this a go as I need to trust him.

    So I’m going to feed her later and take the food away after half an hour. If she hasn’t eaten enough I won’t inject. My vet reckons that after a couple of days she will be hungry so will eat at meal times.

    I think I’ll need to give this a go.... My husband will be at home tomorrow so he can keep an eye on her
     
  32. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    OK. Hope it all works out well for Patches.

    Had a stubborn dry food addict diabetic cat. Took 6 weeks for him to really 'get into' eating canned food. Even then, it took some appetite stimulants to help.
     
  33. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    Thanks, fingers crossed she will eat okay later!
     
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  34. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Ok, if you trust your vet, go with his advice but yes, if she doesn't eat much tonight, don't shoot. The golden rule is, when in doubt, don't give insulin - it's a powerful substance and even what seem like tiny doses to us are quite a lot for a cat.
    Whatever tests you can manage at the moment will be useful but always before shooting at the very least. If you end up shooting in the morning at the current dose, the same steep drop could happen so make sure your husband knows what to do.
     
    Deb & Wink likes this.
  35. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes! What about sprinkling a little Parmesan cheese on top of her food to tempt her? Cats like strong-smelling foods and this might encourage her to eat...
     
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  36. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Or warm her canned food a bit in the microwave, so she can smell it better?

    All sorts of things you can do to make the food more appealing to your picky cat.
    I used this document to transition my dry food addict diabetic cat to canned food.
    Transitioning Dry Food Addicts.
    Many of these tips work for a picky eater also. Like the parmesan cheese Diana suggested.
     
  37. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Patches is your kitty and you have the right to choose what you think it's best for her, even if that sometimes means going against your vet. I'm not saying you have to, but just that it's ok if you want to, most of us here have done it at some point.

    For a kitty that went from 13.4 to 3.6 at just +3 and then went so low that the AT couldn't even pick up an actual number, keeping the same dose could be dangerous and cause another hypo... I would reduce the dose to 0.5, given that PMPS is high enough and she eats and test 1-2 times before bed time.

    If you decide to stick to the 1u, please take a couple of readings before bed and if you can, leave her a little bit of food for overnight (if BG drops, some food would rise it up a bit).
     
    Deb & Wink likes this.
  38. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    How did suppertime go with Patches, Sally? I hope she ate enough for you to give insulin? Let us know if we can help with anything else this evening.
     
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  39. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020

    Hey Georgina & Perlutz

    Can I just check how you find those syringes? We had a batch of syringes (from the vets) that seemed more difficult to go in. We have been using the Caninsulin ones which are much more expensive but go in without Patches feeling them. I was thinking of ordering some of the Prozinc ones as they have the 0.5 markings. They are 3 times the price of the ones in your link, so if they work as well I’ll get those!

    Patches is doing okay. She is kind of playing ball with the 2 meals a day and happy in herself. We tested her BG at 12 yesterday and she was 7.2 which was a relief.

    After spending the last few months worrying about her drinking too much, I am now worried she isn’t drinking enough! ( only 150 ml in last 24 hrs). I think I’m just really worried and anxious about her at the moment! (That’s also why I’ve tried not to be on the forum too much. It’s really helpful and the support is great, but it can also raise my anxiety. Not you lovely guys, it’s me!)
     
  40. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi Sally
    Georgiana will answer you I'm sure ref the syringes, but a word on your comment about Patches not drinking as much - this is a good sign!! High blood glucose causes cats to drink a lot of water so if her intake is down, it should mean that her bg is getting better controlled. If you really are worried you can always add a little water or tuna juice to her food to keep her nice and hydrated.

    We totally get your anxiety, we've all been there, I promise you. And it's true, spending too long here can make that anxiety worse - just take what you need here and then go and get yourself a nice cuppa. There's no right or wrong way to use the forums, it's whatever is best for you :)

    Keep smiling and I hope the improvement continues!
     
  41. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Hi Sally,

    Rest assured that there’s no need to spend 2.5x more on branded syringes:) Perlutz has been on both Caninsulin and ProZinc so we’ve been given both brands of syringes with each first vial of insulin. I’ve ordered the Vet UK ones when we ran out and they’re just as good, they have clear .5 markings and they go in easily. We’ve been using them for a year and will continue to.

    Great news that Patches is improving :cat:

    Take care :bighug:
     
    Deb & Wink likes this.
  42. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Good news on Patches drinking less water! Besides telling you the insulin is helping, it also means you don't have to scoop the litter trays as often either. Smaller clumps of litter when you do scoop.
     
  43. SallyT

    SallyT New Member

    Joined:
    Jan 31, 2020
    I’ve ordered the syringes. Thanks for the tips.

    Thanks also for the lovely messages.
     
    Deb & Wink likes this.
  44. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hi, I simply wanted to make you aware of this.

    All the "Sticky" or pinned posts in the Prozinc forum have been updated and there are a couple of new ones.

    Highly recommend that everyone using Prozinc or helping those using Prozinc read them thoroughly.

    I'll be doing that myself. Been expecting this for some time. Came about a week before I thought it would.
    Thanks Marje, and Robert, and especially Djamila for the Modified Prozinc Method. You folks are FANTASTIC!
     

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