Shoot or not? Not used to these low numbers

PMPS was 10.8 on Alphatrak and 40 min later 9.8. He is hungry and pissed off because I panicked and had to prick his ear 3 times when I tested the 2nd time...

He is usually in very high numbers and I’m not sure what to do now? Wait a little bit more and see if it goes up? Shoot less? Skip dose entirely? Please help!

 

Any Prozinc people around? @Elizabeth and Bertie in the UK or @Djamila or @Rachel across the pond?

 

I need to make a decision soon and I don't know what to do it's been an hour since his usual insulin time and he wants his dinner too

 

I know how difficult this is Georgiana. The trouble is, the rule is that you shoot "on the rise" but he seems to be dropping very slightly. Yet if you don't give him even a token dose, there's a possibility that he will sky rocket and all the nice numbers today will be gone. And adding to the dilemma is that he isn't usually this low so there's no previous data to consider when deciding what to do.
I'm hesitant to advise as I'm not a Prozinc expert but those I've tagged above will be better placed so let's hope they come on the board soon. I think also @Kris & Teasel and @Yong use this insulin and they may be around... don't know, the board is a little quiet at the moment.

ETA is it too late in the day to put a call in to the vet?

 

Yes, too late for the vet now...

I'm gonna test him again once he comes out from hiding under the dinning table...

 

Ok - and can you keep your ss up to date if poss so when people do arrive and look in here, they can get the picture?

 

I can empathize -- we just went through a too-low AMPS, though we're Vetsulin users -- if it helps, look at the thread I started titled Low AMPS -- you can pretty much read the whole story, we survived, it apparently was one of those glitchy "double bounce" occasions -- in fact I think it was an indication he was due for a dose decrease; nice low readings over Memorial Day and now it looks like he's bouncing (BG back in yellows) again

@FurBabiesMama -- any chance you are on? I know you had previous experience with ProZinc

 

oh yes, thank you for that! It's updated now

 

Just tried to test again and could not get enough blood I have a very unhappy kitty right now

 

@1.5 13.7 I think I'll give either 2.75 or 3 units

 

Thank you, I will have a look

 

Hi Georgiana, are you going to be able to test after giving the shot? ...This is a much lower preshot than you've seen before. If you shoot then I'd suggest a much reduced dose on this occasion unless you're confident about being able to monitor after the shot.

 

remember, I've been at this only a little over a month; am retired so have read a lot on the board,

 

@Georgiana & Perlutz, have you also posted in the Prozinc forum? (Sorry if I've missed that you've done that.)

 

Hi Elizabeth, I have enough strips and I can test. He won't be happy about it, but it's for his own good. He just had his dinner and I'm preparing the insulin. Still don;t know how much to give....

 

I haven't, no. I thought it's quicker to get a reply here...

 

You have a number of options, and you may want to see this from the FAQ's. Be aware that these numbers refer to human glucose meters. You'd need to add a bit on top of that for Alphatrak.

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
Below 150 mg/dl (8.3 mmol/L), don't give insulin.
Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

 

I did post an update on his current situation on the ProZinc forum if anyone would like to have a look.

 

Sometimes it is, sometimes it isn't, but there aren't any respomses yet to your earlier thread on that forum so at least you've got some replies here and you can post over there and link to this, if necessary...

 

@Diana&Tom @Elizabeth and Bertie @CandyH and Catcat I’ve done it! Gave him 2.25.

I don’t know if it’s a good dose, should’ve been higher or should’ve been lower, but I couldn’t stall any longer. I’m relieved and scared at the same time but if the worst happens, I’ve been through borderline hypo before, I have high carb food and honey and strips to test.

I’m thinking to wait 2 h or at least 1.5 before testing, he’s a bit annoyed and I wasn’t gentle on his ears in my panic. He usually gets another snack in about 2 hours from now, before bed time. He will get that after testing and then ofc I’ll stay up late so I can test more.

I’ve never stalled before and now I’m unsure on how to do it tomorrow? Should I delay it by say 1h in the morning?

Thank you everyone for tour help!

EDIT: also not sure how to put the insulin dose in the SS now?

 

That sounds ok in the circumstances, Georgiana - he is very probably rising faster now so hopefully you will have stopped a real sky rocket. Hopefully if you can stay up late and keep an eye as you say, all will be well although this is new territory so be prepared for anything.
How long is it you stalled for, an hour?

 

Stalled for a little over 1.5h

 

Ok so normally you could have up to an hour's delay before needing to adjust the next shot time. Over an hour and a half, I think you'd need to delay the next due shot by at least half an hour. Does that sound right @Elizabeth and Bertie ?

 

This young man would also like to say thank you to everyone!

Ps:can you see he’s not impressed with me right now?

 

LOL -- classic stink eye

 

+2 after giving insulin is 20.4... Went up considerably... I'm hoping that wasn't it with the nice, low numbers

 

He can still come down again though, that's only +2... don't despair!

 

This morning's +2 was already going lower so I'm not holding my hopes up high.

I must say this evening it's not going as I was expecting. It's 10:30 PM and I'm eating string cheese (completely forgot about my dinner earlier when stalling), waiting for Perlutz to pee so I can test for ketones and cleaning the drains...as you do at 10 pm

 

I stopped testing at +4 last night, it was going down at a slow rate at that point and Perlutz himself decided to go to his bed in the bedroom. Woke up to a very high 29.3 and I'm not sure of it's because he's had his snack later last night, but he hasn't been meowing for food this morning and he seems rather quiet... I'll keep an eye on him before I go to work and I'll try to come and check on him in my lunch break later.

 

Oh that's a shame he's gone up again this morning, but not totally unexpected I think? Could be due to the late and lower dose last night, although he didn't seem to be rising particularly fast then. It's so hard to see a proper pattern anyway. He does drop during a cycle and pre shots are usually high but every now and then you get a surprise - like yesterday. It's always possible that he has a "sputtering pancreas" which means that he produces some insulin of his own sporadically - if so there's not much you can do about it other than monitor and analyse those low times so when it happens you have an idea how long the lows are likely to last and dose a bit sooner, possibly, to catch the rise. Or maybe Perlutz just metabolises Prozinc in an unusual, unpredictable way. I wonder also if the vet might discuss another insulin with you that might suit him better. Or maybe the tumour isn't helping and if that can be treated, it might give bg more consistency.

Sorry, just thinking aloud here, not very helpful! I know how frustrating it is but you're doing an amazing job, keep going!

 

We haven't really discussed another insulin but my guess (based on generic insulin chats we've had with him) would be that he's not really into prescribing human insulin. Of course, the locum vet thinks Lantus could work better for Perlutz, it was briefly mentioned yesterday...

 

Yes it was Lantus I was thinking of. Maybe worth pursuing in the future.

 

Not going to change anything (even if I tried, I'm sure it wouldn't get me anywhere) until we go to The Ralph for CT scan/MRI and maybe surgery. The vet we'll be seeing there has a specialist interest in endocrinology so at the moment I'm putting all my hopes in her. I clearly can't figure out how to regulate his diabetes and his usual vet doesn't either really so...

 

Oh no, I didn't mean try to switch insulin yet, if at all, you need to get the specialist involved first. I was just suggesting that if Prozinc really doesn't suit Perlutz, there are other options further down the road. Hang in there!

 

Looks like history it's repeating itself... 2 days of low numbers followed by blacks! Just got a +2 of 34.2

 

Uhhhhhh....sigh... so sorry to see this. The sooner you can get some specialist help with this the better.

 

Well PMPS brought us another low number, 13.2. I didn't stall tonight, gave him 2.75 units. Yesterday I gave him 2.25 and wasn't enough so I increased a little. Hoping it will all be a good night, although long. I just went and bought more strips and lancets. Please don't worry, we had hundreds of lancets and enough strips to test 1-2 times an hour all night long, plus 2 spare glucometers with their own supplies. We just have 2 different lancet devices, boyfriend prefers the Freestyle, and I prefer the Accucheck with drums and I ran out of my favourite.

@Diana&Tom I called The Ralph today and we won't know much until the day of the appointment. We have an 1 hour allocated for it and the vet will discuss all options with us on the day. The lovely lady I spoke to today checked and said they have a cardiologist there on that day so if they decide to do the CT scan that day, it might be a possibility, depending on how busy they are as well. At the moment they didn't know much themselves as they haven't yet received Perlutz's history from him vet (they chased them today and I will chase them myself again soon).

Off to make some coffee

 

Well that really is interesting - 13.2 at PMPS after such a high AMPS... that's not bad at all. My brow is well and truly furrowed trying to work out what's going on... does he have a sputtering pancreas, is the new insulin giving longer duration... or probably other unknowns to add to the list.

Well done for being brave with the dosing - I think the PZI ladies would approve - so all paws crossed here that we'll see a nice run of numbers now.

I take my hat off to you, Georgiana, you're doing an awesome job and staying calm and collected

 

You and me both, Diana! Here's an accurate representation of me trying to figure this out lol

 

Yes that's about it!

 

I forgot to mention that when I came home in my lunch break I found he vomited part if his breakfast. I'm getting really concerned with the vomiting as he did few times in the previous 2-3 weeks...

 

Maybe he ate a bit too fast? Or does he groom a lot and throws up the occasional furball? Or could just be due to the insulin. Something else to mention to the vet.

 

I did mention it to the vet, at that time it was mostly hairballs he vomited. He suggested I brush him more but we do brush him and he's not grooming himself nearly enough to justify throwing up few hairballs in few weeks...

Can I ask why would the insulin make him throw up?

And, if you remember I posted lots of poopy updates a while back... He still does the bum shuffling on the rug/floor after a poop? Any ideas why? The steam mop and I are becoming too close friends lately lol

 

Well, I don't know exactly why insulin might make him throw up, it might just cause some sensitivity sometimes... I don't know how common it is but I'm sure others here have experienced it from time to time. And again with the poopy issues, I don't think it's uncommon. Maybe it's food-related. This is almost another thread in its own right!

 

+3 17.8

 

Can't fathom it, would have expected a bit lower but hopefully the dose you gave will stop too steep a rise...

 

My my! Sorry I did not reply earlier! I'm not around much during the week but you've had some excitement and looks like the 3.25U dose was the broke the wall . He's having some trampoline time so *in my opinion* I would try to hold the 2.75U dose so long as his numbers permit. You're doing very well, Georgiana and Perlutz! Love that smile

 

Yes, will probably stick to 2.75 as I just got a 3.7 lime green just a moment ago at his +7! Gave him half a can of food and he is happily eating at the moment. He seems pretty normal despite the low number, he was just sleeping (poor thing keeps going to the bedroom to sleep and I go and wake him up and bring him to the living room for testing).

 

+7 3.7

+7.5 4.8

 

+8 5.4 and I am off to sleep I feel sorry for whoever crosses paths with me tomorrow lol

 

Wowzers! Well done for staying up and getting all those tests, hope you've stocked up on coffee for today.
There's definitely something different going on since the dental + new vial. The new vet would I think be interested to see the yesterday's curve... late onset and long duration?
Today will be another challenge then...

 

Oh dear! AMPS only 6.5 I wish I could figure out what is happening in that little body of his.

EDIT: There was another vomit this morning. Apparently it was’t a lot, mostly watery with few bits of food

 

That's a beautiful number! I know it's mind-stretching though - I wouldn't like to suggest what to do now, no dose for sure but even if you can stay home and catch him on the rise, the shooting schedule would be messed up.
I really think a quick call to the vet is warranted at this point, to ask his advice. And if you can pop home at lunchtime to test then, do so and post the updated number on your ss and post on the PZI forum to ask for thoughts on what's going on?
Meanwhile enjoy the moment if you can - 6.5, wow!

 

Yes, definitely no insulin this morning. Unfortunately I have to go to the office but I’ll try to come and test at lunch time - I’m expecting high PM numbers.

I feel like I’ve been requesting too many calls from the vet, dreading having to request another one so I’ll try to get an appointment today if there’s any late ones (I wouldn’t take Perlutz ofc).

I still can’t believe the numbers from last night, I most certainly did not expect a lime green! I’ll follow your advice and post again in PZI. Really hope someone has some thoughts on this.

 

I don't think it's unreasonable at all to ask the vet what to do in these circumstances - I'm sure they'd like to see Perlutz getting better as much as you do ( well almost as much!) so a couple of minutes on the phone shouldn't be too much to ask. Or could you email your ss to them and ask what they think?
Same goes for posting here of course - don't ever shy away from asking questions, that's what the board is for after all and everyone really cares. It seems a little bit quiet here atm but that can all change! I would tag the Prozinc people so your question gets seen by the right eyes.

 

15.5 already at +2.5

 

Oh dear! So it looks as if the new vial, at least, is giving good duration but when the insulin is gone, he shoots up. It's probably a fine-tuning dosing issue, so you can shoot at the usual times, and something that the experienced Prozinc dosing peeps would have some ideas about. Very frustrating but I don't think it's particularly unusual. It may be that a different insulin would be better in the longer term.
I wish I has some ideas for you but I can only suggest a fresh thread on the other forum, tagging the members you know are good at this - Djamila, Rachel, Yong and maybe others?

 

@Diana&Tom I will do that as soon as I can. I could really use some help with the possible scenarios for today's PMPS, I got only 3 hours of sleep last night and I'm shattered tonight, I don't think I'll be able to stay late at all

 

I know, Georgiana... hugs... you really are doing well so please give yourself some credit, but FD is so frustrating and puzzling at times, and you do need help and you do need sleep! Really hope some of the experienced Prozinc people will give you some pointers.

 

Just called the vet and I couldn’t get a call back but they made me an appointment at 2:45 today. The problem is I might not be able to go home and test around lunch time. I’m trying to come up with something but it’s complicated with work today

 

Can you print a copy of your ss and take it with you to the vet appt?

 

I always do that! I look like I'm about to discuss a planning permission when I roll out my A3 paper

 

As expected PMPS 31.1

 

Drat! More or less his default number. Try not to be despondent, though, I do think the recent dental and/or the new vial of insulin are contributing to better numbers, it's now a case of getting the dosing right... not too high so he gets too-long duration forcing you to miss a shot, and not too low so the insulin peters out too soon and he's zooming up again by pre-shot time. We need someone to look carefully at the data and suggest a dose to try out and stick with for a few days.

 

And if nobody else has said this, you're an Ace #1 furbaby Mom for having hypo necessities right there, ready to go

 

Congrats on the reduction, Perlutz! *Just my opinion* If the Vet appointment went well and there not finding anything else that may impact his numbers, I might suggest a teensy tiny reduction. I'd suggest 2.5 if it it's easier but ideally, I would like to suggest a fine dose of F2.25 instead. I found, with our syringes, there is a regular drop between each 0.25U dose and my boy seems to take well to these tiny changes. This is how I get the F and S doses

 

Oh I'm just so confused! When I thought I know what to do, go back to 2.75 he gave me a blue number and then next morning boyfriend did his insulin before I woke up and kept the 2.5 aaand later in the afternoon the vet said I should stop playing with the dose so much *ouch*. Yesterday he went form 11 to 30 in 4 hours and today the insulin is acting longer than usual again! I gave him 2 units at 12.1 and that's the boldest I've been so far It's probably going to be a long night

 

I do feel your frustrations, Georgiana. Anyone would be confused. It will be very interesting to see what 2u does at 12.1 - do keep your ss updated if you can so that if you have any questions, people can see straightaway what's going on. I know you know what to do if he goes low though.
Let's hope that you strike lucky with that dose. Every time he gives you a blue he goes back up again really fast, so it's a matter of stopping him in his tracks... the 2u might just do that.

 

Hi Diana Of course, I will update the SS as soon as I start testing him, probably gonna let him be for another hour or so since he is just chilling and enjoying having the whole bed for himself.

I don’t know if the 2u at 12.1 was a good decision, but sooner or later we had to try a closer to his usual dose at a lower number. Dunno if today was the best of days as I’ve spent all morning and afternoon with my niece and nephew, both toddlers, and they have sucked all the energy out of me plus I start work earlier than usual tomorrow but can’t go back now so we’ll see how it goes (hope it goes well). I bought a new box of strips and have the usual high carb and honey although I hope they’ll not be needed.

I’m thankful to have you guys here on FDMB! And coffee, sweet nectar of Gods

 

16.7 at +1.5

 

Well he probably wasn't dropping then at pre-shot time. But it's the next couple of numbers that might give more of a clue about what's going on. How frequently are you going to test? You probably don't need to do every hour - give yourself and Perlutz a break.

 

Oh no, definitely not every hour! I’m thinking to test again at +3.5 or +4 as I don’t expect him to drop too much before that and take it from there. If he’s still above say 12-13, I might go to bed and set up an alarm in 2-3 hours or so. If he’s below that, I’ll stay up and test more often. Something like that - how does it sound?

 

Yes something like that sounds fine.follow your instincts!

 

My my how they keep us on our toes. Are you testing Perlutz for ketones, Georgiana? What was he in the hospital for? Did I miss something

 

Yes, I do test for ketones. I tested him almost daily last week but gave us all a break this weekend. Will test again tonight though.

He was hospitalized for tests (quite uselessly I would add - could’ve been done as an outpatient) at a referral veterinary centre.

I have a post with more details here http://www.felinediabetes.com/FDMB/...-inflammatory-diagnostic.215814/#post-2395475

We’re out and about for 2-3 hours, but I will reply when we get back home