Discussion in 'Prozinc / PZI' started by SamsonsMom, Jun 27, 2017.
Finally some lower numbers - 108 at nadir on 2u
Looks good on you, Samson
Samson's numbers on 2u still look worse than they did on 1.75 - do I just need to give it more time? @Yong @Kris & Teasel @Djamila @Rachel
I think you need to give it more time. It's almost 6 of one and half a dozen of the other.
I agree with Kris. You're getting the occasional nice blue nadir. To me, the numbers on both 1.75 and 2 look really similar. I know it looks bad because of the pinks, but you were getting high yellows and now you're getting low pinks...with the variance, those are really the same numbers.
Thanks guys! I also ordered some new insulin (had this one about 4 months) so we'll see if that makes a difference?
I agree with Kris and Rachel .
Samson is at 453 at +3 after his morning shot I'm getting so frustrated with this process. It doesn't seem to me that this could be "bouncing" because his morning number was not low. Can anyone help explain this @Kris & Teasel @Rachel @Djamila @Yong ?
ETA: I was so frustrated by this I took his BG again 5 minutes later and got 368 - what's up with that? I am not happy at all with these numbers. So upset.
Hi samsonsmum, sorry I'm not incredibly active right now. I herniated a disc in my back again and can't sit at computer very well. The 453 and 368 are within meter variance and unfortunately every meter is allowed a variation.
I can't look at his SS right now but I think his blues still had wiggle room. Would you want to try a fat 2.0U next time you can monitor? Let's see what the others think too.
Hi @Yong, thanks and I'm so sorry to hear about your back, wishing you a speedy recovery! He's been at 2.u for 6 days now and his numbers have been worse than when he was at 1.75u. When you say a "fat 2u" do you mean like 2.25? I am tempted to drop him back to 1.75u - blues at nadir are better than all these pinks
You could try him back on 1..75 u for a few days to see if his numbers improve OR you could increase to 2.25 u. Either choice is fine and might give good decision-making data. The way forward isn't always crystal clear. Sometimes you have to try a couple of things to see what works best.
Yep, either way is fine. You kind of have to pick one and go with it...what would you feel most comfortable with?
Thanks guys. Sorry for writing on here so much. It kinda seems like the higher Sam has gone on his dose, the worse he does - he didn't do well on 2.5 u and isn't doing great on 2u either- so I think I'm more comfortable trying 1.75 again. Thanks and I'll keep you all updated (obviously, haha)!
Write on here as often as you need! That's what this board is for.
Better numbers last night and this morning on 1.75u! I could tell immediately when I woke that Samson was feeling better because he was running around playing with his toys instead of just lying there
Edited to add: back in the blues at +3
Wow! 100 point drop at +3...here's hoping this is the answer!
Yep! He seems to do better at this dose and has been extra frisky and playful today!
I'm loving these curves I'm getting from Samson - classic curves! His numbers at AMPS and PMPS are still sometimes in the pink, but I've been doing a lot of reading online about BG expectations for diabetic cats and the consensus seems to be that as long as the cat is between 100 and 300 for MOST of the day, it's fine. So I'm happy with these results for now.
Yes! Very acceptable curves! Time to reword your thread title or start a new thread.
It's all thanks to you guys @Kris & Teasel @Rachel @Yong and @Djamila . Thanks for all your patient advice!
Hey all! Long time no talk - it's because Samson was doing a lot better on PZI and had regulated to some nice curves daily. Well, no longer! TO make a LONG story short, I currently live out of the country. Samson's care is in the hands of a very dedicated caretaker, and she checks his BG levels at AMPS, +6 and PMPS twice a week, when she has days off. He was doing fine. Last week, he had to go to the emergency vet after an episode of diarrhea that left him lethargic, refusing to eat or walk. They checked him out thoroughly and said nothing was wrong with him and discharged him after one night of observation.
In the hospital (he was there on Friday morning through Saturday morning) his insulin schedule was kind of wonky. On Fri morning, the caretaker didn't give him insulin because he refused to eat and it was not safe to give him his shot. In the hospital, when he checked in, his BG was low due to not eating so he didn't get his Friday am shot. In the evening on Friday, they gave him the shot but only 1.5 units instead of his usual 1.75. On Saturday morning they still only gave him 1.5 units. On Sat evening they told his caretaker to only give him 1 unit, and to try reducing his dose to 1.5 units. We only did this once as his BG immediately started to climb too high.
Sunday PM he was returned to his usual dose of 1.75 units but his BG has been too high since then. 436 Monday PM and 426 today AM. He was regulated at 1.75 before, so the whole point of this post is to ask - is this bouncing around normal after hospitalization and messing with his dose? Can anyone weigh in with advice I can pass on to his caretaker? THANK YOU!
Did they check for pancreatitis? A quick SNAP fPL which gives a yes or no answer. Is she testing him for ketones?
They tested for absolutely everything and there was nothing wrong other than an outsized reaction to the diarrhea.
It's not unheard of for numbers to stay elevated for a few days after a vet visit. Although it's also possible that it's bouncing from an undetected low number. Probably the safest thing to do is wait until the CG can get a mid-cycle number (any chance she would try to grab a couple of them?) to see if there is a drop happening, and then if not, and if Samson has had a couple of days to relax after the vet, then consider a small increase.
Thanks @Djamila ! He did have a weird low number - 125 in the AM on the Saturday morning of his vet visit, even tho he hadn't had much insulin during his stay. Maybe it's from that? CG is grabbing a mid-cycle on her day off tomorrow.
Possibly Samson didn't eat much at the vet, giving him that low number on Sat. I agree with Djamila, give him a few days to chill out, grab a mid cycle when possible, and let's go from there. And just be sure she's checking for ketones.
Thanks @Rachel, @Djamila and @Yong !
Can anyone make sense of Samson's numbers today: AMPS 215, +6 67, PMPS 362? Very strange pattern :/
Hmmm...looks like a good pattern to me. The 215 to 67 is great. The 362 is probably a little bit of bounce inflation since he isn't down in those greens all that often.
Thanks @Djamila ! I just thought it was weird because the AMPS number was very low, so was his nadir, but his PMPS was more or less where it usually is...
Hello, I'm new here. Our cat Taco was diagnosed with diabetes 2 months ago, he's 12 yo. His BG at the vet was 425, they started him on DM . I went all out and immediately got my own meter and did a curve a couple days into the food.Cut him off cold turkey from his free dry and 1 can little friskies chicken and gravy. Nothing changed. Took him back and in addition to the DM Pate he was put on 1U twice a day. Curve again, and he's all over the place, no rhyme, no reason, but NEVER under 300. Into that a few weeks and he is now on 2U twice a day since 4 days. Again all over the place on his curve and stick. Last night before he ate , 12 hours after his first meal he was at 275. This morning 12 hours after last night he was at 400. I'm completely stumped. Any suggestions? Please Forgot to say that Taco is on Prozinc, and can someone show me where I can find all the abbreviation you all use here, I'm lost
Hi @TacosMom! I'm going to make a new post for you so you can get some more eyes on it...not as many will see it here at the bottom of someone else's post.
Here's the link to your new post! http://www.felinediabetes.com/FDMB/threads/post-for-tacosmom.185733/ Just click on that and it will bring you to a new thread and below that you'll see my reply.
Hi all! Samson finally regulated after his vet visit and my most recent post, getting into dark greens at his nadir consistently! Here's a new one, though: his AMPS number today was also dark green: 54. Obviously, his caretaker didn't give him any insulin. How do these situations work, though? I told her to grab his +6 number, then his PMPS, and depending on the PMPS possibly adjust his evening insulin dose. Is that right? Thanks! @Djamila @Yong @Kris & Teasel
Wow, those nadirs are great! Here's the thing: if Samson is spending more time in greens, that opens up the possibility that his pancreas could start to heal, which means his insulin needs could start changing, and his numbers might start being a bit unpredictable. Time will tell on all of that. For now, yes, skipping the dose on low numbers is the right thing to do. Another thing you might recommend is that when she gets a number that's wildly different like that to repeat the test and make sure it isn't a wonky test strip. They do occasionally read wrong.
If that 54 is correct, it might mean that he went awfully low during the night, which is a bit concerning. Does he have access to food during the night so he can eat if he needs to? I hate to lower the dose if this is just an anomaly though, since those greens are so good for him. If she could get an overnight test, that would be ideal, and then keep an eye out if there are any more strange numbers like this that might indicate that he's ready for a reduction.
Let's see what others say, and if they think he should get a reduction now. I tend to lean more toward the aggressive side in dosing.
Thanks @Djamila ! I think it was a fluke test strip - she tested him again and he was at 354. Oh well. I'll file this info away anyway in case something like it does happen later on!
THIS IS AN EMERGENCY - Samson has stopped responding to PZI. Please look at his chart for details. Over the last few days, his AM and PM numbers have been almost 500. I bought a new bottle of insulin last night thinking the other one (only 6 weeks old) had expired. He got his usual 1.75 units and 3 hours later (at night) was back down to 270. Emergency averted, I thought. Nope. This morning his AMPS was back to 494. Nothing in his environment or diet has changed. I live abroad and someone else takes care of him. I am freaking out. Can someone please help? What should I do? Why could this be so? I will have a +4 and +6 number to add later today. @Djamila @Yong @Rachel @Kris & Teasel
ETA: If his numbers later today show he's still responding to PZI at all, should I push his dosage up to like 2 or 2.5 to get him back into normal AM and PM numbers?
Deep breaths...sending you a cross-ocean hug!
A couple of possibilities: one is that he needs a reduction. The nadirs were getting lower, so maybe they are getting too low and he’s bouncing in response. The other option is that there is a health issue propping up the numbers and he has a UTI, dental issue, pancreatitis, etc. Check with the caretaker if he’s seemed off at all: not eating, meowing around the litter box, peeing outside the box, lethargic, sitting like a meatloaf with paws tucked under himself, etc. And if she can look at his teeth/gums and see if they look red or irritated.
Then let’s see what the updated numbers show and see if she can get some extra tests in for a few days. If he’s bouncing, a single cycle might be high while another cycle might show a dive.
Hang in there. I’m sure this must be hard to be so far away!
@Djamila : thank you so much for your quick response. Today is the caretaker's day off. she'll get +3, +6 and +9 numbers that I will share. cAN You address this question?
"If his numbers later today show he's still responding to PZI at all, should I push his dosage up to like 2 or 2.5 to get him back into normal AM and PM numbers?" Or should we sit tight with his normal dose of 1.75 or 2? THANK YOU!
eta: No other health issues. she says he's been normal or even much better. She said this: "Like I said, everything else is normal. He's even had fewer hairballs and less shedding."
Update: 362 (from 494) at +3.
I agree with Djamila. He's still responding but might be bouncing or might have some other issue brewing.
Thank you for the input. It seems unlikely that he's having a health issue. Should his caretaker therefore lower his dose? She said his +6 was 350 - very high compared to recent nadirs. Please advise! @Djamila @Kris & Teasel
Is the caretaker willing to grab some other mid-cycles? The problem is that a bounce (when the cat stays high after going too low) can last several cycles. So the only way to know if that's what's happening is to get mid-cycles on a few days (or evenings) close together and try to catch a low number. The flip side is that if she does that and only finds more high numbers, then that means that there is a hidden health issue. The most common one is dental problems. They can sometimes be spotted by looking at the gums and seeing if they are inflamed, though a vet would be able to tell that best, especially if her gums are naturally a darker color. They don't come with any obvious symptoms other than suddenly high numbers. I'm sorry there aren't any easy ways to solve this mystery. More tests or a vet visit are really the only ways to figure this out.
Hard to say. Will you be home to monitor soon? If so, I'd leave the dose alone if it's only a few more days. You need more testing to know if it's bouncing, as Djamila said.
If I remember right, she's living overseas for a year, and just left a few months ago.
I won't be home soon - living abroad for one year. Caretaker has a full time job so can only grab mid cycles on her days off (weds and sun). Should we keep his dose the same for now? Thanks!
ETA or drop to 1.5 if the theory is bouncing? She said his gums look fine. With a bounce, are the mid cycles also high (like sam's numbers today)?
I would keep it the same at this point because if these numbers really are high (not just from bouncing), you don't want to be giving him less insulin. Could she grab some before bed tests? How many hours between the shot time and her bedtime?
Thank you. With bouncing do mid cycle numbers stay high like sams today?
It depends on the cat, but typically they will go low for one cycle, and then will have anywhere from one to five cycles after that where they will be "stuck" up in high numbers. It's how their body tries to protect itself from the "too low" numbers. The liver dumps a bunch of glucose into the blood stream to bring them back into safer ranges, but then it takes anywhere from a few hours to a few days to get back to normal.
Thank you. So, for now keep the dose the same and get as many extra tests as possible?
Yes. And post again in a few days and we can look at the new data and see if it give any hints as to what's going on.
Thank you all so much for the guidance!
Hi SamsonsMom! I'm sorry I am not around nearly as much as I was before since I started working. I very much agree with what Djamila and Kris said though. Especially those before bed tests.
Was there any chance he got into contraband or she gave a higher carb food by accident? I just recently did that myself .
Bumping because there is some new info on the spreadsheet - Samson has dropped back into his normal ranges, so wondering if it was a fluke of if he was bouncing and his dose needs to be reduced? Thanks!
I am having the same problem with my cat except she is in 7.5 units of PZI. Now I am reading about "bouncing". Her numbers hover in the high 300s and higher. Don't know what I am doing wrong.
If you can give us a little info we can start offering some advice:
When was your kitty diagnosed?
Do you test her blood glucose regularly at home?
What food do you give her?
How quickly was her insulin dose raised and by how much at a time?
Does she have any other health issues currently?
Please start your own thread here on this forum so more people will see it. Right now it'll get lost in this thread someone else started.
Amber was diagnosed with diabetes 4 mos. ago and two days later went into heart failure where she was diagnosed with HCM.
She started in 3.5 units of prozinc, but slowly kept increasing the dose which is now up to 7 units with the numbers not going below 300 at the peak. Her normal range is in the 350-395. I test her at home twice a day. She is still losing weight. 13.5lbs down from 17.5lbs.
She is also on 1.25 vetmedin, 12.5 furosemide and 5 mg benazepril.
She is on fancy feast classic wet food and some pro plan wet food.
That's a very high starting dose. The usual is 1 unit twice a day. Cats with other health issues, including HCM, can be more difficult to regulate. It's possible she's a high dose kitty but it's also quite possible that she's been getting to much insulin all along. The only way to know is to do more testing near the middle of the cycle to see how low she goes. When do her twice a day tests happen relative to insulin dosing time?
I did a curve on Saturday and her lowest number was 275 at 3:15pm.
I test at 7:30am and pm. Her am level is close to 370-395 and pm is 350/360, but she eats all the time, she is starving and drinking water all the time. She had bloodwork and kidney functions were still very good.
How do I know if I am giving her too much insulin especially since she is still losing weight?
The key to assessing a dose is to get BG data from the middle part of a cycle. Here's the testing routine we recommend:
Here's how to approach finding the good dose range:
test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
test at least once near mid cycle or at bedtime daily to see how low the BG goes
do extra tests on days off to fill in the response picture
if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
post here for advice whenever you're confused or unsure of what to do.
If you're testing with food recently on board, the BG will be inflated. If you're not testing in the expected low BG time period you don't know if she's dropping too low or not. BG responses can vary day to day or cycle to cycle (day versus night) so she isn't necessarily dropping to the 200s every cycle. She might be going lower but you have no way to know. Her clinical signs suggest that her BG needs better control. We ask people to track their data over time in this spreadsheet because it's viewable by all members and its the first thing we look at before offering advice.
I suggest you start your own new thread on this forum. You're still lost in Samson's Mom's thread. Then go to the top of the ProZinc forum's thread list and look for the yellow info sticky explaining how best to use ProZinc (PZI). How to decide on a dose and assess it is explained in detail there. The spreadsheet we use here is vital if you want the best feedback from us. We look at the trends to see what a dose is doing. It's very easy to use and there are people here who will set it up for you if needed.
Hmmm...it's really hard to say. That 77 isn't really that low. She could try dropping the dose to 1.5 on Wednesday when she can test. Then if the numbers are higher and flatter through the cycle, go back up to 1.75. It's such a guess at this point, but I'm inclined towards thinking those higher numbers were maybe a fluke - like maybe he was just feeling a little under the weather for a few days or something. But if he is dropping during non-test times, lowering the dose a little could possibly help out. If you decide to have her lower a little, don't leave him down there for long if his nadir stays higher than green.
Just saw your response @Djamila - thank you!
After these posts Samson went back into his normal ranges - which, to be fair, are just OK, in the 300s AM/PM and 200s at nadir. Today, though, he was back in the red at AMPS. Is it just par for the course for there to be spikes from time to time or does this indicate a larger problem with his insulin regimen? Thanks! @Kris & Teasel @Yong
ETA: Djamila and Kris, I see you ultimately switched your cats from ProZinc to another insulin - why? I am wondering if I should switch Samson to a different insulin when I'm home for a couple of weeks in January.
A bouncy cat will spike into red (or black! ) occasionally. Focus more on the nadir values when assessing a dose. You could try 2 u soon to see what happens - the 77 was a few days ago.
Thanks! Why 2u? I thought we were assessing whether he should be DROPPED in his dose...
I was just scanning down the mid cycle numbers since he's been getting a 1.75 u dose and the dark green numbers are in the minority. You could certainly leave him at 1.75 u for now.
Not sure why a drop in dose in on the table at this point in time. Is the thinking that a slightly reduced dose might reduce the gap between PSs and nadir values?
When I posted a couple of weeks ago about his really high numbers, members suggested that he might be "bouncing" due to a too-high dose. So I thought that was what we were assessing? Also @Kris & Teasel can you remark on why you switched your cat's insulin and if you're happy with the switch? Strongly considering putting Sam on Lantus.
Your kitty's SS on ProZinc has some similarities to Teasel's when he was on ProZinc - consistently high PSs even if the nadir values were in better territory. In Teasel's case, I viewed it as a dramatic rebound at the end of each cycle. Sometimes he'd stay high and flat for quite a few cycles in a row and that's a bounce effect as well.
I switched Teasel to Lantus in February of this year and persisted with it until this past September. I also switched to a pet meter and that had an effect on the colour distribution on my SS. The Lantus allowed him to go lower without bouncing as high but he did bounce. He would also drop too low and then I had to test/steer with food/retest etc. He was lethargic a fair bit on Lantus and I could tell he didn't feel well even though his numbers were improved. I decided to try him on Levemir to see if he'd flatten out more because many kitties respond that way - very long duration, long stretches of flat numbers, etc. Teasel doesn't act that way at all on Lev. In fact it acts much more like an in and out insulin. It's what I wished ProZinc had done for him. He still bounces but they don't last long and he feels much better on Lev.
Thank you for that explanation! do you think I should switch Samson to Levemir and if so do you have any pointers on doing that?
Samson might do very well on Lantus - many kitties do. There are also more Lantus users than Lev users. You might consider Lantus first. It's very expensive in the US so many people order it from Marks Marine Pharmacy in Canada (based in Vancouver).
You could post on the Lantus forum asking for advice. There are a lot of very experienced people there (huge forum).
Thanks @Kris & Teasel ! I did post on that forum. My main questions are these:
I'd like to order the box of 5 pens from that Canadian pharmacy but it takes a long time to ship from Canada - is it not necc. to refrigerate Lantus? do you guys use syringes to draw from the pens and if so can you explain that process? any links to where to buy the U100 syringes? THANK YOU! Also, should I get .3 cc syringes or .5cc? Is 30 gauge OK?
Yes, Lantus should be shipped in a way that keeps the pens cool. In the winter freezing is a danger too. Marks Marine Pharmacy can probably give you more info on that if you call or email them.
Yes, you draw the insulin from the pen cartridge as you would from a vial. When you open up the pen, the rubber end of the cartridge should be exposed. You put the syringe into it as you would into a vial but you don't inject any air into the cartridge first.
A lot of US folks order from www.awdiabetes.com. I'm in Canada and buy syringes from my vet. You want U100 syringes that have half unit marks and are 0.3 mL (cc) capacity. I have 29 gauge syringes but many people like 30-31 gauge. My needles are 1/2" but many prefer 1/4".
Hi there! We were considering a possible decrease, but the data you have never caught another low, so at this point I agree with Kris that 2u might be a better way to go. Please have your caregiver increase the dose on a cycle when she can monitor with an extra test or two, or at least keep an eye on him.
When will you be back in the states and with Sam again? Many folks have been happy with the switch to Lantus or Levemir (we've tried both too), but I wonder about trying to switch insulin if you aren't here? It's often recommended to increase monitoring during a switch which might be difficult right now?
Good point @Djamila! I'll be at home with Samson from Dec. 31 to Jan. 11 and will start the Lantus then with increased monitoring.
Good luck with Lantus! Maury is doing much better on it than Prozinc. He was a slightly bouncy boy and look where we are now (antijinx). We had a visit to old bouncy territory but that was my fault for being a scardy cat and skipping a dose . I ordered from Marks Marine Pharmacy and I think I got the insulin in less than a week.
Here are the syringes I use for Maury, I used them with Prozinc towards the end with the conversion chart and to help me get used to U-100s. With Lantus there's no conversion though:
I draw the insulin from the pens, like mini vials. Here's the video:
Thank you @Yong this is invaluable information! Question: once starting to use a pen do you leave it at room temperature, or take it in and out of the fridge? I've read that the former is better.
I keep mine in the fridge. I put some paper towels in a cat mug and sit the pen as upright as it will on its own.
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