Dosing advice for Oscar - Can't get out of the pinks :(

Discussion in 'Prozinc / PZI' started by Oscar and Carrie, Apr 20, 2021.

  1. Oscar and Carrie

    Oscar and Carrie Member

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    Hi everyone,

    I've been a bit quiet as we moved house last week so busy with that!

    I would like a bit of advice with Oscar. I had him at 0.5u for just short of 3 weeks, in the hope that it was the bottle of ProZinc that was not as effective, but even after a change to another one there was no improvement in numbers.

    I increased him to 0.66u just over a week ago, and this has had little impact. If anything his numbers have gone up!

    The vet suggested I shouldn't have increased his dose as he hadn't been on the 0.5 long enough to see an impact and that his numbers looked fine before the dose increase ?? (though if I'm following the SLGS method, a week is enough isn't it?). My argument was that I'm testing frequently enough to see very quickly what the effect of a dose change is and that his nadir had never dropped under 10 so his BG levels were still too high.

    I'm going to try and get a curve today, but it does look like he needs an increase. Should I go up to 1 after the 0.66, or should I do 0.75 first for a week, and then up to 1 if needed?
     
  2. Pabs&Ro

    Pabs&Ro Member

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    Carrie. I wouldn't advise on dose but my vet wanted Pabay on the same dose for 5 days when he was on prozinc. Even with prozinc the increase in the dose can cause a clinical hypo at about 3 days apparently. It takes time to have a full effect because one dose affects another. My vet has always told me to be careful at that point following a dose increase. So I don't understand your vets point.
     
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  3. Oscar and Carrie

    Oscar and Carrie Member

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    This is my thought!

    I understand maintaining a dose for a week to clear any bounces that might occur from the initial increase (unless at any point the BG drops low enough to warrant an immediate decrease), but to keep going for weeks on a dose that is clearly not enough seems odd to me. I wonder if it is because they are not used to treating cats where the owner is testing daily, and normally they would keep you on a dose for a long time, bring you in for a curve and then adjust?
     
  4. SashaV

    SashaV Well-Known Member

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    I'm not giving advice on dosage, but I definitely think he needs an increase.
    Prozinc is not longer lasting, one dose CAN effect the next cycle, but Prozinc is more in and out.
    And the longer you keep an ineffective dose, glucose resistance sets in and gets harder to break through. I'd wait on @Deb & Wink @JanetNJ or @Shelley & Jess to give a go ahead. Just my thoughts :oops:

    And I think the vets are taking it very slow, since most doesn't test and wouldn't catch a low. They're just forgetting insulin is a hormone, and the BG is never the same two days in a row..
     
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  5. JanetNJ

    JanetNJ Well-Known Member

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    I'd try 1 unit.
     
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  6. Oscar and Carrie

    Oscar and Carrie Member

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    Thanks Janet and Sasha.

    I've increased to 1 unit tonight and will keep an eye on him.

    I'm sure my vet will not be happy with me again!
     
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  7. Deb & Wink

    Deb & Wink Well-Known Member

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    Sorry, but we disagree with your vet. 3 weeks is PLENTY of time to see if a dose is working or not. In fact, holding a dose for that long can lead to insulin resistance, as Sasha mentioned back in reply #4.
    So be it.
     
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  8. Oscar and Carrie

    Oscar and Carrie Member

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    Thanks Deb,

    I really feel awkward going against the wishes of my vet, but knowing that I am doing what's best for Oscar and have the knowledge of this board behind me makes me feel more confident in my decisions.
     
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  9. SashaV

    SashaV Well-Known Member

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    Have you tried telling your vet, that you want to work with him or her?
    I was told Mauer needed to eat diabetic dryfood before I had any chance of remission, because of the slow carbs.....?!
    I tried... but it didn't make sense. My vet went out sick for most of the year, when she got back I wanted to make sure I had her support. I did, Mauer was doing GREAT, and I should let her know if and when I needed a prescription and she'd give me one. I proved I did better on my own.
    Or maybe it's time for a new vet?
     
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  10. Oscar and Carrie

    Oscar and Carrie Member

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    I am keeping them updated with all the changes I'm doing, and I've explained that I'm following the AAHA guidelines. They have been generally supportive when I've discussed the change to low-carb diet and using a human meter instead of a pet meter, and they are letting me get on with looking after Oscar my own way, but they do like to tell me every time they call that they think I change his dosage too frequently and I'm not giving it time to settle in. That's the one thing we seem to disagree on.
     
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  11. SashaV

    SashaV Well-Known Member

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    But instead they want glucose resistance to set in? Prozinc is in and out, no depot effects to take into consideration.
    My vet refused to change dose on Caninsulin for a month!!!! Stupid :banghead::woot:

    A blood glucose isn't steady, never the same, neither should insulin be. When it's not a depot.
     
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  12. Oscar and Carrie

    Oscar and Carrie Member

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    Just got a reading of under 10 during the AM cycle for the first time in over a month! :joyful:

    Let's hope this is a sign of better numbers!
     
  13. JanetNJ

    JanetNJ Well-Known Member

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    good. Lets hold this for several days, then we can reevaluate and see if you need 1.25
     
  14. SashaV

    SashaV Well-Known Member

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    Wonderful!!! :bighug::bighug:
     
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  15. Deb & Wink

    Deb & Wink Well-Known Member

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    If the dose and the frequency of changing it is the only thing you and your vet disagree on, you are ahead of the game. Many vets don't think their clients should home test at all, or use a low carb food.
    Yeah!

    But it does look to me like Oscar will need another dose increase soon. We need to get him out of those darn pinks and yellows.
     
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  16. Oscar and Carrie

    Oscar and Carrie Member

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    The vets haven't called at all since I e-mailed to tell them about the dosage change. I will take their silence as passive acceptance :D

    We've had a few hours in the blue so far today, keeping those fingers crossed.
     
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  17. Deb & Wink

    Deb & Wink Well-Known Member

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    Sounds good to me!
     
  18. Oscar and Carrie

    Oscar and Carrie Member

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    @JanetNJ @Deb & Wink

    Would you be able to review and advise on Oscar's dosage?

    After a day of high, flat numbers, he's dropped quite low tonight (+4 of 4.5/81). I'm going to get a few more readings tonight, but would you recommend an immediate dosage reduction to 0.75 in the morning, or maintain this dose of 1u if 4.5 is the lowest he goes?

    PS. I have given a tablespoon of low carb wet food at +3 and +4 so the +4 reading may have been lower without food.
     
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  19. Deb & Wink

    Deb & Wink Well-Known Member

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    I think that Oscar is finally making some good progress on this 1U dose. So if you can monitor as usual, I'd keep the dose the same.

    Technically, per the SLGS dosing protocol, Oscar earned a dose reduction. But he's been high for so long, for many weeks, I'd like to see him stay at the higher 1U dose for a bit longer.

    p.s. Notes on the SS in the Remarks column about the +3 and +4 feedings will come in handy, as you look back at the SS in the future. It's good to have notes such as this on the SS, as a memory jog.
     
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  20. Oscar and Carrie

    Oscar and Carrie Member

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    Thanks Deb, this is what I was thinking, which is why I was unsure as to whether or not to decrease. I work from home at the moment so I'm able to monitor regularly - will hold the 1u dose and keep an eye out.
     
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  21. JanetNJ

    JanetNJ Well-Known Member

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    Oh I see an 81! Keep this dose a bit longer.
     
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  22. Oscar and Carrie

    Oscar and Carrie Member

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    Thanks Janet I will!

    He had really good numbers during that PM cycle on the 25th, but he's been quite high since. He's been stuck in flat pinks all day, so I'm expecting another drop this evening. Does this look like bouncing to you from that earlier low number?
     
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  23. Pabs&Ro

    Pabs&Ro Member

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    Bounces can take 3 cycles to clear. Flat lining high can mean too much insulin. See what deb and wink say as the earlier low number was a while ago.
     
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  24. JanetNJ

    JanetNJ Well-Known Member

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    Hmmm. That probably cleared by now. You may need a tiny boost soon but let's watch another day. :)
     
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  25. Pabs&Ro

    Pabs&Ro Member

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    Sam - is there any chance you gave a fur shot this am?
     
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  26. Oscar and Carrie

    Oscar and Carrie Member

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    Not as far as I am aware :(

    Will see how he does tomorrow as well and then make a decision on whether to stick at 1 or increase to 1.25
     
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  27. Deb & Wink

    Deb & Wink Well-Known Member

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    One good number is not enough. You need more than that one BG to be in the green.
     
  28. Oscar and Carrie

    Oscar and Carrie Member

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    Morning!

    After a day of flat pinks yesterday, Oscar had a better PM cycle and this morning had a lovely pre-shot number of 11.5/207! This is the lowest he's been in the morning for well over a month, so really hoping to see lots of blues and greens today. Keeping everything crossed :nailbiting:
     
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  29. Oscar and Carrie

    Oscar and Carrie Member

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    @JanetNJ @Deb & Wink

    I've had a reading of 4.0 (72) at +4 today, so probably an hour or so away from where his nadir usually is, so I'm thinking it's best to reduce to 0.75u from this evening?
     
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  30. JanetNJ

    JanetNJ Well-Known Member

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    Oh nice! Did you have to steer to get that number up? Or did it come up on its own You could reduce. Our just give a skinny 1.
     
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  31. Oscar and Carrie

    Oscar and Carrie Member

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    He has a small meal of LC wet food at +4, so the +5 reading may have been influenced. I'm going to get another at +6 to see if it still keeps going up two hours after that small meal.
     
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  32. Deb & Wink

    Deb & Wink Well-Known Member

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    If you are able to steer the cycle with some food, then keeping the dose at 1U would give Oscar's pancreas a chance to heal. If the insulin injections are a good amount, then his pancreas can rest and heal a bit.
     
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  33. Oscar and Carrie

    Oscar and Carrie Member

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    Thanks Deb, I'm going to be sticking at 1 units for a while unless I see him drop too far into the bright greens.

    His last two day cycles have been fairly good, and his pre-shots are starting to come down again.
     
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  34. Deb & Wink

    Deb & Wink Well-Known Member

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    YEAH!
     
  35. Pabs&Ro

    Pabs&Ro Member

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    Well done. Holding your nerve is hard - it has paid off. Great.
     
  36. Deb & Wink

    Deb & Wink Well-Known Member

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    Oscar, you're headed in the wrong direction! Back down please.
     
  37. Oscar and Carrie

    Oscar and Carrie Member

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    :(

    Yep, after a couple of promising days, it looks like we're back to where we were!

    Would you suggest increasing now to 1.25, or holding this dose for a little longer?
     
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  38. Deb & Wink

    Deb & Wink Well-Known Member

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    I'd recommend a dose increase, to the 1.25U amount. You've given the 1U plenty of time to see it's impact, and that lower dose simply isn't bringing down Oscar's BG levels enough.

    UP, UP, UP with the dose.
     
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  39. Oscar and Carrie

    Oscar and Carrie Member

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    Hi all,

    So tomorrow will be Oscar's 7th day on 1.25u

    Whilst his pre-shot numbers have now started to drop which is good, I'm still not really seeing any blues or greens mid-cycle.

    Would you recommend increasing now to 1.5, or giving the 1.25 a little bit more time?
     
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  40. Deb & Wink

    Deb & Wink Well-Known Member

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    If Oscar were my cat, I'd increase to 1.5U. You've given the 1.25U plenty of time to show what it can do, and it's not doing enough.
     
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  41. Oscar and Carrie

    Oscar and Carrie Member

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    Cheers Deb.

    I'm going to do a curve today to double check he's not going lower later in the cycle (and as evidence for the vet as to why I am increasing again) and then I'll start on the 1.5u dose from tomorrow morning if his nadir is still not approaching 5.5.
     
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  42. Oscar and Carrie

    Oscar and Carrie Member

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    Oscar stayed in the yellows throughout the day, so made the decision to increase to 1.5 from his PMPS shot.

    Really hoping we can keep bringing the pre-shot number down lower closer to the 11/200 point. Keep everything crossed!
     
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  43. Deb & Wink

    Deb & Wink Well-Known Member

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    I have several sets of paws in Oscar's corner, keeping them crossed for lower numbers for him.
     
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  44. Oscar and Carrie

    Oscar and Carrie Member

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    Hi, just a quick update from me.

    Day 3 on 1.5u and not much change as of yet. He's had pretty much flat numbers for the last few days so hoping to see some movement soon.

    I've also purchased a ketone meter and tested this for the first time. The number came back at 1.4mmol. I've had a look at some of the files on here and it looks like if it's above 2.4 that's when I should seek vet treatment? For now, should I focus on increasing his water intake and try and get that a bit lower?
     
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  45. SashaV

    SashaV Well-Known Member

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    I belive you're right, but I'm not experienced in ketones.
    Could you perhaps do some later readings? He might be bouncing from a lower BG you didn't catch.
    Would also be awesome if you could record what he eats and when :oops:
    Did you change anything around the time you lost control of his BG?
    Could he have an infection somewhere?
     
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  46. Oscar and Carrie

    Oscar and Carrie Member

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    Do you mean recently, or back in March when his numbers just jumped up?
     
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  47. SashaV

    SashaV Well-Known Member

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    Back when his numbers jumped up..
     
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  48. Oscar and Carrie

    Oscar and Carrie Member

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    No, nothing at all changed except he'd switched to a new vial of insulin. Diet and feeding schedule etc were all exactly the same so I have no idea what caused it to jump up.

    I thought it may have been a dodgy vial, so I got a different one but sadly no change.
     
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  49. SashaV

    SashaV Well-Known Member

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    I thought so... why I'm thinking an infection of some sort. How is his teeth?
     
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  50. Oscar and Carrie

    Oscar and Carrie Member

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    They seem fine to me, though he is back at the vets a week on Monday so I will get them to look over his teeth. Here's a picture if you can spot anything.
     

    Attached Files:

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  51. Pabs&Ro

    Pabs&Ro Member

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    Could you catch a urine sample? Vet can dipstick it for various things (not all of which are accurate) but some things are indicative. The sample needs to be fresh. So when you catch it put it in the fridge and out of the light. Might be worth the vet checking for blood and if cloudy perhaps get a culture? It seems odd that he is not responding to the increase in the dose (but an increase dose take 5 to 7 days to have in impact).
     
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  52. SashaV

    SashaV Well-Known Member

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    Red gums... get the vet to check it out! It could be the reason..
     
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  53. Oscar and Carrie

    Oscar and Carrie Member

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    I think Oscar must have know I was complaining! :nailbiting:

    After days of flat number he finally pulls a 5.7! Big drop so I'm expecting a big bounce in the morning, but let's hope that now the dose has kicked in I start to see an improvement
     
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  54. Alana & Fatty

    Alana & Fatty Member

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    Hi Carrie,

    Just saw your comment about the ketone reading of 1.4mmol/L -- if you search my name, there are some posts with some good discussion about ketones from last week or so. I'd definitely encourage you to get some more food and lots of water into Oscar and keep monitoring that. There seems to be a bit of debate about what exact number is trouble, but either way, that's higher than you want it to be.
     
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  55. Oscar and Carrie

    Oscar and Carrie Member

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    Thanks for the advice Alana, I'll definitely have a look through some of your posts.

    I'm feeding him six times a day at the moment. He has a larger meal with his shot, and then two smaller meals at +2 and +4. I have been adding two tablespoons of water to his main meal, but I'll start adding more to the smaller ones as well. I've not notice him drink at all from his bowl since I changed him to wet food.
     
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  56. Alana & Fatty

    Alana & Fatty Member

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    Ah yes -- Fats doesn't drink from the bowl either, just the bath tub tap! He basically gets "soup" to eat though. Hopefully that nice 5.7 means a lower ketone reading too. I think they can show up at lower numbers sometimes but that's for sure a good direction to be heading in :D
     
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  57. Oscar and Carrie

    Oscar and Carrie Member

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    I've just retested his ketones and they were down to 0.8mmol, definintely a better direction!

    His +4 BG was 4.2/76 and that's with him eating bits over the past hour. @Deb & Wink @JanetNJ shall I drop back down to the 1.25u tomorrow morning?
     
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  58. Deb & Wink

    Deb & Wink Well-Known Member

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    Agree with Sasha, those gums look like they are a bit inflamed, a bit of gingivitis, maybe some plaque on the upper teeth in the back. Can't see real well to tell. Definitely an "ask your vet" question.

    I don't think you do want to decrease the dose just yet. Mainly I'm saying that because of the slight elevation/presence of ketones.

    Finally some blues and greens! But you want more than 1 cycle with lower nadirs, and when your cat has some ketones. Try feeding a bit more food to Oscar, at his main meal if he will eat it. Maybe only a teaspoon or two. More food means he might not "burn up his own body tissue" to get energy to fuel his body. Ketones are produced when not enough food + not enough insulin and/or infection/inflammation.

    Keeping him hydrated will help to flush out excess ketones from his bloodstream too, since he'll need to pee more.


    p.s. New thread when you get a chance please, as this one is getting mighty long.
     

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