Wed I think...

Daisy, my mischievous orange guy, got the refrigerator open while I was at work. No idea how long it was open but insulin was warm. Would this have ruined it? I really can not purchase another vial right now but Gretchen has been running so high again.

 

It may have, but assuming you were gone 8-9 hours and it wasn't open the whole time, it's likely fine. Just make sure there aren't little white bits floating in it.

You are still much lower than your previous dose. I would suggest increasing by 0.25u every three to six cycles. (a cycle is 12-hours) until you start to see an insulin response. Gretchen could definitely use some more insulin to get those numbers down.

 

I agree with Djamila that her dose needs to go up in 0.25 u increments after three cycles. You can slow down once you start to see yellow and blue on your SS.

 

Ok...thank you!
I had actually done a google search on that and found a whole bunch of posts from here lol. Prozinc is fine. I already did today’s dose and I did give a very “healthy” 1.25 I will move her up tonight to 1.5

 

I know it looks like you have plenty of room to maneuver, but I wouldn't increase every 3-6 cycles because you can't do mid-cycle tests except on weekends. So, you could theoretically be doing increases without having any idea what the increase is doing. Unless your ability to test mid-cycles changes, I suggest you continue to follow the "start low go slow" protocol and methodically increase the dose when you're available to test.

Just my two cents...

ETA: I agree that the Prozinc is probably fine. I've accidentally left bottles out overnight with no problem. However, just keep it in mind when you switch to a new bottle because if the efficacy is impacted at all, you might see unexpectedly lower BGs when you give your "standard" dose out of the new bottle (been there, done that!)

 

Hi JL! I do appreciate your concern about monitoring the mid-cycles to make sure the increases are safe. The reason we recommended the more rapid increases is because when Gretchen started on Prozinc, her dose was dropped by too much. She needs to get closer to an appropriate dose quickly and safely. Right now she's being way under-dosed and that puts her at greater risk for developing ketones. Since ketones are a greater risk than hypo in her current situation, the increases can't really wait for the weekends at this point. Of course once she gets closer to an appropriate dose, greater caution will be needed.

On a different topic, I'm super interested in how you were treating Tubby. Any chance you still have your spreadsheet and could reconnect it to your signature? I'd love to see how you were using Prozinc and R together.

Bobbi - JL referred to "start low, go slow" (SLGS) so I wanted to explain that: Prozinc doesn't have a sticky for SLGS. That's used in the Lantus/Levemir ISG, although many of the principles are similar to those described in the Prozinc protocol stickies. There are two main schools of thought on how to dose the L insulins. SLGS is the more cautious of the two. If you're interested in reading more about them, they are at the top of the Lantus/Levemir forum.

 

I understand what you're saying, and your logic isn't invalid... I just respectfully disagree somewhat. I don't believe Gretchen's dose was dropped too much during the transition given that she is not ketone prone, N was started at 2u and mid cycle data was limited (I am not convinced she wasn't dropping lower than was captured), she has food out 24/7 so some of the values could be food influenced, and the numbers are from a pet meter. She also wasn't regulated on N and there's no way to isolate out the multiple variables she had experienced, so a "do over" when starting with Prozinc seems measured and reasonable. Or at least that could be argued.

If you have specific questions, let me know and I'll try to answer them. Tubby was an acrocat and so had unique needs. I also used "R" back in the day with another cat but that was also a very specific situation. I have significant respect for "R" and how easy it is to get in trouble with it so tend not to say too much without ample clarification.

I'm an old-timer and I am guilty of not having kept up with all of stickies that are posted on the various ISGs that now exist. If I recall, SLGS predated Prozinc, Lev, and so forth, and wasn't tied to a specific insulin but was rather a conservative methodology for arriving in a slow, methodical manner at an ideal dose. When the cat is recently diagnosed, the ability to monitor is limited, and there's no history of DKA, I tend to err on the side of being conservative. I certainly remember my early days where the insulins sounded like alphabet soup ("N," "L," "U," "R") and I had no concept of their "action" and how much impact such a tiny amount of liquid could have. So as the owner and cat settle into a rhythm, and wrap their head around the disease, I lean toward taking it slow. Doesn't make it right... it's just my viewpoint. And thus is the value of open discussion and peer review, eh?

 

What’s a sticky?

I worry about Gretchen developing keytones. She has been acting much much healthier on the Prozinc. More bright eyed and awake. And I do want her numbers down, but I feel more comfortable when I can at least do a midday test. If she’s still running mid 400’s I’ll increase a bit Friday am, as I’ll be here.

Thanks all and I value/appreciate all opinions!

 

To throw in my two cents (just because I can ) I'd increase more often if she was mine. I had the same concerns you did when I was treating Gypsy...but over time I started to increase more often in an attempt to bring her down. The longer she spends in high numbers, the more likely you are to develop glucose toxicity...which means that the numbers would remain high constantly. The treatment for that is just to increase every 3 (or 4) cycles usually until you break through and the numbers go down. That can be extremely stressful for bean and cat.

As for the ketones, I certainly hope she won't develop them. We've seen more cats develop ketones from sitting in high numbers in recent years. When I first got here it seemed to happen less, but over the past year or so, I've seen a lot more...not sure why. I wish I did know! If you're not going to increase aggressively, I'd like to strongly urge you to test for ketones as often as possible. I wouldn't go more than 2-3 days at MOST without testing while she sits in high numbers. I'm not trying to worry you...it's very possible she'll remain fine! But the longer she is in high numbers, the more likely ketones are...and catching them early is the best way to ensure treatment is fast and effective!

The stickies are at the top of the page. They are labeled with a yellow "sticky". They're different pieces of info that have been approved by the admins and are super useful! Please take the time to read them if you can and let us know what kinds of questions you have!

 

Stickies are at the top of each forum (Prozinc, Lantus/Levemir, etc.)

 

I’m kind of starting to wonder if toxicity has already happened. She was diabetic long before I caught it. Bad Mom I know but hindsight is 20/20

 

So I see Gretchen was in the 500's again this morning.

Do you think Gretchen got into any contraband food overnight? Dog food maybe?

If not, then maybe it's time to "start low, go fast" ... Or at least a little faster. I'm NOT a fan of being aggressive when you can't get mid-cycle tests BUT I think we need to get her out of these blacks. Given the data you have on Prozinc and its typical nature, I agree with the others that you're probably not at high risk of hypo the way you might have been on N... at least not right now. I don't personally like making assumptions (too easy to get in trouble doing that!) but you now have some history on Prozinc.

So given this morning's black, I'm going to reverse myself and say that I think it makes sense to step on the gas a little. I wouldn't "floor it," lol, but you've been patient and done your best to go slow and make sure you're being methodical. Kudos for that. My opinions are evolving based on the data and also the fact that Gretchen had likely been diabetic for quite some time before you caught it, which I didn't realize. You probably do have some glucose toxicity going on at this point, but it is what it is. It's unfortunate but not necessarily catastrophic.

Did you give 1.5 or 1.75u this morning? I wouldn't be surprised if you did the latter, given the black. I personally would go to 1.75 today and tomorrow, run a curve on the 1.75u on Friday when you're off, then if numbers are still high, maybe go to 2u over the weekend and get some data on that dose.

Sometimes my guys would give me a quick response to the dose change and drop down into better numbers, only to then settle back into higher numbers. Other times it would take time multiple cycles to see the full result of a dose change. Every cat is different, but the data will guide you as you learn Gretchen's idiosyncrasies.

Just remember that dental issues, contraband food, UTIs, etc can inflate BG, so if you think you have any of those things at play, you might want to keep it on your radar to address them. And please do check for ketones.

BTW, I wouldn't increase the dose every 3 cycles because you'll be doing multiple increases with no mid cycle data whatsoever. But I'd consider maybe every 5-6 cycles so you can "time" the changes so you can maximize the value of the data you collect on your days off.

Again, just my two cents.
(For those who don't know me, I happened to pick up on the "fur shot" drama over on Health awhile back so followed bobbi and Gretchen over here)

 

So I think I may have scared you a bit with the toxicity thing and I DIDN'T mean to do that! Let me clarify a bit. Glucose toxicity SOUNDS really bad because of the toxic part. BUT all it really means is that the kitty is stuck in high numbers, usually due to not getting enough insulin. Is it bad? Of course it is. Is it devastatingly catastrophic? No. We've seen it a TON here. It's easy for cats to get it since they often AREN'T diagnosed quickly. Don't blame yourself for that. Humans can get diagnosed faster because they can explain their symptoms of more drinking and peeing, etc. But when I caught Gypsy laying with her face on the side of her water fountain, I just thought it was adorable and she was having a zen moment with the water fountain. Now I realize she was desperately thirsty and miserable...but how could I have known that at the time? Sure, NOW it seems obvious, but NOW I've also been a member here for umpteen years and know a lot more than I did then. Don't blame yourself. We've ALL been there.

Glucose toxicity happens and when it does, the best thing you can do is just increase the dose accordingly. It really does come to a point where it "breaks through" and the numbers go back down. I completely agree with JL's assessment that you should hit 1.75, do a curve on Friday, and then bump it up to 2 that night if Gretchen didn't go low (which I don't think you'll see...but I could be wrong!). Then get what data you can, and we can talk about increasing again if needed.

I do disagree about not changing the dose more frequently. As I said above, we've seen this SO MUCH and since Gretchen is sitting in those high numbers, you really want to get her out of them as fast as possible. With her numbers currently, she's not likely to go too low. Changing the dose less frequently is going to make that harder and make it take a longer time. As you start to see lower numbers, you would want to change the dose more slowly, of course. But this is why I love this forum! JL and I can each give our opinions and reasons behind it, and go from there! It's good to hear more than one side of a story to help you make an informed choice.

Please do ask any questions you have, and we'll be happy to help out.

JL, thanks for connecting Tubby's SS! I see a few weeks of data on there with R. We've talked some about using R with prozinc but none of us have any experience with it, and we don't want to advise someone badly. We've been wanting to see an SS with it so we could hopefully start to recommend it when it's warranted.

 

As for not changing dose more frequently: my logic is to "walk before you run." I'm not saying never, I'm saying start with every 5-6 cycles, evaluate how that's going, and go from there (primarily because there will be no mid-cycle data for some of those increases). She can always accelerate if the results are positive and she becomes comfortable with the tactic.

As for dosing R with Prozinc: yes, I have a lot of experience with that BUT Tubby was an acrocat and that changes everything. The R doses would be astronomical (and potentially deadly) for a standard diabetic and so what we saw with him wouldn't necessarily translate. I used R as a bolus insulin to pull down food spikes until the Prozinc kicked in. I have several years of data. I'd be glad to help however I can, I just want to make sure that anyone who uses R treats it with tremendous respect!

 

I was just searching for what ‘glucose toxicity’ is and read Gretchen’s name then realized I was in my own thread somebody needs SLEEP.

Thank you for explaining that!! It frightened me and I’m fairly sure she’s there. She was on 2 units of Novilin and her numbers were spiking down but zooming back up- so yes the dose of Prozinc started a much less.
I read what you all write and kind of create my formula so ...thank you all!

Now that I realize I’m in my own thread I’ll go catch up and read everything more closely.

 

@JL and Chip ...no contraband btw..dogs getnsupplements at night so food isn’t left down. She has free feeding on Young Again.

And not 100% sure about that blob of blood and stuff I found this am...not sure which fur kid or which end it came from, but that thing had EYES.

 

JL , you're SO right...R must be treated with respect. We've had a few kitties here who've had DKAs before and had a hard time getting regulated. Though we usually recommend switching to Lantus or Lev at that point, when they are dealing with DKA or haven't been on P long, sometimes R might be a better choice. I know they use it sometimes over in L as a bolus, but no one that I've ever worked with on here has. It's been recommended before by some of the folks on the L forum that we might try using R with Prozinc before they switch (for whatever reasons..acrocats, IAA, ketones, other crazy situations), but we didn't have the data or comfort level to do that. It makes sense if we could get them on R so they didn't have to learn a completely different type of insulin AND try to use R with it. I can see how that could be dangerous and very difficult to do. But we just didn't have the experience we needed! All that to say, we may hit you up for some data/information at some point in hopes of learning a little more. Trust me, we DEFINITELY would respect that it should only be used in certain situations and only with a GREAT deal of data collection/a bean who is able to monitor carefully.

Definitely time for some sleep for you @Gretchen(sugarbaby)&bobbi! I've done the same thing before!!!

 

Last night she was 346 PPMS and this morning at +8PPMS she’s back up to 480. . That will be higher by AMPS cause I gave her her treat with urinary supplement.

Haven’t decided yet if I’ll go up to 1.75 before heading out towork as I don’t know how far down she dipped with yesterday’s lower number.

Thoughts?......

 

I’d raise it. You’ve got good data showing she didn’t drop much on 1.25...which indicates to me that she isn’t dropping low on this dose most likely. With the high numbers, I’d want to get them down soon...

 

I agree with Rachel. I’d go for the increase. Are you testing for ketones? If not, I’d really recommend doing that regularly.

 

I did raise up to 1.75 but I forgot to put it in my ss. I’ll do that now.

Yes checking regularly for keytone. None so far thank goodness.

 

I fell to sleep and didn’t get much of a curve but according to all the red considering bumping on up to 2.