Hey there, I am currently stalling with Ram after he tested 228 this AM. I am thankful to finally be getting some lower pre-shot numbers in 100-200 range in these past few days, but I'm concerned about shooting his regular 4 units at these levels. Any thoughts on a proper dose?
How do you feel about that number? He's got a good rise going. Did you feed anything between the 228 & 273?
I gave him a couple dried minnows as a reward for the first test. I feel pretty comfortable shooting over 300 I guess, but under that I start to get worried. I am just concerned about overshooting since it looks like his numbers are starting to come down significantly. In the past week he has had some of his lowest PMPS and now this morning is his lowest AMPS.
Looking back you've shot full doses on a 295 & 272. When starting to shoot on lower pre-shots that what has been 'normal' for Ramirez get a couple of tests early in the cycle. It will start to paint the picture how he does when shooting lower than normal numbers. Also, if possible, some mid cycle tests or a before bed test in the PM cycle will really help tell us what's going on. There's some great information in the PROZINC DOSING METHODS sticky pinned at the top of the Prozinc ISG on how to handle lower than normal pre-shots along with alot of other valuable information.
You're right. I just fed and gave him the full dose since he's probably around 300 by now. I'll try to get a couple of those tests in, I only have 1 left but more should be delivered this morning. And yes, I'm going to start getting some tests in during the night too. Thanks so much for the quick responses and all the help, I really appreciate it!!!
I am stalling again after Ram's PMPS @ 182. I am concerned about shooting 4 units at this level, especially with no info on how he does at night yet. His cycle is also a bit delayed since I fed him ~45 min later than I usually do this AM. Will be getting the next test shortly.
Second test @ 201. I think I'll reduce the dose to 3 units just to play it safe and I'll see if I can get another test in before bed to see how hes reacting.
Just seen your before bed test. Do you have any higher carb food? We need to slow him down and you'll need to get more tests in tonight. I'll stay up for a bit if you have any questions.
Thanks for the heads up! I still have the glycobalance dry food and felovite II that the vet gave me awhile ago.
Yes I should have some syrup around, I'll look for it now. The felovite also has corn syrup in it. Just fed him a bit of the dry food.
Yeah, he was low once when I took him to the vet, before I was monitoring him myself, and they used that and gave me the rest of the bottle. Regardless, I've got the maple syrup now.
Mix a small teaspoon in with a dab of his LC wet food. Not too much wet food we need to keep him hungry.
Ok, I was kinda panicking so I gave him about a teaspoon w/ no food before you replied. Does mixing it w/ food make a difference?
Nope, sometimes just easier to get in to them and doesn't make a mess! I'm hoping the dry food kicks in soon.
Me too! I am reviewing the hypo sticky right now which is super helpful. Going to do another test in a bit.
We're trying to really slow him down right now because we're so early in the cycle. He's not hypo yet but I'd like to slow him before it happens
Okay, the syrup probably put the brakes on things, but it won't last. No more food for now and another test in 30 minutes.
Can you get another test in an hour? The insulin still hasn't reached it's peak and doesn't look like the dry food has bumped him too much and we don't know when the syrup will wear off and when the dry food will wear off. Just don't know if the insulin is going to pick up momentum again.
I think Ramirez is looking for a dose reduction. We should re-evaluate after tonight's adventure and see what tomorrows AMPS brings.
Sounds good! And I agree, he was prescribed the 4 unit dosage while he was on glycobalance dry + wet food so I was anticipating a reduction at some point when making the switch to just LC wet food.
It's been a couple hours since the food and syrup. You're in good shape. Does Ram usually get any snacks/LC food overnight?
That's great to hear! He doesn't get any food overnight currently. Thanks again for helping me out with this, I really appreciate it!
He "earned" a dose reduction with that 79 last night. We usually recommend reductions in 0.25u, but I'm thinking maybe a bit more. Do you have syringes with 1/2 unit markings?
A few random thoughts from last night: First thing, you did everything right at PMPS last night, you stalled, reduced the dose and got that early test that allowed you to head off any trouble. It's always difficult to figure out how much to reduce by but looking at you AM cycle yesterday 02/13 your reduction seemed reasonable. For future reference another thing to take in to consideration would have been the amount of the rise. 182 and 201 could be considered the same number with meter variance, when you see numbers like this do another stall and see what it brings. We need to get your spreadsheet sorted out a bit and get those PS stall numbers entered and the two tests within an hour in the PM cycle entered in the same cell. The start of the stall goes in the +11 columns with the "+time" and the BG number you actually shot on goes in the PS column, again with the "+time" so we can see it was a stall. For any other tests during mid cycle stack the numbers in the cells. You'll need to manually color code the backgrounds with the paint bucket and change the font color to white if needed. When numbers cross color coding (your 79 & 106) fill the cell with the lowest color. HOW TO USE THE SPREADSHEET sticky has more detail if needed. It should look something like this when you're done. I didn't like how fast he was dropping last night. 1. from the preshot to the +2 test 2. from +2.5 to +3 test after feeding dry food We didn't have room for him to drop another 40 points if the dry didn't kick in fast enough. That's why we pulled out the HC syrup. It works well to put on the brakes and give you a fast bump but it doesn't last. And about mixing the syrup in with LC food - in theory, mixing HC syrup with LC wet should give us MC, but it's okay you gave Ram just the syrup, you kept him safe. We should get you set up with a few cans of MC wet food and a few cans of HC wet gravy food. LC<10%, HC>18%, anything in between would be MC. From Dr. Pierson - new Food Chart looks like Fussie Cat Super Premium Chicken in Gravy is listed at 17% and some of the Friskies in gravy or sauce are higher carb. From what I see most members stock their hypo kits with small cans of Fancy Feast, lots to choose from there. (My Jess has a very sensitive stomach and I only use syrup when needed with her). And, a bit more reading for you if you haven't seen @Deb & Wink's write up about the +2 test already - will explain a bit why we did what we did last night. Why the +2 Test is Important - more detail information for Prozinc users by Deb & Wink
OK my spreadsheet should be sorted out now. Not sure if I'm using the notes correctly, so lmk if I should make a change there or if I'm missing anything else. Thanks for the detailed info! I'll stock up on some MC + HC wet food today. The +2 test write-up is super helpful, I have a much better idea of what to look for and how to react now.
Shelley and Chin. You both did a great job last night. Kudos to both of you. Very good idea to link that +2 test writeup I did. Forget some times that I made it a shared google doc, instead of only having it on my computer at home. It's a lot to take in. But something you might want to print out and have a copy in front of you. Something to study, so you can try to think about some of those concepts that are mentioned.
Wow what a day Ramirez had, it is incredible Great job Chin for following him so thoroughly and @Shelley & Jess you were amazing helping him with the decisions, i know myself how grateful i am to the people that stick up to us with Chico and explain what is happening and what do the numbers mean Chin, the black preshot number and the higher values in the following cycle is a bounce. In my laic words: a bounce is the body's "protection mechanism" kicking in in the moment when he sees lower values than he is used to in the previous cycle. A bounce lasts from 1 to 3 cycles. You can check Chico's spreadsheet, we are going thru exactly the same things now. One cycle he has very beautiful numbers the next one all red and pink. Chico's bounces usually clear in 1 cycle and it is still nerve-racking but i am constantly reminded that it is part of the process and as soon as he will get used to the lower numbers he will stop having so many until they will disappear altogether. An important reminder to both of us is not to let ourselves demotivated by bounces, they come and go Chin i also wanted to congratulate you for the progress with the spreadsheet, keep up the great work and i am certain Ramirez will appreciate it and it will make a difference
Thank you for the extra info on bounces and continued encouragement! I gave him 3U last night to play it safe, I couldn't stay up late again to monitor him. What I'm wondering now is what to do if he tests ~200 again at PMPS. Should I reduce to 2.5-2.75U, or keep stalling until he gets a higher number w/ a decent rise and try 3U again? Would ease my mind to have a bit of a plan in place before it happens again. Also, just a general housekeeping question, if I'm looking for help again with a low PMPS should I start a new thread or keep everything in here? I recall reading something about making sure threads don't get too long. Thanks again everyone!
I'd recommend starting a new thread. Remember to link the old one in at the top of the new thread. Using the ? thread prefix could get more eyes on your thread. The words "HELP, with low numbers" and what the lows are listed in the thread title can be helpful too. 200 isn't particularly low. But Ramirez dropped to the mid-level greens from that 201 the other night. I think that he's a bit overdosed at the moment. You had dropped his dose to 3U but then you hiked it back up to 3.5U. We don't dose based on the pre-shot BG. But on the nadir, or how low a particular dose takes your cat. But first, they have to clear the bounce. A big part of the high BG levels is also the higher carb dry food. I'd recommend trying to hold the dose at 3U for a while. At least 3-6 cycles and see what that does for Ramirez.
Hey i was wondering if a change in schedule wouldn’t be helpful if you cannot stay up too late. There are protocols of how to make the change smoothly without affecting the routine. If you want I can look it up in Prozink group for you just to make sure it is not different from Lantus. we started by giving the shots at 9AM and 9PM but when we started following Chico during the night we would end up going to be every night at 3-4 AM and that is not sustainable in any way. What we did is switch it to 7AM and 7PM which helped a lot. i know every one of us has different schedules and what works for us doesn’t have to work for you but i thought it might be worth giving you the idea
With Prozinc, you can stall for up to 1 hour and still keep to your regular shot schedule. It's a bit more forgiving on changing shot times than the depot type insulin s like lantus and levemir. Ramirez is still bouncing pretty high. So keep the 3U dose for now. Is Ramirez still eating the high carb dry food?
He's been off dry food for almost 2 months now. He's on fussie cat tuna & salmon now, I picked that brand cause it looked like it had the lowest carbs on the food spreadsheet.
Yes, just to slow his decline down. It hasn't been a part of his diet otherwise and I didn't feed him any more after that night. He's having a pretty steep decline again tonight so I gave him some higher carb wet food this time, but after checking your write-up again I see that it can sometimes depend on the pre-shot number. I'm wondering if it's ever okay to see a 50% drop @ +2 from higher numbers like his 454 PMPS tonight or if it's just as bad as if it happened at a lower pre-shot number?
Chin, i will let @Deb & Wink answer your question, i will just tell you that a 50% drop in BG happens to Chico almost every second cycle that is not a bounce, with Caninsulin it was happening even more often, i don't think it is "normal" but it is happening sometimes. Our goal is to flatten the curve, smoother drops after the insulin shot. You did a great job catching his +2. I think rather than the lower pre shot value caused it, it is the bounce clearing off, that's why this cycle is active - the preshot value seems to indicate that the bounce was clearing. Keep in mind that not always a black preshot means not an active cycle
If your cat tends to really drop fast around +2, which is when Prozinc usually kicks into action, then try feeding a small amount of food at +1 and/or +2 to slow that drop. "Steering" the cycle. You did a little bit of steering last night, by feeding Ramirez at +3. Next time, try reaching for his regular low carb wet food first, to see if that helps to slow the drop. You'll have to experiment a bit to find what works better for your cat. LC first, then MC, then HC food is the general sequence. Too much of a drop from ANY pre-shot number early in the cycle means you need to keep a closer eye on the cycle. Steering the cycle with some food can help too. I think the black BG this morning was a bounce from those "lower than his body is used to" BG levels last night. In other words, he's bouncing.
Would you please start a new thread for Ramirez? We like to keep them to 50 posts or less. Link this old thread in at the top of your new thread. Thanks.
