PZI dosage advice required Carbonel AMPS 239

ht
Hello Everybody,
Carbonels BG# were too high on 1/2u twice a day afer her plummet to 47. So I have gradually increased her dosage to 1u in the morning and 1u at night. Today I did a glucose curve which is set out below. I have not done the +12 reading yet, because I think that if she has 1u that she might crash again either overnight or tomorrow. I would like somebodies advice as to the dosage for this evening in the event that her BG is still around185 ( lower than her AMPS). I know that this is not particularly low, but it was about the same when she crashed last time. Her numbers also did not go up for the PMPS.
I have attached the link to my previous posts in PZI tp://www.felinediabetes.com/FDMB/viewto ... 24&t=21901
Perhaps I am catastrophising but here are the numbers.

AMPS 239 1u
+2 225
+4 185
+6 191
+8 180
+10 185
Thank you
Carol and Carbonel

 

Re: Carbonel AMPS 239

Hi Carol,

Did you mean to post in the PZI Insulin Support group or here on Health? I see by your previous post (btw, edit it to include http, rather than just tp) that you were getting good advice there. It is slower on that forum than this one, particularly in the daytime, so it may be that you wanted to post here also.

I am not sure if it was a typo, but you said Carbonel's BG numbers were too low on 1/2 unit twice a day so you increased her dose? I am confused as you would generally decrease insulin so bg levels don't go too low.

I used PZI but it has been awhile. I think your numbers look great on 1 unit. If she isn't up to 200 at +12, you can wait 30 minutes and take another test. Or you can shoot a reduced dose.

If I were you, I would put PZI dosage advice needed in your subject line to catch the attention of current PZI users.

 

Sorry Sue,
Yes it was a typo. I meant high. PZI told me to post here if I needed an answer in a hurry. I have just tested and her blood was 196 but my syringes only have increments of .5. Does this mean that I give her .5u?
Thanks for your response
Carol and carbonel

 

Do you have to shoot right now? Can you wait 30 minutes? It may be that she moves up above 200 and then you would feel better about a regular (1 unit) dose. You can shoot the reduced amount also (yes, 1/2 unit).

This is where this whole thing becomes a real sugar "dance", Carol. You want to shoot enough that she moves into the lower numbers, and earns a dose decrease but doesn't go too low. Are you going to be around for the next few hours so you can test and make sure she doesn't go too low if you give the one unit? Are you going to be real nervous if you give the one unit and would rather err on the side of caution? (Giving 1/2 unit won't hurt; it just may set you back in the scheme of this dance because she may go higher over the cycle than you would like. But this is all about data gathering and the lower dose will give you data you can use.)

It would be very helpful if you would do a spreadsheet. (http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=16) You can attach it to your signature and then everyone who reads your post can see the history. It will also help you because it is color coded and you can see at a glance what is happening.

 

Re: Carbonel AMPS 239

Hi Carol!

I would go with 0.5u if you are worried about a crash, or if this PS is a lot lower that the ones you have been seeing for her. Alternately, you could eyeball 0.75 and try that for a few cycles and see how the #s look. Can you remind me which PZI you are using? If your syringes have 1/2 unit markings I'm thinking it's a U100 PZI... I'll go check your other thread & see if it says there...

For some background for others reading, Carbonel has had a pattern of flattish #s followed by a late drop to a low PS, making it confusing to get her dose figured out. She's not really at the point of earning dose decreases from a nadir going too low, it's more like the next PS might be a 45 or something, that has been her pattern so far. To me it says lower the dose and build back up if needed, that's where I'm thinking 0.75 might be the way to go....

 

Thanks Sue,
I decided to go with the 1 unit nailbite_smile as I am in for the evening. I hope I am not going to be sorry as she has gone down around +10 in the past and I will be asleep at that time as I live in England. Is this what it is like? Are there never stable periods where you can give the same amount of insulin morning and night for weeks? I am back at work next week and I won't be in a position to keep an eye on her.
Thank you for your prompt response.
Carol and Carbonel

 

Hi Joanna,
Oh dear too late, the deed is done! ohmygod_smile. Carbonel is on u100 PZI. My syringe goes up in .5 increments. I did make sure it was just under the 1unit mark so I may have given her .75. Perhaps I aught to go to bed now and set my alarm for 4.45am.
Thanks for your response,
Carol and Carbonel

 

You can always set your alarm, wake up and check her. (That may let you sleep better in the long run anyway.) Leave out food so she can eat if she feels herself going low.

My guess is that she is moving toward less insulin and this is a wonderful thing - maybe even a move toward no insulin (anti jinx) because she reacts well to a small dose and is moving down in numbers. But for a while it will be challenging and you will be testing and asking questions.

The times when you would just give the same amount for days with no movement is not what you want (though it does sound reassuring...) You want to see numbers like you are getting, and you want to be able to reduce the dose.

The hope will be that by the time you go back to work she will be on a low dose and you will have lots of data to help you make decisions.

 

Carol, yes often you can give steady doses - right now we're just doing a little backtracking to figure out what works for her, since her #s have follow a pattern that's a little confusing. I think with a little more experimenting and data you'll have it figured out, and then hopefully it will get more straightforward.

If you can edit your subject line on the 1st post of the thread and put "PZI" in there, that will help get more eyes on her #s. There are some PZIers who check Health regularly but don't visit the PZI forum, and they may have some good ideas for you as well.

For reference for everyone, here are some of her earlier #s:

AMPS 270 2u
+5.25 212
PMPS 180 no shot
------------------------------------------------------------------
AMPS 261 2u
------------------------------------------------------------------
AMPS 263 2u
+6 238
PMPS 236 1u
-------------------------------------------------------------------
AMPS 187 1.5u
PMPS 58 no shot
-------------------------------------------------------------------
AMPS 239 1.5u
+6 221
+11 130
------------------------------------------------------------------
(not sure of the dates for above, but it's recent data)
-----------------------------------------------------------------
8/15
AMPS 268 1.5u
PMPS 191 .5u

8/16
AMPS 207 1u
PMPS 47 no shot

8/17
AMPS 342 1u
+8 250
PMPS 286 0.5u

8/18
AMPS 220 0.5u

Today's curve
AMPS 239 1u
+2 225
+4 185
+6 191
+8 180
+10 185
+12 196 1u

 

Thank you Sue,
Unfortunately I have 5 cats so no chance of food surviving till tomorrow morning in our kitchen. I will set an alarm that is a good idea.
Carol and carbonel

 

p.s. I think it's ok if you went with 1u. I wouldn't worry too much really about the low #s at the end of the cycle - I think that is her body taking advantage of the insulin and using it well to put her in good #s. What would be worrisome is when you see a low # before they have reached nadir time, so say if you got a # like that at +4 in the cycle, then you would want to feed them to be sure they don't go much lower than that. By +10 or +12, as far as I know it's a safe # to see. It can indicate the dose was too high, but as long as they didn't go low earlier in the cycle. I'm a dingbat on timezones :mrgreen: so I don't know when 4.45 is in reference to your shot time. I would probably go for a bedtime check (unless you shoot at bedtime). If that's at least 2 or 3 hours after the shot and the #s are mid-100s or higher, I wouldn't worry too much.

All of that said assuming you haven't seen hypo symptoms with her when you've seen the lower #s. I think you said before that she was hungry and ate well, but otherwise seemed fine. If she was actually sick or something, of course that changes the picture...

Which brand of PZI is it? Most of us use U40 I think, can you post what the full name of it is? It would be a ohmygod_smile if it turns out it is some type that gets longer duration or something that the others. I hadn't thought of that before, I generally assume newbies are on ProZinc, but never assume I guess.

 

Hi Joanna,
Thanks for the reassurance with regards to the 1unit. I am sitting here sweating, although it is rather hot! Carbonel is on Insuvet Protamine Zinc. When she had the low Bg# before, she was just very hungry and was asking me for food. That was why I checked her BG. She has not vomited at all with her lows. I gave her her shot this evening at 8.30pm, half an hour past her usual PM shot. 4.45 is 3 1/4 hours before her morning shot. I will test her blood at 11.30pm which is 3 hours after her Insulin. If her Bg is mid 100s or higher do you think it will be safe for me not to get up early?
Regards,
Carol and carbonel

 

Hi Carol,

Actually a +4 would be better and more reassuring. PZI usually nadirs somewhere between +4 & +7 or 8.

If I get a decent 100's or higher at +4 with Harley I feel he will not drop much lower and if he does he has enough room for it and is safe.

It's great that Carbonel knows to eat when she goes low, that's exactly what her body needs.

Turn on a fan, get a piece of chocolate or a glass of wine and take a deep breath, you deserve it.

 

Great to see you posting.

It could be becaue your skipping shots and changing dose that the numbers are bouncing around.
I was thinking possible dawn phenomenom but think it more likely that it's because you have skipped or reduced the previous shot.

You could pull back to a .75u and monitor, thus building up your info. Try and get some more inetrmediate tests.
It's also possible for a cats nadir to move (regardless of the insulin. There will always be cats who effectively go against the grain. You have to work out where yours falls)

If your back at work next week and going to struggle to get many tests in, good to get a curve on a w/e when you are around.

I think you've said the ss is difficult for you, but honestly it can make is so much easier for you and others to figure out what's going on. :mrgreen:

 

I started a thread to double check on the Insuvet & be sure it doesn't behave differently than the other PZIs. Here's the thread if anyone wants to follow or contribute:

viewtopic.php?f=28&t=22901

 

It's a pure bovine insulin, been around a long time, some in the States used to order it till it became so difficult to get into the States.

You need to stick with a dose.....give it time......don't chase the numbers by changing the dose. It usually is a b.i.d. insulin in cats but like some, Mishka for instance, every day can be a different day on the same darn dose. I call them her "pockets". She's either going to use it and make it b.i.d. for that day...or she isn't going to move much at all.......or she is going to go way down low and make it a s.i.d. shot for that day only. She is on IDEXX.

I always, always get a test shot at least 2 hrs. before feeding and shooting. That at least tells me if she is still going down or on her way back up. There are those days were she will get extended duration and so many hours past shot time that I just skip the shot. Diabetic 7 years this Oct. and still playing games with my mind.