Continuing from the previous thread: https://www.felinediabetes.com/FDMB...for-nico-good-whats-next.239213/#post-2693270 Still some ups and downs, but we are making our way. Breakthrough dose was 4.5u, now his pancreas is awake and we get to back off— YAY NICO!! Love you, bubs.
@Chris & China (GA) @JanetNJ @Deb & Wink Delayed 3.0u insulin injection until +14 due to food avoidance and another bout of vomiting (small amt., clear liquid— water?— 1x only). Tried a different food flavor and he seemed to be fine for a bit of time after, and was able to give 3.0u at ~8:50/9p (+13.75/+14). Please advise on dose scheduling now that we are quite a bit off, will need to know what to expect in the morning. Hoping my sweet boy is okay..
If he's high enough at +11 in the morning, you can go ahead and shoot ....that's one of the nice things about using ProZinc..it's more flexible.
That's pushing it a little too much I think. If he's high enough at 8, shoot.....and we can try to make up that other hour another cycle
Thank you. He’s still in the 300s +2 so we’re gonna try to rest. I think I’ve caused potentially problematic testing anxiety in him at the moment, he runs away from me any time I come near him since his +2 test. Heartbreaking.
Happy news to report this morning!! AMPS 293 and 100% back to normal eating/drinking/energy level/behavior/etc!!! So last night must’ve been stress-related.. Happy to see him back at the food dish early this morning. Hoping for a good day!
Thank you!! Quick update: We are trying to get Nico back on his usual schedule after a brief hiccup yesterday evening, so we tested at his +11 tonight and he was high enough (270) to shoot so was given 3.0u. Had a +2 a bit ago and still rising (347). But, given his trends a +2 is much too early to see any sort of drop. I anticipate if it happens it’ll be between his +4 & +6 overnight. We shall see! Also, say a quick prayer for some tummy upset relief overnight; stress is hard on the gut for both of us, but especially Nico’s at the moment.
No bouncy was when you went from 416 to 66 back up to 460. Lol. This is a nice curve down into healing greens. It probably went up at +2 from a combo of the last shot wearing off (looks like you are getting 12-13 hour durations now) and food bringing it up.
LOL if only I could keep him down in the blues and greens. Back up this morning.. AMPS 384. 3.0u given.
Slowly but surely, his body is adjusting to the lower blues and greens. It takes time for a cat to bounce less, when they drop so low. What do I like seeing on your SS? Rarely any black BG numbers now. Lots more lower BG numbers, in the pink, yellow and blue ranges. Baby steps Em. You are making progress in baby steps, but definitely some good progress. Sending healing vines your way.
Patience is usually a strong suit for me, but I guess not this time. Encouraging words are so necessary for me right now, and so appreciated. The fact that you took the time to look at his spreadsheet and then note his progress means so much, when at times it’s hard to see all the bouncing and wish he would just feel better. No diarrhea today, which is AWESOME. And, we are about a half hour from his PMPS and insulin injection. Just praying for an uneventful night. But, speaking of such, we have had some green in the middle of the night. Is it important I test at that +5 overnight to make sure he’s not dipping too low? Thoughts? @Chris & China (GA) @JanetNJ?
He's looking better...no more ugly black numbers! I'd hold the 3U dose a little longer. Is there any chance you re-tested last night when you got that 77? Any time you get a number that's that out of character, it's a good idea to immediately re-test to make sure it wasn't just a wonky test strip.
I have been doing that actually, when I get a sort of “out of the blue” number, high or low. I can’t remember what it was overnight though, close enough that I knew it was valid. I could go check if it’s important? But for future, should it be notated on his ss? And if so, what is the format I’d follow? I’m gonna try to get a +4 or +5 tonight just to make sure he’s alright. He seems to be feeling MUCH BETTER though, thank goodness!! Should I give a 3.0u dose tomorrow morning if he’s above 200? Anything below that I’ll come check in with someone first..
No, if you DID re-test and weren't worried, knowing now won't make any difference. It's not 100% necessary to put a retest on your spreadsheet....it's just important that you know to do one if you get a number that's just out of whack from what you expect. If you want, you can put "retested 77, got ##" in the remarks or you can put both numbers in the same cell...like 77 @ +6, RT ## (but you will need to color code that cell manually) I'd like to see you giving the same dose both AM and PM since that's the way we usually dose ProZinc, but some people do use a sliding scale based on the PS number. Maybe 300+, 3U 250-300, 2.5U 200-250, 2U Hopefully @JanetNJ can add some words of wisdom
I’ll wait to hear from someone depending on his number in the morning. I’m a bit confused. Maybe we shouldn’t have done 2.0u tonight..? @JanetNJ advised though; now I feel like I messed up..
Nope...you didn't mess up! At this point, we're all still in the "data-collecting" phase. Every different thing you try, every test you get....it all helps figure out the puzzle that is Nico
Thank you for this. His +4 yielded a 290, so I’m confident he won’t dip below 100 tonight and am headed to bed. Will be in touch after our AMPS. Night night. Zzz
OK Lets do 2.5 for both cycles (as long as the preshot is high enough). If it winds up not being enough we can bump it to 2.75.
We may be bouncing a bit today— not sure if that’s to be expected or not. Just ran a +5 and he was 324. I guess pink is still better than red or black.. I’d say I anticipate a higher number tonight, but who knows really.
Em, I ALWAYS look at the SS to see what is going on before I reply to a post. It's so important to know what is going on, and the SS is our main way to check that. I look at any notes over in the Remarks column too, and look at past trends in the numbers. Yeah for Nico not having any diarrhea today! Good poop updates are so important. Plain canned pumpkin can help firm up the stool, as well as provide more fiber to stave off constipation issues. You might want to make a note on the SS on what the food was for the cycles, so you could see if a particular flavor or kind of food is a potential culprit in the diarrhea. Nico is responding so much better to the insulin these days, that I think holding the 2.5U dose that Janet recommended is the way to go for a few days.
He really is! We stayed a bit higher today than in previous days, 200s-300s— he’s had 2.5u for both AM and PM cycles today. Planning to hold it there and see how he does. So far he’s so much better!! Appetite and thirst are corrected, way less urinating, stools are back to normal, he’s playing well, and he’s back into his healthy weight goal range (set by his vet) which I can’t be more excited about. Goodnight from Nico and the gang.
Am thinking we may need to pop back up to the 3.0u dose to kick these 300s to the curb, but will sit tight at 2.5u a bit longer to see if his body will do it for us. Thoughts @JanetNJ @Chris & China (GA) @Deb & Wink? I’ll keep you posted.
Not surprised by a PMPS of 303. 3.0u given. Hopefully that’s to boost he needs to kick these 200s/300s for good!
Sounds good. Compared to a few weeks ago 303 is pretty good. Lol. A few weeks ago we were just happy when it wasn't HI
A very true statement. Haha! How easy we/I forget.. ! Should I check him overnight (+5 or so, in case of a green dip?)??
Should I be concerned about this +4 414???? I am.. I plan to check him again at +7 to see whether we are still trending up. Stressful to see those 400s again when I want nothing more than for him to continue to feel better and stay a bit lower more consistently. Mama Em is sad. @JanetNJ @Chris & China (GA) @Deb & Wink
Emily, you have to remember that Nico is still not used to those lows. So, that lower blue last night 12/9/20, was the likely cause of the higher pink pre-shot this morning, 12/10/20. No, I would not be worried about the 414 BG at +5. (Was that at +5 or +4? You have the number in the +4 cell on the SS.) Did you get that +7 test done this morning?
Oh, +5 I think. Now I don’t remember lol I think +4 actually. I’ll change it. He was 369 tonight PMPS. We shall see what happens in the coming days. I can never predict. Not ever.
UPDATE: AMPS 60. Retested @12.5 96. Retested @13 122. 0.5u given. Here’s hoping he doesn’t skyrocket later! Thank you. I’ll have a new number shortly!
You made the right choice, in reducing the dose this morning, 12/11/20. Woah Nico! That was certainly a dramatic difference at AMPS today. That is saying to me that Nico is dropping lower at night, and the dose is too high now. I'm not sure what it should be, but maybe around 2-2.5U? Yes, I can understand why your SS notes said that Nico was feeling "Yucky" with those higher red and pink BG numbers. At least now, you are able to tell better when he feels worse, by various symptoms.
@JanetNJ @Chris & China (GA) @Deb & Wink Clocking in Nico’s PMPS tonight at 398. What are we thinking for dosing tonight? 2.5u? 2.0u? And how should I monitor his overnight (TGIF!!!)? His +7 was 245.
I'd go back to 2.5 and hold that dose for several cycles. As I said earlier, we usually do shoot the same dose both AM and PM and I had thought that's what you were going to try instead of the scale dosing. Can't hurt to try it. Maybe Nico will settle down (but since he's a cat, I wouldn't bet on it!)
Get a +2 or +3 to start....depending on what's going on then will dictate whether you need to get more tests or not later in the cycle
I tried, but he was 60 this morning and I couldn’t really give his usual dose (3.0u), especially since I wasn’t going to be home all day to watch him. @JanetNJ advised a scale dose, and to return to his usual this evening. Now it sounds like 3.0u is too much, so @Deb & Wink advised 2.5u or 2.0u. I can hold a 2.5u for several cycles as long as he’s not dropping down as far as he did this morning (right?!)...
Nico is looking ok on the 2.5U dose for now. He got down to the blues today, with that 140 BG at +6. So don't be surprised if Nico's BG level is higher for the PM pre-shot. I still think you should hold the 2.5U dose, as long as Nico's BG is high enough. Prozinc has a bit more flexibility in adjusting doses, than the depot type insulins like lantus and levemir do. So it's usually ok to shoot the next cycles dose, if you have only stalled the previous cycles dose for 1 hour. For example, AM insulin shot was 1 hour later than normal, so the PM pre-shot test will be only 11 hours since the morning dose. Does that make sense Em?
Yes, that’s great— thank you! He did test PMPS at 379 so quite a bit higher. 2.5u were given just a few minutes ago. Will plan to hold as long as he isn’t too low, and ask for help if something seems amiss. Thank you for all your help!
@Deb & Wink @Chris & China (GA) @JanetNJ PMPS 77. Was hoping I’d actually get some quality sleep overnight.. stalling and will report back in 30 mins. Of I can push him up over 150 should I still try to give 2.5u??
Welcome to the wonderful world of sleep deprivation known as Feline Diabetes He earned a reduction so whenever he's high enough for insulin, his new dose would be 2.25
118 @+13. Please advise full (2.25u) dose, or partial dose? And how often to test overnight. Usually it’s a +2 from here, then dependent upon his numbers from there. Correct? @Deb & Wink @Chris & China (GA) @JanetNJc
I don't have enough experience with ProZinc to encourage you to shoot the full dose at only 118. I was hoping since he went up about 20 points in the first 30 minute stall, he'd go up another 20 (or more) in the next 30 but now we're getting to the point where if you continue to stall, his numbers could start to drop again just because he hasn't been fed yet. I think you should probably just give a token dose (like 1U?) just so he has some insulin on board. This is for contemplation only @JanetNJ ,@Deb & Wink I do not know if it's something that's ever been tried with ProZinc but we've done it with Lantus.....it's shooting 2 18 hour cycles.....so you'd go ahead and feed him now and then if he's high enough at +18, shoot then.....and then skip the AM shot completely and wait another 18 hours to shoot again (which puts you back at your usual shot time). Example....usually shoot at 6am/6pm.....PMPS is too low so you wait until midnight (+18) to shoot. Then you skip the 6am shot and shoot at 6pm tomorrow (18 hours after the midnight shot) and you're back on time.
Gotcha. Should I wait and see if Deb or Janet respond prior to giving even a token dose of 1.0u? EDIT: 1.0u given at +13.5.
@Deb & Wink @JanetNJ @Chris & China (GA) Nico is currently at 246 (+7.5), so I’m hopeful we will be a-ok to give 2.25u tonight. Just hopeful he doesn’t continue to drop, but we shall see. Wanted to let you know early enough in case he’s too low for a full dose this evening and some discussion needs to be had before all y’all head off to bed for the night (pacific time 7pm shoot for us here). Keep me posted. I’m off to a massage!
Ah, contingency planning. Both Janet and I are on the east coast. I think I have an earlier bedtime than Janet does. Nico is working his way back down the dosing scale. I don't think you have enough data to judge how Nico would do if you shot the full dose when he is in the low blue range. Yes, using MPM dosing method, you can still technically give your cat the full shot as long as the BG is >50 IF you are around to monitor and guide with food more intensively AND you know how low a particular dose takes him. When you don't have that capability for monitoring, than you need to more slowly work your way down to a lower and lower pre-shot in order to be giving the full dose, by striving for lower and lower pre-shots where you give Nico his full dose of insulin. For now, I think you want him to be >150 at pre-shot to give him his full dose. As you gain more data on how Nico is doing on a particular dose, you can lower that guideline to 140, then 130, then lower. It was much easier when Nico was really high, BG wise. Now, it takes a bit more thought to decide what you want to do. So now is the time to restudy those Sticky PROZINC DOSING METHODS and make sure you know what to do if no one is able to get back to you in time. "Better too high for a cycle, than too low." Too low would be <50 mg/dL. @Chris & China (GA) I've never seen anything like that 18 hour dosing used with Prozinc. Sure wish there were a few more experienced Prozinc people to weigh in on this idea. My 2 cents worth. Since Prozinc is NOT a depot insulin, there is no depot that drains if you skip the shot or give a greatly reduced dose. One cycle does have some impact on the next cycle, but not as strongly as lantus and TR would. Giving a token dose, a reduced dose for a cycle usually is sufficient if someone needs to stall and the BG has risen enough to give the insulin. If the BG levels are still not high enough to give insulin, then a skipped shot is still the recommendation.
@Deb & Wink @Chris & China (GA) I’m a little upset he’s back in the black tonight. Almost retested, but not sure I wanna continually put him through that. I’m sure it’s just part of his bounce, but still really bothers me to see. I knew he was gonna be high, just wasn’t prepared for quite that high. PMPS 516. 2.25u given. Eating well, lots of thirst. Bummed for him tonight. At least we will all get to sleep.
Yea. He was 485 at PMPS tonight.. will bump him to 2.5u tomorrow morning. Unless you think this may still be a big bounce from Sunday?????
@JanetNJ @Chris & China (GA) @Deb & Wink we aren’t seeing any movement really today, yet. Why would that be?? AMPS 305. +4.5 300. @JanetNJ now at 248 (+8). <<shaking my head>>
@JanetNJ @Chris & China (GA) @Deb & Wink Gonna work on getting a new thread going a bit later today— I’ll tag you all there and link this one. We had a great day yesterday, then this morning back to the higher 300s (AMPS 366)which I’m not enjoying seeing. We are going to take it easy today, lots of snuggles. Maybe that’ll help him. I’m also going to try switching him over to a FF pate diet after a lot of talk about how kitties are reading higher bg levels on Friskies (perhaps a recipe change with higher carbohydrate levels?) to see if maybe that will bring him down a hair too. Probably will start that Sunday when we are out of Friskies wet food. Okay, that’s the update. I’ll be back later!
I'd liek to see the numbers come down just a little more. Can you do 2.75U? I'd like to see the nadir closer to 90-100.
We can certainly try it— id like his numbers down more as well. Will start 2.75u tonight and monitor closer overnight (good thing about Fridays!). Sound good?? Which intervals should I test overnight?— I was thinking 4 or 5, 7 or 8. Let me know!
@Deb & Wink @Chris & China (GA) @JanetNJ 106 at AMPS. Holding food & dose, retest in 15 mins. It seems 2.75u is too much, but 2.5u isn’t enough. Shoot 2.74u and have constant monitoring today and carbs if needed to see if he can stay okay at 2.75u or head back to 2.5u and risk those high black and red numbers again??