9/6 Carbonel AMPS 333, +12 175

Hello again,
I have been having some problems with Carbonel on the Prozinc. She kept going really low with 2 jabs a day so I decided to try 1 jab a day. Could someone please tell me how on earth I am going to get her AMPS # lower. My needles are only in halves and I don't think that there is a smaller increment needle in the UK. Below are her BG readings for the last
8 days.
8/30 AMPS 282 1.75u - I am guessing
+11 171
8/31 AMPS 282 1.75u
+8 93
9/1 AMPS 319 2 u
+12 54
9/2 AMPS 314 1.75u
+12 75
9/3 AMPS 327 1.5u
+12 151
9/4 AMPS 325 1.5u
+12 327 .5u
9/5 AMPS 232 1.5u
+12 129
9/6 AMPS 333 1.75
+12 175
Thanks
Carol and Carbonel

Hi Carol,

Glad to see you back. Joanna did some research on your insulin as we don't get it here in the US and don't know much about it and started a discussion on the health board to see if anyone knew anything about it. One of the vet techs did some comparisons to the other PZI's and found some differences but not alot. It does state that it has a much longer duration than we see in our insulins.

Also we have had 3 or 4 new members in the last month from the UK and at least one of them is using the same insulin as you are. Simon (UK long time member) is helping people find meters, strips, food, etc. Check on the health board, I think his subject says "UK Members check in here" or something like that, maybe you can get some good information from them too, they might know where to get syringes with 1/2u markings.

That said, ideally you want your AMPS and PMPS to be about the same, which it looks like you are getting. Over all your numbers look pretty good, even if they are alittle high so you are on the right track. 9/4 +12 is the only odd ball # you've gotten and that could have been a food spike or something.

If it were me I think I would pick a dose 1.5 or 1.75 and stick with it for about a week and let Carbonel adjust to it and see if she might not even out.

I hope Joanna checks in to add what she has learned.

Oh, I don't think I learned much, lol. I think people said it was basically the same. That long duration thing I think they say for the other PZIs as well, I think it's more for dogs than cats. Very confuzing. :dizcat

Nice to see you around Carol!

I would lower your dose. It's hard to tell without much mid-cycle data, but most cats do best on two shots a day - when one +12 PS is a lot lower than the other, and lower than you want, I would say the dose you shot leading in to that was too high.

Here's what I see:

8/31 AMPS 282 1.75u
+8 93 --> looks perfect
9/1 AMPS 319 2 u
+12 54 --> looks like 2u was too much insulin, her nadir could have been lower than this
9/2 AMPS 314 1.75u
+12 75 --> ditto
9/5 AMPS 232 1.5u
+12 129 --> ditto

I would do 2 things.

1) I would drop the dose down to something no higher than 1u, possibly even 0.75, and try that for at least 3 days (barring low #s) on a BID basis, and see how the #s look. You want sort-of an even AMPS & PMPS, and a good nadir.

2) I would try to get more mid-cycle data. If you go BID, I would especially focus on cycles 3 & 4, when you should have some overlap built up and can get better results than on the first day. I think you need a sense of her nadir time, if you don't have that already. Without that, you are going a bit blind as to knowing where she is lowest in the cycle. I would pick one day and try to do a curve - get tests maybe every 3 hours or every 2 if you can handle it, and see if you can see a U-curve in her #s. Without that, it's hard to pinpoint the dose.

She is getting pretty good #s, so that is nice. BID would help her get better insulin coverage throughout the 24 period, rather than getting good coverage for 12 hours, and then possibly running higher for the second 12 hrs (again, more mid-cycle data will help you see what is going on, maybe some bedtime tests even if you didn't give a shot, will point to whether she is going high earlier or later in the nighttime).

It's hard for me to tell from the data you have if the dose is too high and that's what you are seeing, or if she gets long duration and/or has a sputtering pancreas. Bix gets 16 - 24 hours between shots, but he is the exception, has a sputtering pancreas, and I only know that from lots of data. He still nadirs around +6, but if he gets a nadir in non-diabetic #s, he is too low to shoot usually at +12. What I can't tell for Carbonel is whether she is in a similar boat - not shootable at +12 due to longer duration, or whether your dose is too high and that's why you have low +12 PSs. So basically I think you need more data to support whether or not SID is really right for her. You may already have that data so sorry if I'm just not remembering.

Hope that helps!!! Keep us posted!

I just wanted to add that if you go to twice a day shots, cut the 1.5 unit in half for each shot.

So .75 unit every 12 hours.

Hi Rob and Joanna,
Thanks so much for your advice.
Unfortunately the BG# and Insulin on the 8/31 that you thought was perfect Joanna was taken down incorrectly.
I have included the reading from the day before as well.
8/30 AMPS 282 1.75
+11 171
8/31 AMPS 250 1.75
+ 8 93 rapid rise between +8 and +12 but then I did give her some food so this might
+12 361 explain the rise.
9/1 AMPS 319 2.00 As this was higher than previous AMPS I decided insulin was too little
+12 54
etc

I only work half day away from home and watch for signs of hunger etc at about +8 when I am home. I think her nadir is
around +12, but I am not sure. The difficulty with all this is that Carbonel is now hunting. I think she only eats the head of whatever she has caught! A scientist friend tells me that brains are higher in sugar, so this may be why!
I cannot stop her going out as I think that this would seriously affect her quality of life as she has always had access
to the garden. You are right, I do need to do a blood glucose curve but can't stay up all night at the moment. Some times her BG# is quite high at +12 and then it has dropped to a couple of points by the AMPS.
If I give her 1.75u once a day as you suggest Rob, do I still give her this dose no matter what the AMPS reading is?
When I was giving Carbonel 1u twice a day by the 4th day her +12 was 65. so I gave her no insulin. Should I have still given her 1 unit?
I have tried 1u twice a day Joanna and I think this is too much, perhaps I am wrong and just a bit scared!!! So .5 twice a day is all I can achieve if I am going to be accurate. My syringes only goes up in .5u so .75 is just a guess.
I don't seem to be able to find Simon's post Rob but I don't think that smaller increments are available in the U.K
Sorry, I don't know what BID or SID is( is this twice and once a day?)or what you mean by cycles 3 and 4 Joanna.
This probably is not a very helpful response.
Regards
Carol and Carbonel

Hi Carol,

Actually I didn't say once a day, I said that if you go to twice a day shots (bid) you should cut the dose in half for each shot. You would take the 1.5unit that you shoot once a day and cut it in half and shoot .75 in the morning and .75 in the evening. You can measure a .75 by pulling the plunger half way between the half unit and one unit mark.

It doesn't look like the insulin is lasting 36 hours. But with out some mid cycle tests (each cycle is 12 hours because we dose twice a day 12 hours apart, there are two cycles every day) we don't actually know how the insulin is effecting her all day long. If you can't do a curve in one day you can get spot checks at different times on different days and it will fill in the picture.

It looks like 2 units once a day is too much insulin, much like the 1 unit twice a day was too much for her, the +12 54 on 9/1 is getting very low from a high AMPS, you don't want her going much lower than that. Her bg's looked better when she was getting 1.5 to 1.75 units.

When we say to stay with a dose for a while that only applies if your PS #'s are high enough, for someone new who doesn't have alot of data the general NO SHOOT # is 200. If you get a PS under 200 do not give insulin. Wait 30 minutes and test again until you get a bg around 200 then you can shoot. I'm very glad you did not give insulin when her bg was 65, she might have died. I'm sorry you didn't understand that. Please come here any time and ask any question that you have like that so we can explain what we mean.

Staying with the same dose for up to a week will allow her little body time to adjuse to that dose and give you time to see if it is the right dose or not and then adjust up or down, then stay with that dose and see how that works and adjust again.

I hope this clears things up, please ask what ever questions you have.

Here is a link to Simon's thread.
viewtopic.php?f=28&t=23335

Robin

I would go with the 0.5 2x/day then, or if you can guesstimate 0.75 you could try that. BID = 2x/day, SID = 1x/day. Cycle = time from one shot to the next. So 3rd cycle on BID would be from when you give the 3rd shot up to the time of the 4th shot.

The +8 of 93 is still perfect - the rise to the +12 is likely the insulin wearing off. I'd be really really surprised if her regular nadir is +12. Sometimes they will get what looks like that, but it's more from the dose being too high - if you lower the dose, you will get a more typical pattern of a drop to around maybe +6 and then a rise back up to +12. For that one day at least, 8/31, that's what you are seeing - a nice U-curve with a drop to the nadir and rise back up to the next +12.

9/1 AMPS 319 2.00 As this was higher than previous AMPS I decided insulin was too little
+12 54

Click to expand...

If you didn't give a shot at night, the previous insulin dose it's pretty much irrelevant to the next morning's PS. The AMPS most likely is the effect of no insulin overnight, rather than any effect from the previous shot.

When I was giving Carbonel 1u twice a day by the 4th day her +12 was 65. so I gave her no insulin. Should I have still given her 1 unit? I have tried 1u twice a day Joanna and I think this is too much, perhaps I am wrong and just a bit scared!!!

Click to expand...

Sorry I forgot you had tried that. Yes, it sounds like too much if you got a +12 of 65.

I would definitely keep a no shoot, and DO NOT give insulin at a PS like 65!!! Most PZIers have a no-shoot of 150 to 200. If you don't have a lot of data or comfort level on lower PSs you set it at 200. If you get a PS lower than that, you retest in maybe 30 minutes or so and give the insulin once they are at a # close to 200. What Robin said.

I hope that all makes sense. I feel like there is some miscommunication somewhere - I don't think the low +12s are a nadir, I think they are a sign of a dose too high. What you typically see on PZI is something like (#s totally made up):

AMPS 300 1u
+1 350 --> insulin hasn't kicked in yet
+2 300 --> insulin is kicking in, onset has happened
+3 250
+4 200
+5 150
+6 120 --> approximate nadir
+7 125
+8 140 --> past nadir, #s starting to rise
+9 170
+10 200
+11 250 --> insulin is poop-ing out, #s rising faster
+12 (PMPS) 300 1u

My guess with Carbonel is that then she may be sitting in higher #s overnight, without that nighttime shot. If you get a low +12 at the PMPS, that is typically a sign the dose was too high that morning. To get a low # at +12, you may have gotten a weird pattern during the day - maybe an inverse curve, maybe #s that were too low at nadir, maybe a flat line and then a late drop at the end of the cycle. None of those are what you want with PZI. That's why I think a curve, whenever you can get one, will really help you see what is going on during the entire cycle.

Okay, thanks Joanna and Rob,
I didn't think you had suggested that I give Carbonel her jab once a day Rob and would not have given her a jab at such low numbers without confirmation anyway. I always err on the side of caution. I have loads of pressure from my husband to only shoot once a day because we have just got our freedom back as my daughter has left home and now Carbonel prevents us from going anywhere in the evening. We live rurally and this problem she has has had a major effect on our lives. My husband was happy to pay the extra for the Insulin when he heard it was a once a day jab. He thinks Carbonel is just a cat but she is very precious to me.
Anyway, do I start with the .5 jab this evening or tomorrow morning? I suppose this depends on whether she has dropped down low from the 1.75 I gave her this morning.
What you are both saying makes total sense to me and I can see looking back at her numbers and behaviour that twice a day is the way to go.
Thanks
Carol and Carbonel

Hi Carol,

Depending on what her bg# is this evening, I would probably wait until tomorrow morning, otherwise you would be adding more insulin than she usually gets in one day if you start tonight.

We all understand about being tied down by a diabetic cat but by going to twice a day shots you can better regulate her and she may become diet controlled and not need insulin anymore. DH (dear husband) would be very happy then.

By changing Harley's diet to low carb wet food he became diet controlled and didn't need insulin for almost a year but than I had to board him at the vet clinic and the stress brought him out of remission in June. But he is getting very close to comming off again.

Since Carbonel is a hunter she already eats raw food, have you looked into feeding her a raw diet in the house?

Robin

Hi Rob,
Thanks for your answer. I do keep telling my husband just that, but Carbonel has been diabetic for over a year now and I wonder whether she will ever go into remission because of this. I don't tell him this! ;-)
I did try Carbonel on a raw food diet initially and could not control her numbers. Looking back I think it was possibly the Caninsulin. I also broke 2 mincing machines ( I could not afford the electric one mentioned on the site I found )and I am only pint-sized. Perhaps if I had found your site initially things would have been different. The vet and veterinary nurse were not supportive at all. I am also a vegetarian and found the whole thing most distressing. Had I seen an improvement in Carbonel I might have been prepared to carry on.
Regards
Carol and Carbonel

Yes, feeding raw would be distressing for a vegetarian.

The more regulated we can keep them gives their pacreas time to heal if it can.

We have seen some, not many, but some kitties come off insulin after years.

We all do the best we can.

Re: 9/13 Carbonel AMPS 345, +12 383

Hello,
I have been trying to shoot .75u of twice a day . Below are Carbonels #'s .
9/8
AMPS 300 .75u
PMps 286 .75u

9/9
AMPS 331 .75u
PMPS 298 .75u

10/9
AMPS 296 .75u
PMPS 308 .75u

11/9
AMPS 212 .75u new insulin
PMPS 298 .75u

12/9
AMPS 312 1.5 had a migraine and mis-read the needle won't do this again :shock:
PMPS 147 no insulin

13/9
AMPS 345 1
PMPS 383

Something strange has happened since I gave Carbonel 1.5 instead of .75. I cannot figure out what has gone wrong with her numbers. I gave 1 yesterday in order to try and bring the dosage down to .5 this evening and look at her PMPS. Can anybody tell me what I should give her please, based on the 383? I have not seen this # since the Caninsulin. She has possibly eaten a mouse this evening.
Thank you
Carol and Carbonel

For tonight I would stick to 1 unit.

She's probable high from going a little low the day before.

Twice a day insulin seems to agree with her, you have pretty even PS #'s but I think the .75u isn't enough insulin. I would try to up it to just under 1 unit if you can eyeball it. I seem to remember that you started with 1 unit and it was too much.

Re: 9/14 Carbonel AMPS 296, +12 254

Hi Rob,
Thanks for your reply. I gave Carbonel just under 1 u last night and her #'s today were as follows.
9/14
AMPS 296 just under 1u
PMPS 254 just over .5u

The amount of Insulin I gave her this morning and this evening could have been the same, it is difficult to tell.
According to my husband Carbonel finished the food she had left this morning around +5. I have noticed on the 2 jabs a day she does not eat as much. Although saying that she wolfed down her food this evening. I hope she won't go too low tonight, do you think this might be a possibility?
How is Harvey doing?
Regards,
Carol and Carbonel

Hi Carol,

We're doing great.

I like it, your numbers have come down a little bit. Just over half or just under one is about the same. I would hold this dose for 3 to 5 days to let it settle in and see how she does, unless of course she goes too low. I wouldn't think she would go to low on this dose and that bg. A bg of 40 or less is too low.

A non diabetic cat's bg is normally between 60 to 120. Ideally you want to get Carbonel's bg's under 200 for now so it doesn't damage her kidneys or liver. And then you go from there.

It's so hard to tell what's going on with out any mid cycle tests. Can you get any spot checks in? You can do it over a few days, get a +4 one day and a +6 another day when ever you can, it will help fill in the whole picture. We don't know how low she is going between shots or how well she is processing the insulin.

By the way, I was going to tell you the other day when Carbonel ate the mouse that I've read here that the average adult mouse has between 3% to 5% carbs so eating the mouse should not affect her bg.

Have a good night.
Robin & Harley

Nice to see her #s evening out on the 2 shots.

Does it seem like she is undereating now? Or was overeating before? Both not enough insulin & too much insulin can affect eating. It seemed like she might be going low on the SID higher dose, which I would guess would trigger hunger. But if she is undereating now, that is a different issue...

I agree you need some mid-cycle tests to evaluate the dose, just too hard to guess what might be going on between PSs.

Hope she is feeling well!!!!

Re: 9/15 Carbonel AMPS 333, +12 175

Hi Rob and Joanna,
It does not seem as if we are doing very well on the #'s if her kidneys and liver are getting damaged. :sad:
I am sure that Carbonel was getting better #'s on the Caninsulin and the Hills! Oh dear, poor thing. I was hoping for better #'s today given her PMPS yesterday but no!!!!!! See below.

14/9 PMPS 254 .75u
+4 230

15/9 AMPS 246 .75u promising
+7 288 ?
PMPS 314 .75u ?

I checked Carbonel's # before going to bed last night and things were looking good as they were this morning. I gave her the same amount of Insulin this morning and I just don't understand the #'s at +7 or her PMPS. I am at work until 2pm so can't get a +6 check until Sunday. Unless my husband is prepared to check her. It is possible that she has eaten bread somewhere, as despite asking neighbours nicely not to leave bread for the birds, they don't for awhile and then they seem to forget. :-x I once could not understand what was going on with her numbers until I found Carbonel with a huge crust of bread in her mouth! :shock: She seemed to be smiling! Actually, I have been out to check and I don't think that anyone is putting bread out for the birds.
Carbonel has 180g of food twice a day. She just seemed as if she had had enough and wasn't as voraciously hungry as other days. She did go back and finish what was left about 5 hours later, apparently.

Regards,

Carol and Carbonel

You might try what Robin suggested, eyeballing just under 1u. The #s look to me like a good pattern, just not enough insulin. Sometimes with PZI if it's not enough insulin they will just sort of sit in higher #s, but then if you can hit the right dose they will drop really nicely into good #s. Sometimes a tiny dose change is all you need to see that happen. It may be she'll need 1u or more, but since that looked like too much before, I'd try a hair under 1u and give that a few days (barring low #s) and see what happens.

It's probably discouraging to you to see these #s but it's a relief to me to see a U-curve! Although the #s aren't great, it is data that tells you the dose isn't enough and you know what to do. When she was getting wacky curve patterns, IMO that adds so much to the confusion that it can leave you feeling kind of lost. Now she looks to me to be on a path that is clear - up the dose a little.

Hopefully she will get some more consistent (and better!) #s soon, and not throw wonky stuff at you again! She does look to me to get good duration, maybe better than a lot of cats, but I'd stay with BID unless you get to a situation where she has a clear drop to a nice nadir, and then doesn't need a shot at +12, rather than being unshootable at +12 but w/o a nice nadir (i.e. confusing pattern).

I think some kidney damage, etc. just comes with the territory with diabetes. Though of course it's optimal to get the #s under the renal threshold, the reality is it takes most cats some time (weeks or months) to get regulated, and some cats never get regulated. Not to discourage you, just to say don't stress yourself over it too much, just is what it is.

My experience with Caninsulin (Vetsulin) vs. PZI is that with Vetsulin you get a more clear-cut and predictable drop, but with PZI you can get better duration so you can maintain them in good #s for longer, at least that seems to be how it's worked for Bix. I had a hard time when we switched from Vetsulin adjusting to how PZI works, but once it does start working well, it is really nice to see how well it works.

Re: 9/16 Carbonel AMPS 248, +12 352

Thanks Joanna,
I guess I am not making the hair's breadth under 1 unit yet!!!! I have asked my husband to do a # check at +5 or +6 if he can tomorrow. I wondered if she was dropping too low and then shooting up for the high numbers ( like her 352 this evening). I guess it is also possible that she is not getting enough insulin and is not dropping much at all.
I will post more numbers tomorrow.
Carol and Carbonel

Ok, I've finally broken down and have put together a home made ss for Carbonel going over old posts. I'll try to link it tomorrow.

Hi Rob and Joanna,
Gee thanks Rob, I feel bad that I have not done one yet. I did ask my dad to help me and he did but we never got to put the #'s in!
Carbonels #'S below are not looking good. Don't you think she was better having 2 units once a day? She at least dropped down low and then went up again. This way she is high all the time, I really feel very distressed about this. :cry:
16/9
AMPS 250 .75u
PMPS 355 .75u

17/9
AMPS 258 .75u
+5 216
+8 262
I don't know what to do now. Her coat is not great and she is not very happy at all. I have not given her her evening shot but I guess it will be high again. Help!
Carol and Carbonel

Hi Carol,

Actually todays numbers look better. If you went back to once a day insulin she would spend too many hours a day without any insulin in her system.

If you will be able to test you might try 1 unit twice a day again. A little more insulin will bring her numbers down a little more.

Sorry I didn't mean to scare you about her kidneys and liver, but it is part of the whole picture that we need to keep in mind.

Her coat will improve when we find a dose that she likes and she starts feeling good again.

Hang in there.

Robin

Spread sheet?

Here I come to save the day!

Since Rob and Harley only gave me Carol & Carbonel to go by, I hope I have the right thread.

Carol & Carbonel: I can help you get your spreadsheet up and running. I can also help you get an avatar up if you would like that. I'm on the CST zone - the same as Rob and Harley. If you would like to PM me the next time you are online for a length of time, we can coordinate our time zone difference and perhaps be online together long enough to get that bad boy up and running.

If you feel uncomfortable with pming, let me know what times (your time, I'll figure out the difference) you are online usually and I'll see if I can sneak in around that time. I cannot give you a certain amount of time it will take to get through the steps to do the spreadsheet, but the avatar business will only take a few minutes. I will need your email address for the avatar. If you are uncomfortable giving out your email address, it will only add a few steps but can be done.

And, I just have to add that Carbonel is just an adorable name, though I am probably pronouncing it wrong