So to catch folks up, last night Nico’s PMPS was quite high, in the 400s, after a token dose in the morning and a day of lower numbers. He was great overnight and came in with a +10 of 297. About an hour and forty five minutes later he had dropped to 226 for his AMPS. I did give him a full dose of 2.25u as advised. I guess my question is, is it normal to see a drop from a +10 or +11 to AM/PM Pre-Shot numbers? What causes that? It’s new for Nico. Just curious. Previous thread(s): https://www.felinediabetes.com/FDMB/threads/nico-1-5-new-thread-link-in-comments.240600/ @Deb & Wink @Shelley & Jess @JanetNJ
Could have just had some food wear off... Or he was active. Activity and exercise lowers numbers. Make that cat play. Lol
Now that he’s had better numbers he’s so much more playful, and myself and his sister keep him on his toes— I AM LOVING IT!!
@Deb & Wink @Shelley & Jess @JanetNJ you guys, my sweet boy is miserable tonight. I don’t know what’s going on with him.. just a wicked bounce from that minimal token dose yesterday, maybe? I could cry, he feels so crummy... I wish there was more I could do for him. PMPS, 514.
Not constipated. Appetite is good. He’s eaten everything put in front of him today. He just gets that “I don’t feel well, mom” that all babies get when they’re sick look. (Adults definitely get that look too— working in pediatrics you get trained to see it, without them having to tell you verbally) He is laying with me, so at least he’s being social, inactively, and not hiding. Just hoping that now two usual (2.25u) doses will bring him back and kick that bounce to the curb. What are your thoughts on keeping tabs on him overnight? I think maybe just somewhere in that mid..
I guess down is an understatement. Lol. I had anticipated getting a +6 but missed my alarm, got up briefly at +9 and he was 39. Medium carb treats have him up to 54 at +10. Stay tuned!
That black last night looks like a "high before the break". Late PM cycle 01/04 thru to AMPS 01/05 looked like he was trying to clear the bounce but didn't quite make it - by 01/05 AM+6 he shot back up and by PMPS he was black. Just mentioning it so you can keep an eye out for that same sort of pattern in the future if it happens again. Nico sure is on a mission and keeping you on your toes! Good catch last night Em. Definition of High before the break as posted by Marje and Gracie taken from this thread https://www.felinediabetes.com/FDMB/threads/slgs-method.228857/#post-2562710 “High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues. He was bouncing He was due to clear the bounce His BG was wobbling a bit like it might be clearing but then the numbers shot way up. BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle. Still, the above pattern is classic high before the break. One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.
Nico earned another dose reduction last night. New dose 2.0u. Please keep a very close eye on that cycle today if you already shot.
This is great information to have. I’d be lying if I said I hadn’t thought that maybe his numbers yesterday would earn him a dose increase (back up to 2.5u). Clearly it’s good I/we didn’t jump the gun on that. I’m still kicking myself for missing that alarm to get a +6 from him during that PM cycle, but that being said I’ve got a watchful eye on him today. Will start with a +3, in a little over an hour, just to make sure he’s still doing okay. My inclination is he will be just fine. Will plan for 2.0u tonight, unless something changes. I’ll check back in soon!
That 50% drop 01/05 PM+3 was the early warning. It's why I'll always recommend those early cycle tests between +2 & +3 regardless of the PS.
I guess it’s a good habit to get in to. I just hate poking him like 8-10x per day, especially when his ear is still a little sore. I just took a +2.5 and he’s at 236. Not sure what that means as far as what’s to come a little later in the day today.. thoughts? I’ll be sure to get another read in a couple hours to see where he’s at, hopefully he does okay; he has a strong tendency for higher numbers, not lower, so my guess is he will stay out of hypo range today.
I'm really hoping he doesn't bounce from that lime green last night. Look at your 01/01 am & pm cycles for comparison of what he might do today. Have you seen Deb's +2 write up? Why the +2 Test is Important - more detail information for Prozinc users by Deb & Wink
Important testing (and reading) to be done today. Hoping he’s not gonna bounce big time, but we shall see..
We are on high alert around here.. (though again, I’m sure he will be totally normal come evening. And by normal I mean, ~200 pre-shot.) +4.5, 51. We just played, he had lunch and some protein treats, now he’s grooming so behavior is a-ok. Just keeping a watchful eye, as his nadir is usually +6ish. I’ll grab another test then, and try not to be totally distracted by what is happening in DC at the moment. Crazy!
It's possible that Nico's pancreas is starting to function a bit on it's own, and putting out it's own insulin. Testing is a good way to take your mind off the insanity of what is happening in DC.
When a cat's BG level drops particularly low, then a bounce is likely to happen. I think that is why Nico is rising at +10. After that low last night, down to that BG of 39, and the lows for today, I think you want to reduce the dose. Maybe not by a lot. But a 0.25U dose reduction is in order. So yes, down to 2U is what you want to do. Nico EARNED that reduction. With both the low from last night, and the low of 51 from today. You don't want to dose based on the bounce Nico may have after a low. I know it's difficult, and your instincts are saying to keep the higher dose. But you have to overcome those instincts and base your decisions on the dosing based on the nadirs or lows that Nico gets on a particular dose. BG numbers in the reds and blacks, almost always indicate a reaction to a low and those high numbers are saying Nico bounced. I don't think we "jinxed" Nico. I think his body still needs more time to adjust to those lows. In the beginning, Nico was running mostly in the blacks and reds, because you had not found that "breakthrough" dose, that would bring his BG numbers down into a better range, into the pinks, and yellows. But once you started to be more aggressive with the testing, switched to the MPM dosing protocol, and found that "breakthrough" dose, Nico has been doing so, so much better. It hasn't been a super smooth process for Nico, but with a diabetic cat it often isn't smooth, and there will be more frequent ups and downs. We focus on the BG numbers a lot here, when we make recommendations. But you are there to observe his behavior and can see trends in his eating, drinking, peeing, etc. So you take those factors into consideration, and look for trends, and not focus on a single cycle or a single day before you decide to make a change. But there are certain safety safeguards that do need to be paid attention to, such as lows < 50 mg/dL. "Feed the 40's." So hold that lower 2U dose for a few cycles, if at all possible. I'm even seeing another reduction in Nico's near future!
Just a quick update. Nico was back at 325 for AMPS, and his +5 an hour ago was 162. May or may not get a +7 or so, just to see how this new dose is doing. I’ll be back! @Deb & Wink @Shelley & Jess @JanetNJ EDIT: +7, 143. @Deb & Wink @Shelley & Jess @JanetNJ PMPS, 354. So much up and down, it’s absolutely crazy-making!!
Gonna see what happens today. Starting out a bit on the lower side.. AMPS, 148. @Deb & Wink @Shelley & Jess @JanetNJ
how different your chart looks from the beginning. I'm predicting another reduction in your near future.
I'd take another dose reduction for Nico, after that BG of 63 at +6 today, 1/8/21. So down to 1.75U dose. Hope you see this suggestion, before the PM (evening) shot.
I did actually! 303 for the poor guy’s PMPS, but 1.75u given/started this evening despite. Nervous for what high numbers that dose reduction will bring, but I’m trying to be cautiously optimistic... TGIF, guys!
@Deb & Wink @Shelley & Jess @JanetNJ hoping you guys can weigh in on this for me today. We had a GREAT number for AMPS (154), which I was super happy about. But now we are showing numbers in the black zone (again), and it’s only +4 (540) . I’m incredibly worried about what’s to come for the rest of today.. What is up with him?? I did second guess my shot this morning, but it wasn’t wet so thinking it wasn’t a fur shot. (And, I did a repeat test to rule out a bad strip too.) But what else could/would cause him such a steep increase in that short of a time frame?? At this rate by PMPS he will like unreadably high for sure. Just sucks. I don’t want him to be miserable (though his behavior is great at the moment, he’s romping through the house currently!) I’ll look for your responses in a bit.
Still black. Very, very black. PMPS, 559. Was secretly wishing he’d surprise us tonight. Not so. I’m sad for him. He’s not acting like he’s feeling bad though, aside from a tad more thirst this evening. Hope he’s gonna come back down tomorrow. I’ll do one more test before bed. Thanks @Deb & Wink @Shelley & Jess @JanetNJ.
@Deb & Wink @Shelley & Jess @JanetNJ 300 this morning (AMPS). Not a great starting out point, but better than the 540 or 559 yesterday.. Will test him Mis and let you know.
I mean I won’t if you guys think we should stick it out longer, for more adjustment I hopes his body will come around. I just don’t know that it will..
I exercise my right to wait and answer when we see PMPS Seriously, the only thing I personally don't like is increasing on a night cycle....but this really isn't an increase more of a failed reduction. The recent 2.0u didn't take him too low Maybe this will help settle your thoughts, from Prozinc MPM dosing If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
I LOVE ALL OF THIS!!! (At least I’m not a failure.) Honestly though, I think we just weren’t ready for two reductions so close together; I really do believe we will be able to reduce him successfully at some point in the near-ish future, I guess now was just not that time. I’m so clearly not an expert, nor do I pretend to be one. His behavior has been pretty good considering.. a little increased thirst yesterday but no lethargy, anorexia, etc. You’d never know he was running 500+ numbers if you saw him, which I’ll mark as a win in my book! Dang, I just love that little guy, I’d do anything to help him. We are fort masters today.. rainy day in Seattle. @@Shelley & Jess about a half hour or so til PMPS, will you be around? I told myself that a good compromise might be that if he’s [somehow magically] near 200 I’d be okay shooting 1.75u again tonight, if not 2.0u. Anyway, I’ll be back in 30-40 mins!
@Shelley & Jess update: PMPS, 370. 2.0u? Go from there? Or wait to see what he does overnight with 1.75u (though like you said previously, he’s not had any hypo numbers at 2.0u, even overnight)?
I'd do the 2.0u. ETA - what time you hoping to test, looks like I might be up with my little missy tonight too.
Oh no. Low?? I usually try to get him between 11pm and midnight (PST), so +4 or +5. I can do it earlier and post if you’ll be up, just let me know! I’m like 95% sure he will be just fine though.
Your +4 sounds good. Not low, 104 @+2 but finally trending down after a few less than ideal cycles. Think she's been going through a bit of an IBD flare, and like Nico today you wouldn't know anything is wrong except for the numbers.
Awe sweet girl. I have IBD (Crohn’s) myself, so I totally get that— those flares can be brutal, in anybody!! (Sorry, probably just a bit tmi but I’m an open book, so sometimes I over share about it - lol!) Is she on prednisone (also like me) for management? Anyway, sorry for the random rambling. I’ll be back in just a couple short hours with Nico’s latest number— I always wage a guess because I’m usually so far off it’s comical, certainly wouldn’t put any money on it; just for my amusement. gotta keep a sense of humor! Tonight’s guess for +4... 275! Well @Shelley & Jess, I was wayyyyyy off.. +4, 420. OUCH. Here’s a thought though.. he’s on the dregs of his current PZI vial, could this attribute to some of his numbers from the last two days??? I think it was filled in October... Just throwing it out there as a possibility. His numbers just seem WAY off to me to be merely coincidental. ??????
Y’all, it’s not good... What is going on with my guy??? AMPS 492. EDIT: +3, 382. +5, 299. joyful: @JanetNJ!!) +8, 179. PMPS, TBD
Could he still be bouncing? I'd love to hear the pro's opinions, but that would make sense I think. I read on here that bouncing can take a few days sometimes.
Yes, that is a strong possibility. Prozinc does get less effective the longer a vial has been opened. YEAH!!! on the blue today.
THANK YOU!! Also, @Deb & Wink @Shelley & Jess @JanetNJ we are stalling LOL (his body is CRAZY!!!) PMPS, 96. Whhhhhhat’s the plan now lol?! 2.0u over 150?? UPDATE: PMPS (+12.5), 109. More stalling...
Hmmmm. We went down from our last test.. PMPS 96, +12.5 109, +13 99. Hmmmmm. Thoughts guys? Hopefully someone is still up... @Deb & Wink @Shelley & Jess @JanetNJ
I know... that’s why I’m not sure. He’s eaten now, should I test again? I mean I know that’s food influenced now though.
Well we are at your mercy.. I’m too new to know anything about anything, so I’ll give whatever you think is appropriate. It looks like both times he’s been like this before it was a 1.0u or 0.5u dose.
You've never shot when he's stayed this flat and low for the hour stall, he's always had some sort of rise....his limes have been overnight....thinking out loud here....
@Deb & Wink @Shelley & Jess @JanetNJ I’ll get a new thread going at some point (when I’m lucid lol) tomorrow, as I know this one now requires quite a bit of scrolling to get here. Just a quick overnight update before AMPS in just 3 short hours: (recap, PMPS +12 96, +12.5 109, +13 99. 0.5u token dose given at +13.) +2 145, +4 150, +8.75 195. He seems to have flattened out. Can someone elaborate on what that means when you have a chance? I did a quick search on here, so I sorta get it, but that’s brand new territory for Nico and I’m not sure I know wheat it means in terms of him specifically or in terms of Prozinc versus other insulins. I’m a bit sleep-deprived so I’m gonna dash and see if I can slide in another 2.5 hours before Nico’s morning routine and “work” [from home]. Hope y’all slept well— I’ll be in touch shortly!
Headed to Napland now, population 1. LOL Nico’s +4 is high, 478. That boy’s disease is gonna be the death of me, I swear!
BIG BOUNCE DAY! AMPS, 370. +4, 478. +10, 519. PMPS, 496. Hoping he clears it overnight. At least this mama gets a good nights sleep tonight!
Link to new thread: https://www.felinediabetes.com/FDMB/threads/nicos-new-thread-1-13-amps-211.241437/ Hope Nico kicks this bounce to the curb this morning! AMPS, 211.