how much insulin given at low glucose levels

Status
Not open for further replies.
L

london2z

Member
My cat, Costello, has diabetes, and I just started him on PZI about a month ago. A recent rundown: After an injection of 4 units of PZI on Fri. afternoon, when his reading was 471 mg/dl, it dropped down to 89 by 1:30 am. So then I gave him 2 units of PZI and by 8:30 am it was down to 45. So I skipped injection. By 12:30 PM it was up to 161, and then I gave him 1/2 unit PZI, as in the article. By 7:50 pm it was back up to 558! So I gave him 4 units, and by 3:am it was down to 266. I then gave him 3 units, and at 10:AM, Sunday it was up to 450 mg/dl. Then I gave him 4 units PZI. When it went down to 161, should I have given him more than half a unit? Is it only after the big glucose swings have stabilized that you can skip a shot, or give a tiny injection, with a low reading?



- Show quoted text -
 
A sliding scale should be tailored to your cat and his nadir and how he responds. It is difficult to generalize with a "one size fits all" scale. You need to have a lot of data and nadir numbers before you change the doses that fast.

And it works for some cats, but not all. Some take a few cycles to settle into a dose; some can switch it up.

One suggestion is to start increasing by .25 or .5 units rather than one full unit. Another would be to post over on the PZI forum and get some advice on your dosing. It is not as busy as Health but there are often people there in the am and pm to help. viewforum.php?f=24

Here is a document with lots of info on how PZI works and is dosed: viewtopic.php?f=24&t=32799
 
Are you giving the shots approximately twelve hours apart at the same time each day? I can't tell. What is easier to understand to to use the shot time as the basis and give the number of hours after the shot with the BG. We call the shot time BG as AMPS(AM pre shot) or PMPS as applicable
 
just to clarify, are you using pzi compounded by bcp or prozinc?

from another of your posts it appears you are trying to follow Dr. Hodgkins old tight regulation protocol? not sure if you are aware that the starting scale for a pzi type insulin has been revised to:
BG

US(mg/dl) Dose

151-170 0.25u
171-185 0.50u
186-200 0.75u
201-220 1.00u
221-250 1.25u
251-290 1.50u
291-350 1.75u
351-410 2.00u
411-450 2.25u
451-500 2.50u

as a former user of the original tight regulation protocol designed by Dr. Hodgkins, i can tell you that the huge doses the old scale had in it often caused my cat to do just what yours is doing, bounce all over the universe. honestly i don't know what to tell you because we ultimately found that smaller consistent doses is what worked for my cat. just know that if you are going to try her protocol, you have to do it 100%, not 80%, not 90%, but 100%. shooting all the time puts the cat in more jeopardy so you have to get in tune with your cat's actions & behaviors as if they were your own and test test test, to keep them safe
 
Hi and welcome!
sometimes the sliding scale does not work for everyone.
especially if you are new and dont have test data to back up what you are doing
We usually recommend that you start low and go slow.
you might want to let you cat get used to a dose and raise slowly fromthere as needed
we ususally say to start at .5 or 1 unit (depending where he is)
and hold that dose for a few days to see how he reacts

If you would like there is a PZI insulin support group with some very knowledgeable
people there to help you through this.

Since Costello does not seem to be responding well to the sliding scale, you might want to
start with .5 or 1 unit and hold it to see what happens

Denise and Shakes
 
london2z said:
I had him started on Lantus about a month ago, as the vet recommended, one unit every 12 hours for one week, then was told to go to two units. Another week and still the high numbers stayed high. I didn't have a meter, then, so I had to go with the glucotest urine testing. Then I found out PZI was supposed to be much better, so I switched. After a couple of weeks, at 2 units, twice a day, still no reduction of levels. Then I increased the daily dose to 3 units, twice a day. The first day it went from 311 in the morning to 93 at night. So I skipped a dose, and by the next morning it was back up to 445. I guess I shouldn't have skipped, and given the 3 units, instead. And just stayed with the twice/day schedule. But then I started 'tight regulation', and it went from 445 to 471 in 7 hours, after 3 units were given that morning. So I followed the chart, and at 471, gave him 4 units. 7 hours later glucose was down to 89. Anyway, this morning it was at 450, and I gave him 4 units. 7 hours later it was at 274, and gave 3 units. Thank you for the changes in the chart. I must be looking at an older version of the site.
Click to expand...

fwiw, lantus may have worked. a month isn't really long enough to see if it's going to work and especially not with the dosing your vet had you do. jumping in dose by whole units has been found to not work and, without hometesting, there's no certain way to know if it was working anyway.

now, as to the pzi, same thing, changing doses by a unit at a time can mean you miss the ideal dose. you won't find many cats on solid unit doses but more often on doses like 1/2 or 3/4 or 1 1/2, etc....

the numbers you give, the 311 to the 93 i assume is 12 hours apart? if so, having such a low preshot number 12 hours after the last shot can be an indicator that the dose given was actually too much since the insulin isn't supposed to still be working 12 hours later. and the 445 the next morning was because the insulin was long out of kitty's system and may even have been a little rebound from going from so high to so low. and no, you would not still given pzi insulin on a glucose level of 93. 3 units of pzi on that number would have been disastrous.

check out the pzi insulin support group here. they'll help you figure out exactly how this insulin works
 
This is to all who replied to my comment. Thank you. To Sue and Oliver, I'm so sorry about Oliver. It must have really hurt. I've had Costello for about 9 years, now, and live alone with him. He's all I really have, so when he goes I don't know what I'll do. I had him started on Lantus about a month ago, as the vet recommended, one unit every 12 hours for one week, then was told to go to two units. Another week and still the high numbers stayed high. I didn't have a meter, then, so I had to go with the glucotest urine testing. Then I found out PZI was supposed to be much better, so I switched. After a couple of weeks, at 2 units, twice a day, still no reduction of levels. Then I increased the daily dose to 3 units, twice a day. The first day it went from 311 in the morning to 93 at night. So I skipped a dose, and by the next morning it was back up to 445. I guess I shouldn't have skipped, and given the 3 units, instead. And just stayed with the twice/day schedule. But then I started 'tight regulation', and it went from 445 to 471 in 7 hours, after 3 units were given that morning. So I followed the chart, and at 471, gave him 4 units. 7 hours later glucose was down to 89. Anyway, this morning it was at 450, and I gave him 4 units. 7 hours later it was at 274, and gave 3 units. Thank you for the changes in the chart. I must be looking at an older version of the site.
 
To dmartini4,
That may work, but on Saturday his reading was at 161 in the early afternoon, and I gave him .5 units. About 7 hours later it was back up to 558. So I'm not sure. I agree that I need to follow the advice of others, and cut it back, some. It's kind of like a see-saw. When you push too hard on one end, it causes too much counter-swing, and then too much the other way, and etc., etc.
 
What could have happened is that he went to low and bounced back up again
We suggest to new people that they never shoot under 200....wait 20 minutes and
test again to make sure they are rising.once they get over 200 then you should shoot.
you dont know what is happening unless you get some midcycle numbers.
It is always good to test at +4 and +6 tosee what is happening and make sure they dont go to low.
.50 might not have been enough but you wont know unless you test mid cycle.
so I might suggest starting over and taking it slow.
please dont shoot under 200 for a little while until you can get some data to back it

If you would like you could go over to the PZI insulin suppport group
Its a small group but they are very helpful

Denise and Shakes
 
Thank you for the offer, but I'm geting assistance from the folks on yourdiabeticcat.com, and the tight regulation method. I don't want to get too spread out. They say pretty much the same, only they use 150 BG as the cut-off for dosing. His BG was 250 this morning, so I gave him 2 units, splitting the difference between the old and new revised sliding scale table.
It seems like mid-cycle testing would be a difficult measure of testing, as the BG can go either direction. After 6 hours the insulin kicks in, and BG drops, then it goes up again. Up and down, all the time, and hard to predict.
 
london2z said:
Thank you for the offer, but I'm geting assistance from the folks on yourdiabeticcat.com, and the tight regulation method. I don't want to get too spread out. They say pretty much the same, only they use 150 BG as the cut-off for dosing. His BG was 250 this morning, so I gave him 2 units, splitting the difference between the old and new revised sliding scale table.
It seems like mid-cycle testing would be a difficult measure of testing, as the BG can go either direction. After 6 hours the insulin kicks in, and BG drops, then it goes up again. Up and down, all the time, and hard to predict.
Click to expand...

actually, mid cycle testing is very helpful as it will tell you if the insulin dose is enough or too much.

pzi actually kicks in at about 2 hours after the shot is given, and is at it's most efficient around 6 hours after the shot so that is why you want to test around that +6 mark. to see what the dose did.

so let's say your amps is 300 and at +6 it is 50. that would be a good indication that the dose is too high because the drop is too steep which is going to cause the pmps to be high too because kitty's body panics at that steep drop and throws in whatever it has to save itself.

if your amps is 300 and your +6 is 250, that could indicate that the dose is not high enough.

and yeah, nothing's predictable about this disease in the beginning :-) in time though it gets to be more predictable.
 
I have been testing him at +6, and giving the doses soon after, based on the +6 reading as described under TR methods. My mistake was giving a dose when the +6 was below 150. It seems like the chances are pretty good that at +4 the BG will be a little higher than at +6. So why the xtra testing? I'm not disagreeing, just trying to figure it out. Thanks.
 
I think the issue is that you are getting dosing and testing advice based on a "normal" PZI cycle which is one shot every 12 hours, rather than on the TR protocol that you are using.
If I have it correct, with TR, you test at +6, and then shoot based on whatever the BG is at +6, then test again 6 hours later, and repeat the process each +-8 hours correct? So Costello could be getting up to 3 or 4 shots in a 24 hour period assuming you get shootable numbers at each test?

Using the 12 hour shot schedule, we would test at +4 and +6, and sometimes at +8 to see how the insulin pushes down the BG, when "nadir" is reached, and then to see how it continues to climb towards the next shot, which would be at +12.

I believe the confusion or communication gap is because "we" are talking about a 12 hour cycle, and you are using TR which is not based on a 12 hour cycle.

Does that make sense?

Carl
 
Carlinsc- Thank you. Yes I have been trying the TR method, as you described. But now I know, and should have known, that the mid-cycle check +4 is to see whether the BG is still going up or down at +6. And if it's still going down, not to dose. Do I have it right? People were saying this, but so much info at once. Maybe I should switch back to the one every 12 hour injections. I think there would be less chance of over-dosing.
 
We do think beginning diabetics do best with a start low, go slow approach until you have the data to predict how they might react to a given dose. PZI can be given more often than every 12 hours, but until you see how it works in your cat, it is very difficult to change doses so often. I would encourage you to start over with one unit, every 12 hours and get a curve in to see exactly how things are working.

And we really encourage you to increase and decrease by smaller amounts like .25 or half units. Tiny differences can make big differences in bg levels.

He is your cat and you decide how to treat him. Here, we are all about keeping cats healthy in good numbers, moving carefully to regulation and remission. we would love to help you if you want our help.
 
This is a marathon - not a sprint - so be patient.

In my opinion - if giving 3u on a BG of 311 resulted in 93 at shot time --- This means that 3u was too much for steady dosing
 
I am grateful for all the advice. It's all almost too much to absorb, but I'm trying. Plus being up all hours of the night wears on you. I'm switching back to the 2 -a- day dosing, starting Monday evening, 10:15 p.m.-1st dose. Monday morning the Bg was 250 at 2 u...+7 BG 298 at 2.5 u...+5 BG 333 mid-cycle ...+2 (10:15 P.M.)BG 345 at 3 u. A commenter said that in this type of situation that because the BG was up from mid-cycle 333 to 345 at pmps, and in fact had beeen rising all day, that 2.5 u at BG 298 wasn't quite enough. So I gave 3 u at pmps. I think because the vet started him on twice a day dosing for 4 weeks, starting at 1 u/every 12 hours the 1st week, up to 2 the 2nd-4th weeks, and 3/twice a day for 2 days before trying TR over the past several days, that wouldn't it be better if I tapered him back down to a half, or one u/twice daily? And not just all at once? Just look at the amounts I've had to give him on Monday, and still it went higher.
 
It could be rebound, but there is no way of knowing without experimenting. Here is some info on it: http://petdiabetes.wikia.com/wiki/Somogyi_rebound It's a hard concept to get your head around, but not uncommon with ProZinc. Basically in some situations, more insulin = higher numbers. Read up on it and see if you think it could apply.

Your vet started at one unit, but then increased by whole units - right? That is an easy way to skip over a good dose that would bring down the numbers. That's why we suggest increasing by .25 or .5 units and holding the dose for a few cycles.

It is confusing, but the picture becomes much clearer when you have more data. And data on the same dose for a few cycles. When you are switching up the doses so often without any previous predictable patterns, it makes the picture so murky.

If he were mine, I would start over at one unit. (What you're doing now isn't working - worth a try to do something different?) I would give it a couple cycles, getting nadir numbers. If he is still consistently high, I would increase to 1.25 or 1.5 and see what changes and how. If you do this, be sure to test for ketones regularly. (Are you doing this now? It is a good idea to avoid a problem like DKA. http://petdiabetes.wikia.com/wiki/Ketoacidosis)

It would be very helpful to you, and us, if you would set up a spreadsheet. That way, it is easy to see patterns and history of dosing and numbers. Here are the initial instructions: Setting up a spreadsheet Sometimes it doesn't work with certain internet search engines. If you have trouble: http://felinediabetes.com/FDMB/viewtopi ... =6&t=50130
 
Why would the BG keep going up on Mon. , with no nadir? I think I'll have to go back to the TR again, as Monday pmps at 10:15 p.m., BG 345, I gave 3 u, 4 hrs later mid cycle, BG was over 600! 3 hrs later, mid cycle- Bg 493. 3 hrs later amps- BG 562, gave 4 u . I have to cancel my ISP (rate raise I can't afford). Not making this up. You all have been so nice, but I'm going to just have to rough it from here. I will try to update you from time to time. Thanks again- WC
 
When the body receive more insulin than it can use the liver panics and releases sugar into the system to prevent itself from going too low, thus the BGs skyrocket. The only effect insulin can have is to lower blood sugar since it is a hormone, but with too much of a good thing you get the reverse reaction. So if you give insulin and the BGs continue to raise instead of going down then the dose it too high.

Mel, Maxwell, Musette & The Fur Gang
 
also, fwiw, one shot won't fix this disease. it takes weeks for treatment to start to work, thus, in my opinion, part of the reason the numbers are still so out of whack. nothing's been consistent. i know there's an urge to fix this overnight but that's also the worst urge because often it makes things worse.

try some consistency for a bit and see if you see some improvement.
 
Yes, I will cut back on his insulin to twice a day, and try and resist the urge to go TR again. But is it ok to go to 1 u/twice day, right away, and start over? With all the insulin in him, now? I suppose that's a silly question, if it's a matter of wanting to get rid of the insulin. But how fast?
The vet checked him for ketones a few weeks ago, and he was fine. And I'm going down now to get testing supplies for ketones.
 
i think it would be. make sure you are testing for ketones though too. do you know about that and how to do it?

if not, you can get the ketostix at the pharmacy with the rest of the diabetes supplies. it's a little strip that you stick in their urine, fresh urine, and then watch for it to change colors and compare it to a chart on the vial they come in. you want it to read none or trace. anything above that requires some intervention. if you were to get moderate or worse, you would need a vet's help to take care of it properly.

not sure which you may be familiar with but if you're at all familiar with cars let's say it would be comparable to the dipsticks/ph strips we use to test antifreeze, or if you're familiar with pregnancy tests, same kind of concept.

any diabetic should be routinely tested for ketones but moreso in the beginning when they are unregulated
 
In general, ProZinc will only last 12 hours and then, it's gone. So you can start over with one unit. If you put together a spreadsheet, then you can maximize your visit when you make it.
 
I should have a spreadsheet, but I am horrible with computers. And after tomorrow I won't have service, anyway. I can't afford it, now. I appreciate it, though.
What if his pancreas needs more help from outside sources, like the PZI, than just 2 units/day? If his pancreas isn't putting out, then? I guess you would need to increase it, then. Gradually!
 
We have been wondering if we could help you with dosing by giving you an email to post to. Then we would post online for you and get dose advice and email you back. Would that be helpful? It is against the rules of the site to give dosing off site - we rely on peer review.

I would really like to see you get advice on dosing.
 
You don't know us well, when it comes to helping a kitty with diabetes we will go to the ends of the Earth. If that means one of us making time to take a phone call we will...if that means throwing on another pot of coffee to sit up with someone whose cat is in hypo, we will. If it means driving 2 or 3 hours to help rehome a cat...yep we've done that too...It is ALL about the KITTIES.

Mel, Maxwell, Musette & The Fur Gang
 
Looks like phone will work the best. I can do that - I have unlimited long distance and I am retired. The discussion would be off site, but I would post, get feedback and then call you back. If that sounds like something that will work, I will send you a pm to get your phone number. (Look up on the top of the page. It will say 1 new message.)
 
Without trying to start anything, I want to just comment on Your diabetic cat site. I'm no longer familiar with who is running it, but in the past, there have been some significant issues between advice there, and here. One of my biggest issues is with something you've run into, namely, aggressive dosing and testing. It is often not possible to maintain the kind of schedule that they advocate, nor is it necessarily safe.

I'm very glad that you are slowing down a bit, you'll likely find it easier on your sanity and your cat will appreciate it.

Jen
 
Hey Jen,

Wally is off line for the present because of budget issues. I am calling him daily and posting for him over on the PZI forum. He is down to 2.5 units every 12 hours. Still having some bouncing but things are generally looking better.
 
Status
Not open for further replies.
Back
Top