The Switch to Prozinc, Part 3

I'm kind of thinking out loud with this post, but I need some guidance. Timmy was 417 this morning. I gave a skinny 2.0 units. This isn't enough when he is in the 400's. I need to be consistent with the dosing so he doesn't bounce, but still give him enough so he comes down into the blues and greens. So if he is in the mid to lower 200's, I could give either a very skinny 2.0 or a fat 1.75. I'm trying to figure out a safe, but effective dose range. When I was on the other insulin, @JanetNJ would make a range list for me and that helped tremendously. With that hypo the other day I'm just apprehensive right now. I ordered the U-100 syringes yesterday so they should be here by early next week, which will help. Guidance, thoughts...help.

 

Timmy might be a kitty who does well with sliding scale dosing. I have no experience setting one up but Janet has done many. I see that you tagged her and I'm sure she'd be willing to help. Those U100 syringes will be a godsend to you!

 

Have a look at Teasel's SS where you can compare his numbers on ProZinc and Lantus. They're still all over the map but there's more blue and green in the Lantus section - and I'm using a pet meter! You've only recently switched to ProZinc so there's no need to consider a switch. Teasel and Timmy are similar in their extreme reactions so a comparison might be interesting to you.

 

I have lost my confidence to go to 2.0, but he needed more today. He is going to keep me on my toes though. When he goes too low it is hard on him, and really hard on my confidence in dosing him.

 

I truly understand this. We want to do what's best in what can be a very difficult situation. I know that Teasel doesn't feel well when he drops too low. He seems happiest when his BG is around 120 to 150, maybe not ideal by the criteria of well regulated but good for him. Now, getting him there and keeping him there is a whole other issue ...

 

Looking at Teasel's spreadsheet, I could be looking at Timmy's if I didn't know better. He does have more blues and greens since you switched though. You have nerves of steel dosing the greens, I know it is an entirely different insulin, but still! Comparing the two spreadsheets makes me feel like I'm not totally off track with Timmy. Thanks.

 

I'm glad that Teasel's chaotic SS makes you feel better, Susan. Dosing on green the first time or two was a bit stressful but it's manageable.

 

Lol. That came out so wrong. Sorry.

 

Don't worry - I didn't take it the wrong way. I know what you mean about the similarity in their SSs. We have a pair of very tricky boys here!

 

PMPS was 341. Gave a skinny 2 units. He probably could have been given at least 2 units to get his down farther, but 2.0 units hasn't been kind to us lately.

 

You're giving yourself a little break.

 

I do not love sliding scales on prozinc. (pretty sure everyone is tired of hearing me say that by now). What I see on spreadsheets with sliding scales is just utterly chaotic bouncing. Timmy actually doesn't seem that bouncy to me, but he is less predictable than you might want. For the most part though, he doesn't run sky high after a low. He just goes back into his "normal" range and hangs out there for awhile. Maybe a very very broad sliding scale. Something like Under 300 = 1.8, over 300 = 2.0.

Lantus has a dosing rule for some kitties that they have to have three hypos at a dose before they get a reduction. It's the rule for reactive kitties that sometimes will just throw a lime green for no good reason (ahem...Timmy!). Kris, can you shed any more light on when a kitty gets into that category? I've only skimmed over in Lantus-Land, not studied. I wonder if something like that might work better - waiting a bit before reducing since right after a lime, he seems to run high for a number of cycles.

I do respect though, that you were just saying this is all pretty stressful for you. Please please please know that hypos don't mean you did something wrong. And high numbers don't mean you did something wrong. This whole thing is a long process of gathering data, looking at the data, and making your next move. You can only know anything in hindsight. So whatever is happening in the present is just new information. You are doing a really really great job. And beyond all the numbers, just paying attention to how you are doing and how Timmy is doing and staying focused on that.

 

Also, remember that you KNOW what to do if he hits those lime greens. You can handle it, and there's usually someone around here on Health if not on here to help talk you through it if you feel like you aren't sure what to do or just want some company when it happens! Basically, Susan, you can take care of him if something happens and that should give you a bit of confidence. I totally get how stressful this is! You're doing a fabulous job with Timmy and he's super lucky to have you!

 

This guideline is part of the Tight Regulation (TR) protocol for Lantus users. Strictly speaking, you have to get three BGs under 50 or one under 40 on a human meter before you reduce the dose. The idea behind it is to make sure that a dose reduction is truly earned instead of being given because of a single lime green. It's in recognition of the fact that these can happen a little randomly. It's important to know that if you follow TR you're doing quite a lot of testing so you can catch an impending crash and intervene.

 

I'm not a fan either but that attititude has been shaped by many months of trying to keep the variables to a minimum while treating my crazy unpredictable FD kitty.

 

Hope those new syringes help! I'm going to try and pick some up this weekend too! Or order... if the store does not have them

 

Thank you all for your insight. What I am understanding is that the sliding scale, at this point, will only make things more chaotic. So Ill shelve that option for now. Timmy's numbers this morning show that he really needs 2 units now. I like the broad scale of 1.8 if he is below 300, and a skinny 2.0 to 2.0 units for over 300. Those new syringes are on their way. They can't get here soon enough for me. I need him to have a dose where I don't have to guide with food or test every single hour. If I do keep steering for a little while, will he start to come down to lower numbers, in theory?

 

Theoretically, yes. His pancreas isn't getting time to rest and heal when he's over about 200 (there's some debate about what is really a "healing" level of BG). So he needs to be in lower numbers in order to recover more function and therefore need less insulin. For Timmy, it looks like he's either too high...or diving. At least for now. So it seems like in order to get him into better numbers more often, you're going to be running the risk of those occasional limes. I wish there was some way to make this all easier for you!!!

 

Yep, unfortunately, Timmy is one of those tricky kitties...with luck in time he will settle down some. While I know the bouncing is trying and upsetting, it's something a lot of kitties have to deal with unfortunately. We had a kitty on ProZinc a few years back who bounced for 2 years...until one day he bounced right into remission! It does happen...and you're doing a wonderful job with Timmy!

 

Your knowledge and guidance helps so much. Thank you! To get him down, I'll have to push the envelope a bit, but if that will get him down, that's what I'll do. So correct me if I'm wrong, but for now, I will use the very broad scale of 1.8 for under 300 and 2.0ish for over 300. I will monitor like crazy and keep my fingers crossed that I can get him into better numbers.

 

That gives me hope. Bouncing right into remission, however long it takes, sounds wonderful to me. Thank you.

 

I think that's a good plan. Hopefully that will help bring him into at least somewhat more stable numbers.

 

Timmy's amps was 347. I gave him 2 units again this morning. I'm hoping Timmy will be feeling "blue" today.

 

Well, he at least got sort of near a blue . Hang in there!

 

Well, maybe he'll want to feel "blue" tomorrow. Those u-100 syringes are scheduled to arrive tomorrow. So after I figure out how to use them, hopefully my dosing will be more accurate and we'll start to make some progress.

 

Grim determination - that's the way to go, Susan. Just ask me! The U100s are very helpful.

 

Timmy's Amps was 396. I gave 2 units. I would like to give 2 units am and pm for a few days for consistency, providing he isn't too low. If his numbers don't move after a few days, should we increase the dose? I can't believe I am even thinking this, but I don't know what else to do. I received the u-100 syringes this morning. If I am understanding the conversion, 1.8 units will be 4.5 and 2 units will be 5. It's going to take me mental minute to be okay with these syringes and the conversion that 2 is 5 , but I'll get the hang of it. I usually order the syringes with black writing on the outside and a red stopper inside to make it really clear. The syringes that I ordered this time aren't like that. They are black writing and a black stopper on the inside. I'm not sure it is called a stopper, but that's what I'm calling it.

His numbers just seem kind of stuck right now. We're just stuck. What do you think?​

 

You'll get used to the black plunger, Susan. Print out the conversion chart and then store the U40s somewhere completely separate.

Yes, give 2 u for three cycles max if he doesn't shift. Then up it to 2.2 u with a U100 syringe. The longer he sits high the harder it is to bring him down. Teasel is very much the same. I know this is a scary mental hurdle for you but you'll get used to it and you know how to steer him if needed.

 

Yes to everything Kris said.

I printed out a few copies of the conversion chart and highlighted the u100 dose that I was supposed to give. Then did a new one when the dose would change. It helped me make sure I wasn't going to mess up when I first started with them. And definitely put the u40's far far away. That is not a mistake you want to make early in the morning!

 

Okay. I had another though/question. Do you think that I should start the 2.2 units with the tomorrow morning dose, or stick with the three cycles at 2 units am and pm? I don't want to move too quickly, but I want to get him moving.

 

Oh, that's a great idea! I just printed out some copies and will highlight the dose. I moved the U-40s to another closet altogether.

 

He's been high-ish a while and going to 2.2 u is a small increase so I'd increase tomorrow AM if I was in your shoes.

 

Okay. Thanks. That's what I'll do. The 2.2 units is 5.5 with the U-100 syringes. Let the games begin tomorrow, Timmy!

 

Increased dose to 2.2. His amps weren't too high pink this morning. He was 320. Give me a blue today, Timmy. Please.

 

You WILL get there, Susan.

 

Thank you for your encouragement, Kris.

 

Timmy's PMPS was 325. Gave 2.2 units. No blues today. Darn it! We'll try again tomorrow. I don't expect him to get into blues tonight, but maybe he'll surprise me.

 

He'll get there...give it time!

 

Up to 2.4 u tomorrow AM if you don't get any good action on 2.2 u today, Susan. As scary as it is, you have to press on to get him to a dose where he responds better. We're here to help!

 

Yes, it looks like he's getting stuck. You and Kris and Blair can make a little club for Sticky Kitties!

 

We've got action. We have a blue! It is at +4 though. My thoughts are that I am going to wait 30 minutes, test him, and then steer with a little LC food before he goes too low. I know that I am pushing the envelope to try to get him moving, so I'm thinking that if I start to steer before he gets too low, he wouldn't hit the limes. Thoughts?

 

Why are you using U-100 syringes?
are you doing the conversions for your SS? It's so much simpler to use U-40 syringes.

 

U-100 syringes are better for tiny adjustments in dosing. Susan has the conversion chart.

Susan, very good job using LC food to keep him out of lime green . Don't give so much excitement at once, Timmy!

 

Ah ha!! The threat of a dose increase worked!!

 

Ugh! That was stressful. He just drops so darn fast. Nothing, and than Wham!! Dosing for tonight? Can I reduce a bit depending on numbers?

 

Wait to see his numbers. You have U100s so you could try eyeballing 2.1 u.

 

NICE!!!!!! Go Timmy!

 

PMPS is 238. How much should I dose?

 

You could reduce a bit...maybe 2 or 2.1 if you can eyeball that? I wouldn't go too far down, though, because quite honestly...you haven't been getting great numbers on lower doses and you monitor well.

How does that feel to you? It's a bit aggressive but I hate to see you lose momentum...it's a catch 22.

 

It feels scary. Lol. I gave 2 units. Eek. I have to get him down though. Hopefully this will be a short, nerve wracking time to get him down. Thank you.

 

Sometimes they do throw out the random odd lows that are lower than they'd typically have on a dose, too. Freya has done it before, because apparently, she has to be difficult in nearly every way. @Rachel may be on to something about the slightest of reductions just to see what he does, assuming you can be there to monitor. I just know that personally, I can look back at times and see where I reduced too much too soon and ended up off track. It's hard not to though, because by nature I'm so cautious. But that's a tricky one, and it may come down to what you think is best for your guy. Sticky cats are hard!

 

Oh! I see you beat me to hitting the reply button, hahah. Hope it goes well!

 

That was a stressful cycle, but oh so nice to see him get some greens again! I think Blair and Rachel and Kris all gave you some good advice to keep the dose strong despite the cycle today. If he had two in a row, or even two within a couple of days of each other I think that would indicate he needs a reduction, but so far his pattern seems to be one dramatic cycle and then the high-and-stickies.

 

Part of me wishes you could have gone with 2.1U or stuck with 2.2U tonight, I know it's only a tiny difference . *My thinking behind this* Past few times he's hit green, he bounces either with a higher number or a flat cycle. Kind of like what Djamila and Blair described. If he holds his usual pattern tonight and it happens again, at least think about holding the dose for next cycle . You monitor very well so you'd catch him if he changed course

 

Keeping Timmy from going into the limes yesterday wiped me out a bit. I do know that I should have given 2.1 units last night, but 2.2 would have been okay too. Ugh. Anyway I gave 2.2 units this morning. His numbers are just hanging out today though. I guess it's to be expected, but still.

 

It's all good learning, Susan.

 

I take one step forward and two steps back. Getting good data though, and building my confidence. So that's something good. I know how to steer, but it's always in the back of my mind, what if I can't. That's where the good notes (I have them in great detail in his notebook) and data building comes in. I don't have enough data on dosing those lower yellow numbers yet, so I always err on the side of overly cautious and it always comes back to bite me. It is such a learning process for me.

 

It is for ALL of us, Susan. I've been fighting to keep Teasel away from the brink this AM.

 

It's good data! That way, next time, we will feel more comfortable keeping the dose the same instead of decreasing.

 

Yup you'll become more comfortable as you collect more data and "know thy cat"

 

Hi Susan! How are you and Timmy doing this weekend? I hope all is well!

 

This past week has been an extremely challenging one. We have had and are still having a family situation. It is getting better, but has definitely taken a toll. Timmy's numbers during all of this have been incredibly worrisome. I have reduced the dose as needed. I cannot monitor consistently like I have in the past right now. I have had some help, off and on with testing this week, thank goodness, but it is not a consistent answer. He drove me to tears last night with going so low at +3, so I steered some with food to keep him from going too low, and of course, he is ultra high this morning. I really need to find a dose for him that isn't pushing the envelope and causing me to have steer to keep him from getting into lime greens. That dose is a mystery because almost every dose given pushes him too far down. It is just trial and error right now to keep him safe. Im overwhelmed at the moment and venting a little helps.

 

I feel for you, Susan. I went through this with Teasel on ProZinc and also on Lantus. He's improved in that regard on Lantus, most of it quite recently. You have that option if your boy is just too bouncy on ProZinc. Even Steph has noted an improvement with Chuck who's the trickiest cat here. This is stressful at the best of times but so much worse when other things in life weigh on us.

Have a look at Teasel's SS to see if it offers you any hope.

 

Susan, I'm so sorry to hear that your family is having a tough time right now. Please know that it's okay to lower the dose a bit if that's what you need to do to take care of yourself and your family. We can only handle just so much stress at once! And it is always okay to come here and vent or ask for a little word of encouragement. We all need that, and sometimes it can be helpful to just be reminded hat you are not alone in managing him, but have a community here that understands the stress and uncertainty.

 

Venting is part of what we're here for! We totally understand how life sometimes gets in the way and just makes things more stressful.

 

Vent away, Susan! The silver lining for you, I think that 1.8U could be THE dose .

 

Nice blues today, Susan! It looks like you're feeling more comfortable with the idea of "taking the ball and running with it". That's great! You'll start feeling more confident about this over time.

 

Wow! Two nice AM cycles in a row! That 1.8 does look like a good dose for now!

 

I see your dose tinkering on Timmy's SS, Susan. Looks like you're doing it very carefully and that's the way to go with a bouncy boy. My guess is he'll be at/around 2 u before you see lower numbers. How are you feeling about all this? How is Timmy feeling?

 

Thank you for checking on us. I took a look at Teasel's spreadsheet and it is a beautiful sight! You made that switch about four months ago. I'm amazed and it certainly gives me a lot of hope. I will admit that there are times when I question if he will ever get regulated, but we only switched to Prozinc about six weeks ago. So I guess it is still early.

The family emergency situation has indeed pushed me to "take the bull by the horns" with Timmy's dosing. I have a lot of data, but really testing each dose to see what will keep him safe and what will be needed to push him lower is an ever-changing balancing act. It is a good thing though. I have to have confidence in the dose when I cant be home during this time, but Timmy doesn't follow the rules, so I still find myself holding my breath when I'm away. I do agree that we will probably be at 2 units to really move, especially at the night dose, which he is always higher. I made a note on my spreadsheet to adjust the dose, I'll be able to monitor him close by then and make small moves. I do know that Timmy has to have dose consistency and very small increases, or chaos ensues. The move to the U-100 syringes was a very good thing for us.

Timmy hides a lot when he goes into lower greens. He feels good and plays in the lower blue range. I know I will need to push him lower to get him lower, but he struggles a lot when I do that. It is a necessary evil.

 

Timmy is so much like Teasel in his responses that they're FD twins! I had to be SO careful dosing ProZinc or Teasel would fly off into the ozone. No sliding scales for us. Lantus requires consistent dosing and it works for him. He seems to be in a really good spot right now - by Teasel standards. I feel like I'm dosing an "easy" cat. I'll enjoy it while it lasts.

I know what you mean about the low numbers' effect on behaviour. Teasel is also quiet and withdrawn when he's in lower greens. His happy place is when he's running in low blues too. I understand the need for exposure to those greens but I don't like what it does to him.

 

Hi Susan and Timmy! How is the 2.0U dose doing?