Donovan Dosing Advice -- New Curve 07/03/20

Discussion in 'Prozinc / PZI' started by Doc Bones, May 27, 2020.

  1. Doc Bones

    Doc Bones New Member

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    @Chris & China (GA) was kind enough to setup a spreadsheet for me a few months ago and I have finally filled it in with this year's information (I do have my prior year's information as well in case it would be helpful, I just haven't added it yet due to time constraints). I am wanting to know if these numbers look good or am I supposed to be trying to get him in the blue or green? My Donovan is eating more wet than he ever has before, but does still eat dry (Dr. Elsey's). When I have tried to remove dry food completely he has chosen to just not eat and could do this for a few days I suspect. He did this when he was initially diagnosed and switched to MD. So, I am taking a gradual approach with him. At this point I have decided I want him to eat period, even if it includes some dry. He is eating less dry than he used to and is probably at about 1/2 cup or less a day. Any feedback would be greatly appreciated.
     
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  2. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    The fact that you have gotten several Pre-shots that were too low to shoot tells us he may be getting too much insulin but there's really no way to know what's going on without some mid-cycle tests on the AM cycle and at least 1 test "before bed" on the PM cycle.

    The Pre-shots just tell us if it's safe to give insulin at all. The most useful information is the tests you get in between the shots to see how low that dose is taking him.

    If you can't get mid-cycle tests on the AM cycle due to work, it's even more important to get a couple of tests on the PM cycle and on any days off doing a curve (testing every 2 hours for 12 hours)

    Think of your spreadsheet like it's a puzzle. With only the pieces along the edges, it's impossible to know what the whole picture is. If you can sprinkle pieces (tests) all over, it makes it clearer what's going on.
     
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  3. JanetNJ

    JanetNJ Well-Known Member

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    Can you try to get mid cycle numbers? 3 units may be just a little much for those preshots but it's hard to tell without mud cycle info.
     
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  4. Doc Bones

    Doc Bones New Member

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    Yes, I will try to get some mid-cycle numbers on Saturday. Will it matter if he is eating throughout the day when doing it? For instance, because I am trying to increase his wet food consumption, he eats wet food at approximately 12:00pm, 3:30pm, and 7:00pm. These are in addition to the very tiny amount pf wet food that he is willing to eat at shot time (10:00am and 10:00pm). He won't eat wet food naturally on his own, hence the scheduled times.
     
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  5. JanetNJ

    JanetNJ Well-Known Member

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    feed however you normally do.
     
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  6. Doc Bones

    Doc Bones New Member

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    Great will do! I will update my spreadsheet with his new numbers on Saturday. Thank you so much!
     
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  7. Doc Bones

    Doc Bones New Member

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    @Deb & Wink , @JanetNJ, @Chris & China (GA) I completed most of a curve for Donovan last night. I missed his PMPS +6 and +8. Seeing his curve what would you recommend? Thanks for your help!
     
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  8. JanetNJ

    JanetNJ Well-Known Member

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    Low preshot today! Might take it down to 2.75 I'm glad you didn't shot this morning
     
    Last edited: May 31, 2020
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  9. Doc Bones

    Doc Bones New Member

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  10. JanetNJ

    JanetNJ Well-Known Member

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    I say that just to see if it helps you get two shootable numbers. If he doesn't get low enough you can always go back to 3.
     
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  11. Doc Bones

    Doc Bones New Member

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    @JanetNJ that makes sense. Question, are his numbers okay or I am supposed to be trying to somehow get him out of the yellow?
     
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  12. Deb & Wink

    Deb & Wink Well-Known Member

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    You do want Donovan out of the yellows, and down into the blues and greens. BG levels down at those ranges help to give the pancreas a rest and time to heal.

    With the curve you did, you can see how low that 3U dose took Donovan.
    You can also see how misleading the pre-shot BG levels are. They tell you that it's safe to give insulin, if the BG levels are high enough. But the pre-shots don't tell you how low the dose is taking Donovan.

    Our protocols base the dose changes on those mid-cycle nadirs, so you can see how important it is to get some tests in the middle of the cycle.

    Per the Prozinc SLGS dosing protocol, that BG of 77 is an automatic 0.25U dose reduction. You hold that new dose for at least 3-6 cycles, unless you get another low <90 mg/dL.
     
  13. JanetNJ

    JanetNJ Well-Known Member

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    Blues and dark greens are those nice healing numbers. :) he was getting close to the bottom of normal which is why I suggested taking the dose back just a bit. Looking good.
     
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  14. Doc Bones

    Doc Bones New Member

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    @JanetNJ, @Deb & Wink, and @Chris & China (GA) thanks for your prior help. I did decrease Donovan's dose to 2.75. His numbers don't necessarily look better to me; they look more inconsistent. Should I take him back up to 3 or maybe 2.75 for one of the doses (maybe night) and 3 for the other dose (during the day)? I thought maybe more during the day since he eats more during the daytime hours.

    What should I be doing differently to move him from yellow to blue? Thanks for your help! All advice and help are appreciated.
     
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  15. Deb & Wink

    Deb & Wink Well-Known Member

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    The pre-shot tests are important. They tell you if Donovan's BG levels are high enough to give him insulin in the first place.
    But you need some tests in the middle of the cycle, to see how low a particular dose drops Donovan. You need to find that nadir.
    That nadirs helps you to use the protocol and adjust the dose if needed.
     
  16. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    I'll repeat what I said earlier....You need to get some more tests in, otherwise there's just absolutely no way to know what's going on (as well as at least 1 test on the PM cycle.)

    Unfortunately, diabetes isn't a "set it and forget it" disease....darn it!

    We really just aren't comfortable giving much in the way of dosing advice without more data That's what a lot of our vets did before we came here and learned better.
     
    Last edited: Jun 8, 2020
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  17. Doc Bones

    Doc Bones New Member

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    @Deb & Wink and @Chris & China (GA) I'm happy to test more, I am just unclear about the timing of the tests. So 1 test in the PM cycle, is that before or after the evening shot? Should I be regularly also testing at +6, +8? I am not sure how to figure out his nadir. AM I doing the extra testing everyday? Every few days?
     
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  18. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    You should try to get at least 1 mid-cycle on the AM cycle ….so a test somewhere between +5 and +7 usually.

    Then on the PM cycle, you get the PMPS first, then get at least a "before bed" test....usually at least 2-3 hours after the PM shot.

    A lot of us drink a big glass of water in the evening so we "have to" get up in the middle of the night....and, well....as long as you're up, might as well grab another test, right?....LOL
     
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  19. Doc Bones

    Doc Bones New Member

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    @Chris & China (GA) gotcha. That is very helpful. I can do that. Should I get these numbers daily or every few days for a few weeks than check back in?
     
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  20. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Daily...every cycle.

    Insulin is a hormone and can react totally different from one cycle to the next. Remember being a 13 year old teenager? One minute you're laughing and the next you're crying (or screaming)?
     
  21. Doc Bones

    Doc Bones New Member

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    @Chris & China (GA), sorry if this seems dense, but I want to make sure that I do this correctly. Are you saying do a curve every day? For a few weeks?
     
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  22. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    No....a curve is when you test every 2 hours for 12 hours or every 3 hours for 18 hours.

    You need to always test before giving insulin....the AMPS and PMPS tests.

    The AMPS is the "morning" Pre-Shot...the test you get immediately before feeding/shooting in the morning.

    The +5 to +7 would be getting at least that 1 test somewhere between 5 and 7 hours from the morning tests. So if you give insulin at 6am, you'd want to get another test some time between 11am and 1 pm (5 to 7 hours since the shot)

    If you can get more tests in, that's even better but not required.

    On the evening cycle, the PM cycle, you'd get the PM Pre-Shot and then get at least 1 more test before you go to bed. If you can get more tests, that's great too but we don't expect you to stay up all night testing every night either.
     
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  23. Deb & Wink

    Deb & Wink Well-Known Member

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    Vary the times you get those mid-cycle tests too. Maybe a +5 one cycle, a +6 or +7 another cycle.
    You are filling in the picture of what the BG levels are.
    To make it even more complicated, that nadir doesn't always stay at the same time. So some days, you test a couple of times mid-cycle, trying to find out WHEN the nadir is happening.

    So Donovan was in the reds at PMPS last night 6/8/20, but we have no idea what happened with his BG levels after that. The protocols all look at the mid-cycle numbers (and with Prozinc the amount of the drop from pre-shot to nadir) to determine dose changes.

    "Know thy cat" is something that has been said on this message board many a time. So, test and make notes in the remarks column on the SS on when you are feeding and how much too. Every bit of data you share with us on that SS is taken into consideration when we make suggestions on the dose and other aspects of treating feline diabetes.

    Notes on the 5 P's (peeing, pooping, preening, purring,playing) and appetite are useful too. Letting us know how your cat feels is important too. Use that spreadsheet for all it's worth. You can really have a lot of data on that SS that will be helpful to you too, when looking back and trying to see the trends and the flow of the BG levels.

    We can't work in a vacuum. No "spacesuits" here, unlike on that spacex flight.

    Please don't wait weeks to get back in touch with us. I'll know you replied to this thread because I have an alert set and I'm watching it. Or a tag works. Usually, I'm only on later in the evenings this time of year. The gardens and home maintenance taking up my time.
     
  24. Doc Bones

    Doc Bones New Member

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    Thanks for so much information. I can do the multiple and varying cycle checks. I will make up a schedule for myself so that I can keep track. I do write down his eating habits, what, when, and how much, so I will continue doing that and can easily add it to the SS. I will work on the 5 P's as well. I have 2 litter boxes (one in a pretty hidden spot which is the most used) and a 1 year old cat so I will have to work on figuring out who is doing what in the box. The other habits will definitely be a little easier for me to track. I will am also more likely to be active later as well, its harder for me during the day due to work. Thank you!
     
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  25. Doc Bones

    Doc Bones New Member

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    Just to keep everyone posted. I am taking Donovan in tomorrow to the vet for a general check up, and blood test if needed, to make sure he doesn't have any kind of infection. His fluctuation in pre -cycle shots, and occasional vomiting is concerning to me (he threw up a tiny bit this morning). He is not a cat who vomits and the new irregularity in his levels are odd to me since he'd been so stable and there hasn't been any change for him. If anything, he is eating more wet food than ever before so I would expect improvement. I will post when I get information and proceed with getting the extra levels.
     
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  26. Deb & Wink

    Deb & Wink Well-Known Member

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    We do appreciate those updates, after a vet visit.
     
  27. Doc Bones

    Doc Bones New Member

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    Hi everyone, I have updated Donovan's spreadsheet and am going to try to get some post AMPS and PMPS results today or tomorrow. He's been a little skittish after going to the vet last week and me basically harassing him all week in order to get a urine sample so that I wouldn't have to take him back to the vet to get one. I finally got one Friday morning at 2:00am so I am now rebuilding trust. Not sure how willing he his going to be to come out an unscheduled shot times today or tomorrow. Fortunately, I will have some other chances this week to try. You will see from his spreadsheet he already refused a shot earlier this week which has probably happened three times in the entire time he's been diagnosed. So I don't want to take the risk of him refusing another shot by harassing him. I have added in food times for the past week on the spreadsheet. How much farther back will be helpful? You will see his dose is up to 3.25. My vet wanted it at 3.50 but I went to 3.25.

    I have uploaded his bloodwork and urinalysis for the last few months. We did discover earlier this year that Donovan has one kidney that is smaller than the other. This was new information. Thus, part of what I am trying to do is keep his kidney function as healthy as possible as long as possible. My Misty died in October and she had kidney disease. When she was still with us, he was eating Dr. Elsey's and Weruwa which seems to be CKD and diabetes friendly. However, since she died he has basically refused to eat it. I switched him to the Fancy Feast Savory Centers because he refused Friskies and regular Fancy Feast. I am now trying to sneak Weruva into his Fancy Feast Savory Centers to see if I can convert him now so that it won't be problematic later. He is very stubborn and is willing to just not eat anything if he doesn't like his food options. I also have one year old, Sierra Nevada, who I got as a kitten in December so now that she has transitioned form kitten food I am feeding them both the same -- new goal is to not get her to eat his food. The other cat's food is always better even if its the same, right! Donovan is non-aggressive so he will just let her eat his to avoid conflict. I am working on training them to use the microchip feeders.

    Because of the delay with me getting his urine sample I couldn't provide the full labwork until today.
     
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  28. Deb & Wink

    Deb & Wink Well-Known Member

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    Donovan is definitely due for another curve. How about Sunday? Or tonight, if you feel like testing every 2 hours at night? ;):):rolleyes: Nighttime curves can provide some interesting information.

    He had a nice blue at that +6 mid-cycle today. So he's hitting right in the middle, where the Prozinc SLGS dosing protocol says to hold the dose.

    Do please try to get at least one more test in every PM cycle, beyond the pre-shot test. Without that test, you are "missing half your data" as one of the moderators would put it. A "before bed" test is fairly standard and easy to get. Unless you work nights of course and never get a day off. :p
     
  29. Doc Bones

    Doc Bones New Member

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    Oct 27, 2019
    Hi everyone, I have new curve results for Donovan. Hist last vet visit a few weeks ago showed no sort of infection or changes but his levels are still fluctuating and high. His spreadsheet is up to date. There are 2 days where his exact meal times are missing because I can't find my post-it and I didn't record them in my journal. All advice is welcomed about dosing. Thanks!
     
  30. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    The curve looks good -- and then Donovan bounced! What that tells you is that your cat's not yet. used to spending time in more normal numbers.

    It really would be helpful if you can get more spot checks. A before bed test every night is truly essential. Without spot checks, you're missing a huge volume of data. You have no way to know if Donovan is in safe numbers. I can appreciate that you can't get tests if you're at work. However, a before bed test every, single night will let you know whether his numbers are dropping or if it's safe for you to go to sleep. For example, on 6/29, he was at 352 at PMPS and at 184 the following morning. You have no way of knowing how low Donovan dropped overnight.

    My other concern is that without more spot checks, you may be missing numbers that would signal a dose reduction. Is there any way you can get a few more tests on a daily basis?
     
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  31. NoahFL

    NoahFL Member

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    Jun 12, 2020
    New here, but totally agree. Had I not spot checked 2 hours after PMPS, I would have missed 2 hypo nights. Now, I always do it.
     
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  32. Doc Bones

    Doc Bones New Member

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    @Sienne and Gabby (GA) and @NoahFL, yes I can definitely do that. I wanted to start last night but Donovan was hiding with all of the fireworks. He wouldn't even come out for his regular 12:30am meal. I will start tonight and move his meal up from 12:30am to 12:00am so that I can test and then he can eat. Thank you!!
     
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  33. NoahFL

    NoahFL Member

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    My cats were the same way last night. I managed to get a test in, but they were all grumpy last night through this morning.
     
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