Don't go too fast with the dose increases. Are you using the MPM or the SLGS Prozinc dosing protocol? Neither your user id signature or the SS indicate which method you are using.
@Deb & Wink I think it’s called SLGS because y’all are generally suggesting an increase very slowly every 3 days. I should have asked for clarification when we started.
So SLGS (Start Low, Go Slow) looks for you to hold the dose for a week, do a curve, and then reevaluate the dose based on that curve, and the BG numbers you have gotten during the week. It's certainly ok to increase the dose faster than once a week. You don't want to increase too fast, and bypass a good dose for your cat. But I don't think you have done that. Felix's BG numbers are still high enough to warrant dose increases. Plus, anytime your cat drops under 90 when you are using the SLGS protocol (dosing method), that is an automatic earned reduction in dose of 0.25U. p.s. I tend to be more aggressive, and recommend dose increases sooner than the dosing methods would indicate, based on the higher mid-cycle numbers you are getting. Plenty of room to increase the dose, before you see greens at mid-cycle.
@Deb & Wink felix was 397 pmps last night and all of a sudden 75 amps just now This seems soooo off. He’s currently getting 1.5 units and my husband is really really afraid to give any insulin. Edit to add, we’ve had a hypo episode before and ended up at the after hours ER ($1000+ later...). We will be leaving for work in a little over an hour. @Panic @Diane Tyler's Mom @jt and trouble (GA)
Skip the insulin when the BG levels are that low, especially if you are unable to monitor. For future reference, since no one saw your tags in time. Also, if you get a BG number that seems really off, test again. It could have been a bad strip, or not enough blood so another BG test within a few minutes is a good idea. Throwing this out as an another option for you. "Better too high for a cycle, than too low for a moment."
@Deb & Wink thank you for the confirmation on what we were thinking. We tested 25 mins later and it was 105. I’m glad we skipped. Fingers crossed for this evening
@Deb & Wink weve been on the 1.5 for a little over a week. As you can see on his spreadsheet he has had a few scary numbers. +2 after his pmps last night he was 527 and today at +4 amps he was 47
That BG of 47 on 8/9/20 at +4 earned Felix an automatic 0.25U dose reduction, using our Prozinc SLGS protocol. Please reduce the dose to 1.25U for the next cycle. Actually, if you had tagged me on 8/6, when you got that 75 pre-shot AM BG test, I would have said to reduce the dose then. Those blacks = bouncing. So Felix is likely dropping to low numbers somwhere in the cycle, and you aren't catching it with a BG test. Whenever the numbers are that high, it's a very good idea to check for ketones. Urine (with ketodiastix) or blood (with a special meter). How is Felix's appetite?
@Deb & Wink His appetite has been excellent for breakfast and dinner and the mini meals in between. I can reduce to 1.25 starting morning. I just skipped when he was 75 (it didn’t dawn on my to reduce) and I didn’t realize to reduce when he dropped to 47 mid cycle. I guess I was “thinking” only to reduce if it was really low amps or pmps.
Any time. Any time in the cycle when the BG is < 90 and you are using the SLGS prozinc protocol means to please take that dose reduction. So now you know for next time!
@Deb & Wink thanks. Once a reduction of .25 is made, would that dose stay in affect for several days or a week (unless another reduction is earned)?
Yes, that reduction would remain for at least 3-6 cycles. Unless there is another drop below the reduction point for the insulin and dosing method you are using, MPM or SLGS for prozinc. It's only when the BG numbers are telling you that the reduction did not work, that you would increase again. But before you increase again, you need to let your cat clear a bounce, because the higher BG numbers persist for a few cycles usually. Your cat isn't used to lower numbers, so their system automatically dumps sugars and hormones into the system to bring those BG's back up, to what the body is more used to.
Felix did not "officially" earn a reduction, but he's awfully close. That 95 at +8 on AM cycle 8/15/20 is a squeaker. Anything < 90 gets an automatic dose reduction. Looks like you went with 1.5U. Please test Felix again during this PM cycle. A" before bed test" is a good consistent test to get every evening. Felix may drop low, since he was at 153 for pre-shot. Sorry, not able to get back to you in time. I'm taking care of a friends place while she is sailing the Maine coast for a month. Running very late, getting on the message board lately.
@Deb & Wink Sailing the coast of Maine sounds amazing. Lucky them! We decided to go ahead with 1.5 even though he was close. Keeping an eye on him. Will test before bed
@Deb & Wink Felix has thrown up a few times today and had very little to eat. We gave insulin this morning but have not tonight. Can we give insulin when throwing up? His number was 378 in the am and 407 for pm
I'm not sure that I would give Felix insulin if he can't keep any food down. That is because if Felix can not keep food down, then what would you do if he happened to drop to really low numbers? The standard way to bring those BG numbers back up, is to feed. Is there a reason for the vomiting that you know of? Vomiting is definitely a concern with any cat, but especially a diabetic cat. Pancreatitis? Different food flavor? Got into some food he should not have? Anything else? Ketones ok? Please test ASAP. Are you able to stay up and get more BG tests for the PM cycle?
@Deb & Wink No new anything with food or flavor. we think it is likely a hairball. He has done this before and it only lasted 2 days max and then would finally produce a hairball. We have not checked his ketones recently. Last time his numbers were super high we had them checked and he didn’t have any but the vet wanted to up his insulin to 4 units and that’s when he ended up at the emergency after hours hypo. We will skip tonight’s dose and hope for a hairball tomorrow
You can test the ketones yourself at home. With either a ketone blood meter or with a urine dip stick, ketostix. You don't have to go to the vet to have the ketones checked. Understood on the skipping the dose for tonight. You might want to read this thread, that talks about things you can do to cut down on the hairballs. https://felinediabetes.com/FDMB/threads/hair-ball-remedy.224077/#post-2506887