Should I or not?

Discussion in 'Prozinc / PZI' started by Esi, Aug 10, 2018.

  1. Esi

    Esi Member

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    Aug 4, 2018
    Cross post-

    After giving Hemi 1u for 3 cycles, I increased his dose by .50 this AM and after 12 hrs, testing once in between, his PMPS # was 147.

    I'm wondering if I should go back to just 1u over night though, as I am currently stuck w/ U-40 syringes and can barely judge a .50 increase, much less a .25.

    Would appreciate anyone's thoughts?

    Edit: I'd also appreciate it if someone could look at Hemi's SS (link in my sig) and give me any necessary feedback. Does it look right?
     
  2. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Are you going to be able to get a mid-cycle test in tonight..say maybe +5ish? If so, I would probably give 1 unit. If not, maybe err on the side of caution and do 1/2 unit tonight.

    In order to be able to judge how a dose is working, you must have mid-cycle test data. You have no mid-cycle tests at all for the three cycles he was on 1u, so on what did you base the dose increase?
     
  3. Esi

    Esi Member

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    Yes, I'll be able to do a mid-cycle tonight. I gave him 1u and will see how that goes.

    I increased because his AMPS was higher this am than it was yesterday and thought, since it was early and I'd be here all day keeping an eye on him, the increase of .50 wasn't too much. He ate really well and his PMPS was decent. Don't think any harm came of it but you're right. I need to get the mid-cycle tests in.

    Still learning...

    Thanks for your feedback.
     
  4. FurBabiesMama

    FurBabiesMama Well-Known Member

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    The thing about basing dose changes on pre-shot numbers alone is that you have no idea if the pre-shot is higher because you are not giving enough insulin or if it is higher because you are giving too much and have had a bounce happened.

    It would be good if you could start to get enough mid-cycle tests in to get some idea of when he is lowest during the cycle. If you grab a test or two during each cycle at different times, you can gradually fill in the gaps and see more of the full picture. ProZinc usually peaks between +4 and +8.
     
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  5. Jenna Josie

    Jenna Josie Member

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    Hi there. We just got some U40 syringes with half markings, which also makes it much much easier to eye .25 and .75, so we’ve figured out that when using full-unit syringes, for .75, put the *bottom* edge of the top (skinny) ring of the black plunger on the line. So, for example, for 1.75, the bottom of the top skinny ring is on the 2 line. For .25 using full-unit syringes, put the top edge of the lower (fatter) ring on the line. For ex, for 1.25, the top of the lower fatter ring is on the 2 line. I think it was Rachel who taught us that it’s less important to be perfect than it is to be consistent, and drawing the dose based on other parts of the plunger makes us consistent even if it’s actually 1.2 or 1.3.

    Maybe you can see in these pix?
     

    Attached Files:

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  6. Rachel

    Rachel Well-Known Member

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    Any mid cycles you can get will definitely help. It looked like the 1 unit yesterday gave you a good cycle, but there's no way to know for sure since we don't know how low Hemi went. My guess is 1 unit is actually giving you a really good cycle, so anything you can get to prove that would be good. :)
     
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  7. Esi

    Esi Member

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    I was able to get a couple of tests in during the last cycle. After 1u, went down to 103, then up to 161 and this AMPS was 338. I'm lost. Gave 1u to start the day.
     
  8. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Don't feel lost. This is not usually a quick process. As I have seen people say, 'it is a marathon, not a sprint'. That wasn't a bad cycle. I would hold the 1unit dose at least through today to see how things play out. The higher PS this morning could just be because his body is not used to going as low as it did last night - not too low by any means, but lower than he is used to. Also, the PS values are usually the last ones to go down. You want to focus more on how low the insulin takes him during the cycle. Will you be able to get some mid-cycle tests today, too? Maybe a +4 and +6 during the day? Those are time slots you have not done yet. It is helpful to determine 1) when he tends to go the lowest, and 2) when the insulin starts to work on him.
     
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  9. Esi

    Esi Member

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    Thank you. Yes, I will try to get the +4 and +6 today. My poor baby sure doesn't like me poking his ears though. This am was probably the worst. He just wasn't happy about the process at all! I've wasted more than a few test strips too. Forgetting to push them in is part of my problem. I do the same thing with my own BG tests. *sigh*
     
  10. Esi

    Esi Member

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    Thank you for that. It took a couple times (more coffee needed) but I get what you're saying now. The pics helped a lot too. :)
     
  11. Esi

    Esi Member

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    So I kept Hemi on 1u for three cycles and this AMPS was 142 so I went down to .5 - out of fear that he'd go too low. Too little?
     
  12. Kris & Teasel

    Kris & Teasel Well-Known Member

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    The dose reduction was a good idea. That's still a low PS to give insulin so early in your FD journey though. I recommend a test at +2 to see where he's heading. If that test number is significantly lower you'll need to feed a small snack of regular wet food to try to slow the BG's descent.

    This is from the "Beginner's Guide to ProZinc" stickie at the top of this forum's list of threads:
    • The proper sequence for dosing insulin is: Test/Feed/Shoot. In the beginning, if your cat’s BG is not up to at least 200 mg/dL {11 mmol/L}, if your schedule allows, you can stall (without feeding) for 20+minutes, then retest the BG. You are looking for a number that is rising, not falling and up to 200 mg/dL {11 mmol/L}. If you stall once, but can’t do another round of stalling and your cat hasn’t reached a BG of 200 mg/dL {11 mmol/L}, you’ll need to skip the dose and wait until the next cycle. NOTE: Because pet-specific meters (such as the AlphaTrak2) often read higher than human meters, you may want to adjust the NO-SHOOT number to 225 mg/dL {12.5 mmol/L} or even 250 mg/dL {14 mmol/L} This gives you an added margin of safety when using an AlphaTrak2 or other pet-specific meter.
     
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  13. Esi

    Esi Member

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    Thank you. I will test at +2.
     
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  14. Esi

    Esi Member

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    Kris, when you say "regular" wet food, do you mean what I am regularly feeding him? For example, Fancy Feast classics, which is what I am giving him now, on a regular basis. Or "regular" as in a higher carb wet food?

    Apologies. I just want to be sure.
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, that's what I mean.
     
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  16. Djamila

    Djamila Well-Known Member

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    Regular as in what you're normally feeding. The other option would be MC (medium carb) or HC (high carb)
     
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  17. Djamila

    Djamila Well-Known Member

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    Oops. Cross posted. Hi Kris! :smuggrin:
     
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  18. Esi

    Esi Member

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    Thanks. I was thinking "regular" could mean any ole canned food that has a higher carb count. I know in the case of hypo, I have grilled FF on hand, as it is higher in carb count and something I fed on a regular basis before his diabetes diagnosis.

    Like I said, just wanted to be sure.
     
  19. Esi

    Esi Member

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    +2 = 194

    Hmmm...
     
  20. Djamila

    Djamila Well-Known Member

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    Well, it could just be a food spike and the BG will start to come down by +4, or it could be that 0.5u is just not enough insulin right now. Insulin doesn't have an exact correspondence between starting number and impact. So depending on where you are in the journey, reducing the dose on a lower number isnt' always necessary. It just depends on the cat. If you're around today and can get another test sometime between +4 and +7, it will help figure out which it is. Don't change your plans to do that though - it looks like Hemi is safe regardless.
     
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  21. Esi

    Esi Member

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    Thank you. I planned on hanging out at home today so no problem getting those extra tests in. (We'll see if Hemi is on board with that.) :rolleyes:
     
  22. Rachel

    Rachel Well-Known Member

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    And on the bright side, even if 0.5 wasn't enough, this will help you be sure of that! All data is good data...
     
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  23. Esi

    Esi Member

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    +4 = 172 so going down. I will retest at +7 (two hrs after lunch)

    Yes, that's what I was thinking, Rachel. I love the bright side of things.

    I learned a very good lesson about data when increasing dosage the other day without much to go on. It was a stressful day to say the least!
     
  24. Esi

    Esi Member

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    +7 = 235

    So, giving him a full 1u would have been okay this am? And giving him a full 1 u for the next cycle is appropriate?
     
  25. FurBabiesMama

    FurBabiesMama Well-Known Member

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    A mid-cycle test last night, maybe +6ish, would have been very telling. It is possible he went pretty low last night since he was only up to 142 by this morning. Personally, I would not yo-yo him on dosing. I would hold the .50 units a few cycles to see what happens with that dose. Consistency is important. It is usually best to hold a dose a couple of days before making a change (the only exception being if he goes too low for it to be safe to give the planned dose). Try to consistently get in mid-cycle tests. I find it helpful to set an alarm for some time during the night. Or, maybe take advantage of any time you may get up to visit the bathroom. :)
     
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  26. Esi

    Esi Member

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    Already went back up to 1u before your msg came through. Will get in a mid cycle tonight.
     
  27. Esi

    Esi Member

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    +6 = 213 - (same as PMPS) Going to try to get a +10 as well.
     
  28. Esi

    Esi Member

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    Well, so much for setting my alarm. I used my phone alarm and forgot I had set it to vibrate the last time I used it (wks ago) so slept right through it and didn't get an extra tests in.

    AMPS is coming up in about 30 mins so I'm hoping someone reads this and can help me decide, if his AMPS is near where it was yesterday, if I should go ahead with 1u if he eats well? His numbers went up after he ate yesterday.
     
  29. Rachel

    Rachel Well-Known Member

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    I'm here! Have you shot yet?
     
  30. Rachel

    Rachel Well-Known Member

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    Okay, you may or may not have shot already. :) I'm guessing you have to go to work today, right? If you happen to read this and he's at a yellow, I'd probably shoot 1 unit. It looks like 1 unit kept him in pretty steady numbers last night. I think if he was lower, I'd shoot less or maybe not at all, depending on what the number is, if you're not home to monitor.
     
  31. Esi

    Esi Member

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    I'm here @Rachel. Good morning. :)

    Hemi was at 179 and ate very well. I will be home to keep an eye on him so I'm thinking I should stick with 1u.

    I have been waiting about an hr after feeding, to make sure his food stays down. So far, no vomiting at all since I switched him to all wet. Anyway, I have about 30 minutes til I give him his dose.
     
  32. Rachel

    Rachel Well-Known Member

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    I think 1 unit will be fine since you're home to keep an eye on him. It'll give you good data to see if 1 unit is a good amount for these days when he's lower. It's tough to make a decision on those low numbers, so it often pays off if you take a small risk to see what might happen when you CAN be home to watch. My guess is he won't go too low based on all that happened yesterday, but it will be nice data to have regardless! I'll try to check in from time to time today during work to see what happens! :)
     
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  33. Esi

    Esi Member

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    Thank you so much, Rachel. :) I really appreciate all the help and advice you all have been giving me.

    I am semi-retired and do most of my work from home so am fortunately able to monitor him very closely most of the time. Hemi is already feeling so much better too. He's actually running around a bit and even played with his toys yesterday. He had pretty much stopped doing that over the past month or so.

    I'll give the 1u and continue with BG tests throughout the day.
     
  34. Esi

    Esi Member

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    Hemi @ +10 was 144.
     
  35. Rachel

    Rachel Well-Known Member

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    Looking good! If you can, next time you get a cycle like today, try to grab a test around +6. You want to see how low the dose takes him.
     
  36. Esi

    Esi Member

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    I had every intention of doing that, @Rachel but had a rough day myself. I have diabetes too and today didn't turn out to be one of my better days.

    Anyway, something really strange (and frightening) happened at PMPS. I got two extremely low readings in a row. 30 and then 28! Hemi was not cooperating w/ my attempts to test either, which put both of us on edge. He didn't act strangely or like he was experiencing any hypo symptoms though. I just went ahead and fed them all, skipped the PM dose and watched him like a hawk.

    I just did another test at +3 and he's up to 235. I don't get it.

    I'm wondering if I should I give him a reduced shot or just let him ride through the night without insulin?
     
  37. Djamila

    Djamila Well-Known Member

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    Yikes! With numbers that low, you absolutely did the right thing to skip. Never ever shoot on a lime green number. The 235 is a bounce from being so low. It's totally normal and nothing to worry about. Basically, in response to the BG going too low, the liver floods his body with stored glucose to keep him alive, and he bounces up from the low numbers to a high number. Just let him ride it out tonight.

    Is the food transition complete? Or is he still eating kibble? I'm curious about the deep drop so late in the cycle, and trying to think how to best advise you for tomorrow's dose. Definitely don't give 1.0u again. But how much to reduce is going to depend onwhat he's eating.
     
  38. Esi

    Esi Member

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    Yes, the food transition is complete. Those very low numbers just two hrs after he had a nice blue, shocked the hell out of me!

    I'm feeding him FF classics and recently, due to one of my other finicky kitties, tried some friskies, which is what I fed all of them after the low numbers.

    One of them threw up all the food they ate but unfortunately I wasn't in the room when it happened. I'm thinking it was Hemi because the puke was right by his dish but Garfield was eating right next to him and had left some food on his plate.

    So confusing.
     
  39. Djamila

    Djamila Well-Known Member

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    Hmmm....Considering how recently he was diagnosed, I'm thinking go back down to 0.5u tomorrow. You could do 0.75u, but that would require you to monitor him, and from skimming back through this thread, it looks like Hemi isn't always super cooperative with extra tests. So 0.5u might make for a less stressful day. You'll likely need to ease him back up in dose, but he may be a little sensitive tomorrow, so I'm thinking it's better to error on the side of caution in this case.

    We'll see if anyone else chimes in with a different thought though since in this case it's a bit of a toss up.
     
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  40. Esi

    Esi Member

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    I agree, @Djamila. I was thinking 0.5u for the am too. I use U-40 syringes so .75 would be very difficult for me to eyeball. I test at 5am cst, feed, then shoot 30-50 minutes after he eats, to make sure his food stays put. I'll check here again in the am, to see if there are any other concerns I need to think about.

    Thank you!!!
     
  41. Rachel

    Rachel Well-Known Member

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    Wow that's so strange! I wonder why he dropped so suddenly and so low. Yes, it looks like you need a reduction in dose.
     
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  42. Esi

    Esi Member

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    He was at 248 AMPS just about 45 mins ago. I don't understand those extremely low numbers either?

    I'm going to shoot 0.5 for a few cycles and see how that goes.
     
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  43. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Scary but good advice from Djamila! :eek::)
     
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  44. Esi

    Esi Member

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    +2 = 214
    +4 = 182

    So far, so good. Going to have to leave for awhile after I give them lunch but will try to test again an hour or two before I do the PMPS.
     
  45. Djamila

    Djamila Well-Known Member

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    Assuming that you will need to figure out 0.75u at some point....one trick that is often used is taking a syringe and pulling up some colored water to where you think 0.75u is. Then that becomes your comparison syringe. So on other days, you pull up the dose, compare it to the colored water syringe, and then shoot. It's more important that you be consistent, than it is that you be precisely at 0.75u. Then from there you can do a little more or a little less than that to fine-tune.
     
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  46. Esi

    Esi Member

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    @Jenna Josie

    Can you share where you found the U-40 syringes (a website, business name or link) so I can check them out? I'm trying to get my supplies from as few vendors as possible so I can more easily keep track and then reorder quickly when needed.
     
  47. Esi

    Esi Member

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    Thank you for sharing that nifty trick. I'm going to give it a try!
     
  48. Esi

    Esi Member

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    @Djamila - I made up a couple of syringes with colored water, marked w/ a sharpie on the plunger lock cap .75 and 1.25. Easy peasy :D This should work!

    Hemi did well today. Got a couple of tests done and another at +11, which was weird (at least to me) that his number went up so much in just one hour! Is that to be expected?
     
  49. Rachel

    Rachel Well-Known Member

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    Hemi looked good today! He didn't really go up too much before his +12...50 points isn't bad. It's fairly common for kitties to go up in that last hour for whatever reason...the insulin is usually pooping out by then I think and so they often end up going up. That's why stalling when you get a lower than usual preshot for 20 minutes can actually work...they can go up a lot at the end of the cycle!
     
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  50. Esi

    Esi Member

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    That makes sense. Thank you!
     
  51. Jenna Josie

    Jenna Josie Member

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    Hi. Sorry, I just saw this. We got them online through adwdiabetes.com. I think they were around $15 for a box of 100. Ulticare vetRx. 3/10cc. 29 gauge. 12.7 mm length.
     
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  52. Esi

    Esi Member

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    Thank you! Question: someone wrote in the reviews that the needles are huge. "Like sticking my cat with a harpoon!" Do you think they're huge? Any issues using them?
     
  53. Jenna Josie

    Jenna Josie Member

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    No, though I don’t really have anything to compare them to. These needles are the same capacity, gauge, and length as the full-unit-markings syringes the vet gave us when Josie was first diagnosed.

    We shoot while she’s eating, and nine times out of ten, she doesn’t even notice. I think the two tricks are inserting the syringe at a 45 degree angle and, most importantly, making sure that the bevel is facing up so that the sharp point is what’s penetrating the skin first. (Also, now that her weight is back up, we use the “roll” vs the “tent” method for pulling her skin up.)

    Someone else with more knowledge and experience may have other thoughts, but this gauge doesn’t feel like a harpoon to us!
     
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  54. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I use syringes of this gauge and needle length and have no problem. Yes to making sure the bevel is facing up and make your poke quick and sure. Occasionally you might feel a little skin resistance but push past it. :)
     
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  55. Esi

    Esi Member

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    Thank you. The syringes I am currently using have a very thin needle. I never even noticed a bevel/sharp point but Hemi has flinched a bit, a few times, while getting stuck. I went and used a magnifying glass and sure enough, there is a bevel! lol

    I'll have to look up this "roll" technique. Never heard of it.

    I'll be ordering them. Thanks again.
     
  56. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Here's a tip I learned online a long time ago: hold the syringe needle under a bright light and rotate it until you see the light reflecting off that flat bevel. Take a Sharpie marker and make a little mark on the barrel below that flat side near the needle (but not ON it of course, on the barrel plastic) so you have a visual guide when you're injecting. That makes keeping the bevel side up easy peasy.
     
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  57. Esi

    Esi Member

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    GREAT IDEA!!! I already use readers and fill under light but never noticed the beveled edge before. I will definately do this. Thank you! :cat:
     
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  58. Jenna Josie

    Jenna Josie Member

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    Take a look at the “Testing and Shooting Tips” sticky in the Lantus forum. :)

    Also, turns out lancets have bevels, too!
     

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