? ProZinc dosing question. Amps 133

Discussion in 'Feline Health - (Welcome & Main Forum)' started by HelloKrystie, Feb 13, 2020 at 6:19 AM.

  1. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Good morning everyone. This morning Sirius’ amps is 131. Stalling is not an option, as I’m already running very late for work. Shooting has me nervous, I won’t be able to check on him for a few hours. Should I skip, again? Or try for a .25u dose? He’s had more missed shots than shots this last week.

    Attached is the link for the very lengthy conversation that started a few days ago. http://www.felinediabetes.com/FDMB/...nd-other-questions.225387/page-2#post-2525667
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
  3. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Thank you, Deb.
    For about the last 15 minutes I keep getting an unexpected error message that wouldn't let me log on to the forum. Have you had this problem before? Thankfully I was able to see your answer because I have alerts set up to go to my email. They’re delayed a bit, but it a good backup.
     
  4. Deb & Wink

    Deb & Wink Well-Known Member

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    The forum administrator does daily maintenance for the message board.
    That daily maintenance usually occurs around 7:40 am EST, 6:40 am CST, 5:40 am MST, 4:40 am PST.
    Those times are US time zones. Adjust for where you live if outside of the USA.

    You have to be patient and wait for the message board to come back on-line.

    Some days it only takes a few minutes for that daily maintenance to occur.
    Other days, it takes 15-20 minutes for that daily maintenance to occur.

    You got caught in the middle of one of those time periods.

    "An Unexpected Database Error Occurred. Please try again later" or words to that effect are what you saw.
    Tiny print on the screen of your smartphone, if you use that to access the message board.
     
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  5. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Pmps 160. Should I be micro dosing?
     
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  6. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Yes, I think 1 drop of insulin could be very helpful to Sirius.

    Do you think you have the technique down for the drop dose?

    Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "flick" to get any air bubbles up to the top of the syringe. Push out the air bubbles.

    Slowly twisting the syringe plunger to push out all the insulin, then when one small drop is all that is left on the end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.

    Give the shot. Monitor.

    Later, if you need to, you could increase the number of drops. But for now, lets stay at 1 drop for Sirius.

    p.s. Go check out Oscar's post over in the Prozinc forum. Cheer Hailey & Oscar on.
     
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  7. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Ive been able to consistently get one drop enough times that I’m comfortable doing it, and recreating it. I’m pretty certain the size of my drops are the same each time. Picture attached of my drop.

    Going to check out Hailey and Oscar now!
     

    Attached Files:

  8. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Same drop, different angle/focus point. I hope this is what you mean by drop, and that it’s the correct size drop!
     

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  9. Deb & Wink

    Deb & Wink Well-Known Member

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    That is 1 drop. Thanks for the pictures.
     
  10. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Ok, what does otj stand for?

    I’ll be home with Sirius all night to monitor and test. When is the best time to test him again to see what the effects are of the drop dose? +2...+3...? +4 would be the latest I could manage, I think.
     
  11. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    OTJ means off-the-juice, insulin being the juice.
    It's when a cat is diet controlled, or sometimes called remission.
    Haley and Oscar are doing an OTJ trial.
    Testing for 14 days, to see if Oscar will stay in those low BG numbers, preferably <80 mg/dL with diet alone.

    I say +2 and +4 would be fine.

    How are Sirius's ears?
    Looking any better or still sore and bruised looking?
     
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  12. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Off the juice!!! Hahaha I love it!
    I hope they make it through! What an amazing feeling for Hailey I’m sure!

    I will try for both!

    His poor little ear...it’s not looking great. (I saw you responded to my thread about it. Thank you)
     
  13. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Hi Krystie! Sirius looks like he is doing great! (Are you glad yet that bf nuked your insulin? And if you ARE glad, that doesn't mean you have to TELL the bf so.):D
     
  14. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Thanks, Kerri!
    I was hesitant to adjust his dose from the drop dose to 2 drops, but over the 3 cycles he received that dose, he was pretty stable, with no crazy dips or spikes. And, I’ve been home with him all day.
    I practiced the 1 drop method about 70 times before I actually did it. And the 2 drops about 50 times. He’s looking pretty good, and most importantly, he’s feeling pretty good. I caught him playing like a crazy man early this morning! About 30 minutes after his am shot he was running and pouncing like a kitten again! This old man hasn’t played like that in ages! I throughly enjoyed watching him.

    The nuking of the insulin very well could have saved him from a hypo event. For that I’m glad. It also forced me to home test that night, rather than trying to learn over those next few days. I had already purchased all his testing supplies, but the more I read, the more terrified and hesitant I became to actually poke him. Well, about 30 minutes after learning of the bf’s idiocy, I had his first home test done. At 176mg/dl that night, if we had given the 3 units prescribed by his Vet, I might have lost him. The bf knows this, and likes to keep reminding me. Which makes me want to open the car door for him...while we’re moving.
     
  15. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    Question, I found the screen shot in an old forum thread and it has me a tad concerned. And thinking about it, I don’t believe I was even told where I should aim for Sirius to be at....

    I’m trying to regulate Sirius’ blood glucose levels, but to what numbers? The ss shows that green numbers (50-99) are normal. But, in the screenshot, it says the no-shoot number for ProZinc is 150. It also says 50-130mg/dl is great control. Wouldn’t I need to shoot to get him under that 150?

    The last two doses I gave to Sirius he was under the 150 no-shoot number. Am I trying to go to low? Even with the micro-dosing that I’m currently trying? His lowest number so far during our sugar dance was 92; his amps was 202, and that 92 was his +6 test. What number should I be aiming for? 50-99? Or just generally below 150, without going under hypo territory of under 50?

    to shoot or not to shoot, that is the question....
     
  16. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    When you first start giving your cat insulin, you have no idea how low a particular dose of insulin will take your cat.
    So, at the beginning, before you have learned to home test, before you have learned how YOUR cat will react, we suggest you keep the threshold for giving a shot, your decision point, at a higher BG number.

    And that you keep the dose lower at the beginning, lower than many vets recommend as a starting dose.

    We sometimes call that threshold a "shoot/no shoot" number but it is really a "stop and think what to do" number.
    So, for people new to the message board, that threshold is set to 200 for a minimum. That threshold can be higher if you use a pet meter, or another insulin like NPH or Vetsulin.
    The threshold, the decision point, the "stop and think BG number" can and should be lowered as you gain experience.
    Experience with testing, with your cat's reaction to insulin.
    Once you become more experienced, that initial threshold will be lowered.
    With Lantus, once you gain experience and move to the ISG (insulin support group), the threshold for lantus is 150.

    For some of the other insulins, such as the Prozinc you are using, the threshold is lowered as we see how your cat is doing.
    It kind of depends on what the nadirs are, what the duration of the insulin is for your cat, what the onset is for your cat, how well you have managed the change to a better food, if you have a timed feeder or are able to leave food out for your cat to eat while you are away at work.

    ECID Every Cat is Different. "Know thy Cat" will help to guide you. You will always know more about your cat then we can ever learn.
    We use our best judgement in trying to guide you.
    Mid-cycle BG tests in combination with the pre-shot tests and other notes on the SS help us to guide you.

    Since Sirius was already down in the middle blue ranges, the 3U you were giving looked like way too much.
    Your bottle of Prozinc was ruined, you could not get anymore until after the weekend and then your vet didn't have the Prozinc in stock so you had to find the insulin elsewhere.

    First dose once you got insulin was 0.5U. Not much test data, that first dose brought Sirius down into the green number ranges. Still not much test data over the next 5 cycles, but Sirius was still in the mid-blue number range. But it looked like 0.5U could be too much. Not enough test data to say either way.

    Over the next few cycles, you were getting a little more test data, still low but obvious that Sirius needed a tiny bit of insulin. How tiny could you learn to dose? Had you practice, practice with those drop doses. You started drop dosing a couple of days ago.

    1 drop did not seem to be budging the numbers much lower.
    So suggested you increase to 2 drops.
    You should try to stay at that dose for 3 cycles, to see if it drops the BG levels for Sirius more.
    Unless, he drops really low, under 60-80 or so. You pick the low or nadir BG number that makes you feel comfortable.
    Set it higher if you like, than the suggested number.
    If Sirius drops below the nadir you have set, then you should reduce the dose. A drop.
    With Prozinc you are looking for about a 50% drop between the pre-shot tests and the nadir.
    You do not want much more of a drop than 50% between those 2 tests.
    If you do have > 50% drop, between pre-shot and nadir, either steer the cycle with food or drop the dose by a "skinny" or very tiny amount.
    Sirius is already on a very tiny amount of insulin, so there is not much of a lower dose you can give him. No way to "skinny" the dose for him unless you can measure even tinier drops.

    Prozinc is an in-and-out insulin. Effects not extending much beyond 12 hours, if that.
    Wears off, is all used up by his body around the middle of the cycle.
    Then the BG numbers keep rising.
    Many cats on Prozinc, have a steep rise between +11 and pre-shot.
    But you don't know that unless you get that +11 test.

    If you can get a +11 on a regular basis, that will tell you if the test you get at pre-shot is a rising or falling BG.
    More reassuring to see that the number is rising, between +11 and pre-shot test.
    Gives you more confidence in giving him some insulin.
    Regular tests in the night time cycle are important too.
    One before you go to bed is always a good idea.

    Not sure if I have answered your question or not.
    At least I hope you have a better understanding of what is going on and why we have made the recommendations we have.
     
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  17. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    You did, to an extent. I think I’m just always second guessing myself is all. Everyone wants to know they’re doing everything that can, and that they’re doing it all correctly. Yes, the no-shoot number for newbies on ProZinc is 200, but that 150 no-shoot is what had me confused. (See picture I finally attached. lol) It just says no-shoot number for ProZinc.... below it lists the beginner no-shoot as the 200. I just want to be sure I’m not trying to hard and shooting when I shouldn’t. I’ll be able to get a +11 shortly (less than an hours time actually), and maybe even one tomorrow morning before his amps.

    One more question: being that I’m still playing with his dosing, when should I do his first curve? Should it be after he’s had 3 cycles of the same dose, or 6 cycles of the same dose?

    I just noticed that I didn’t post the picture I was referring to. I do that a lot when I’m nervous, I forget things. Usually important things....

    Thanks Deb, you’re a wealth of knowledge. And what’s more, you’re always willing to share and help.
     

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  18. HelloKrystie

    HelloKrystie Member

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    Jan 26, 2020
    @Deb & Wink pmps 113. Should I shoot the 2 drop dose?

    Edited:
    I shot the dose.
     
    Last edited: Feb 15, 2020 at 6:45 PM
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  19. Juls and Billy

    Juls and Billy Member

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    Dec 28, 2019
    Krystie, I think your question falls into the range of every cat is different and a pinch of it's up to you. Where Billy is concerned, Brian and I decided we were happy with an OTJ range of 50-120. He is active, feeling good and doing great. 50-120 works for him, and he hasn't been creeping over that, so we're happy. Over time, Billy's having less and less morning readings over 100, and continues to do well. So well that I've cut down to one test a day. (I picked morning, because he traditionally has his highest readings then.)

    Honestly, you're going to have that "no shoot" number, (for Billy ours was 150) and if he's lower than that, you aren't going to give him insulin anyway. So continue to monitor how his behavior is, peeing preening pooping etc, and if it's good, you might find that he's doing fine in a range such as 50-120.
     
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  20. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Just remember: You can't help Sirius from jail! ;)

    I'm so glad to hear about the playing this morning--that's so encouraging! I saw your other notes about ideal ranges and shoot / no shoot / etc. It's a lot to sort out, I know. I think you're in a great spot working with these low doses so quickly. I let Tigger stay a long time in what I thought was "too low to shoot" but what was also too high for good control....Just a kind of limbo/stalemate. So I'm excited to be working with tiny doses now. I think you just landed on that good help from Deb really early in the process, so you got to avoid the skipping-doses limbo we were stuck in.

    I know that also doesn't answer "what's the number where I just don't shoot" or "what's the range I'm aiming for." I'm not sure how to answer that....Those numbers have been moving targets for me. I just know the more tests/data the more knowledge you'll have and the more you'll be able to see the "big picture of Sirius." But it sure looks like you're on the right track! Happy weekend!
     
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  21. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Krystie, what I basically did was walk through all the factors that I used to come up with dose and explained some of the reasoning behind the decisions.
     

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