? Switching to Prozinc - a couple general questions

I didn't realize you had been testing after feeding Panic for pre-shots. If you must give her food to get her to co-operate, use the food as a bribe. Give her a small bit, test and then give the rest as a treat for her co-operation. You're probably Ok if you are testing immediately when Panic finishes eating but better to grab the test before if possible.
I take it the "food machine" has a timer and doesn't allow snacking in the 2 hours prior to AMPS?

 

Well that's on me, I started it to get her used to testing and her numbers have always been so high I didn't even consider how the dosage/insulin switch would alter that. Plus she's no longer in the ravenous stage where she'll trip herself running to the food bowl every morning so it may be easier now. Would even a small bribe bite still influence her numbers though in an instance where I need to wait and retest to get it up more?

Yes, I try to give her a bite just before I go to bed and then set the feeder around 2:30 and 4:30, test/feed/shoot at 9.

 

And I am testing within 10 minutes of her starting to eat, not waiting around, in case you were wondering if those numbers were food influenced.

 

10 minutes wouldn't cause much if any change in BG but any longer and the food she's eating would be starting to get into her bloodstream. Better to get a pre-shot at all costs but good to know if there is any food influence for dosing purposes.

 

AMPS was 346 this morning, I woke up throughout the night to make sure she was getting food at the appropriate times. But +3 she's 469?! I'm like 99.9% sure that wasn't a fur shot this morning. Ahh!

 

Likely bouncing from lower readings you just aren't seeing. You don't have any night cycle data since you started ProZinc and quite often our kitties go lower at night than during the day. Try to get, at minimum, a before bed test every night (around +3 is ideal) so you get an idea of where she is heading. If you happen to get up in the middle of the night, grab a test while you are up. The more data you can collect, the easier it is to figure out what Panic is up to.

 

Now that you mention it I wish I'd thought to test her last night when I kept waking up to check on her food intake. I was actually going to test her before bed last night so I could start getting some PM readings but fell asleep early. I need to get into the habit.

I do hope those are bounces. And last night she finally passed some good sized stool too.

 

Sometimes constipation will cause some elevation of BG so perhaps that BM will help bring her numbers down a bit very soon.

 

Hi,

Last time Galaxy had a checkup, the vet offered to shave the back of his neck to make it easier to inject him. Since then, I haven't missed a shot, no fur shots, no pierce-throughs either. I can see Panic has really long beautiful fur, so you might not want a shaved patch, but I think it's worth a try, just for peace of mind.

 

Hooray for poop! It not only makes them feel better, but as Linda says, it can sometimes bring the BG down a little too. Oh, the things we talk about around here....

I would suggest keeping the pumpkin going for a few days to make sure she is staying consistent.

 

I have considered it! But I'm not sure how much it will help. :0 I only say that because she already has some bald patches on her where I was getting out the mats she had and haven't grown back but I still struggle in those areas because her skin is tight/thin. Part of me does want to give her an entire lion cut, if not just to get the rest of the mats out LOL.

We take our cats' BMs very seriously here! XD I sure will, luckily she really enjoys the pumpkin so I'm happy to see it's actually working.

 

In case it’s helpful, this link has a nice photo of the “roll” technique Djamila describes: http://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/

 

So this may still be too soon to officially tell but it LOOKS like her nadir seems to be +4? Is that a little on the early side? PZI sticky said it's normally +5 to +7 but I know ECID. I tested her last night at +4 and she was 139!! Over 360 points lower than PMPS. Just now I got today's +4 and she was 123, 340 points lower than AMPS! I'm happy to see some blues but they're almost scary considering how much and fast she drops.

Edit: I spoke too soon - +6 is 103!

 

I don't think you can assume when she reached nadir just yet. I have to wonder if she dropped down in the day cycle yesterday too but we don't have any mid cycle data to know for sure. It looks to me like she may very well have bounced from some lower numbers yesterday leading to that black for PMPS. Hopefully the bouncing will ease off as Panic gets more used to those lovely blues.

 

I was wondering that too, wish I'd been able to test yesterday. Clearly can't assume anything xD I'm not used to those blues either, they're making me nervous!

 

Being nervous because of those blues is totally normal. Happens again with dark greens but like everything else, it just take a little getting used to. You and Panic are doing great!

 

Thanks, Linda! That's very encouraging to hear! <3

 

@MrWorfMen's Mom Sorry to bother you but I had a quick question about Panic's PS numbers. The past few PS tests (AM and PM) have been really high (500+) even though she's pulling some nice low blues during the day/night. Are those high PS numbers something she just needs more time to ride out or is there something I should be doing for her? I give her mini meals around +3, +5, and +7.5.

 

HMMM! I'm inclined to think those high pre-shots may be bouncing from the huge drops she is getting down to the blue range. On the 24th Panic dropped 478 points, way over 50% of where she started. That makes me wonder if lowering the dose a wee bit might not smooth things out a little. Some cats bounce more than others and clear bounces faster and Panic looks like she is one of them. Lowering the dose should decrease the drop and hopefully give Panic's system a chance to get more use to being in lower numbers even if she doesn't go quite as low as she has been. How about trying 1.75u for 2 or 3 cycles to see if that helps bring down those pre-shots and then re-evaluate?
How are Panic's clinical signs otherwise.....good appetite, bowels OK now, interested in her peeps and environment etc.?
The other thing you could try is moving that last feeding back to +6.5. Looks like she is hitting nadir by +6 and wonder if that feed later in the cycle is shortening the insulin's action time.

 

Thank you for taking a look for me ^-^ I'll try the 1.75u and see how she does and pull back that last feed time, is it okay if I ping you in a couple days to get your opinion on how she does on that dosage?

Yes she is doing great, better than ever I'd say. Big appetite, bowels good, acting more like herself...her coat is really silky again, avoiding people she doesn't like again, boxing the other cats around like she used to. Lots of improvement. ^-^

 

Update: on 1.75u she is still dropping a lot during the day and getting high PS numbers. Today she was AMPS 510, +3 217, +6 560. I did another test to make sure that wasn't a bad strip but got another reading of 490. It's so out of place I can only think it was a bounce maybe? :/ But I don't know why she would have bounced today.

 

Just heading out for a while but will reply on my return. Got to admit, I'm scratching my head a bit and have to think about this.

 

I'm not sure if I'm glad you and I are equally perplexed or concerned that she's managed to stump you LOL.
Any insight is much appreciated as always, no rush! <3

PMPS 400

 

Well you will constantly see ECID (every cat is different) here on the board and Panic is proving that to be true but she is taking it a bit too much to heart and trying to befuddle us and it's working.

Now that said, I find that 400 this evening very interesting. A 90 point drop from earlier this afternoon at the end of the cycle leads me to wonder if we need to back off a little more and see what happens. I do have to wonder if she dropped lower last night later in the cycle and then bounced up this AM. While some cycles look like Panic hits nadir around 5/6 hrs post shot, she doesn't seem to be doing much of anything consistently right now. When did you last check ketones and what was the result? With those black readings showing up, I'd suggest checking daily or at least every couple of days would be a good idea for now.

If ketones have been negative, then I'd try dropping to 1.5u for a few cycles and see what she does with that. I think she is a bouncy kitty and when bounces she really bounces.

Is there any way you can feed at +2 instead of +3? Not sure if that would work with your schedule but I wonder if it might slow down her drop which seems to be well started by +3. The other thing I would do is set an alarm and check her later during the night to see what's happening say around +6/7 during the night cycle. There may be some activity there we are just not seeing that could shed some light on the situation.

 

I promise she's not this ornery in real life! *giggle*

Last ketone test was the 17th I think (it was negative), I've come close a few times since, but she's being very tricky in me catching her. She keeps her rear very low to the ground when she pees and coupled with her hair blocking the stream I'm struggling to catch any. I'm nursing a cold right now and staying home tomorrow so I'll keep her with me all day and see if I can't catch her in the act and try again. Since I haven't gotten a test yet though, do you think I should hold off on lowering the dose until we're sure she's negative?

A +2 feeding is totally doable, it's +2 right now so I went ahead and gave her a snack. I'll set my alarm tonight too and get a late reading, tonight's the best time for me to do it.

 

I'm sure Panic's a total sweet heart but she is a cat! My Menace got her name for her mischievous behaviour but fit her well for our diabetic journey too! They all refuse to read the instruction manual...but some deviate more than others.

If Panic's appetite and demeanour seem normal, then I think you can go ahead and drop to 1.5u. She still dropped almost 300 points again today, more than 50% and that appears to set off the bounce to 490 a couple of hours later. She is dramatic!

If you are feeling poorly don't worry about testing the night cycle tonight. Panic needs you in good shape so you need to find a balance. There will be other nights to do that. Right now you need to concentrate some on getting you better!

 

I hate to contradict, and the vast majority of the time, I agree with Linda's recommendations, but this time I'm going to disagree. The drop was steep at 2u, but you were getting some nice hours in better numbers during the mid-cycle. On 6/28, with the reduction, you see an early drop and a rise back up. With prozinc, and when coupled with numbers like this, that usually simply means that the kitty is having a good insulin response, but the insulin is "running out" too soon. It just isn't enough to hold the numbers down for more than that quick drop. When the dose is more appropriate, you should see a drop, and then a flatter surf through the middle, and then a rise at the end. Vetsulin gives something of a V shaped curve, while prozinc gives more of a smile (when it's working well).

The high PS numbers are because (a) you never really got to a high enough dose, and (b) it takes time to heal and start to bring those PS number down. You've been on Prozinc less than a month. You'll need to be patient and give it more time to see the PSs come down.

So I think these reductions are heading the wrong direction, and would recommend going back up in dose.

I know it's hard when you get opposite advice from different people, and hate to muddy the waters, but that's my two cents. Feel free to try it, or disregard - whatever seems best to you.

 

Haha aww! That's so funny albeit frustrating Menace lived up to her name XDD

Yeah those are some huuuge drops! I went ahead and gave her 1.5u this morning so I'll see what she does today, thanks for the suggestion

I do feel yucky but I've been fighting this cold for over a week now, and already missed a couple days of night tests because of it so I wanted to power through last night xD After her PMPS of 400 last night, I got a +4 of 223 (I was trying to get a +3 actually but sickness made me fall asleep early on accident) and at +6 I got a 207...nothing too suspicious, but her AMPS this morning was 465.

@Djamila So do you think she should have been holding that 2u dosage a lot longer until the bounces smooth out?
Another thing, is it possible that she's not so much "running out" of insulin but rather her food intake is burning it up too early? She eats a LOT still...1 3oz can for breakfast, another full can for dinner, and pretty much goes through another can throughout the day for her snacks and then almost another full can throughout the night, which is nearly 4 cans (12oz) a day.

 

When i look at her spreadsheet, I don't actually see bouncing. I see the insulin getting used up before the end of the cycle, and as it runs out, the numbers rise. That's different than bouncing. In bouncing you usually see a drop and steep rise (your spreadsheet shows more of a drop and then a surf - 6/19AM and 6/26AM, or a drop and then a gentle rise 6/21AM and 6/22AM). In bouncing, the drops are usually followed by a few high flat cycles with very little insulin response. You don't have those high flat cycles. You have good cycle after good cycle. Even your PM cycles where we don't have a lot of data, do have enough to indicate that she's responding to the insulin. And again, the morning cycles are all showing nice responses - not high flats.

So yes, I would have kept at 2u, and maybe even done some very small sneaky increases from there to try to lengthen the duration of the insulin without sending her diving.

As for food, it can impact things, but I tend to think of timing the food as being more of a factor as they get better regulated, and I tend not to worry about it too much before then. However, I know over on the Lantus forum, they do a lot more with using food to manipulate the curve, so I would definitely defer to Linda on that. Just not an area where I've seen as much success and wouldn't know how to guide you on that.

As for the amount of food, she's only 5.6 pounds, so that sounds like a lot of food, but my hunch is that she's eating that much because she's still spending time in such high numbers, and probably needs the extra calories. As long as she isn't overweight for her size, I wouldn't worry about the amount. Keep an eye on her weight though in case she starts gaining too much.

 

Gotcha. Hm. Now it does make me wonder.

I won't pretend I know what the right decision is; you both are much more knowledgeable than me. I'd like to know what Linda thinks of your input, considering you're the one with the ProZinc experience.

Well we still need some extra pounds on her so I'm not too concerned with her eating too much right yet; she's probably up to at least 6 lbs by now but I'll have to confirm on a more accurate scale than my own.

So far today I'm not a fan of what I see. +3 421, +5 301, +7 471. She's already higher than her AM reading this morning.

 

@Djamila I really appreciate you providing another perspective here. Quite honestly, Panic is a puzzle and my experience with ProZinc is far more limited than yours. I have found that sometimes with Vetsulin, dropping the dose slightly to ease off the sharp huge drops allows kitty to get re-acquainted with lower numbers mid cycle albeit not necessarily as ideal as the blues Panic has been seeing but nevertheless lower giving a smoother curve. What struck me with Panic is that she seems to drop early and rapidly zooms back up to high numbers after those blues. And the drop from 490 to 400 in yesterday's day cycle makes me question if the insulin petering out early. If the insulin is petering out early, then a longer lasting insulin might be something to consider. I thought it was worth trying a reduction to see what Panic would do but with today's numbers I fully admit my hypothesis is not looking good.

What do you think of raising back to 1.75u tonight and then 2u tomorrow AM?

 

I'm okay with adjusting the dose back - we tried it at least.

I'm really puzzled with her PS tests too then...the 16th she did pull that 188 in the AM but was that just a fluke then? I hate the thought that ProZinc may not be lasting long enough for her. I don't know anything about Levemir but Lantus just might not work with my schedule...I really need that half hour or so of wiggle room every week. Linda, could all the food she's eating have a part in this or probably not?

What makes you think the 490 to 400 indicates the insulin petering out exactly? Wouldn't that indicate there was still insulin in her system since it went down? ...or food spike wearing off?

 

Food can play into the equation but to some extent it depends on the cat. Even our diabetics, provided they are Type II which is what most cats are, have some insulin being produced. Whether they are utilizing that insulin efficiently or not producing enough is the question. Feeding should encourage insulin production. You've been feeding Panic in the early part of the cycle which to me would be ideal so as not to shorten the cycle. Feeding in the latter part of the cycle would typically use up the remaining insulin action more quickly than ideal especially if insulin production is very low. That said, every biological being is unique and it's possible that feeding Panic a snack in the latter part of her cycle could stimulate her pancreas to pump out more insulin and extend the cycle. All of this is pure speculation and all you can do is try different feeding schedules to determine what is optimal for Panic.
I noticed that 188 on the 16th but we don't have any more data to know what Panic did during the rest of the cycle but then the dose was also reduced that day. Hindsight is 20/20 and unfortunately, we can't always be there to get tests at those particularly interesting times. That low at AMPS suggests the dose is NOT petering out early but that scenario has not repeated so is it relevant or an anomaly? Don't know. If you are available, you could try moving her feeding time to see if that make any difference.
Does Panic seem ravenously hungry when in high and/or blue range numbers? Portions will also play into this. How much food is Panic eating (calories count) per day because she isn't a big cat by any means at 5.6 pounds.

 

I see. So some things we'll just never really be able to figure out for certain.

Yes I remember that, I had to leave for work that day, I would have loved to see what she did that cycle as well but >.<
I can absolutely change the feeding times, nine times out of ten someone is home if I'm not, so if you have an alternate feeding schedule suggestion I'm all ears.

She doesn't act particularly ravenous at any time - granted she's always hungry, but not ravenous. If I had to say when she acts the MOST hungry it's always first thing in the morning. She'll squirm and throw her head back against my chest during PS testing because she's anxious to eat.

I give her Fancy Feast Classics Poultry & Beef collection, the 3oz cans so they average about 85-95 calories a can. Excluding the almost full can she gets at night she's probably consuming 260-280 calories a day? Not including treats like bonito flakes (she's not a big fan surprisingly). She should be closer to 7-9 pounds naturally.