Need advice about high numbers

Discussion in 'Prozinc / PZI' started by NatashaL, Mar 19, 2020.

  1. NatashaL

    NatashaL Member

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    Apr 9, 2019
    Hi,
    My cat Ron has been testing around 300s regulary, he is taking 3.5 prozinc twice a day. He's on the diabetic dry food and ff classic. The doctor told me to stop testing him every day so we got pretty lax about it. It's been about a week and a half since I last tested him and he was 250 then. Today I tested him and he was the highest he's ever been- 425. I am really nervous, but the vet said to go by his symptoms more than anything and he's acting fine. He isn't excessively drinking, he isn't peeing a ton, he doesn't seem ravenous or lethargic. He's affectionate and seems fine.It is possible that he ate some leftover food on the floor that I didn't notice when I wasn't looking so that could be why he tested high. Any advice? Thanks so much!
     
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  2. Deb & Wink

    Deb & Wink Well-Known Member

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    Got a spreadsheet we could look at?
    It's the trend and patterns in the numbers that helps us to see what is going on.
    Plus, we need those BG numbers put into context.
    If you had a SS we could look at, that would be a good deal easier.

    Signature? So we know what type of meter you are using, etc.
     
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  3. NatashaL

    NatashaL Member

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    I don't have a spreadsheet, sorry. As I said I've only tested him twice in the last 10 days. What is a meter?
     
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  4. Deb & Wink

    Deb & Wink Well-Known Member

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    A meter is a device for testing a cats blood glucose levels. Sometimes referred to as a glucose meter, a glucometer, a hand held meter, a point of care glucose meter.

    The meters come in pet specific versions and in human type meters. Most people here use a human meter for testing their cat's blood glucose at home.

    A "signature" is those little bits of information you see at the bottom of peoples posts. They show up in light gray, and a smaller font size. Tells us things about your cat that we need to know to help you better.
     
  5. NatashaL

    NatashaL Member

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    Okay I'll have to start testing more regularly again. How often do you test? I added it to my signature some of his info. Thanks.
     
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  6. Deb & Wink

    Deb & Wink Well-Known Member

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    High is high, not dangerous in the short term. Can cause organ and nerve damage in the long term. Bouncing could be happening, with that high. Don't know, since it's difficult to put one number into context. Maybe Ron ate a whole triple serving of a hot fudge sundae, an entire gallon of maple walnut ice cream, with extra chocolate sauce, jimmies, and whipped cream with a cherry on top.

    You probably want to be testing daily for ketones, either in the blood or the urine.

    Other bits of information in the signature are useful. Like your first name, what insulin you are using.
     
    Last edited: Mar 20, 2020
    Reason for edit: spelling - again
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  7. Deb & Wink

    Deb & Wink Well-Known Member

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    Testing, how often. Well, it's always a good idea to test before you give your cat insulin. We call that blood glucose test, the pre-shot test. That test is done every cycle, so you know the Blood Glucose levels are high enough to give your cat insulin in the first place.

    Then you test to find the onset, nadir, duration, and overlap for your cat. So you'll need some tests in the middle of the cycle. Around the +4 to +7 hour time frame is when most cats have their nadir, or lowest point in the 12 hour dosing cycle.

    Then, since you are using Prozinc, you want to find the duration. How long does the insulin last for YOUR cat. So a test now and then at the end of the cycle can be helpful. Some cats BG levels rise a lot in the last hour or 2 of the cycle. So tests at +10 and +11 are useful. Doesn't have to be every day, but sometimes if you are around.

    A test before you go to bed is good. PM cycles are when many cats drop low, so getting some tests done in the PM cycle is helpful. Maybe a +2 and then a +4 or +5 if you are still awake.

    Have you picked a dosing method to use with the prozinc? SLGS or MPM?

    No idea what your work/life responsibilities are. So push back if you can't test often and we will brainstorm for other alternatives, make other suggestions.
     
    Last edited: Mar 20, 2020
    Reason for edit: spelling and syntax - deb gets tired when staying up past her bedtime and makes lots more syntax mistakes
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  8. NatashaL

    NatashaL Member

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    I must need to read more info because I don't know what SLGS or MPM is. We usually give a snack mid-day, they really all get hungry mid-day. Should we stop that? I'm in quarantine, so I'm here all the time now!
     
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  9. Deb & Wink

    Deb & Wink Well-Known Member

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    Here is some more reading for you.
    Lesson plan for you today is to print out and review the dosing protocols we use here.
    Sticky PROZINC DOSING METHODS

    p.s. That was a test, to see if you knew what SLGS (Start Low, Go Slow) and MPM (Modified Prozinc Method) meant.

    No, a snack at mid-day can help to even out the blood glucose levels.

    What you don't want to do with Prozinc, or most insulins, is to feed after the middle of the duration of the insulin. That is usually in the middle of the 12 hour cycle with Prozinc. So feeding after about +6 can simply cause the BG (blood glucose) levels to rise faster. That is because basically the insulin has been used up by the cat's body processing the food given earlier.

    No more insulin, it has "pooped" out, BG's go back up.

    p.p.s. Sorry you are stuck at home. That has happened to a lot of people. Stay safe and well.

     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

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    If you could get a spreadsheet up and running, that is an excellent tool to help you track the blood glucose readings. You attach a link into your signature, so that gives those of us here helping you a "view only" version to look at. You can share it with your vet also.

    Plus there is a remarks column on the right hand side of the SS, where you can keep track of the food fed and when and make any special notes like your cat is not eating well. Helps us to interpret the SS (spreadsheet) with more than the numbers to look at.

    Directions are step by step, with instructions on how to do the setup on a pc, tablet or smartphone. There is a template you copy, so you don't have to "reinvent the wheel" and create your own version.

    FDMB Spreadsheet Instructions

    What it all means is explained here: Understanding the Spreadsheet/Grid
     
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  11. NatashaL

    NatashaL Member

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    I'm sorry to not have a spreadsheet, I don't have the bandwidth for that right now. But we upped Ron's pronzinc to 4 twice a day after he was consistently testing in the high 300s. It hasn't made any difference and I'm worried he's insulin resistant. So today we started to doing the curve testing. So far it's 411, 430, 384, 380.
    He is otherwise acting normally, he hasn't lost weight, he isn't excessively drinking. I did see him take a kind of longish pee yesterday. We fed him this morning after the 411 one, it's been 6 hours since he ate and had insulin.
    I'd appreciate any thoughts. I have a call in to the vet, but I hate the idea of just pumping more insulin in him if he isn't improving.
     
  12. Deb & Wink

    Deb & Wink Well-Known Member

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    If you can log into the internet, the spreadsheet is a google document. All you need is a google email account to set it up. It's stored on the internet, like many documents are these days.

    Not sure what you mean by "not having enough bandwidth."
     
  13. NatashaL

    NatashaL Member

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    I meant emotionally.
     
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  14. Deb & Wink

    Deb & Wink Well-Known Member

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    Ok.
     
  15. Deb & Wink

    Deb & Wink Well-Known Member

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    I think your vet will be able to guide you better, since they have more history on your cat.

    A single set of numbers does not give us enough context to know what the current dose of insulin is doing. We look for patterns and waves of action and trends over time on the SS to see what is going on. Without that information, I don't feel confident enough to give you any feedback on the current dose of insulin.
     
  16. NatashaL

    NatashaL Member

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    Apr 9, 2019
    Okay I'm back. My husband created a spreadsheet for the vet, I hope it is helpful enough. It's all the data we have. We don't remember when we started giving him 3.5 of the prozinc, but 3 weeks ago we moved up to 4. After going to the vet, who did a full blood panel and urinalysis and culture and finding nothing wrong, we are at a loss of what to do. The vet said to go up to 5 units which feels like a big jump to me. He had been testing in the upper 300s, sometimes even 400 (as you'll see on the spreadsheet) and then two days ago after 3 weeks on 4 units he was 220 before dinner and then 315 today. I'm wondering if maybe we go up to 4.25 and cut out lunch? We do feed him breakfast, lunch, dinner and then a snack before bed. He's on the dry diabetes food for most of that, with lunch being fancy feast. Thanks, and I hope this information will give you more to go on.
     
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  17. Deb & Wink

    Deb & Wink Well-Known Member

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    Natasha, thanks for the additional clues, to help flesh out what is happening with Ron. Of course, I now have more questions for you.

    Which dry diabetes food is Ron eating? That may be a big part of the reason for his BG (blood glucose) levels remaining high.

    Pre-shot tests are the last BG (blood glucose) numbers to come down to better levels, especially with the in-and-out insulins like Prozinc. Without some mid-cycle tests, you have no idea how low a particular dose of insulin is taking your cat. What the nadir is.

    Our Prozinc dosing protocols need the mid-cycle numbers in order to know when to adjust the dose. Plus, without the mid-cycle numbers, you don't know how low this particular dose of insulin is taking your cat.

    There is a standardized, color coded spreadsheet that we ask members to use. We have a template that you copy and link to your signature. You do need a google email account to do the setup and maintenance of the SS. Instructions include setup using a pc, tablet, smartphone.

    FDMB Spreadsheet Instructions

    Your vet is also raising the dose much faster than we would recommend. We increase/decrease the insulin dose by 0.25U increments at a time. At this point, I'd recommend getting some mid-cycle tests. Keep the insulin dose the same for now. Let's see what the mid-cycle numbers are, before you increase the dose.

    Would you be able to get some mid-cycle tests, some when in the +5 to +7 hour time frame. We count time in hours after the insulin shot. So +1 is 1 hour after the shot, +2 is 2 hours after the shots, etc.

    The blood glucose numbers looked better last spring. So I'm kind of wondering what the insulin dose was last spring, May & June & July for example. I'm also wondering what has changed since then. Because the BG levels are getting higher and higher. He started to look worse, BG level wise, around September.

    So what changed in that time frame? Any information that you could give could be helpful here, to try and figure out what is going on with Ron.

    p.s. If it were my cat, I would not jump from 4U to 5U, without some mid-cycle test numbers. Even then, I wouldn't increase by that full 1U of insulin, but take it slower and steadier.
     
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  18. NatashaL

    NatashaL Member

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    Thanks so much. We did do one mid cycle test when we did a curve test a couple of posts back. But I can do more. The day before we went to the vet this is what it was: 5:30am: 411, 7:30am: 430, 9:30am: 384, 11:30am: 380, 1:30pm: 380, 5:30: 353.

    The only thing that I can think of that changed in September was that we started giving wet food for lunch- fancy feast. But that seems like the opposite of what people have been saying is good if that made his numbers rise. The only other thing I can think of is that we did raise the insulin at that point when it started to rise.

    We're using prescription Purina DM dry food.

    Thanks so much! The vet was saying since all of his other blood work look good it could be a tumor on his pituitary gland or in his stomach. Have you heard anything like that before?
     
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  19. Deb & Wink

    Deb & Wink Well-Known Member

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    AMPS 411
    +2 430
    +4 384
    +6 380
    +8 380
    PMPS 353

    It's very possible that you increased the dose too quickly, too fast, and bypassed a good dose. That could explain the higher test numbers starting in September. If your cat was getting too much insulin, their body would have reacted with a self protection mechanism, and dumped various sugars and hormones into the bloodstream, to keep your cat safe.

    Plus that dry food is 18% carbs, prescription Purina DM dry food. (2018) AAHA Diabetes Management Guidelines for Dogs and Cats suggests 12% carbs max for cats. Here on this message board, we tell people 10% or less carbs is more appropriate for a diabetic cat.

    Does you cat Ron like the wet food you are feeding? Which of the Fancy Feast styles of food are your feeding Ron?
    Yes, a tumor on the pituitary is the cause of acromegaly. There are a number of cats here dealing with acromegaly. I'm not aware of tumors that are found in the stomach. Neither their causes, or their effects on a cats body of a stomach tumor is within my area of knowledge.
     
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  20. NatashaL

    NatashaL Member

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    We're feeding FF classic also Friskies pate. Yes he does like it. But we have four other cats and they prefer dry so I was trying to accommodate that as well. It's frustrating that a prescription diabetes food is so high in carbs.

    So do you recommend continuing to check at the five plus hour mark for a couple of days before we increase the dose?
    Thanks again.
     
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  21. Deb & Wink

    Deb & Wink Well-Known Member

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    Have you thought about meal feeding? Only having the food out at certain times? That can help your non-diabetic cats to learn that they need to eat what food is available. Only feeding your diabetic cat the Fancy Feast classic pates and the Friskies pates that you mentioned, would be a better choice for Ron than feeding him that dry diabetic food.

    If you do decide to switch your diabetic cat Ron to only the low carb canned food, please be aware that his BG levels may drop 100 basis points or more, overall. I think that food change should be your first step, as opposed to increasing the insulin dose yet again. I'd give that at least a week, maybe more, to see what difference it makes in Ron's BG numbers.

    Or as @TempestsMum suggested, switching all your cats to wet/canned food. It can be done, but some cats are more stubborn about eating canned food than others. I know my diabetic cat Wink was. I tell people he was a founding member of DFAA (Dry Food Addicts Anonymous). I used every trick in this document, to get him to switch.
    Transitioning Dry Food Addicts.

    Took patience, lots and lots of patience. Fed him in a separate room, closed the door so my other cats could not bother him, and went from there with the transition to all wet food. It was not easy, trust me on that one. But it was worth it.

    I'm not sure you should increase the dose. I was thinking about the high numbers this morning, and had a couple more questions.

    What was the starting dose of insulin? How many units?
    What increments were used for the dose increases? 0.25U, 0.5U, 1.0U increments?
    Are you able to give us an idea of how long Ron was on a particular dose before it was increased? Roughly, it doesn't have to be exact.
    Was the dose ever decreased? reduced?
    Does Ron have any other health conditions? (You said the vet did a lot of testing and did not find anything) Double checking.
    Is he on any other medications?
    How are his teeth? In good shape? Recent dental? or has it been a while?
    Do you test for ketones at home? Either through urine dipsticks or with a special blood ketone test meter?

    The test during the mid-cycle should not simply be at +5. Some cycles, you want to get a +6 or a +7. Vary the test times, to help flesh out the data. Always get a pre-shot test, to make sure the BG is high enough to give Ron insulin.

    I'd like to get a couple more people to come and take a look at your situation. But I think your cat has been overdosed for some time, and actually needs a dose reduction.

    I think he was trying to go into remission, but then the dose was increased in September 2019 and Ron simply keeps getting higher and higher pre-shot tests because the dose is too much.
     
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  22. NatashaL

    NatashaL Member

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    What was the starting dose of insulin? How many units? I know this is frustrating, but I don't fully remember. I am pretty sure we started at 2.5, then increased by .5 until we got to where we are now. However he was at 3.5 for at least five months I want to say.

    Was the dose ever decreased? reduced? No, the dose was never reduced. Although obviously when he was testing under 180 we didn't give him a dose.
    Does Ron have any other health conditions? (You said the vet did a lot of testing and did not find anything) Double checking. No, he doesn't. THe vet said he had some protein in his urine but that was the only bad thing aside from the high glucose.
    Is he on any other medications? No.
    How are his teeth? In good shape? Recent dental? or has it been a while? About a year ago he had almost all of his teeth removed. This was right before he was diagnosed.
    Do you test for ketones at home? Either through urine dipsticks or with a special blood ketone test meter?No.

    The test during the mid-cycle should not simply be at +5. Some cycles, you want to get a +6 or a +7. Vary the test times, to help flesh out the data. Always get a pre-shot test, to make sure the BG is high enough to give Ron insulin.
    Okay, the last two days we tested him at +6 both days and he was 250 and 253. So that's good, right? We did not up his dose. And in the last couple of days like I said we have been giving more wet food instead of dry (not more food in general, just replacing dry with wet). We still do give a snack of dry at night to avoid them waking me up all night for food, but I can start to wean them off that.

    I'd like to get a couple more people to come and take a look at your situation. But I think your cat has been overdosed for some time, and actually needs a dose reduction.

    I think he was trying to go into remission, but then the dose was increased in September 2019 and Ron simply keeps getting higher and higher pre-shot tests because the dose is too much

    [/QUOTE]
    I'm sorry, the formatting is so crazy here, hopefully you can tell when I'm answering you and what is your original question!
     
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  23. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, I kind of waded through things, and found your answers.
    So starting dose of insulin was 2.5U
    Doses were increased by 0.5U each time.
    3.5U dose was held for 5 months.
    Dose was never reduced.
    Shots were skipped if the BG was <180.
    No other health conditions, but some protein in his urine.
    No other medications, beside the insulin.
    Almost all teeth pulled about 1 year ago, right before his diabetes diagnosis.
    No ketone testing being done.
    Getting a few more mid-cycle tests now, varying the time.
    Changing to all wet food, but cats still get some dry food at night.
     
  24. Deb & Wink

    Deb & Wink Well-Known Member

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    You can leave some wet food out at night. It won't go bad that quickly, not overnight.
     
  25. NatashaL

    NatashaL Member

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    Apr 9, 2019
    Yes, that is right. The weird thing is that the wet food doesn't seem to satiate them the way dry does. Yesterday I did mostly wet food and when I left dry food at night they went crazy for it like they hadn't eaten in years. lol.
    The last two days at 6+ he was 253. I'm going to test at 5+ today. Do you think I should lower it back to 3.5? When we raised it to 4 it didn't seem to do anything anyway.
     
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  26. NatashaL

    NatashaL Member

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    Okay, so today I tested him at 6.5+ and he was 85!! I've never seen him that low. Obviously I will test him again before feeding. But if anyone has thoughts about this I would appreciate it!
     
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  27. Deb & Wink

    Deb & Wink Well-Known Member

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    That BG of 85 is an automatic dose reduction, per our SLGS Prozinc dosing protocol.

    So reduce the dose by 0.25U immediately. For the next cycle.

    Since you are feeding less of the higher carb dry food, you may want to drop the dose a bit more, back to 3.5U.

    Dry food has more calories, for the same quantity of food.
    Dry food also has a lot more carbs, way too much for a diabetic cat.
    Too may carbs, can keep a diabetic cats BG levels too high.
     
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  28. NatashaL

    NatashaL Member

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    Thanks again. He was 212 before the nighttime feeding and we gave him 3.5U. I guess we don't have the right needles to reduce by .25
    I'm really mad at the vet who told us to go to 5 and wait a week to test. I'm very grateful for your advice. We will continue with the mostly wet food. I'm guessing we should test in the morning to make sure he's not too low to shoot? We had stopped doing that because he was always so high and the vet told us to "leave him alone".
     
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  29. Deb & Wink

    Deb & Wink Well-Known Member

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    You "eyeball" the dose, doing your best to get the 0.25U change.

    It's the placement of the plunger, that is the key. This picture shows U100 syringes, but the concept of the plunger placement is the same with U40 syringes.
    025unit-1.jpg

    Yes, we strongly advise people to test before every shot. So you know your cat's BG level is high enough to give the insulin.
     
  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Natasha, we have more experience on this message board with feline diabetes, than most vets see in a lifetime. Don't be too mad at your vet. They have experience with a lot more conditions, a lot more types of animals, then we do here. So we try to teach first you, and then your vet.

    Maybe share the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats with your vet. And tell them to come check out the message board, and our dosing protocols and other information.
     
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  31. NatashaL

    NatashaL Member

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    Thanks again, for some reason I'm not getting notified when you reply. I can't tell you how grateful I am for all of this info. If not for you I would have been giving him 5U and waiting to test until Thursday with no change in diet!
    So, these were the tests for today:
    AMPS: 312
    5+: 82
    PMPS: 323

    He is really bouncing now in a way he wasn't before we started feeding mostly wet. We also adjusted so he is now getting 3.5U after yesterday's 82. Should we just keep holding steady with what we're doing? Mostly wet now, 3.5U? Our needles are divided by 1.0 segments, so eyeballing .25 is pretty hard. I guess we need to order new ones.
     
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  32. Deb & Wink

    Deb & Wink Well-Known Member

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    I'd drop back down to 3U for now. That BG of 82 from today was an automatic 0.25U dose reduction.

    There are U40 syringes available with 1/2 unit markings on the syringe barrel. Or it's possible to use U100 syringes with a U40 insulin with the use of a conversion chart.

    More "bandwidth" now? Or still overloaded and "burnt out"?

    Still really looking for our standardized color coded spreadsheet, with at least a couple of weeks of data. Doesn't have to be everything. It would make helping you much, much easier. Kind of feel like I'm driving a car blindfolded, without that data. Nothing since 4/9/20, except what you have in the thread. Makes it much harder to interpret what is going on.
    You might want to check your User Id, Settings, Alert Preferences. Make sure the "Replies to a watched thread" check box has a check mark in it. Plus the other appropriate notifications when someone replies to your thread.

    Also, double check the email you have for your User Id account. It's under "Contact Details."
    Make sure you have "Watch Thread" turned on at the top of your thread also. Then select "and receive Email notifications" and you will get an email alert sent to your email account too.
     
  33. NatashaL

    NatashaL Member

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    Okay I'll work on that spreadsheet in the morning. So go from 3.5U to 3 tomorrow? Even though he's been in the 300s pre-shot?
     
  34. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes please on the reduction. I still think Ron is being overdosed.
     
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  35. NatashaL

    NatashaL Member

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    Thank you!
     
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  36. NatashaL

    NatashaL Member

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    Okay my husband is working on the SS and it should be done soon, maybe by the time you read this. But I tested at 6+ today and he was 385! Sighhhhh. Do I just remain the course? We went down to 3U this morning.
     
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  37. Shelley & Jess

    Shelley & Jess Member

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    Jan 23, 2020
    Hey Natasha, I haven't seen Deb around today (I hope everything is okay) I'd stick with what Deb recommended just yesterday.
    Tagging @Chris & China (GA) for review.
     
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  38. NatashaL

    NatashaL Member

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    Oh no I hope she's okay! Thanks for responding!
     
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  39. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Yes, continue with the 3U dose. What you're seeing today is a bounce from the green yesterday. Bounces happen when 1. they drop too low, 2. they drop too quickly, 3. they drop into numbers their body isn't used to anymore (or any combination of all 3)

    The liver releases stored sugars and hormones to bring the BG up quickly. It can take up to 6 cycles for those hormones to clear the body.

    It's also very important to start testing before every shot. You want to make 100% sure he's high enough for insulin at all and our cats can surprise us even when we're sure about what's going on.

    Getting the 2 Pre-Shot tests and then at least 1 test somewhere mid-cycle (5-7 hours since the AM shot) and a "before bed" test on the PM cycle will help show what's going on.

    Most cats do go lower at night, so it's really important to get that "before bed" test so that if he's dropping too quickly, you can set an alarm and get more tests later in the cycle.
     
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  40. NatashaL

    NatashaL Member

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    Okay thank you for this!
     
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  41. Deb & Wink

    Deb & Wink Well-Known Member

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    What Chris said on the dosing and the bouncing.
    Give your husband a giant hug or two from us. :bighug::bighug::bighug:
    I see that you now have our standardized, color coded spreadsheet up and running. Thank you so much for getting that done.

    How are you doing Natasha?

    p.s. I'm here and doing fine. Just getting a whole lot of things done for myself today.
     
  42. NatashaL

    NatashaL Member

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    I'm glad you're okay!!
    I'm nervous about Ron's bouncing around, otherwise pretty good!
     
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  43. Deb & Wink

    Deb & Wink Well-Known Member

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    Well, when a cat drops that fast, from the pinks to the greens, and that low (84 BG) on insulin, they are going to bounce. You have to be patient and wait until the bounce clears. That can take 3-6 cycles.

    As important as it is to get mid-cycle numbers, we need to see the pre-shot tests done each cycle also. Prozinc dosing protocols take both the pre-shot test number and the nadir, and uses those 2 numbers to make adjustments to the dose. So we need to see a pre-shot test number every day.

    Will Ron be cooperative with getting that test? Is there a favorite treat he likes? Bribes are a good way to get your cat to agree to be tested.
     
  44. NatashaL

    NatashaL Member

    Joined:
    Apr 9, 2019
    He's been really good about being tested but lately I can tell he really doesn't like it. He purrs the whole time but his tail has started to twitch. If I give him a treat while I test him will that not affect the number? And if he is really low do we just give him a snack?
     
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  45. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Treats at test time is how we "bribe" our cats to accept the testing in the first place.

    Food doesn't get into a cats stomach, get digested, and into the blood stream for at least 20 minutes to 1 hour. So no, giving him a treat while you test him will not effect the BG number.

    It's only the pre-shot test that we like to see uninfluenced by food. No food for 2 hours before the pre-shot test is taken. Think of it as fasting your cat for 2 hours.
    All other tests done during the 12 hour cycle, we expect to have some food influence.

    Really low when? Define "really low."
    How much were you thinking of for a "snack sized" snack?
     
  46. NatashaL

    NatashaL Member

    Joined:
    Apr 9, 2019
    I don't know, 84 seemed low to me. Maybe a few bites of wet food?
     
  47. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    A few bites of wet food won't hurt. Maybe a teaspoon. The next time you get a low number. Like that 84 from yesterday, 4/21/20. Start with Ron's regular food. Then if the number still seems low, you might try 1 more teaspoon of the low carb and retest in 20 minutes. Next step, if the number is not rising, or the number is still dropping would be to give him a bit of medium carb food (10-15% carbs). If the number keeps dropping, that is when you would pull out the high carb food (16-25% carbs) and feed him the gravy from that, and maybe a touch of syrup like corn syrup (karo syrup), honey, pancake syrup, maple syrup. Whatever you have on hand with lots of sugar in it. Ice cream even works, but skip the kinds with too many chunks of stuff in them, go for the plain ice cream.

    Since you are using the Alphatrak, any BG reading of 68 or below is a take action time. You want to monitor more closely, feed some food slowly, so you don't fill Ron up too fast, test again in 20 minutes or so. Lather, rinse, repeat.
     
  48. NatashaL

    NatashaL Member

    Joined:
    Apr 9, 2019
    Okay great. Thanks again for all your help!!
     
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  49. NatashaL

    NatashaL Member

    Joined:
    Apr 9, 2019
    Hi again! I first want to again voice my gratitude for all of your help and everyone who has chimed in. We would be flying 100% blind without you and we have until this point.
    So this morning's numbers are:
    AMPS 395
    5.5+ 86
    Does this mean we reduce again? We ordered new needles but it's hard to go down .25. Or do we hold steady and wait the 6-7 cycles to see what happens?
    Thank you!!!!
     
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  50. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yes, absolutely time to reduce the dose again. Any number <90 mg/dL (5 mmol/L) is an automatic dose reduction.
    No waiting for any cycles (6-7) to see what happens.

    That reduction was "earned" and you need to take it.

    Do try to keep the SS (spreadsheet) updated. In case you get a low number, and we are helping you in an emergency situation, the first thing we do is look at the SS.

    You're not "flying blind" anymore. We've got your back.

    Please start a new thread, and link this old thread in at the top. We try to keep posts to a maximum of 50 replies, and this one is getting long. Makes the database behind the scenes more efficient too, to limit the number of responses back and forth.
     

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