* Basically our vet started Ernest on Vetsulin 2u twice daily. He increased him to 3u twice daily over the next 2 weeks. * Based on the information in the FD Facebook group, we switched him to Prozinc, started testing BG twice daily preshot with Relion human meter and switched him to Friskies low carb wet pate food twice daily. * Unfortunately, we didn't realize we should've started low so we fast-tracked him to 3u twice daily of Prozinc. * As soon as we realized our mistake, we brought him back down to 1u twice daily. * He has now been at 1u twice daily of Prozinc for 2 weeks and is BG preshot testing in the 300-400 and eating his pate in 4 smaller meals (still 2 can of Friskies Pate) * We've attached his spreadsheet filled out from the beginning. What should we do now?? Thank you!!!! https://docs.google.com/spreadsheet...wAH4bjeQAm-MbOpPIzoI37irDg5tisTIXG9ET/pubhtml
Thank you Red & Rover! We've been at this 2 months but it feels like 2 years! I feel like we need to start slowly increasing but I don't want to make any mistakes . I really appreciate you tagging help!
Welcome Ja' and Ernest! Question: are you testing Ernest an hour before giving insulin, as is shown on your spreadsheet? Right now there is virtually no data indicating what insulin is doing to Ernest. The pre-shot number is the last number to go down, so it is hard to determine what the dose is doing for him. I understand not everyone has the ability to test often due to their schedule, but are you able to get any mid-cycle numbers in? Right now there's not anything to work with. As a way to fill in the "gaps" in your spreadsheet, you can alternate testing times each day. For instance, one day you can test at +2, +4 and +6, and the next day test at +1, +3, +5. and +7. Just to start finding out when onset and nadir is. I recommend a +2 at every cycle, morning and night. Cats drop lower at night so it's important to get a "before bed" test in to make sure Ernest will be okay during the night. +1, +2, etc : how many hours have passed since insulin was given (+1 means one hour has passed) Onset: the time when insulin starts to take effect - in Prozinc, this is typically at +2 Nadir: the point in the cycle where BG is at it's lowest and insulin is taking full effect Cycle: a cycle is 12 hours, from the time insulin is given until 12 hours later when the next shot is given, and the cycle starts over. There are 2 cycles in a 24 hr day
Yes, my husband works from home and he can start getting BG readings during the day. So... no changes until we get more "during day"' readings? ....and Thank you!!
Yep! Let's see what the numbers look like and find out what's happening. What times is he getting his snacks btw? We usually recommend multiple small meals along with breakfast/dinner. I'd give about 4 meals per cycle, or 8 meals every 24 hours. It helps balance the insulin out. With Prozinc it's good to normally give a snack at +2, and then a couple more before nadir. We don't have the data for Ernest's nadir yet (testing will help us find that) but it is usually between +5 and +7 for Prozinc.
Ernest is starving ALL.OF.THE.TIME ......... so we give snacks (Dr Elsey's Clean Protein Chicken Recipe) after each BG test & shot.
Is Ernest underweight at all? If he needs to gain a few I would not restrict feeding. Unregulated diabetics can't utilize food properly which leads to starving kitties. He also isn't going to be feeling better hunger-wise until we get him on the correct dose. I would kick the dry. Dr. Elsey's is low-carb but takes a long time to leave the system, it makes regulation a little more difficult than it needs to be. Good treats are freeze-dried chicken (PureBites) or homemade baked chicken. I'd make up a batch, freeze most of it, and tear it into little chunks to use as treats.
Ernest was 22 pounds. He dropped down to 11 pounds. He put on a few more pounds but isn't where he should be. He is really happy right now and he doesn't know why....lol. He will be very happy to eat more. We will cook him some nice organic chicken breast in the morning and use as treats. Thank you.
It's really hard to see what is going on with Ernest, on the SS. All those cells that are neon green should be white. Could you try to fix that please? Only the cells where you have BG tests should be color coded. Not sure why you are having this issue. Also, the pre-shot tests should be in the AMPS or PMPS columns. Not sure why you have them in the +11 column. Is +11 when you actually test? Cats can have a big change in the BG levels, within the last hour of the dosing cycle (a cycle being 12 hours). So you want to get a test at the actual time before the shot, not 1 hour before. Prozinc sequence is test, feed, shoot all within about a 15 minute timeframe, if you can manage that. No waiting 20-30 minutes between the food and the shot like there was with the Vetsulin(aka Caninsulin). I see that Panic (aka Elizabeth) already asked if you could get some mid-cycle tests. Those are what we really need to see, in order to know if Ernest needs a dose increase or not. Home cooked chicken sounds great! Want to cook some for me too? I'll trade you some homemade Cream of Cucumber soup.
Mmm I'll take some chicken AND cream of cucumber soup! 22 lbs! How much should he realistically weigh? Cats need 20 calories per lb to maintain their weight. Underweight cats should not be restricted to this rule until they're back to where they should be. Unregulated cats often need twice as much as their ideal amount of food. I hope he enjoys the chicken and extra food! Let us know how he does when you get those mid-cycles in. If he happens to dip under 90 at any time he earns a 0.25 unit reduction.
The things we've learned so far: * We need to get as many mid cycle numbers as we can. * We need to test, feed & shoot within 15 minutes. (Yes, we were testing an hour before) * We will stop using Dr Elsey's as treats and switch to cooked chicken....and feed him more. * We will figure out why the cells are green and fix them. (Have no idea how or why that happened??) * If he drops below 90, reduce by 0.25u. (Would love to see that since he was 433 this morning) Thank you very much for your advice.
If you right-click on of those green cells and then click on 'Conditional Formatting', do you see these conditional format rules pop up on the right side of the screen? I'm wondering if maybe you accidentally deleted the format rule for values that are 0 (which should be white), so then the next format rule that would apply would be <50 which is neon green.
https://docs.google.com/spreadsheet...8SYcoFALLOfwqzjGa_jF9_IkAq-wYLt452g_Q/pubhtml Updated Spreadsheet for Ernest. Thank you all for your guidance.
Looks much better! One more piece of homework for you! If you make your signature, you can add all of Ernest's medical info so no one has to ask about the basics. Food, insulin, diagnosis date, spreadsheet, age, meter brand, dosing protocol, any other medical issues. Signature Instructions Oops, one more thing. Here is the Prozinc Dosing Method Sticky. There are two methods: they are to act as a guide so YOU know, even if no one happens to be online during dosing time, how to handle low pre-shots, and how to decide whether to maintain, decrease, or increase the dose. It's important to choose one so we can help and guide you based on the dosing method. For instance, SLGS has reductions at 90, but MPM has reductions at 50. SLGS is less strict, probably a good starting method. If later you decide one method isn't working for you, there's nothing wrong with trying the other one.
Since you have Ernest's SS in your signature, we can look at that. No need to post the link to the SS every time. Except I think you have the link to the SS incorrect. Because the link you put in your reply has the color coding fixed, but the link to the SS in your signature still has the old neon green formatting. See, you learned something else today!
We updated our signature a few hours ago and we're going with SLGS...our link has been updated. Ernest is a real trooper. Thank you for your help!
Oh my yes definitly let him eat as much as he wants... Just no food at least 2 hours prior to the preshot test so the number is not food influenced. The rule of thumb is ABOUT 20 calories per pound of ideal weight so if 20 lbs is a good weight for him, he will need about 400 calories per day. That being said, sometimes unregulated diabetic cats need more food because their bodies can not properly utilize the nutrients and so they are literally starving even though they are eating. Friskies cans are about 180 Cal each. I'd probably give him 2.5 cans plus the chicken
Actually the SS link you have in your signature is not working. It's asking me to log on to your Google account to view it. Think you missed a step in the setup. The spreadsheet instructions are here. https://felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ Please check that you have set things up correctly, starting at step 5 I believe is where you need to start checking. Then after the permissions are fixed, we should be able to view it. Only you are able to update it, via your Google account.
SS is now visible! I guess your husband performed some "computer magic" and got it to appear. Thank him, he's a real David Copperfield. I don't think the 1U of Prozinc is enough for Ernest. He is still in very high BG numbers. Try to increase the dose to 1.25U and see if that helps lower his BG levels. Next cycle that you are able to do that dose increase would be a good time. Maybe the last day of August will be a good one for Ernest's BG numbers. Keeping our paws crossed here for him and you.
I'm so glad you suggested the increase. That's what we thought too! Robert will start the increase in the morning. Should we increase morning and evening? Thank you very much!!
The increase to the 1.25U dose is until Ernest shows you that dose is too much or not enough. So the increase holds for both dosing cycles, AM and PM. If Ernest drops below 90 mg/dL at any point in the 12 hour cycle, the dose gets reduced by 0.25U. I don't see that kind of dose reduction happening any time soon, but my "crystal ball" doesn't always work to see the future.
Tag me again in about 6 cycles. So I'll take a look at Ernest's SS and comment on what I see. I'm betting he'll need another dose increase in the next week.
Yes, time for an increase. The 1.25U dose isn't helping to bring Ernest's BG levels low enough. So 1.5U on the next cycle you can monitor.
Discouraging... I was really hoping for improvement increasing his insulin. It just doesn't seem to be making a difference... I know, I know... marathon not sprint. At least we haven't had red numbers in a couple of days.
Don’t be discouraged. Your dose really isn’t much yet. My cat didn’t even see a number under 300 until I hit 3 units.
I was just telling my husband that he's prob going to be one of the sugar kitties that needs 2.5-3.5 Can cats that require higher doses go into remission? I hear people on the Facebook group that say their cat went into remission after a few months. Thank you! ja'
Oh yes! Off the top of my head I know a kitty that was 18u twice daily go into remission! He had IAA though, which is why he was such a high dose kitty. There's also a member here who's kitty was on insulin 11 years before going into remission, so it's always possible! I believe most of those kitties that recover in the first few months were caught early on and did not have much damage to the pancreas. That's why some cats only need a diet change.
Ernest had his annual physical Jan 2020 - no red flags - no big weight loss. Then in June he just stopped eating . How early is "caught early"? Thanks! ja'
It's probably a relative term, honestly. They say cats that get regulated within the first six months are more likely to go into remission - but again, that's not a hard and fast rule. Cats on Lantus are more likely to go into remission too - but we still have kitties that can hit remission with the undesirable Vetsulin and NPH insulins so ... every cat is different!
So we started Ernest on Prozinc July 9th. How long is the bottle good after opening?? I'm a worrier. I'm worried that something will happen to his current bottle or something.... Is there any reason I shouldn't order another bottle ... JIC - just in case??
There are some good suggestions to check if your insulin is still good in the Stickies at the top of the forum. This one >>>>>>> Sticky INSULIN CARE AND SYRINGE INFO Proper Handling and Drawing Won't hurt to have a spare vial on hand. In case you drop it or something, or it gets pushed to the back of the fridge and freezes. Some bubble wrap around the vial can help, in case you drop the vial. Or some kind of padded foam covering. Probably won't help if you drop the vial on a hard surface like the cement floor or the kitchen tile. Been there, done that with a vial.
I'd recommend the increase to a 1.75U dose, per our Prozinc dosing guidelines for using the SLGS (Start Low, Go Slow) method of dose changes. Sticky PROZINC DOSING METHODS
@Deb & Wink @Panic @JanetNJ So it's been 2 days of 1.75u....2u starting tomorrow? or wait another day? Also, why did we have a few yellows a few days ago but none with these last 2 increases?? Soooo confusing. Thank you!!
I've never increased early but it looks like he's going to need some more juice. Those are all high yellows ... basically pinks. He could just be having some glucose toxicity and need more increases to break the barrier. Or he just needs a higher dose in general. Alas, it's a moving target!
What Elizabeth (@Panic) and @JanetNJ said You want to see blues and greens, not just those high yellows. Dose increases can need to be done a bit faster than the protocol dictates, if the kitty is in the higher pinks and yellows. The 1.75U dose is simply not enough insulin for Ernest right now.
Thank you all so much for your help! This is all so new and scary! I can't tell you how much we appreciate your guidance. So grateful!!
Hey, we were all new to this message board at one time too. Simply "paying it forward" by helping others out here. p.s. Hopefully Ernest is just bouncing. Those pinks and reds are not where you want him to be, but let's give the dose increase time to work.
I googled "bg bouncing in diabetic cat".... so confusing. Can be high if dose is too high or too low...really??? Ugh
Here's a Bouncing 101: Bouncing is a phenomenon that occurs when the body experiences (or at least thinks it does) hypoglycemia. Luckily the body uses bouncing as a defense mechanism against this where it attempts to compensate the low blood sugar by dumping excess glucose provided by the liver in an attempt to raise blood sugar back to “normal” numbers. Unfortunately, “normal” is a relative term according to the body. For a diabetic whose body has been untreated for so long that it considered very high numbers to be the new normal, lower numbers can often make the body overreact in attempt to save itself, even if it’s not in danger. A cat who has been suffering from diabetes for some time may at the point of diagnosis have a new “normal” of 400. When insulin is introduced and brings it down, even to 200 (still diabetic levels), the body thinks it is in danger, dumps excess glucose, and thus the blood sugar skyrockets up to the 400-600s. After enough time has passed, the body will eventually realize that 200 isn’t such a bad number, and bouncing will happen less often. Note some cats are extremely bounce-prone and a switch to Lantus/Levemir is needed. There are three main causes of bouncing: when blood sugar drops too low (hypoglycemia), drops lower than the body is used too, or by dropping too much too quickly. Typically if a cat drops more than 50% of their blood sugar a bounce is likely to happen, or if they drop 100 points within an hour. While bouncing can be considered as a safety net in the instances of hypoglycemia, it can look very confusing on paper. If a kitty is on a dose that drops them lower than is safe, it can cause a bounce ... if you don't lower that dose that is now too high, the bounce clears and then starts over again. And again ...
So where we are with Ernest at this point, are we okay to continue with Prozinc? ...just give it time for his body to realize Prozinc is his friend?...
Prozinc is a good insulin, I would not write it off immediately. Some people say to give it a few months before switching. Panic was on Prozinc 6 months and I just wasn't happy with the results so I made the switch. That said, Lantus is a really, really good insulin. If you want to switch, even "just because" I would not try to convince you to wait. It's not like it's a step back.
@Deb & Wink , @Panic , @JanetNJ So should we just continue the 2u for a while and let his body "catch up"?? Thank you!!
Prozinc may be Ernest's "friend", but the 2U dose should not be held for more than 7 days, when using the SLGS dosing protocol/guidelines/method. If his body was "catching up", I don't think you would be seeing so many pinks with those mid-cycle tests. It's very possible that Ernest is dropping lower at night, but there is no data to tell us what is going on in the PM cycle.
Okay, I got a 2+ pm test tonight. I'll set my alarm and get another one in about 3 hours. I'll try to test a couple of times the next couple of nights. So we should increase to 2.25 within a couple of days? or tomorrow? Thanks!
@Deb & Wink @Panic @JanetNJ I got a few pm tests last night. Still red & pink at night. Today was day 4 @2u . Should we increase to 2.25u in the morning? and continue to get a couple of pm tests? Thank you for your guidance!!
No worries, I really appreciate all of the time and advice you guys offer!! Ernest def needs your help to get better. We don't know what we're doing and our Vet is nice but working with 25 year old info. We will increase in the morning to 2.25u. Thank you!!!
Of course! Feel free to ping me more than once if needed, I don't usually forget to reply to anyone I promise >.< Give Ernest a snuggle for me!
Yes, please increase the dose to the 2.25U dose. Starting for 9/12/20 AM shot, since it looks like you already gave Ernest the PM dose for 9/11/20. p.s. Please start a new thread in the AM, and link this old one in at the top please. This one is getting long.
I think you are stuck in glucose toxicity. I think you are going to see high numbers until you hit the breakthrough dose. If it were MY cat, I would do 2.5 tomorrow.
