? Planning Ahead And Looking For Advice

First I'd like to mention I am apart of a couple different feline diabetes support groups and also ask for advice through them. Also since he is on Prozinc if his dosage is a single number like 1 or 2 units we use the U40 syringes (they don't have the half markings) and if our dosage needs middle numbers we are using the conversion chart for U40 to U100, which is why our doses are 2.2 or 2.4, etc.

Okay I just want to try to set up some sort of plan for my dosage with Tootsie. If you look at my chart he started out at 2units of Prozinc and we kept him there while we transitioned his food to all low carb wet. We held everything for a few days and did a curve. I then went to the group and asked for advice and we decided to move him up to 2.4units. We got into our first blue numbers with this dose during mid cycle of the second night. Then on 7/2 his AMPS was in the 300s and he went up at +4 and +5 so we thought we maybe got a fur shot that morning. So I came for advice and we decided maybe the 2.4units was a little high and we would drop him down to 2.2units for a few cycles. But then we did his PMPS and he was in the blue numbers (first time for this before a shot and especially since he was in the 300s during the day) So then I thought maybe he was doing a bounce? Don't really know because I'm still so new to this. Again asked for advice and was suggested to give just 1unit instead of skipping all together because he was seeing good numbers, so I did. Then this morning his AMPS was in the 400s again so I did 2.2units and he was 177 at +5. Now depending on what happens tonight at his PMPS what do you think we should do? If he's higher stick to the 2.2units or if he is lower again reduce the dose? His numbers are just really confusing me.

On a side note he is doing really well. He hasn't ever acted sick since being diagnosed. Just did lots of drinking and peeing. The drinking has slowed down dramatically and his urine output has gotten better. He is getting all his water from adding it to his wet food. And he doesn't act as hungry anymore either like he was in the beginning. Still bathes himself, cuddles, purrs, pooping and acting normal.

 

Hi Ashley-

There are a number of different protocols and approaches to dosing, and they are each effective in their own way. Having been part of three different FD groups myself, I see benefits to each one, although I'm partial to the one we have here since I've found it to be the most effective for my cat and my life/schedule. While each group has its strengths, mixing and matching can be dangerous. I would suggest that you take some time to really dig into each of the groups you are involved with, decide which approach will work best for you, and not go from group to group asking for advice. Pick one and stick with it for a few months. Then if you aren't seeing the results you want, consider one of the other approaches. This dance takes time, and being consistent in your approach will give Tootsie the best chance for safe progress.

 

I really only use this group and one other. I follow a few different groups but don't post in them. This group and the one I post in are pretty similar as far as protocol. I post in both to try and get more responses. So far I haven't gotten much of a response from either.

 

I would say that the 2.2u is your better dose right now. The high cycle yesterday morning was most likely a response to the 102 the day before. 102 isn't low, but it's lower than Tootsie has seen before, so her body reacted. When you got the blue PS number, the stalling technique would have been the first step: Wait 20-30 minutes without feeding and test again. See if the number is showing a rise. If it's clearly going up, you can give the dose. If it's only gone up a little bit, you can stall another 20-30 minutes and try again. While you are stalling, most cats will start pulling on our heart strings and convince us they are dying without their dinner. You can go for a walk, take a shower, whatever you need to do to stay strong. They aren't going to starve. After this happens a few times, you figure out Tootsie's patterns and can work around it more easily.

Tootsie is responding well to the diet change and the insulin which is hopeful. Have you read through the yellow stickies at the top of the Prozinc Forum? Our forum is quite small, so the more you know and understand, the better you'll be able to make decisions if no one is around. Also, read other people's threads and find folks that you can tag in your post if you need a quicker answer. It doesn't always work, but sometimes if you tag someone you can get their attention sooner.

 

It just seems like with his AMPS this morning being 424 and then dropping all the way to 177 at +5 that his dosage would be to high. That's a pretty big drop.

 

It is a pretty big drop, but it's not dangerously big by any means. Most likely if you hold that dose for a few cycles, Tootsie will start to flatten out a bit and then it will be time to try that 2.4u dose again.

You may have read the 50% drop as a guideline to know if a dose is working. Bear in mind that our meters are not particularly accurate, so you can round off the 424 and the 177 and see that the dose is about right.

 

Sorry but what do you mean by 50% drop guideline? And that our meters aren't accurate and to round off? I have been doing tons of reading all over this page but its a lot of info and im still trying to consume it all and remember/learn.

So even if his pre shot numbers are in the blues you would stick with the 2.2u for a few days? I know you say not to go back and fourth with groups and like I said I only use the two, but the one person that typically responds to my post suggested we try doing 1.6u for a few cycles.

Its just really hard to make these decisions on my own right now when I'm still so new and learning everything. Its a lot to take in you know? I just know they say to start low and we never really started with even 1u with the Prozinc so how do I know our perfect dose wasn't missed somewhere between the 1u and 2u? Especially after switching the diet.

 

You're getting really good action from the insulin at this dose, so it's unlikely that you missed that ideal dose. And remember that the ideal dose can be (and is!) a moving target. The insulin needs will change as things in the cat's life change.

Going back to 1.6 doesn't seem like it would be a good idea to me. Why did they suggest that? You're finally seeing some good action and lovely blue numbers at this dose, so you really want to keep going and try to get into those blues and greens. That's when the pancreas can start to heal, which is what we want!

I think what Djamila was trying to say with the 50% drop guideline is that some say that if the cat drops more than 50% during a cycle, that means the dose is too high. And for the rounding off...well meters have a certain amount of variance in them. If you test the exact same drop of blood with the exact same meter twice, you'll get different numbers. They shouldn't be HUGELY different...but there is a variance that can lead to 424 being seen as 410 for example and 177 is close enough to 200 that you can round the numbers to say it was close to a 50% drop. Now don't let this freak you out (it did for me the first time I read it). Just because meters are completely accurate, they're still fine to use. They tend to be more accurate at lower numbers, and really, the numbers THEMSELVES aren't so important unless we're talking about super low numbers. What we are looking for are patterns, more than numbers. For example, the pattern on your SS right now says at 2 units, you got reds at preshot and went into yellows sometimes during the cycle. As you've gone up in dose, you're getting more pink preshots and blue mid cycles.

I personally would try 2.2 for a few cycles as well...let that flatten out some and then let's talk about moving up to 2.4. Since you can see that the dose increase is working already, that's why I would suggest it.

 

Thanks that makes a little more since to me. But you did see that when we started to get those lower numbers we were doing the 2.4u? He has only gotten the 2.2u dose once and that was this morning. I'm okay with trying 2.2u for a few cycles, no problem... But is it okay to give that amount if his pre shot numbers are in that blue range?

 

You've gotten really good advice.

I too would stay with 2.2 for a few cycles to give it a chance and see how it does. And, if a PS number is low, stall without feeding for 20 minutes and test again to make sure it is rising. Then, do that a second time, if needed. Only skip a shot if the number remains way too low. It is best to consistently give the dose unless you just absolutely cannot. When you do give the shot on a lower than usual number, monitor carefully and be prepared to take action, if needed. Times like that are great learning opportunities. You get a chance to see how he responds to that scenario so that you will feel better equipped to decide what to do the next time it comes up.

 

He tested 325 tonight and we are giving the 2.2u. But what is to low at the dose? Do you personally think the blue numbers would be to low and if after stalling he was still in the blue then skip? Or give the dose if I'm able to monitor him and see how he does?

 

If you start seeing too many very low pre-shot numbers, that can mean the dose is too high, but occasional low ones can just pop up. The guidelines say, when you are just starting, you should not give a shot at all if the numbers are below 200 (with human meter). As you become more comfortable and have more data to review, you will want to 'test the waters' a little. A lot of it depends on you and how comfortable you are, how much risk you are willing to assume. And, as you go, it will depend on how you see him respond to things.

For example, say you had a pre-shot of 150-ish so you skipped the shot completely, and you saw his numbers steadily rise throughout the entire cycle. So, when you get another 150-ish preshot, you decide to give him half the normal dose, and you see that his number do not go too low during the cycle and maybe even stay a little higher than you would like. So, when another 150-ish pre-shot comes along, you decide to give him 75% of the normal dose. During that cycle, his numbers go too low. So, the next time you see a 150-ish, you would probably reason out that you would not want to give him 75% again, but you would rather stick with 50% or somewhere between that and 75%. Do you see what I mean?

There really is a lot of 'live and learn' and 'trial and error' with this. It is true that 'every cat is different'. It is also true that things are ever-changing even with the same cat. Do not ever think you can come up with a formula that is always going to work the same. You may give the full dose on a 150-ish pre-shot and see him do great, then you may do the same thing two weeks later and see him go too low. You have to learn to get as much data as you can and make the best judgement calls you can and be ready to roll with whatever comes up. Ain't this fun!

 

What a great example! I love this!

And we're happy to help with suggestions Ashley. As you get more experience, you can make judgement calls a lot easier. We've all done it for awhile now and we got suggestions when we were new...so we're happy to pay it forward!

 

I appreciate it! Thank you guys! His preshot tonight was 325 and he gave the 2.2u. I plan to check him at about +4 to see how he is doing. Numbers may be higher the next few nights due to all the fireworks

 

Well we are already testing the waters with this guy again. This morning his AMPS was 187. We have decided to give 1.6u based off our PMPS the other night when he was 159 and we gave him 1u. He actually went up a little bit to 188 at +5 with that 1u dose. So since his normal dose right now would be 2.2u we decided to go with 75% of that dose as mentioned above. I hope I've made the right call this time. We will be around for awhile to give a few checks, especially at his normal low times of +5 and +6.

 

Let us know how it goes today!

 

I hate fireworks! Mia is such a scaredy cat anyway, and of course, animals are going to be scared of 'bombs' going off that they do not understand at all.

 

Looking good so far! Will you be around to get another test during this cycle, maybe at +8 or +9?

 

So his AMPS was 187. He tested 250 at +3, 170 at +5, and 138 at +6. We won't be around at +8 or +9. We have a 4th of July party at 3:00est. I was going to check again at 2:30est which is pretty much +7.5 and leave food out. Only problem is I don't know if we will be back by the 2 hour mark to lift the food before his PMPS.

 

He also ate a little food after I checked him at +5.

 

Take a minute to celebrate these pretty blues! Woo hoo!

 

Okay so we got a other blue AMPS this morning. It was 180. We are going to do another 1.6U dose just like yesterday. But @FurBabiesMama you had mentioned if we just seen these numbers once and awhile then it was okay to test the waters a little, but you also said if we were seeing them more often, then that could mean our original dose is to high. Well this is starting to feel like a pattern especially with the AMPS. What do you think I should do?

 

I am so happy for you that you are getting all of these great numbers! If it was me, I think that I would probably go to 2u AM and PM for a few cycles to see how that does. Maybe that will level things out so that you are not having to adjust one dose every day.

 

Another thought... you are not getting any numbers that are anywhere near too low. So, maybe at a 2u dose, you could hold it steady if/when you get one of these upper 100s pre-shots and see how it does - if you are ready for that.

Since you do not have a whole lot of data yet, have you considered moving it to one of the spreadsheets that are available on this site? Hopefully, you are going to start seeing some numbers a little below 100. On the spreadsheets we use, those are coded a dark green - that we love to see on our sheets - but on yours, that range is clumped together with the too low numbers. It would just be easier, at a glance, to see patterns or times if/when he goes too low, if you have more appropriate color coding. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

I agree that I would increase. Looking at yesterday's data, you didn't end up with numbers that were anywhere near too low on that 1.6 dose. Therefore, you could probably bump up the dose on those blues int he 180 range and see if that helped push the nadir numbers down. I might try 1.8 for a few days if it was me and then go from there, but that's definitely your call!

 

Rachel, are you saying 1.8 for AM and PM? She was giving 2.2 and just reduced to 1.6 due to the pre-shot below 200.

 

The only thing is I started with 2.0units and gave him that for weeks. Even before my spreadsheet was started. I did my curve off the 2.0units. We never got out of the yellows with that dose and even had lots of reds. He was on the 2.0 units since 6/6/18.

 

That does not matter now. Insulin needs can be ever-changing. If things go in the right direction, you hope to see his numbers get better and better and the dose get lower and lower. With Mia, I have had to adjust up and down several times. Most recently, she was doing beautifully on 1u then starting having higher numbers, and I had to go back up to a fat 1u. I just reduced from a fat 1u a couple of weeks ago because it started making her go too low. Such is this 'dance'.

I find that it is important to be consistent whenever possible. So, I was suggesting 2u in hopes that things would level out enough that you would not feel that you had to adjust the dose down so often based on the pre-shot values.

 

Okay. I dont mind going back to 2units and trying that. I'll give it a go and see what happens. And for the spreadsheet I really perfer the one I'm using. If there is a way for me to add the additional color and edit the header numbers on mine then I don't mind doing that, but I just really like the set up and feel of the one I'm using better. Its more clean and laid out in my opinion and I can be really OCD about those kind of things. Once I'm use to something its hard to change it as silly as that may be to others

 

@FurBabiesMama my spreadsheet has been updated

 

A dark green range, yay! Maybe you will have a number to turn that color soon.

 

Green!!!

 

@FurBabiesMama I know! Exciting!!!

 

Another GREEN

 

Now, he is just showing off! See, 2u looks a lot different now than it did a couple of weeks ago.

 

Tootsie tested 142 tonight for his PMPS! What do you guys think I should give for his shot? 2units still?I will be around to monitor him and check. Or should I try 1.8units?

 

Did you stall without feeding to test again to see if it is going up?

 

I didn't. I forgot about doing that. We decided to give the 2units a try. My husband and I are both home and we have all the supplies ready if he did happen to drop to low. Corn syrup and high carb wet food and dry food.