Discussion in 'Feline Health - (The Main Forum)' started by Thaiger & Katie, Feb 7, 2015.
Went from 246 pmps to 198 at +2 to 48 at +5. Acting normal at the moment. Should I be concerned?
Re-rest to confirm the result.
Yes, intervening is a good idea.
Have you got Karo/honey/other syrup?
Have you got high carb food?
Feed 1-2 teaspoons of high carb food, or low carb food plus a few drops of syrup on it.
In 20-30 minutes, re-test the glucose.
If still low, repeat the feeding.
Repeat as needed to get 3 rising numbers and past the nadir.
Not sure of the carbage on this ProPlan wet wood that I had laying around but she just ate two spoonfuls with a couple of drops of honey.. Will retest at 130am. She wasn't happy about being woken up for that, though.
Is going from 246 to 48 at +5 a cause for concern? Should she continuously be monitored now?
I would re-test to confirm that the meter reading was somewhat accurate.
With Prozinc, once you establish the amount of drop with a given pre-shot range and dose, you can develop a custom sliding scale where you adjust the dose based on the pre-shot and your knowledge of how the ProZinc works in your cat.
She needs to be monitored until you know for sure she is rising and will stay above 50. I'd post your AMPS in the morning for dosage advice and plan on no shot if under 200. If over 200, you probably need to drop to 0.5 units.
Retest at +5.15 was 44. still dropping..
It takes about 20-30 minutes for high carb syrup or gravy to hit.
I might repeat the following again, since Thaiger continues to drop.
Feed 1-2 teaspoons of high carb food, or low carb food plus a few drops of syrup on it.
In 20-30 minutes, re-test the glucose.
If still low, repeat the feeding.
Time for a couple more spoonfuls of food with honey and retest in 15 minutes.
Will you be able to monitor for a bit? I've got to crash; the !@#$% sleep disorder is going off.
I'll stay up @BJM! Bud has me wide awake although he just tested 209 so I think we're good!
You guys are truly the best... +5.30 and back to 47... Test again in 15 min to make sure it's still climbing?
Has anyone ever told you that when you go to the High Carb foods (the Fancy Feast Gravy Lovers) what you should do is pop open the can and then take the lid and smash it down onto the food and squeeze the "gravy" out (into a little bowl or something).....the gravy is where the carbs are. We don't want to feed the "meat part" too because we don't want to fill them up so that they're not willing to eat again if necessary
So when we say "a teaspoon or 2 of HC food", what we really mean is the gravy part (and most cats go CRAZY for it)
We want them to be willing to continue to eat IF we need them to eat later in case their BG goes too low again
Absolutely! I'll be here!
@Chris & China - thanks for the tip. Didn't even think of that!
+5.45 and at 80 now... big jump?
That can be normal after feeding high carb. I'd still get one or 2 more tests to make sure she's still rising. High carb can spike the blood sugar but might not keep it up necessarily.
It may wear off fast as it was fueled by gravy and honey.
At this point, give a couple teaspoons of low carb food to help sustain it without elevation.
Re-check in 20-30 min.
Ps Really, I am in bed and about to sign off! Not that I'm OCD or anything!
That's great!! Now no more food and retest in 30 minutes...if she's still about the same, retest in another 30...but if at the next test she's continued to climb, you can wait for 1 more test an hour later and if that's good, call it a night!
However, if her next test shows her dropping again, but still above 50, give her some of her low carb food and the "2 hour clock" would start over
Once they're "UP" to a safe place, you want to test for 2 hours after without food to make sure they can stay up on their own before going to bed
Little bit of conflicting info there - to food or not to food? We are now at +6 and at 77. Leave her alone and test again in 15? Give her food? She's really getting fed up with the ear pricks, poor thing.
If you feed low carb now it might sustain her numbers but at the same time you want to make sure she'll be hungry enough to eat some high carb food if she starts to drop again. So it could go either way.
And I would think retesting in 30 minutes would be okay at this point
that's basically the same number....I'd leave her and just retest in 20-30 minutes (77 and 80 are pretty much the same number)....THEN if she's still "surfing" (in those same general numbers) I'd test again after 30...and if still doing OK, get 1 more test an hour later
When am I out of the woods as far at the most potent that the insulin would be? Now at +6?
Basically, you want to keep feeding them until they get into the high 70's or above....then you stop feeding, but continue testing at 30 minute intervals for 2 more times....if they're still holding their own or climbing, test 1 more time an hour later (so you have 3 tests in those 2 hours after the last food)
BUT, if they drop (and by more than just a couple points), and you have to feed again, as long as they're above 50, always start with the Low carb food...a teaspoon or so and then the 2 hour "clock" for testing starts over
Can I just double check the AT in your title doesn't relate to an alphatrak does it? You mean at +5 don't you? Just wanted to double check as it isn't mentioned which meter you use in your signature.
Nadir could be up to +7 or more but I think it's looking good.
I am thinking that means "my cat was at 48 @ +5"
Yes - at +5 hours! I'm using a Relion Confirm - i'll add it to my sig now.
Ah good Just wanted to clarify, you are in good hands
It may be worth mentioning that since today is the first day of insulin, she still has Iams dry food down for grazing (not a low carb food) and then is on Friskies Pates for wet food. Vet told me to do the food change slowly so i've managed to get her on solely low carb wet food but still have the dry food down which she isn't eating much of, but it's still there.
Katie it looks like you've got some great helpers here so I am going to *try* and get some sleep. You're doing great and I'll check in on this thread when I get up!
@phlika29 I have to leave....can you keep an eye out for her for awhile?
Also, @manxcat419 is was online and she's had quite a few nights like this lately and has pretty much learned the ropes
My general feeling is she's past the point of being too worried, but does need to go ahead and do those checks to just make sure she's able to stay above 50 without food for at least 2 hours before going to bed.
Thanks a ton to EVERYONE. Have another test in 5 minutes and that will have been slightly over an hour without food.
Well now I have to stay up for at least another 5 minutes...
I have to get off here....I'll try to check back in in a little while to make sure you've got help or she's safely moving up
That's great...now as long as she's still surfing, get 1 more test an hour from now and as long as she's still good, you can get some sleep tonight!
@Chris & China yes that's fine. It's 7.30 am uk time
we're at 98 now.. +6.30 hours. Safe to call it a night or do I need to hold out for the 3am check in 30 min?
So here is what we're looking at so far:
PMPS was 246. At +2, we were at 198. At +5, went down to 48.
Did some high carb food and honey for two rounds - no food since +5.15... went to 47 at +5.30, 80 at +5.45, 77 at +6 and now 98 at +6.30..
That's a good number but you should hold out for a test which is 2 hours after no food to check it doesn't drop again. Sorry
I assume that will be the 3 am one?
It looks like she will get herself a reduction In dose tomorrow.
I think I can rest easier now because I think you're out of the woods but another test in an hour would probably be best. Great job Katie!
@Stacym20 I don't know much about prozinc. Was I right to say a reduction is required at the next shot? Please correct me if I am wrong.
yeah - 20 more minutes will be the 2 hour with no food mark. I can hold out until then. Do I need to get up again and check before the AM shot time?
246 was a really low starting point for her - I haven't seen numbers under 400 in a while.. Is it safe to guess that if she is still around that 250 mark, i should only give ~.5u (i say ~.5 because i have u40 syringes so would be eyeballing it). If she's back in the 400's she should get the full 1u, right?
Yes @phlika29 a dose reduction for sure! @Thaiger & Katie personally I would shoot 0.5 units for anything over 200. One unit might be okay with a preshot of 400 but it would require the same intense monitoring like you've done tonight. I think I'd go with 0.5 and work you're way back up if need be.
@Stacym20 I guess its unlikely but is it a no shot if under 200 or do you stall with no food and retest to see if rising?
I gave the pm shot at 8pm and am planning on giving the am shot at 8am... However - I have something that I absolutely cannot get out of tomorrow night and won't be home until around 11pm to give her the pm shot... And then I need her back on an 815am, 815 pm schedule because of work.. So my thinking is (please correct me if i'm wrong):
PM shot today (2/6 actually) was given at 8pm
Hold off on AM shot (2/7) until 11am and give .5 instead of 1u
PM shot at 11pm (2/7) and give .5
Check BG at 8am on (2/8) and if >200, give .5 (this would only be 9 hours since the last shot) - trying to figure out how to get her back on the 8am and 8pm schedule..
Gosh, this has been something of a 'baptism by fire' for you.
But you did great!
Do you have syringes with half-unit markings? If not, it would be good to get some of those. Or, it is possible to use U100 (instead of U40) syringes and use a conversion cart. This can be helpful if if there is a need to measure smaller doses.
I don't have any with me, no. But it sounds like i'm going to need some!
Again I have no experience of prozinc but it isn't a deposit insulin is it?
You could start a new thread over on the forum and see what other users do.
How about give the morning 0.5 dose at 9.30 am and then give the evening dose at 11 pm. That way you split the difference in time so you are 1hr 30 late with each dose. Or maybe it is better just to be late for the evening dose? You know to always check the preshot glucose don't you?
If it's close-ish to 200 I might stall and shoot if rising without food. I think 170ish and under I don't think I would even bother stalling and just forego the shot. I don't really want to give dosing advice since since you just started insulin and we don't have a lot of data on different doses yet. I might be tempted to just shoot at 8am and forego the 8pm shot altogether to stay on the 8/8 schedule but maybe someone with more experience could agree or disagree.
And yes, ProZinc is an in and out insulin.
at 100 +7 hours later! Another 10 minutes would be 2 hours without food. @phlika29 - safe to go to bed now? Okay to wait until 10 or 11 or the AM shot?
Hi Katie, have you had three rising numbers (test results) in succession? That's a general rule of thumb.
Yes @Elizabeth and Bertie
Well the last two were the same.
I would say it is okay to go to bed. With regards the am shot I don't think I would wait till 11am. Personally I would split the difference unless someone tells you otherwise. So retest at 9.30, if over 200 give the 0.5 unit and then give the insulin. You are okay to monitor BG during the day aren't you?
Katie did you see this post ? I missed it. I would follow stacey's advice. Not mine.
Okay, sounds good! Thank you
hopefully someone with more proZinc knowledge can help before 8, that's just what I would do personally is try and keep the 8/8 schedule
Yes I would check back here just before you shoot and then someone else may have posted with an another idea
One last thing. Can you edit the title of your post to something with prozinc in it ie prozinc dosing schedule advice needed
I'm really going to bed this time... Glad Thaiger is in a safe range now!
In the future, if you know you have someplace you have to be that's going to screw up your schedule, start several days early so that by the time you're "there", you're not so far off of the 12 hour shots
If you'd know 4 days prior to an event where you'd be gone until 10 (for example) and your usual shot times are 8/8 you could have shot at
But it sounds like it's too late for that now.....but something to keep in mind for the future
Sorry all - I'd left my account logged in and gone to take a nap ahead of Rosa's last test. Glad to hear Thaiger's safe and back into good numbers.
Katie, I agree that it would be simplest all round if you could skip that evening shot.
However, if the BG is high when you get home, I would suggest giving the shot. ('If the cat needs insulin, it needs insulin.')
If you do give the evening shot then, as you say Katie, when it comes to the morning shot that would mean that it's only been 9 hours since the previous shot.
Even if the BG is over 200 in the morning (and therefore deemed shootable) there is the fact that there may still be some insulin in the system from the previous shot, and the shots could be 'overlapping'.
I use a long-lasting PZI that works on overlap. And that means that each insulin shot gets a 'kick up the backside' from the previous shot, some of which is still in the system (although is wearing off at that point).
If you were to shoot a .5 dose that morning (9 hours after the previous shot), it may have more effect than a 'typical' .5 dose. Does that make sense..?
It may actually turn out that Thaiger's BG isn't high enough to shoot in the morning at +9. So you could skip that shot. That would be simple too!
An alternative to skipping a shot is to shoot a reduced dose.
Sometimes, even a nominal amount of insulin can act as a sort of 'duration booster'. And even if that small amount of insulin isn't enough to actually drop the BG much, it can still stop the BG rising so high/fast before the next shot. (Sorry if this is all too much information too soon...)
I think you're going to have to 'play it by ear', Katie.
We know so little at the moment about Thaiger's response to insulin so it's impossible to predict how things will play out over the next few days. (It'd be nice if he'd just sail into remission....)
Well done for today. Top job.
I hope you get some good sleep.
We're here whenever you need us.
Good morning guys... It's times for our AM shot and she is at 87 so i'm not doing a damn thing! is 87 okay? does she get her wet food like normal? do I check again in a couple of hours and then maybe shoot? If you weren't following the drama in this thread last night, the info is in the comments section of her spreadsheet.
@BJM -- I see you're online...
Yup, checking in on you.
Good call on skipping the dose.
Today, if you can, pick up some U-100 syringes so you can dose in smaller amounts.
U-100 means 100 units per mL
U-40 means 40 units per mL, so 40% less per mL
Multiply the U-100 syringe marks by 0.4 to adjust them, and you get
0.4 * 0.5 = 0.2 units of U-40
0.4 * 1.0 = 0.4 units of U-40
0.4 * 1.5 = 0.6 units of U-40
0.4 * 2.0 = 0.8 units of U-40
0.4 * 2.5 = 1.0 units of U-40
Basically every 0.5 unit mark on a U-100 syring equals 0.2 units of U-40
Ok, so she shouldn't get a morning shot at all? Okay to go ahead and give her some breakfast?
Also, can u get syringes from any pharmacy? And it looks like if I want to give half a unit, then I'll be aiming for the 1.25 mark on a u100 syringe.
No shot under 150 mg/dl without serious test data showing it is safe.
Unless your location requires an Rx, get syringes which are:
3/10 cc (mL)
Short or long needle (I like short)
29, 30, OR 31 gauge (I like 30)
Got it! ThanKS again. I'll go whip her up some breakfast.
87 is more than 'OK', Katie.
Thaiger is holding in beautiful healing normal numbers at the moment.
Glad to read that you got Thaiger safely through the night.
87 is a brilliant number!
We are now at +15 from the PM shot and at 156. I'm trying not to poke her more than every 3 hours at this point because she seemed to be getting sore after the drama last night. I will be gone at my event from 7pm-11pm so if she gets above 200 before then, should I give her .5u or skip it since I won't be around to monitor?
Actually, I'd suggest eyeballing 0.25 units, or getting some U-100 syringes and using the conversion chart (see link in next post by Elizabeth and Bertie). Each 0.5 unit mark on a U-100 syringe measures 0.2 units of ProZinc.
Then if above 200 mg/dL, you could shoot a very cautious dose.
Not sure if someone posted the link for the conversion chart (so, sorry if I'm duplicating info) but the link is here:
So it is +19 hours since her insulin shot and we are only at 208.. I'll be leaving in 3 hours and will be gone for 3-4 hours (so I won't be home to keep watch on her). Should I hold off on a shot and just wait until 8am tomorrow which is what I would like the schedule to be or is it safe to shoot a smaller dosage now? She was at 246 last night before getting 1u and got low into the 40's before the 6 hours mark..
It looks like just 1 unit still takes her too low when starting from around 250. At that level, you might look at 0.75 or 0.6 (using a U-100 syringe)
At barely over 200, maybe 0.25 units if you feel like you can eyeball it.
If she has ever had ketones, you want to shoot; if not, it may be OK to skip until tomorrow.
No ketones that I know of (adopted her 5 years ago and she is 16). I also don't have u100 syringes yet so I would be totally eyeballing.. I think I'll pick up u100 tonight while I'm out and then test her when I get home around 10... if she is above 250, should I give her .25u to get her through the night and then get her in early afternoon tomorrow or wait until 8am so she is back on schedule? I feel bad for not having her on a schedule and am trying not to overlap shots.
See how she is when you get home. A token dose to tide her over to morning should be OK if she's high enough. Then you can work on the schedule in the morning.
So she is at 329 now and i'm getting ready to walk out the door... Is it safe to give her .25 or .5 ? I bought the u100 syringes so can give a smaller dose. And I'll be back in about 4 hours to check on her..
@Elizabeth and Bertie
Played it safe and went with .5u from a 100u syringe which i believe is about .2u for a u40 syringe, yes? Will be home in 4 hours t ocheck on her
It seemed like such a tiny amount and was still difficult to eyeball even with the u100 syringe! Thanks for the conversion chart.
Safe is good. Better too high for a day than too low for a moment.
Sorry I am just now seeing this! I think 0.2 should be just fine. And being able to check in at +4 is perfect. I'll be checking in on you later!
If she is still high in 3 hours (10pm) , do we re shoot or wait until the normal morning dose at 8am?
I would wait til 8. If you reshoot, you'd be dealing with 2 different nadirs.
+4 and we are at 354... Looks like the tiny amt of insulin didn't do anything for us... Is leaving it alone until 8am still the best option?
You want to be able to shoot in the morning, so you would only want a small dose to keep it from going too high. Maybe 0.25 - 0.5 units?
Would I then have to be concerned about two nadirs again like @Stacym20 mentioned? I would really like to be able to get her on the 8am and 8pm schedule tomorrow since I have to go back to work on Monday and will be gone all day - would like to make sure that going to .5U tomorrow instead of the 1u will be safe when I can't be at home to monitor.
And just for my education - when we talk about .25 or .5, are we talking in u40 or u100 measurements? I was referring to U40.
3rd question - please excuse my ignorance... But: how long does the insulin needle need to be to make sure it's going subcu? The U100s I picked up today are 8mm longbut the U40's from the vet are 12.7mm
With the tiny doses, I think it is unlikely that you'd need to worry about the overlapping nadirs issues. If you were shooting full doses, I'd be very concerned.
I was referring to 0.25 units whatever you use to measure it. If you use a U-100 syringe for a U-40 insulin, you report the actual dose in units, not what is marked on the syringe. On a U-100 syringe with half unit markings, each tick mark = 0.2 units of U-40.
I use the short 8 mm needles and have no problem with it going in.
okay - i'll get another.2 - .3 into her now and then call it a night... Is it correct to think that if her levels are in the high 300s or even back to the 400s i was seeing a day ago that she should stick to 1u? She got low when I did 1U with the starting point of 260.
Was probably closer to .4u - it's so difficult getting these tiny doses!!
If you pulled to the second full unit mark on the U100 syringe it would be 0.8 units if you wanted to try that. 1 unit might be okay if you'd be around to monitor
I went just about to the first line on the u100 syringe so about .4 and then she had about .2 a few hours ago = ~.6 and 1u took her to the 40's last night - though her starting number was much lower.
....I just realized that you were probably talking about her morning dose... D'oh! Lack of sleep catching up on me.
Whew! Yes for her morning dose.
Sorry! I should have clarified!
I'll be shocked if I see anything lower than 300 in the morning so i'll plan on trying .. Thanks for the plethora of advice. I feel much more helpful to her with this education.
True, but we want her shootable on your planned schedule.
Maybe 0.8 units then in the morning? We can always work our way back up.
Hahaha my msg was supposed to say plan on trying .8 in the morning. I'm losing it. Goodnight y'all.
Should I be concerned with getting up to check her numbers in a few hours or is she high enough that it isn't needed?
I would *think* she would be okay but it never hurts to set an alarm for a +4 or +5 for piece of mind.
Lol piece... I'm losing it too. Peace!
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