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New here and Concerned about the numbers.....

Discussion in 'Feline Health - (The Main Forum)' started by Goose, Oct 3, 2019.

  1. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Hi all,

    New to this site and feline diabetes. My cats name is Do daa and he is 11.5 years old, 14.5 lbs. and has recently been seen by the Vets and diagnosed with diabetes.

    (Yikes this is a long post!)

    He is a diehard dry food only cat for his whole life and I know that's a problem in the long run. He has currently been weened off the original dry food Friskes Seafood Sensations and is currently on Dr. Elseys Clean Protein Chicken.
    He is supposed to be eating just a little less than a full cup (.90) at (450-470 cals) a day. We have broken it down to 1/3, 1/3 and 1/3. He is also a diehard Grazer and does not eat a lot at any one given time. 10-20% of a 1/3 of a cup. Transitioning him to wet food, if possible, will take time. This is a stressful time for all involved.

    He has yet to eat the full 1 cup requirement per 24hrs. but seems to be progressing towards that goal a little each day. Dr. Elseys is 59% protein vs. FSS at 30% and it's taking him longer to digest? His bowel movements are normal so far. There it no unusual walking.

    He is on Prozinc with the dosage at 2 units in the morning, and 2 at night, a total of 4 units per day. He has only been on Prozinc since mid day last Friday Sept. 27th. 2019.

    I'm using the Relion Prime meter with u40 syringes. Test strips are current.

    We are very new to all of this. A couple of times this past week, he has been high "HI" on the meter which means 600+.

    The vets are closed on the weekends and on Wednesdays (issues on these days of course) and we've had to wing it logically a couple of times.

    I'll give the numbers for the days so far: (TEST/FOOD/INSULIN is the procedure)
    9/27: The day he was taken to the Vet
    He had his first shot around 1230pm
    1048pm 511

    Was not told to leave food for him overnight and then... crashed in AM.

    9/28: 934am 35 - tested again - 46 no insulin given (very lethargic) Did not know about Karo Syrup at this time or didn't hear from Vet. Information overload.
    952am 51 tested again 57 then ate food

    1134am 118
    133pm 366
    535pm 427
    931pm 504 insulin given
    Food left overnight

    9/29: 922am "HI" per meter 600+
    937am insulin given
    1147am 413
    604pm 559
    937pm 375
    951pm insulin given
    1133pm 278
    food left overnight

    9/30: 849am 112 food but no insulin given
    954am 107 (Called Vets because of these numbers - down after food?? Went to Vets, left him there all day, they tested our meter against their "pet" meter, apparently ours is less accurate at the lower end of the numbers 20-30 points - according to them. Picked him up at 530pm, big stress on Do Daa all day, no eating no peeing. Not helpful.)
    846pm 460
    902pm insulin given
    food left overnight

    10/1: 850am 373
    901am insulin given
    851pm 68 no insulin given
    10:06pm Checked again 79 - no insulin given

    food left overnight

    10/2: 854am "HI" per meter 600+
    859am insulin given
    1050am 592
    255pm ( 6hrs after does) 502
    842pm 157 no insulin given
    food left overnight

    10/3: 837am 573
    849am Insulin given
    846pm 180 no insulin given

    *(The food left overnight has been 1/3 of a cup or slightly less)

    All the blood work tests were done including a urine tests all of which came back normal except for the high
    glucose. Which started us on this journey.

    I am confused by these results. Is Something Wrong?
    Many of these days he has only received 2 units in the course of the day.
    If it's below 200 we do Not give him insulin. A couple of times it's been really high in the AM and really low in the PM.
     
  2. Margie and Jackson

    Margie and Jackson Member

    Joined:
    Apr 26, 2019
    Yikes. I hope you get responses from people familiar with Prozinc and more experienced in general, but that seems like too much insulin. You could also try the Prozinc forum for folks who use that insulin.

    You might read in the stickies about the somogyi effect, in case you want to bring that up to your vet. This is when too much insulin can cause high blood glucose.

    Good luck, and I’m sure you’ll get a more experienced response soon.
     
    Amina&M'row likes this.
  3. Panic

    Panic Member

    Joined:
    Apr 10, 2019
    Hi Goose! I agree, 2 units is definitely too much for him. You don't want him going lower than 90 on a human meter when he's on ProZinc. The high numbers you're seeing are bounces, it's his body's way of protecting himself from dropping too low. The body dumps excess glucose to protect itself and thus we get those really high 500-600s. He definitely needs a reduction ASAP. I'm not experienced enough to give a suggestion of how much though.
     
    Amina&M'row and Nan & Amber (GA) like this.
  4. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Welcome, and well done with the testing!

    I do not use ProZinc, so I can't advise on dose, but it does look like the 2U might be too much for him.

    One thing you could do to help people evaluate the data you have is to put it in spreadsheet form. We have a common format we use on this forum (click links in most of our signatures to see examples). Instructions here:

    FDMB SPREADSHEET INSTRUCTIONS

    Let us know if you have any problems setting it up and putting a link in your signature.


    What you are probably seeing is a phenomenon called "bouncing", which Elizabeth explained very well. The thing that makes it extra-tricky to figure out is that the bounces can last a while-- up to three days! This is one reason we like to see the BG data on a spreadsheet-- sometimes you have to be able to look at patterns over several days before you can see what is going on, and the spreadsheet gives a nice visual shorthand.
     
  5. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    I agree with @Nan & Amber The dose is too high and Do daa is trying to compensate for that.

    Tagging @MrWorfMen's Mom for you. She knows more about prozinc than I do.

    In the meantime, please read about what to do in case of a hypo. The information can be found here.
    Symptoms of & how to treat HYPOGLYCEMIA - what to do if your kitty experiences hypoglycemia
    Jojo's Hypo Tool box - be prepared, what to have on hand in case of an emergency

    It is good to print them out and have them on hand.

    The only time you need to pick up food is 2 hours before shot time so that the shot test is not food influenced. Until you start shooting a lower dose, I would leave food available at all times.
     
  6. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Hi and welcome to you and Do Daa! So glad you are home testing and caught those lows and not given insulin at low pre-shots. The starting dose of 2 units is roughly double what a normal starting dose is. The problem is that our kitties are notorious for being stressed at the vet and that leads to elevated BG. That elevated BG often leads to the vet prescribing a higher dose of insulin than is needed and it only becomes apparent once kitty is back home in their own environment.

    The other thing that may have caused some of the low numbers is the change of diet. The difference in the carbs in Friskies dry food vs the Dr. Elsey's is substantial and has likely brought about a lowering of BG. While a kibble diet is not optimal, the Dr. Elseys is an acceptable low carb option. I know only too well how difficult it can be to get some cats to transition to a wet diet. I fought with my girl for quite a while through our journey. Just keep trying.

    Does Do Daa have any history of ketones or DKA (Diabetic Ketoacidosis)? If not, I would suggest you reduced the insulin dose to 1u twice daily as long as pre-shot is 200 or higher and mid cycles tests are not dropping below 90. I'd hold the dose for a period of at least 5 days to start and then re-evaluate.

    It would help us help you if you would set up a spreadsheet and keep it updated with your test results. We are very data oriented here and the spreadsheet will give you a great way to track progress in a very visual way and keep information readily available so you don't need to type out a list of readings to get help. If you need any assistance getting the spreadsheet set up, just holler. We can set it up for you.
     
    Amina&M'row likes this.
  7. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Hi Goose and welcome to you and Do Daa. You have come to the right place for information and support to help Do Daa get his BG (blood sugar) regulated and feeling a lot better.

    Please create a signature so that we can see Do Daa's information right away when you post.
    Setting up your signature (light grey text under a post). Here's how:
    click on your name in the upper right corner of this page
    click on "signature" in the menu that drops down
    type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what he eats/any other meds or health issues he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.

    Nan gave you the link to the spreadsheet, and here is another link that explains how to understand the spreadsheet:
    http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

    When you set up the signature and then the spreadsheet, it's very helpful to put the spreadsheet link (eg. Do Daa SS) at the very end of Do Daa's info, even make it bold so it stands out.
    The instructions tell you how to create a text link (the URL spreadsheet links can be very long and take up a lot of room and signature space is limited).
    Much easier to find, just in case you have a bit of an urgent event or question and the spreadsheet data needs to be consulted.

    Will Do Daa eat canned food at all? If he is willing, and you decide to transition him to a low carb wet diet, here is a Food Chart from www.catinfo.org by Dr. Lisa Pierson DVM. Dr Pierson recommends " start with protein minimum of 40, fat maximum of 50, carb max of 10, and for cats with kidney issues....phos less than 300."

    Many members feed Fancy Feast Classics, Friskies pates or 9 Lives varieties, because they are available and affordable. If you worry about him having food when you are at work or during the night, many of us use a timed feeder so that compartments can be set to open at certain times, and food will be available. Many of the feeders have little ice packs that fit under the dishes so that wet food stays cool and can be used in warmer environments.
     
  8. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Thank you all for your replies! I've yet to test him, but will be soon.

    How do I start a private conversation?
     
  9. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    You click on the person's avatar, then click "start a conversation"
     
  10. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Again, thank you all for your assistance. I will be going through this thread in the coming days.

    Do Daa's BG tonight was 337 and he was given a 1U dose. We're going to re-test at 1130pm to see what 1U is doing with BG at 337.

    Tested at 1130pm - BG at 205. Not sure what it will be in the AM.
     
    Last edited: Oct 4, 2019
    MrWorfMen's Mom likes this.
  11. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    We had been giving Do daa 1U at night and 2U during the day (only 2 days tho) after a brief conversation with the vet because of the up/down/bouncing- but that doesn't seem to have helped much. Having the dosage different in AM and PM doesn't seem to be helping. This is indeed frustrating.

    I have the last couple of days numbers but today he was high all day.
    840am 558
    857am 2U insulin given
    1140am He ate some wet food for the first time in a long time
    3pm 516 - because of the wet food?
    843pm "HI" 600+
    9PM 2U insulin given ( we felt it necessary to give 2U tonight because of the numbers...)

    I haven't looked at the spreadsheet information yet. Someone mentioned that they could assist with that I believe if needed.
     
  12. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    It takes time to get anything close to regulation....be patient! It was a good 5-6 months before I started to see anything that resembled a pattern with China.

    ProZinc can be dosed based on the Pre-shot test, but we've found it usually works best when you give the same dose both AM and PM …...and it's important to test in between the shots too so you know how low the dose is taking him.

    I'd suggest dropping back to 1.5U and holding that dose for several days. Let's see how he's doing then. 2U dropped him too low, so it's best to drop him back a little until you get more tests in.

    I'd be happy to set you up with our spreadsheet. Just click on my name and choose "start conversation" to send me a private message so I can get some information
     
  13. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Hi Chris & China,

    Your suggestion is to give him 1.5U during the day and 1.5U at night? Does the constant changing of the dosage help or hurt?

    2U was given today because he was high in the morning, and really high at night. I haven't noticed 2U bringing him down too far... like going from 500 back to 300. It's seeming like 100 points is about it. But without the spreadsheet, I'm guessing it's hard to see a bigger picture.

    As mentioned above, he was high all day 840am 558 - 2U insulin given - 1140am ate some wet food - 3pm 516 - 843pm 600+ - 2U insulin given. Given this info. how would dropping him to 1.5U twice a day help him?

    Does hunger play a role in increasing BG? We gave him 2U at 9pm and tested him again (no food for 2hrs) at 1130pm and the meter still says "HI" 600+.
     
    Last edited: Oct 6, 2019
  14. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    The fact that 2U dropped him to very low numbers on 9/28 is the reason I suggested a lower dose. It's always better to start lower and gradually go up.

    Yes, 1.5 both AM and PM.....Usually we suggest giving the same dose for both shots at first anyway. With ProZinc, you can give different amounts, but we've seen better results with a consistent dose. If it doesn't end up working well for Goose, we can always try a sliding scale dosing later.

    Until his numbers are lower, he'll want to eat more than normal, but the only time it's really important that he not eat is for the 2 hours immediately before Pre-shot tests so you get a number that's not influenced by food. In between shots, you can feed multiple mini-meals which are easier on the pancreas than 2 big meals per day.
     
  15. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Chris,
    These numbers were today/tonight 10/8:
    850am 560
    902am 2u given
    309pm 208
    850pm 535
    858pm 2u given

    Your suggestion is nearly the same as @MrWorfMen's Mom.

    Common consensus is that starting Tomorrow AM/PM I'll start giving ( Do Daa ) 1U of insulin No Matter His High Numbers. Suggestions for how long this should go on before I see any results? What exactly am I looking for? A 100, 200 base point drop constantly? Or?
     
  16. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    @Goose ….we're very data driven here so we need to get you a spreadsheet for you to put your numbers into.

    I'd be happy to help you with it. Just send me a private message so I can get some information from you. Click on my name and choose "Start Conversation"

    We also need you to fill out your "Signature" so people can quickly see which insulin you're using and get a little background. You'll see our signatures under each of our comments. Things we like to see are:

    Your name/Cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues or medications? and a general location.

    We want to see a nadir around 90 with Pre-shots around 200 but that will take time to achieve. For now, I'd just stick with the 1U dose (if that's where you've decided to start) and hold it for at least 3 days and then let's see where you're at.
     
    Last edited: Oct 8, 2019
  17. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Chris, etc,

    I started Do Daa on 1U yesterday morning.

    847am 356
    904am IU given
    3pm 560
    843pm "HI" 600+
    852pm 1U given

    Today:
    842am "HI" 600+
    852am 1U given
    303pm "HI" 600+
    900pm "hi" 600+

    I'll included tonight's readings later, which will be the end of day two at 1U.

    As of right now, and can't see 1U helping him at all. Is this how it's suppose to be? Because it seems he's constantly Really high. I don't want to do damage.
     
    Last edited: Oct 10, 2019
    Reason for edit: added info
  18. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    High numbers do take time to do damage...it's the low ones that kill quickly but yes he may need more insulin. I think I originally suggested 1.5

    We really need to see his numbers on our spreadsheet though. Without the spreadsheet, you're really tying one hand behind our backs.

    Are you testing for ketones? You can get urine ketone test strips at any human pharmacy. Here are some Urine Testing Tips
     
  19. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Yes, you did originally say to start at 1.5U. I figured that 1U was as low as I would go as not to overshoot a correct dose for him.

    I have been speaking with MrWorfMen's Mom about the Spreadsheet. She has indeed agreed to help me with that. She has been Very helpful.

    I have yet to do the SS because I have a clear dislike for Google, however I think we may have found a work around for the phone number exposure - a requirement for a gmail account apparently. I appreciate my privacy and am always online with a VPN.

    I have not been testing for ketones. He had a complete blood panel and urine test not 2 weeks ago, everything was fine except the high BG.

    I just gave him 1.5U tonight. I'll continue with this dose and hopefully we''ll see some improvement.
     
  20. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    The Net has been down for a couple of days due to the power being out, so no access to the site. Luckily the generator did just fine.

    We've been continuing to test, lately about a week or so 3 times a day, AMPS, +6 , PMPS.

    Do daa is still up and down, readings like 120 - 600+. Today marks the 8th day at the 1.5U morning and night, as Chris suggested. Nothing has been steady so far but he has shown little effects aside from noticeably drinking water and peeing a lot. No other outward signs.

    I did test Ketone once and it was negative. How fresh does the urine have to be? It was in a clean puddle on some clean plastic sometime overnight.

    I'm ready to get some help with the Spread Sheet if anyone can get it up and going for me. I have lots of numbers.

    Thanks!
     
  21. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Hey, Goose, sorry you have had power outage. That is always difficult.

    Please get your signature for Do daa done, and you can click on Chris & China's picture or name, then choose Start a Conversation. She is one of the members that helps others with the spreadsheet set up.

    Setting up your signature (light grey text under a post). Here's how:
    click on your name in the upper right corner of this page
    click on "signature" in the menu that drops down
    type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using/glucose meter you're using/what he eats/any other meds or health issues he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.
     
  22. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Signature is all set.
     
    Idjit's mom likes this.
  23. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    The spreadsheet has been set up. I've PMd you the link for your signature.
     
  24. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'm wondering if the dose is still too high but the testing being done is not necessarily giving you the full picture of what is going on. It's also possible you are seeing glucose toxicity from sitting in those high numbers for so long.
    ProZinc's peak action (nadir) is generally any time between +4 and +7 post shot. Getting a test at +6 every day is great but it may be that the lowest point in the cycle is occurring before +6 and therefore you are never seeing it. Also, you have very little in the way of night time data. If you can grab a test every night at +2 or +3 and again before you go to bed, it will help you see what is happening during the night cycle which is important since our kitties have a tendency to go lower at night than they do during the day.
    Do you have syringes with half unit markings? If not I would suggest getting some so that doses can be adjusted in 0.25u increments.
    Try to randomly get some tests in during the expected peak period when possible and some night tests and let's revisit the dose again in a couple of days.
     
  25. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Hi,

    The dosage Do Daa is getting is at 9am, check at 3pm, and dosage at 9pm. It's the schedule that works best.

    If he's given a test (+2) after 9pm - (11pm) - since he's a grazer - am I suppose to withhold food again, (9pm-11pm) for those 2 hours? Testing him 4 times a day is going to put his paws in tender shape at one point...

    We've tried 1u twice a day, 1.5u twice a day, 2u twice a day - none of this, according to the SS is working.

    Should we try to switch from (+6) to (+4) to see if there is a lowest point in the cycle? Wouldn't 1/2 way through the cycle (+6) be logical for the lowest point? Or is he just flat out getting too much insulin at 1u, 1.5u, or 2u?

    I do not have the syringes with half unit marks yet, I'm about half way through the first box of regulars, but will be ordering those soon.

    I've added the last two days to the SS.
     
  26. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You need to take the pre-shot test without food influence (fasting). Food doesn't matter when it comes to any other tests that you take.
    Half way through the cycle (i.e. at +6) is not necessarily the lowest point and right now you are trying to find the lowest point so see if Do Daa is dropping lower than you are currently aware. If it's possible, to keep testing to a minimum, just do one test on each cycle sometime between +4 and +7. One day do the +4, the next +5 and so on.

    If you use a different paw for testing each time, there should be no problem. Have you tried testing Do Daa's ears? Being able to test in both locations would give you more options.

    Do Daa's numbers seem a bit better on the 1.5u dose but it's still unclear whether a slight reduction or increase is needed because we really don't know what he's doing on the night cycle at all.
     
  27. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Hi,

    He's just about as inactive during the day as at night. Testing more at night especially after 11pm is not likely. We need to find the best dosage without numbers past 9pm or, if we decide to, 11pm.

    The +6 numbers on the SS have been completely withholding food between 1-3pm for his +6 test. Does this matter? Doesn't the food effect the +6 number just like the AMPS and PMPS? Or at AMPS/PMPS we're just concerned about insulin amount to give him...?

    We started doing the testing in his ears, he doesn't like it at all and blood was forming between the layers. We do not want to give him a hematoma, we've dealt with that before in another cat and it was expensive to fix. He is much more compliant testing with his paws.

    So tomorrow we should do the +4 test, next day +5, next day +6, next day +7? (just to +7?) Just to see if there are any differences in the numbers from just the +6 test?
     
    Diane Tyler's Mom likes this.
  28. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Yes that will help us see what is happening.

    If you hold mild pressure on the poke spot after testing, there should be no worries about a haematoma. That said, if Do Daa is Ok with paw testing, then use his paws.

    It's entirely up to you whether you will do a test on the night cycle or not however, without any night data, figuring out the best dose is going to be difficult if not impossible. The night cycle is half the day and often there are lower readings overnight than during the day cycle. Insulin dosing should be based on how low the dose is dropping BG so missing that data will make it harder to help Do Daa.
     
    Diane Tyler's Mom likes this.
  29. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Ok, for the next 4 days, the testing will change to that. He seems ok with the paw testing, it's just the frequency that might be harder on him eventually.

    So people are getting tests in during an entire 24hr period? I can't see many people getting up at 2am, 3am, etc to test. What do you consider the night cycle?
     
  30. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    There are folks who do test through the night. Some will test if they get up to use the facilities. Others set an alarm. Most will test before the shot, a couple of hours later and then before bed but that depends on your shot and bedtime.

    I am not suggesting you get up in the middle of the night to test. Tests done in the early part of the night cycle can be a good predictor of what the cycle looks like which is why we suggest a couple of hours post shot and before bed. Even if the before bed test is the only one on the night cycle, it helps.
    Look at the SS like a jigsaw puzzle. The more pieces you have the clearer the picture. Obviously you'll never get all the pieces, but random testing rather than always testing at exactly the same time every day, fills in the missing pieces.
     
    Diane Tyler's Mom likes this.
  31. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    So the 9pm PS test and say around 11pm would be ok? Having food would not be a factor at 11pm test? Or any other daytime test?

    Yes, this seems like quite the jigsaw puzzle.
     
  32. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Exactly! Only the pre-shot tests should be fasting. :)
     
  33. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Okie Dokie :) We'll see how it goes. For the next couple days, you mentioned we should stay at 1.5u. I'm not sure where we'd go from there..
     
  34. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    That was why I asked about the syringes with half unit markings. If you can get some syringes with the half unit markings, you'd be able to do 0.25u dose changes which are preferred to 0.5u because tiny dose changes can make a big difference for cats.
     
    Diane Tyler's Mom likes this.
  35. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    hi,

    I just tested for ketones in urine stream, it came back negative. I took his BG at +2 from pmps and it went up from 433 to 520 at 1.5u. Why?
    SS has been updated.
     
  36. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    I think you could go up to 2U at your next shot. We usually suggest increases in .25 unit increments, but with him running so high, I think it's your best bet.

    Glad you're testing for ketones and that he's negative...keep testing, especially with him running so high

    It's really weird that he went so low on 2U before.....Are you 100% sure you were giving 2U?

    And are you using U40 syringes? or have you changed syringes?
     
  37. Goose

    Goose Member

    Joined:
    Oct 2, 2019

    How will more insulin be better? I'm having a difficult time understanding this. He seems to be stuck between 400-600+ no matter the dosage which is getting us nervous for his health.

    When we were first starting out, the Vet showed us how to measure 2U with the syringe. We were at 2U day/night per the Vet initially, per my notes. 2U seems to be keeping him abnormally high. He has seen a lot of Bouncing. Even 1.5U seems to be keeping him very high as you can see on the SS. This mornings reading was 402 however. It's more difficult to measure/guess where 1/2 is on the normal U40 syringes.

    As we look at the syringe, should the back part of the rubber plunger be resting on the 2U mark leaving the space from the front of the plunger to the next mark a .5 unit? Or should the rubber plunger be in the middle with insulin on either side? Does the width of the plunger take up a .5 unit? We may have been giving him to little insulin at the 1.5U giving him 1.25U instead....

    How often should we be testing for ketones? He is drinking a lot and peeing a lot. Other than that, he's alert and eating when he's hungry.

    We are using the U40 syringes given to us by the Vet and have not changed them. We are in the process of ordering 1/2 unit marked syringes, we'll see.
     
  38. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    It's more important to be consistent on your dosing than exactly 1.5 or .5 or 2.5, etc.....so when you're doing 1/2 unit increments, decide what .5 is for you, and try to replicate it as closely as possible every time.

    If you find a syringe that you feel is pretty accurate (lines all seem to be straight and in the right place) you might want to use that one as a "sample"....draw up some colored fluid like juice, coffee, Kool-Aid, etc. to wherever you want the dose to be and then you'll have something to compare to.
     
  39. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Do Daa was give 2U tonight as he was 573. Updated SS.
     
  40. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    At +2 pmps he is Up to 585. 12 points higher on 2U.
     
  41. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Went back to 2U as recommended on 10/23 at night, and 10/24 in the morning - went Straight up as per SS. I'm thinking 4U a day is to much, 3U a day still had him really quite high.

    We went back to 1.5U tonight but even then, as you look at the SS, 1.5U twice a day is not helping him out of the high 400's to 600's.

    Any ideas guys? Should I go lower that 1.5 twice a day? Insulin overload?

    Suggestions welcome from all.

    I have the 1/2 mark syringes coming.
     
  42. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    12 points is really nothing. It's nothing worth worrying about at all!

    Often, when we first increase, for a reason we don't understand, the numbers go up. We even have a name for it....New Dose Wonkiness (NDW)

    I really think you need to hold the 2U dose for at least 6 cycles and we'll go from there.

    Do try to get a couple of tests on the PM cycle if you can. Not always just a +2
     
    MrWorfMen's Mom likes this.
  43. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    2U for 6 cycles = 3 days? oops.

    NDW happened for the first 7 days and he was on 2U. We stayed on 2U after that for 3 more days, then per recommendations, we went to 1.5U for the last 14 days.

    On the SS, the first time he was on 2U per the vet he bounced and crashed. He seems to have gone up in BG the entire time he has been on 2U day/night. This also seems to be happening on 1.5U, although no bouncing to low numbers, he's in the 400-600 range consistently. We've noticed that when he was on 2U he was drinking a lot, lately it seems to have lessened on 1.5U. He is not ravenously hungry either, he eats his allotted 1 cup (470-500 cals) per day.

    I am failing to see how more insulin is going to help him, even 1.5U seems like it's too much, according to his Spread Sheet information. Are you seeing something that I am not?

    +2 for us is 11pm, so no testing after this point, sleeping. I'm afraid for his organs and his health looking back over the information and seeing such high numbers consistently. Kentones were tested tonight, they are Negative.
     
    Last edited: Oct 27, 2019
  44. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Chris asked me to respond as she isn’t feeling well tonight.

    2U for six cycles is three days.

    I will be quite honest; I’m not a PZ user and haven’t dealt with it. But, with any insulin, you have to know how low the dose is taking the kitty and cats often will be low at night. I’ve seen cats go from 400 to 40 to 400 in one cycle and without the midcycle tests, one would think they are just high.

    I know it’s difficult to get up at night but with no midcycle night tests, I’m not comfortable making a comment whether this dose is too high or too low.

    There is indication that he’s definitely come down on the 1.5u dose but you are going to have to decide if finding out where he’s going at night is worth losing a little sleep for a few nights.

    edited to add: NDW never lasts for 7 days. It’s usually 24 hours or less.
     
    Last edited: Oct 26, 2019
  45. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Hi,

    As I look at the SS, 10/6, 10/7 and 10/8 he had 2U night and day. Other than the numbers that are all over the place at the beginning with 2U, those are 2U numbers for 3 days in a row.

    How many nights do you suggest? + what after his 9pm Shot?
     
  46. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Sorry....because you didn’t tag me, I didn’t see your question. I kept coming back but figured after Sunday morning that you weren’t around.

    I see you’ve been getting another test in at night and that helps. I would suggest a +2 and +6 test; you can mix it up, too. Another night, get a +3 and +7. A couple tests a night will help. It’s not possible to say for how many nights because it depends on how he does.

    However, it certainly looks to me with the last few nights’ tests, that he needs an increase to 2u if you can and will test.

    To tag any of us so we see you have responded, just go to the post where we responded and I’m the far right corner, click on “reply”. We will get an alert that you replied just as you should get an alert on this response.

    Also, you can tag members by just putting the ampersand in front of their user ID in your text. As an example, to tag me, you’d type @Marje and Gracie. Once you start with a User ID, it will give you a drop down box of members to select from.
     
  47. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Hi,

    Sorry about that.

    Given that 3 day stint at 2U and the bouncing in the beginning with 2U, and 1.5U giving him consistently high numbers - how will giving him more help? Isn't he already getting too much insulin and his body is fighting this? - isn't that what another poster had suggested? Glucose toxicity?

    A quote from MrWorfmens Mom in one of the posts above: " I'm wondering if the dose is still too high but the testing being done is not necessarily giving you the full picture of what is going on. It's also possible you are seeing glucose toxicity from sitting in those high numbers for so long."
    -- The dosage he was and still is on as of this quote above is 1.5U day/night ... to much?

    +3 after 9pm is all that's reasonably attainable for extra numbers at night.
     
  48. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    You had zero nighttime tests for the dates you gave so missing half your data means you can’t interpret anything from those dates.

    Glucose toxicity is when they are hyperglycemic too long. The consistently high numbers start to impact the body in negative ways and cause increased insulin resistance making it harder to get to a dose that works.

    While it might look to you that the BG was seeing a lot of variation, it wasn’t on those dates.

    What Linda (@MrWorfMen's Mom) was saying is she couldn’t tell whether the dose was too high or too low and glucose toxicity has set in.

    It looks to me like 1.5u is not enough insulin. I know he has dropped low on it before and there are reasons why he likely did:

    • insulin syringes are notoriously inaccurate even some being up to 0.5u off; many use calipers to dose accurately especially if more than one person is shooting
    • absorption can vary up to 50% from shot to shot
    • If you don’t test enough to know onset, nadir, and duration then you probably aren’t feeding the curve appropriately and if food is not given at the right times, numbers can tank even if the dose might actually be ok
    • things change; diabetics can be affected by things such as barometric pressure
    I have seen cats on this board die from prolonged hyperglycemia and definitely hypoglycemia when vets instructed the caregiver to shoot a dose (too much as it turned out) without testing. Both are terrible deaths.

    The only way we can really help you and find out what is going on so we can get the dose to the right place is for you to test enough, even just for seven cycles, at one dose so we can see the full picture. It’s your decision whether you want to do that or not.
     
    Last edited: Oct 31, 2019
    MrWorfMen's Mom likes this.
  49. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I agree that it looks like an dose increase is needed. I think 2u would be safe given how high BG is but if you are still concerned about going up to 2u, then getting syringes with 0.5u markings would be an alternative as that would allow you to more accurately increase in 0.25u increments.
     
    Marje and Gracie likes this.
  50. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Sorry but I don't see a signature with all the information about your kitty,food, type of insulin, dated diagnosed, etc
     
  51. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Not sure why you aren’t seeing it. It’s been on there for several days.
     
  52. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi Marje when click on her avatar this it what I get
    Feline Diabetes Message Board - FDMB - Error
    This member limits who may view their full profile @Marje and Gracie
    I get this on a lot of other members on here, I just want to see the name of their cat, the insulin used, meter, just the usual stuff someone puts in their signature
    I even get this if I click on FurBabiesMama , it's weird
     
    Last edited: Oct 31, 2019
  53. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Oh...so sorry. I thought you meant in the signature block. I am sure that is what he meant, too. What you are referring to is the profile. It is a member’s prerogative as to whether they want that info out there or not. They can choose to keep it private. It’s also possible they don’t know they can edit it.
     
  54. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    If I go to Goose avatar and click on it it will say . Profile Page. Follow and then ignore, but no word that says information
    Then I click on Profile Page and that's what comes up.
    I was just wondering how would someone be able to see the information about their kitty, no biggie
     
  55. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Because I have Moderator’s permissions, I can see all of it but I do know what you mean because, before I had Moderator’s permissions, there were many that I couldn’t see. I know exactly where you are talking about, but, again, it’s up to Goose as to whether he wants to change it. Some people really want privacy and don’t want to have that information out there. Yes, it makes it much easier for all of us because when I was not a moderator, if I was looking for a member’s posts and they had it selected like Goose, I couldn’t find their previous posts.

    But again, either he isn’t aware that is how he has set it up or he wishes it to be that way.
     
  56. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Thanks Marje I was just always wondering why?
     
  57. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I don’t know...it’s just the way the board was set up so members could maintain some privacy. There are scammers that come on the board.
     
    Diane Tyler's Mom likes this.
  58. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    The SS has been updated from last week. We had 179k in the area again without power, so no Net was available. Twice in the last 2 weeks, the first was over 200k without power.

    I've gone back to the original decision by the Vet, the dosage was 2U in the AM and 1U in the PM. This testing dosage has been going on for 5 days already. We'll carry on with this testing dosage for the 7 days as mentioned, if he's doing better, we'll continue longer. Let me know your opinions....

    Let me know how the SS looks to you guys. Within the past day or two, the numbers look a little better. I've noticed that with the advent of wet food, he is drinking less water. Before he was drinking like a fish.

    The wet food, Fancy Feast Classic, has been introduced into his schedule for eating as his first choice. He's eating about 25% of the 3oz. can at a time, and then some of the Dr. Elsey's dry cat food until he's finished eating.

    I do have the 1/2 syringes now if suggestions on insulin need to be smaller dosages. Not great to hear that the syringes are notoriously inaccurate....

    The added wrinkle is that we have a total of 8 cats. 5 are indoor only, the other 3 are in and out. These are drop off strays for he most part who have wandered here over the years and stayed. All have been fixed and aside from one, all are over 10 years old. 2 out of the 8 are MANX, with a 3rd almost a MANX with 3" tail.

    So, some of my frustration is coming from the fact that separating them so Do Daa can eat is more difficult. He is the only cat we have ever had who has diabetes.

    Thank you all for your help so far, it is appreciated.

    In my Sig:
    Do Daa (male cat), 11.5 years old, First Diagnosed 9/27/19, Prozinc insulin dosage 1.5U at the moment, Relion Prime, Dr. Elseys Clean Protein, No other meds or health issues. Goose in Coastal Maine. Do Daa's SS
     
  59. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    While giving different doses AM vs PM can work for a few cats, it's generally something that is only works once kitty is reasonably regulated. The full unit difference between the AM and PM doses is huge and at this point in time, I think it's just setting Do Daa up for more bouncing and skews the view of how much either dose is dropping BG. Consistent dosing at least until kitty is regulated is recommended. It doesn't look to me like numbers have changed much if at all on the new dosing.

    I would suggest trying 1.75u consistently morning and night along with some monitoring to see how that works but the decision is yours to make.
     
    Diane Tyler's Mom likes this.
  60. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Hi,

    We wanted to try the Vets numbers more thoroughly as not to completely dismiss her suggestions.

    1.75U am and pm is upping his dosage to 3.5U per day vs. 3U per day now. Is this the route you'd like me to try? Slightly more insulin for better numbers? How long do we try this dosage? We did the 2U am and 1U pm for 7 days.

    Don't know how accurate/consistent I'll will be trying to get 1.75U each time if the syringes are notoriously inaccurate.

    The SS is updated. The numbers do seem to be constantly high still no matter the dosage. But, seeing a lot more in the 300's and 400's now also....
     
  61. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I suggested 1.75u because that would be the next logical dose adjustment based on the data you have. 1.5u wasn't enough and we recommend 0.25u dose increases so as not to inadvertently miss the best dose. You were giving 3u per day and increasing each shot by 0.25u will increase the daily dose to 3.5u. We usually just refer to the singular dose amount here.

    I'd hold the dose for at least 3 days (6 cycles) and if numbers are improving, up to a week. And don't forget to get those night time tests EVERY night. If you make it a habit to test Do Daa as part of your bedtime routine, it will become second nature. Most cats go lower at night than during the day so missing that data leaves half the picture blank.

    While syringe markings can be inaccurate, the important part is to be consistent. Get a used syringe and draw up what you consider to be 1.75u using coloured water. Use that sample syringe as a way of measuring future 1.75u doses consistently.
     
  62. Goose

    Goose Member

    Joined:
    Oct 2, 2019

    Ok. So starting tomorrow morning through Saturday we'll set the dosage at 1.75 am and pm and see what his numbers look like Sunday AM. He actually ate 3/4 of a fancy feast can today, he hardly has ever eaten wet food for 11 years, but still likes the crunch of the dry food more.

    :)
     
  63. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Just noticed you are shooting different doses a.m. and p.m. I agree with @MrWorfMen's Mom that this is not the best strategy. I thought you were going to shoot 1.75u twice a day? He looks to me like he needs more insulin at a consistent dose.
     
    Diane Tyler's Mom likes this.
  64. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    We went back to what the Vet had suggested to us more than a month ago, 2U am, 1U pm - we did that for a week for consistent numbers on that dosage.

    We just started him on 1.75U or a rough/best guess on the syringe, on 11/7. I've noticed that he's numbers are showing more 500's than the previous 300's with 2U/1U. We'll see what they look like after 3 days like MrWorfMens's Mom mentioned. Seems like this isn't getting easier to find the correct dosage.
     
  65. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I’m afraid I can’t comment since the SS isn’t updated. But it is really my thought that his dose is going to need to go up above 2u; however, it’s best to get there by 0.25u increments after doses are held several cycles.

    You haven’t found the right dose because you’ve been holding the wrong dose for too long ;) And you only recently started testing more at night (great job!!) so that we could actually see the dose wasn’t correct. We have found that dosing different amounts just doesn’t work in cases like this. Vets suggest it because they don’t understand FD.
     
  66. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Holding the dosages that we have tried was based on getting a consistent, thorough readings over a/the 3-7 day stretch. We've come a long way in 6 weeks, and dosages have been different many times since the beginning.

    I was planning on updating the SS on Sunday when there were more numbers available. Testing more at night is more difficult as +3 at his 9PM shot is 12AM. Do Daa is being a good sport about it but obviously we'd like to find the correct dosage or maybe switch to a different insulin if this one is proving non-effective.
     
  67. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    With his numbers, I wouldn’t be holding doses 7 days. Why leave him in higher numbers? PZ is not a depot insulin like Lantus and Levemir and so you easily see the effects within a 3-6 cycles of consistent dosing.

    None of us can give dosing advice if the SS is only updated once a week. We typically say give an insulin like Lantus, Levemir, PZ six months of proper dosing and see how it goes before switching. Of course, it’s fine if you choose to switch to Lantus or Levemir. They are more gold standard insulins. But the approach is completely different.
     
  68. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    I really don't want to leave him in high numbers at all, and his Ketones have been negative. The SS is usually updated a couple times a week or more. I was just going to wait to update it until I got more numbers on 1.75U, no other reason. We are absolutely looking for proper dosing as soon as we can.
     
  69. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    The standard here is to update the SS as soon as you test. That way, if he drops, everything is current. If the SS is not current, it limits our ability to help you.
     
    Diane Tyler's Mom likes this.
  70. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    SS is updated.
     
  71. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Thank you!

    If you don’t see any blue numbers tonight, I’d raise the dose to 2u every 12 hours in the morning.
     
  72. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    SS Updated.

    No blue numbers. He hasn't been in the blue in a long time. We'll start 2U (am/pm) in the morning. This will be for the same 3/4 days?
     
  73. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    If you can get a few tests tonight. Honestly, unless you see lower than 200, you should not hold any dose longer than six cycles.

    Thanks for updating!
     
  74. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    I'm not sure I understand. Any dose longer than 3 days? So if 2U doesn't work than ..

    He's been in the 200's 6 times since we started.
     
  75. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Things change. The longer he’s at high numbers, the more resistance to the insulin. We are just looking where he’s been most recently.

    So yes, I’d give 2u every 12 hours for three days. If no numbers below 200 and you have enough tests for us to tell he didn’t likely go lower, then we raise the dose to 2.25u every 12 hours.
     
  76. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Looking back over the SS, he's been quite high to really high the whole time. I would rather he not develop a resistance to the insulin. Now, is that just a resistance to Prozinc or all insulin?
     
  77. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Likely all of the longer lasting insulins.

    He’s been high because your vet had you drop the dose back and then shoot different doses a.m. and p.m. And....we needed more tests to see how low he might be going. All these things contributed to numbers staying high longer.
     
  78. Goose

    Goose Member

    Joined:
    Oct 2, 2019
    Well, the Vet is another story altogether.

    Ok. Well, we'll start with the 2U tomorrow morning thru Wednesday and see how he is on Thursday.

    Ketone test is negative.

    Updated SS. He went up 89 points. No food since last test at 9pm.
     
    Last edited: Nov 10, 2019
  79. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I have moved the remainder of this post to the PZ Forum. It can be found at Do Daa’s PZ Dosing.

    Any further comments on Do Daa should be submitted on the linked thread above. Thank you!
     

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