Thoughts on Izzy's Numbers and spreadsheet? Thanks!

Hello all! I wanted to check in with everyone and see what you thought of Izzy's spreadsheet and numbers? She's been averaging in the 400's and 300's during Nadir. but on occasion her numbers would be in the double digits which is very odd to me. I get so nervous she'll have another episode. Thanks in advance to anyone that can help. You all have been so helpful during this journey. Have a great night!

 

What do you mean by her numbers are in single digits? Any cat in single digits would be dead. The lowest I see is in the 60's. My suggestion would be to do 1.25 units when the preshots are above 400, and to get more mid cycle numbers.

 

You are right! I meant double digits. I edited it. She had dropped to 40's and 50's a few weeks back in nadir which was a week after she hypo. So it scared me. Thanks i was thinking the same thing up it just a little. Now if the preshots are in high 300s would you go down to 1unit or stick to 1.25 units? TIA

 

If you can be around to test and steer with food is probably ok to raise it if it's close to 400 (like 380+) you had one time about 2 weeks ago when the preshot was 387 and 1 unit brought her down to a safe 72, so I would do that only if you will be around. You don't have a lot of data yet so I say yes, but cautiously.

 

Yep, I think we need some more mid-cycles. I'm not sure what is going on, but it's possible there's some bouncing with those red preshots since we do see that she's hit some greens, and even lime greens in the past. Any chance you could run a curve sometime soon?

 

Lauren, are you testing for ketones? I like Rachel's suggestion to get a curve done

 

I will work on a curve today! Tested at 9 then i'll test at 12pm, 2pm, 5pm and 9pm! Are those good times to test? Thanks

 

If that works best for you today, that's fine . Whenever you can grab extra tests the SS will start to fill. Would I be pushing my luck if I asked you to get a before bed test every night or every couple nights . You can just tell me NO

 

Absolutely it would be about 3 hours after pm insulin. Anything to get more accurate curve to figure out what's going on!

Thanks!

 

3 hours after insulin would be perfect! That should tell you each night if you're in for an active cycle or not, since it won't be a food influenced number.

 

What do you mean by active cycle or not? Lots to learn! I did the curve yesterday if you want to take a look. Still bouncing around lots. Thanks in advance!

 

over 450 I would do 1.5

 

Do you think this is a good basis to go off of?

450+: 1.5 units
380-449: 1.25 units
201-379: 1 unit
200 or less: no insulin

 

The only change I'd make is on the low end. I think one unit in the 200's may be too much based on 1 unit at 287 bringing her down so low. as you get more data this may change. I'd say

450+: 1.5 units
380-449: 1.25 units
285-379: 1 unit
250-284 .75
200-249 .5

 

A sliding scale is important on Vetsulin, because of the rapid onset and because each cycle is its own thing. But we don't recommend it on Prozinc unless your kitty's insulin reactions have proven that they are necessary (rare), and only after at least a month of data with stable food and careful increases. Frequently adjusting the dose on Prozinc causes bouncing and makes it very difficult to know what is really happening regarding the efficacy of a dose.

I would recommend reading the Stickies for Prozinc. They are a great resource for learning how to manage this particular insulin.

 

Makes sense...Would you recommend just sticking with 1.25 but hold off on insulin if her Preshot reading is 200 or less? Thanks Djamila

 

If her numbers stay about the same, I wouldn't hold 1.25U too much longer but think about increasing to 1.5U. Are you checking for ketones?

 

Yes to the no shot under 200 until you have more data. You're doing a great job of collecting a bit more, so that really helps. I have a feeling she's going to need a dose increase pretty soon though. Have you done her PMPS (p.m. pre-shot) yet this evening?

 

I agree. I'd stick with small, careful increases. A sliding scale isn't something I would consider for quite some time. I do think you'll need to increase soon, though.

By an active cycle, I mean a cycle where the numbers drop radically. Basically, say you take a test at +3. If your preshot was say...in the 500s and your +3 was in the 200s, that's a sign that you might be in for quite an active cycle since she dropped so much and hasn't hit nadir yet. That's when we recommend staying up and monitoring through nadir to be sure she stays safe.

 

I don't know.... I think she's going to run into trouble shooting 1.25 at 200. But I'll defer to your experience.

 

Pm pre shot 460.

 

I'm not sure how to test ketones. I may have to read up on that!

 

460 PMPS

 

It does depend on being able to monitor and knowing your cat, for sure. Some cats are bouncier and more caution is needed, but in general, this is still a fairly low dose, and fairly high numbers. My understanding with vetsulin (and correct me if I'm wrong), is that the insulin kicks in pretty much right away, so the pre-shot number is the number that is acted on.

With prozinc, and when a kitty is climbing the dosing scale, before regulation, the onset isn't (usually) until closer to +2, which means that the pre-shot number indicates if you're in safe ranges, but the number acted on is almost always higher because the kitty is fed at shot time, numbers climb from there, and then the insulin kicks in. So a pre-shot of 200 isn't the number the insulin acts on -- that number comes later. So the nadir is used more heavily at that stage to determine how a dose is doing.

Caveats: when the kitty starts healing and the pancreas is helping out more. Then we don't always know from cycle to cycle how much help the cat is going to give him/herself. So the pre-shot number becomes much more important at that point. Or if a cat has long cycles, so that the insulin is kicking in before it has really had a chance to rise from the previous cycle. Or if there is variation in the shot time so that you end up with overlap.

I realize there are a LOT of "or this....or that..." involved in all of this.

We don't have a lot of data on Izzy yet, so it is a little hard to predict at this point. One clarification for Lauren is that I said, "soon" for the increase, not "now" So please do keep an eye on the numbers tonight. I had a few more questions for you first...

That being said, I think Izzy will be fine tonight, just make sure to grab that +3 before you hit the sack.

And now for the questions for Lauren:
1. Is there variation in your shot times? Or are they pretty precisely at 12/12? Prozinc can tolerate some variation, but I'm wondering if that might have been a factor in the 5/14 cycle.
2. How is your schedule looking like this weekend? You don't need to do another full curve, but if you can keep grabbing a +3/+5/+7 or a +4/+6 through the weekend it would really help. You do have some curious patterns that make me want to make sure that the curve you did was representative and not a wonky cycle.

And one thing to keep in mind - you generally want to do dose increases on cycles you can monitor. If you go to sleep at +3 tonight, Izzy will hit nadir without you being able to monitor. Probably okay, but we aim for safety which means increasing when you can check around the nadir and make sure the increase is okay. Please don't stress about it, there is a lot to learn around here! Do take some time to read through the stickies though to get an understanding of how Prozinc works, and then ask as many questions as you have.

 

Great job last night!!! Hopefully you can get a nap in today to make up for it!

 

Thanks! My 10 month old is up a lot at night so I figured I'd get numbers when I could Yes a nap would be ideal!

Also I try to stay within a half hour of her insulin shot times of 8:30am and 8:30pm. It's tough sometimes to be home at those exact times all the time.

 

Even without a baby it's hard to keep completely consistent -- the fact that you can even remember to give the shot at all earns you a gold star!!!

I flex on Sam's shot times fairly often (at least the evening one) because of my work schedule. Just by 30 minutes or less, like you. It's just something to keep in mind whenever you get an unusual pre-shot. The numbers can rise over 100 points during that last hour for some cats, so flexing even a little can end up giving you an unusually high or low number, and then impact the cycle that follows as well. It's totally fine to do it - even up to an hour on prozinc, you just have to factor it into your thinking about the numbers.

Is the food listed in your signature still accurate? Was that a change from something else fed previously, or has she always been eating that? And if she changed, when did she change?

 

Thank you Good advice! I switched her over to low carb wet food at the end of April. I wasn't testing her regularly avid she hypo'd a week later That was a scary night!

So this forum has hit me on track with testing her BG regularly.

Got a 100 on her low curve this afternoon +5

Thanks everyone

 

Nice

 

Wow! I wonder if your +6 might have been green?! You are getting some great responses on the insulin. Given those responses, if you do get a lower than normal pre-shot - something in the yellows - you might try stalling to make sure she's rising before you give the dose. To stall, you just wait 20-30 minutes without feeding, and then test again.

Fingers crossed those pre-shots start to come down too!