Needing help with Tiffy's ProZinc adjustments

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Hi. I need someone to explain sliding scale with examples. I'm currently giving her 2 units in am and 2.5 in pm. Her #s r decreasing but still high after am shot into pm. She is currently on a can of evo spread. 3/4 @ shot with 1/4 @ + 1.5 to + 3. Help
 
Sliding scale means you get the pre-shot test and based on the number, you select a dose.
Low pre-shot, lower dose.
High pre-shot, higher dose.

First, examine your spreadsheet.
Look at the pre-shot numbers, then the result you got with the insulin dose.
You want a dose which gets down near 80 mg/dL on an AlphaTrak or 50 mg/dL on a human glucometer, but not below.

Initially, you might make a rough split, such as below 300 and 300 or above.
I believe I saw a pre-shot in the 300s which resulted in a nadir around 150ish on a dose of 2 units.
At a pre-shot in the 400s, 2 units only got down to the 200s. Thus, a pre-shot in the 400s needs a higher dose. You might test 2.5 units with that kind of pre-shot.

Eventually, you'll develop a more refined scale with different doses for pre-shots in the 200s, 300s, 400s, etc.
 
Link to old thread with some background. http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=96956

Only the in and out insulins, the short duration insulins, can be dosed with a sliding scale. Prozinc is one of them where we can do this. Because there is no protocol with Prozinc, we need to develop an individualized sliding scale just for Tiffy.

That sliding scale might look something like this:

400 > 2.5U
300-399 2U
200-299 1.5U
<200 no shot

I'm not saying this is the exact scale to use for Tiffy. It's what we are trying to develop with the testing you are doing. When you are around to monitor more, like at night or weekends, then you have the choice to be more aggressive in the dosing if you want.

Some people are more comfortable with more aggressive dosing. Some people are not. Some days may allow you to be more aggressive, other days you may have to be more conservative in the dosing.

Tiffy is living with you. So you probably have a much better idea than we do on how the different doses are affecting her.
 
Hey Everyone. Tiffy's numbers are the bomb. Pinks and yellows, one red. the 2.5 and 2 are working. Any other suggestions? I think in a week you guys will have a better idea where she is with the 2.5 and 2. She is moving down and doing well on the can of Evo. The Doctor suggested not lowering it more than a can in am and pm. That was his prescript.
Eventually we will be able to lower, but lets see at next checkup.

Okay, Big thanks to Deb for shrinking the Pic for me. Tiffy is a trip though.
The mouth sore is in the whiskers. I got a better look. It looks better. I put baby oral gel on it. It might be the result of a fight with one of my cats. The boy is tough :twisted: She backed off of him. So he might have fought back and put her in her place. That is okay. She beat Darma up so bad she pee'd the floor. She again attacked her today so bad. I know I shouldn't have gotten involved, but I had to grab darma. I got swiped bad, but she was bad, (tiffy :evil:) She grab her with her teeth and wouldn't let go and was pulling back and forth. I grabbed darma. Lucky Darma didn't have a wound. I don't know why either??? But I order 2 fences and Have one now, which is okay. Just got it after that fight today. Darma is a little fat and can't fight real well. Also, my cats don't know how to fight.

I will give the sore a couple of days. It might go away. Looking better. Does anyone know a behavior board
:mrgreen:
 
THIS IS JUST AN EXAMPLE.

When Bob had been on insulin for a couple of weeks, 1u twice a day of PZI, his numbers still were pretty high. Preshots in the 400s and I was rarely testing for nadir. This was before I ever knew about FDMB. My vet upped him to 2u twice a day, and a week later to 3u if his preshot test was higher than 400.

His numbers still weren't good. My suspicion was that he was going low and bouncing from too high a dose. That's about the time I found this place. So I talked to my vet about it.

My vet gave me a scale to use for dosing:

If Bob's preshot tests were:

400+ 4u
300 - 399 3u
200 - 299 2u
100-199 1u
Below 100 her instructions were "call me on my cell phone before giving him a shot"

I used it for a week. I started testing more mid-cycle (duh, I should have been doing that all along, but what did I know?)

I saw some mid-cycle readings that were in the blue numbers, but his preshots weren't coming down. I finally decided that he was bouncing all the time because his dose was too high.

So...
Without saying anything to my vet, I adjusted his "scale" and pretty much cut his doses in half over the next couple of weeks.
Not only did I continue to get good mid-cycle numbers (low blues and greens) but his preshot numbers started to come down too. He quit bouncing once I lowered the dose, but I didn't lower it so far that he stopped getting good nadirs that ranged from 40-120 or so.

From that point on, I just kept shooting on a scale, but much lower doses.

He rarely had a preshot over 300 at this point.
300+ 2u
200+ 1u
100+ .5u

If he was around 250, I shot what I thought was about 1.5, and if he was around 150 I tried for .75u. It was guesswork on my part because I was using syringes with nothing but whole unit markings.

A couple times near the end of his run on insulin, I shot .25u on preshots that were below 100.

The lowest number I ever saw on the meter was a 40, and it didn't panic me. I fed him half a can of LC food and went back to bed. I saw a 42 once, but I was on a break from work, so all I could do was give him a 1/2 can of LC food and go back to work. He never displayed any "hypo" symptoms that I saw. But I wasn't testing every day at nadir either.

DON'T FOLLOW MY SCALE!

There is no magic formula for sliding scales. They require a great deal of experimentation on your part. In order to use one effectively, you need to try to catch a number in the range of 5-7 hours after shooting to try to see the "low point" of the cycle.

You take the preshot number and the nadir number, subtract them, and determine how much of a drop a certain dose gives you. But never assume you're going to get the exact same result two shots in a row. This will at least give you a "ballpark" idea of how much to shoot on a specific range of preshot numbers. If you aren't sure, under dose rather than over dose. Every cycle can show you something.

My other two "rules of thumb" with Prozinc/PZI are:

Don't assume that what didn't work last week won't work today.
Don't assume that what worked last week will work today.

It isn't just insulin and food that influence a cat's BGs during the day or night cycles. Other "things" going on both inside his body and outside (environmetal things like stress, storms that freak him out, whatever is happening around the house that day, how much exercise he gets, etc) - all of those things have an effect on the BGs too. Every day is unique with your cat. So even if you shoot the same amount of insulin into the same exact preshot number, don't assume the numbers after that are going to be identical, because they won't be.

And just because a 1u dose dropped him 100 points two weeks ago, the same dose can drop him 200 points today, or not drop the BG at all. He isn't the same cat he was two weeks ago.

I advocate sliding scales with PZI/Prozinc just because I believe that it is a more effective way of using that type of insulin than holding a dose for 3, 5 or 7 days is. That doesn't mean I am right. It just means that in two years, I have interpreted what I have seen in spreadsheets and threads for PZI cats that way. And I know it worked for MY cat.
 
NIce pinks and yellows today. But if you get a high black number in the morning, I think you might consider giving a slightly higher dose, 2.25U or 2.5U dose. She seems to only drop to mid yellows on that dose.

Next goal: yellows and blues!!!
 
For the intercat fighting:

- make sure everyone's claws are trimmed; talons of doom may result in large vet bills! ... or medical bills if you get in the crossfire!

- active play sessions help reduce stress ... and a cat being ill with something will affect the others. Aim for 15-20 minutes twice a day. Doing this before shot time meals will trigger the hunt, catch, kill, eat, groom, sleep behavior cycle. Bonus: may help insulin work better.

- Feliway diffusers send out calming pheromone scents and may help, too

- cats like vertical space and it provides more territory to spread out if you use 3 dimensions. Tall cat trees, furniture arranged so cats can get highter, even putting staggered shelves on the walls can help.

- boxes and hidey holes to curl up in make it so only one direction needs to be watched for another cat.
 
Hi, Everyone. Thanks a million for all the input. I made a couple of observations. Number 1, when I feed her treats in early morning hours like 2 or 3 am, it spikes her, so no more middle of the night bathroom treats. Number 2, when I feed her at +1.5 to +3, she is okay, but +3.5 to +5, it spikes her preshot number. Number 3, she is irritable when she is in the high 400s and 500s. And she is there at preshot on 2 units. Please Look At SpreadSheet to confirm this. I shot her 2 in am due to the 297 number. I should have done what I was going to do which would have been 2.5 and 3 tonight to bring her lower. Tell me what you think about that for tomorrow. I did 2.5 tonight due to the 538 number tonight. I didn't want to do 3 units due to the 2 unit in am. I thought that would drop her real low and bounce her. Depending on her demeanor, which is ****, hoping she lowers by +2.5 to +3, I will Bg her, but all in all she is coming along.

As for the nails, I can do her only when she sleeps and is relaxed or at least right now. I bought two 44 inch gates and keep them separated. In the future when I start generating, I will buy a vertical crate for her, right now she is in like 3 foot by 3 foot sort of like playpen crate.

So please check the ss and I am sure you guys will agree that at 2 unit her preshot is high and she doesn't drop enough, so 2.5 and 3. I think is good, but will incorporate it within next few days and I will be around because work is slow next weeks.
Debbie, I can't do 2.25, the syringes are hard to eye a quarter, and the plunger is think, which makes it impossible. I mean I can try that but don't think it will drop her enough anyway just by looking at her numbers with 2.5, so I think the above might work well with her. Feedback please :-|
 
It would be much easier to be sure if you could get more data. For example, today was the yellow preshot the low for the cycle or was she lower overnight and was coming up? On 6/29 she dropped almost 50% at +4 - wonder what she was at nadir? Anytime a dose drops them 50% at nadir, it is a pretty aggressive dose. It would be good to see more midcycle numbers in that 4-7 range to see how the 2.5 is working before you raise the dose. If she is dropping 50% or more, then the red and black preshots can be bounces and more insulin won't help. If she starts up at +7 or so and climbs to that red from more reasonable numbers, then more insulin may help.

If you could get more data, then I'd feel better about supporting an increase. If you decide to increase the dose, monitor carefully and try to catch possible low nadirs and the rise.

You could post on the PZI forum where everyone has experience with your insulin and you should get more specific dosing advice.
 
Magnifiers may be helpful And all these varieties are available from our shopping partner, Amazon (click link at top of page).
Syringe magnifiers clip on the syringe barrel.
Visor magnifiers help for those who don't have glasses.
Clip on magnifiers add to existing glasses; I like the Carson Clip and Flip.
Free-standing magnifiers may help too.
 
Math for the conversion is
0.4 * U-100 syringe mark = U-40 dose
Because ProZinc is 40 units per mL vs 100 units per mL, ie 40% concentration
 
Okay, Thanks Guys, but I need more help. I am having trouble getting the u40 syringes. So...
So I eyed 2.25 for the am and shot 2.25 and her pm was high for me 448. (See spreadsheet)
I shot her 2.50 in pm, but monitored as suggested from above. You guys are right. I need to curve her after Nadir. So +5.5 and forward. See spreadsheet. at 5.5 she was 177. Lowest ever and never really curve her then at that time or later, and that maybe why every once in a while she vomits at 3 or 2 or 4 am. She might be too low.
I fed her tonight 1/4 can at +5.5 (177 bg). What should I do? reduce to 2.25 at pm? I don't think that will help. Any suggestions? :? :shock:
 
I can't get syringes from Duane REade. So having trouble getting u40s.
I am not understanding the conversion either, but can we do that once I get a handle on syringes. I can't get them?
 
U-100 insulin has 100 units in 1 milliliter; U-100 syringes can measure 0.5 and 1.0 units of U-100 insulin
U-40 insulin has 40 units in 1 milliliter - it is 40% of the concentration of the U-100

If you use U-100 syringes with a U-40 insulin, you take 40 % of the measurement on the syringe barrel to determine the U-40 dose.
Thus
0.4 * U-100 syringe 0.5 unit mark = 0.2 units of U-40 insulin
0.4 * U-100 syringe 1.0 unit mark = 0.4 units of U-40 insulin
0.4 * U-100 syringe 1.5 unit mark = 0.6 units of U-40 insulin
0.4 * U-100 syringe 2.0 unit mark = 0.8 units of U-40 insulin
and so on.

Our shopping partner, ADW (link at top of page), may have U-40 syringes and definitely has U-100 syringes
 
Theresatramondo said:
I can't get syringes from Duane REade. So having trouble getting u40s.
I am not understanding the conversion either, but can we do that once I get a handle on syringes. I can't get them?

What is the issue getting syringes? Out of stock? You need a prescription in NY state?

There are a couple of places to mail order the syringes. If your state requires a prescription, you will need your vet to provide that first, even for mail order.

Our shopping partner ADW (American Diabetes Wholesale) has the U-40 and U-100 syringes. Click on the link at the top of your screen. And they have free shipping right now on ALL orders.
 
Hi, I am not understanding the conversion still posted by bjk. Finally got those initials.
I need to know for 2.5 insulin on u40 what is that on the u100.
but in any event, I am using u40 and feel more comfortable just eyeing the .25 dosage increase. I have a prescription. Duane Reade doesn't have the syringes. he is trying to order.

Deb, my cell on the spreadsheet won't expand, so I have thin columns, can you help

Also, I freaked out with last night's nadir of 177 and gave her a half can, which spiked her morning number. How much more after +5 can she drop? Do I need to freak out and feed her?

Also, she has what I believe to be a hematoma in the test ear. there is the size of quarter red blotch under skin and it is hard. Any suggestions? I went higher, but don't want to test that ear and the other ear is dead :YMSIGH:

I like the 2.5 dosing in evening and the 2.25 in morning. I don't think I need to freak out with her. I had something else I wanted to say, but can't remember. Maybe 1 treat will suffice instead of a whole 1/4 can??? Feedback?
Her numbers are looking glorious.
 
Theresatramondo said:
Hi, I am not understanding the conversion still posted by bjk. Finally got those initials.
I need to know for 2.5 insulin on u40 what is that on the u100.
but in any event, I am using u40 and feel more comfortable just eyeing the .25 dosage increase. I have a prescription. ..


This is BeeJayEm (BJM)

If you have U-100 syringes to use up, just follow this conversion chart which already did the math - Conversion Chart

When you get your U-40 syringes, you can make a reference gauge so you are consistent in measureing.
Making a Reference Gauge For Half Units of Smaller
 
Also, I freaked out with last night's nadir of 177 and gave her a half can, which spiked her morning number. How much more after +5 can she drop? Do I need to freak out and feed her?
No need to frek out until she drops under 50. she could have dropped another 127 points and still be ok. We would have suggested another test and a teaspoon of food, not half a can. ohmygod_smile

Tiffy still has a long way to go yet to see a 50. Yes, it's possible to go lower than that +5 you got last night. If you get another low scary number, put that 911 up and people on here can walk you through it. I'm loving that 177. I want to see even lower for Tiffy.

The low of 177 could have contributed to the bounce this AM also. Her body is not used to those low numbers and panics. We'll get her there eventually, to realize those lower numbers are normal.

Also, she has what I believe to be a hematoma in the test ear. there is the size of quarter red blotch under skin and it is hard. Any suggestions? I went higher, but don't want to test that ear and the other ear is dead :YMSIGH:
Don't know on the hematoma but BJM may have some suggestions. What do you mean by the other ear is dead? haven't poked it much so it's more difficult to get blood? You can try poking higher, or lower down towards the fold. Or you can try the paw pad as an alternate test site. Or give her a break for a bit, fewer tests.

p.s. I fixed your ss so it will wrap the text. If you need to do that yourself, click on the entire row you need to change, over in the left most column. Then go up to the editing commands bar. There is an icon that looks like a bunch of lines going across a page with an arrow wrapping around to the left. Click on that. Your text should now wrap.
 
A hematoma in the ear is a small pool of blood between the skin and the cartilage of the ear.
From the Merck Veterinary Manual Online
"Treatment is surgical to allow drainage. After draining and flushing, several mattress sutures can be placed to eliminate the pocket."

This suggests a vet visit may be in order.
 
Thanks, I will do the teaspoon next time. She seems high right now and it is only 4:49 pm. At 177 was +5 and it was 12 midnight, so I was going to bed and what I will do is leave out a treat or a teaspoon of food at that number or don't?
as far as the hematoma, it is bruised. I called the vet and he said hit another spot and when I take her in next week he will check it, and the abrasion on side of mouth, which is getting better, btw.
So I am not really liking the 2.25, I think I can do better with the numbers, any suggestion?
 
HI CAN YOU WEIGH IN ON TIFFY, I MOVED HER TO 2.25 IN AM AND 2.50 IN PM, BUT STILL GETTING HIGH IN PM PRESHOT AND SHE DOESN'T DROP MUCH ON 2.25 AT NADIR. I FREAKED OUT LAST NIGHT WITH A 177 AT NADIR AND LEFT A QUARTER CAN. SEE SS AND ALL THE NOTES, PLEASE. I VALUE YOUR OPINION. DO YOU THINK I SHOULD RAISE HER, DEB THINKS MAYBE, SO THE 2.25 TO 2.50 AND NIGHT 2.50? dO YOU THINK I SHOULD HAVE FREAKED OUT WITH THE 177 NUMBER? dEB SAY NOT.
 
Using a human glucometer, these are reference numbers for decision making

< 40 mg/dL - treat as if hypo

40 - 50 mg/dL
- at nadir - possible dose reduction
- early in the cycle - steer with food

40 - 130 mg/dL - non-diabetic numbers

180 - 280 mg/dL - Renal threshold, depending on data source and cat's renal health. This means glucose is spilling into the urine and possibly harming the body. Ketone testing is advised.

200 mg/dL - "no shoot" number for beginners; may be adjusted down as data shows it is safe. For ProZinc/PZI type insulins, seldom below 150 mg/dL. Depot type insulins may shoot low to stay low when they have data to show it is manageable.
 
Guess I am harder to "freak out" with those blue numbers in mid-cycle. If this had been earlier in the cycle, like at +2 or +3, I would have told you to get another test in an hour or two.

What freaks me out? Numbers in the 30's. Those freak me out. :o :shock: :o

If you look back at the SS, you will see lower numbers on 6/22 at +4. She came right back up, but you did feed her 1/2 a can that time too.

so I was going to bed and what I will do is leave out a treat or a teaspoon of food at that number or don't?
1 to 2 teaspoons is all you need to do leave out, at that time of night.

You can always leave out a bit more to make you feel more comfortable. Your call.
 
okay, will do, but do you think I should increase the 2.25 am shot? look at her curves. she stays in 200s, mid to high 200s.
And if I get low tonight at +5, I will give a teaspoon, Deb, thanks so much for your support.
Now, Bjk, Are you telling me if her am preshot and pm preshot numbers are 150 don't dose her? This is very important to know, because I feel that I am heading down that road. ~O) :-D
 
Yes, I think you can increase 0.25 units.

Note that those reference numbers were using a HUMAN glucometer.

If pre-shot < 180 on AlphaTrak, you have 3 options
1) Skip the shot - the next pre-shot glucose is likely to be high.
2) Stall without feeding 30 minutes. If above 230 or rising and you'll be able to monitor, shoot.
3) Shoot a reduced dose. Developing a sliding scale for your cat lets you adjust based on the gluocse levels.

BeeJayEm
 
Theresa,

If Tiffy is high in the morning, over 500, she needs a higher dose.
If Tiffy is lower in the morning, say 300, she needs a lower dose.
If Tiffy is very low in the morning, say under 150, you may need to skip the shot, especially if you will not be home to monitor.

The dosing does not need to be a fixed amount every shot with Prozinc. You adjust the dose according to the sliding scale you develop over time with testing.

I think you are ready to go to one of the Insulin Support Groups, to get that more specific advice you are looking for with the Prozinc. There is one specifically for PZI and Prozinc users. It's labeled the PZI user group but it is for both insulins. There are people there that can look at your SS and help you to develop a sliding scale for Tiffy.

Here’s how to post in ISG forums
Every day ( or as often as you can) you open a new thread/post. We call them "condos" (short for condition report)
- The subject has the date/cats name and BG readings ie 06/23 CATname AMPS 400 +2 333 + 5 224. You add a ? icon if you have a question. You can update your subject as you get a reading, or whenever

- The contents of your post have a quick update on how your cat is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today CATname was in a good mood, playing and eating well. But he is peeing a lot and his BG is really high. Should I increase the dose?

For your first post put "newbie" also in your subject so everyone can welcome you!
 
thanks deb.
I will just update you guys, I increased morning does to 2.75 and kept pm dose the same at 2.5. I was going to increase to am to 2.50 and pm to 2.75 so a quarter in each session but the pm preshot was so high I decided to do higher in am and do .50 but look at her numbers. they are high and not decreasing at nadir. I like to give the dose a chance to kick in like three days, but...
 
I don't know that there is a 'give the dose time to kick in' with Prozinc.

You have to look at the pre-shot number and base the dose on that number in order to use a sliding scale. A 2.75U dose would not be right for Tiffy every morning. It would have been too much for her on 6/20 AM with that 297.

If the 2.75U yesterday AM, only brought Tiffy down to the high yellows (200's) it may not be enough. It looks like her nadir may be a bit later than the +5 you are testing. You got a PM +5 of 177 on 7/1 with a dose of 2.5U.

I don't know Theresa. Can you get anymore tests in this AM cycle? Sooner rather than later?

Theresa, I have no skills at developing a sliding scale. That is why I thought if you posted over in the PZI forum, Sue and Oliver or Robin might be able to suggest a sliding scale for Tiffy.

You can still post here too.
 
I agree with Carl. I was several months into testing when I started a sliding scale, so I had a massive amount of data and never had to shoot over a 1.25u. I am still eyeballing a u40 syringe, so it is possible. My cat's numbers never go over 200 anymore, except during weather events that aggravate his arthritis, or anything that makes him stress.

My vet is a very cautious woman, and had me start on 1.0u regardless of how high his BG was, which proved to be just what was needed. Just like Carl, I took a non-vet approve step and raised his shot to 1.10u and then presented her with the numbers. She let me take over shot adjustments when I showed her what we had done by testing with variable shots.

For my cat, Every Day Is Different! Eventually he would fall into a pattern and even started to regulate his own drops in BG with food. He even turned his curve upside down at one point, and we started getting lower and lower numbers.

My current sliding scale goes like this:

3oo+ - 1.0u
200-299 - .75u
170-199 - .50u
150-169 - .25u
130-149 - .10u
100-129 - Skip it, or try a .10 ONLY if I'm going to be home.

Only a few months ago, his shots on each of those scales would have been .25-.50 higher. His relationship to his insulin changes constantly, and he drops into 2-digit numbers about 2 hours into the shot. He's never hypoed. These tiny shots don't have the duration the larger shots get, but now if I waited for him to reach 200, it would take, at a minimum, a day and a half. He's always been a tiny eater, so he doesn't get the solid backing of food to support a really large shot.

I can't stress enough how much testing I did to arrive at this. You will know more about how food and insulin and outside and inside influences affect your cat, than you probably ever thought you would know. I believe that the longer he stayed in the low normal numbers the quicker he healed. Even the habits he had when his BG was really high (400-500) started to show up on numbers in the 200s, meaning his body was now recognizing 200 to be too high.

On a sliding scale, BG numbers will start to be normal very very fast. So testing is critical. If you free feed (leaving food out when you aren't there), you might notice that food spikes play a part in the BG, depending on when your cat ate. For my cat, at his advanced age (18), I wanted his daily life to remain as normal as possible. So he often eats before I get home, so I have tested to establish his general food spike number, and factor that number into his shots.

Check daily for the 5 P's (pooping, peeing, playing, purring, and preening). Stress from constipation kept my cat in the high BG's for a long time. I also got glucose urine strips to check in between shots to figure out his renal threshold (270), so any number below that was at least keeping his kidneys sugar-free.

Lastly, a sliding scale is lot of "Let's see what happens if I do this" method. if you are going to start a sliding scale, I would start at a 1.0u shot, even if your pre-shot number is 500+ for a least a week, testing, at a minimum, at preshots and (+6). Start on a day when you can be home all day. That will establish a base where you can start adjusting numbers, then only adjust .25 at a time. You will start to see how aggressive you can take the shot as you get to know how your cat operates.

Good Luck!
 
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