Mister's dosing

Discussion in 'Prozinc / PZI' started by MisterBillie, Jan 18, 2022.

  1. MisterBillie

    MisterBillie Member

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    Continuing from the discussion in my first thread here:
    https://www.felinediabetes.com/FDMB/threads/new-member-wet-food-feeding-guide-4-cans-a-day.257824/

    Today in his AMPS @ 1.5u, he tested at 341. I finally got around to doing a midday test which was recommended by @FrostD and it was 322 @ +6hrs. This leaves me more questions than answers TBH.

    His appetite is way down today. He even threw up a little bit of his food and is lethargic. I still haven't figured out how to get him to eat 5 cans a day (his weight is 17lbs). At this point, 3 cans is the most I can get him to eat and that's a good day.
     
    Last edited: Jan 18, 2022
  2. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Three cans is not bad, although with his size (he's 17 lbs??) he could eat more. You do not have to wait until he's finished eating to give the insulin. You test, feed/shoot... which can be done simultaneously.... the shooting and eating part :) That's what I always did. Usually shot while he was eating or, if I knew he was hungry, I just went ahead and shot then gave the food... but it was super easy to shoot while he was eating.
     
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  3. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Way to go getting the mid-cycle test!
     
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  4. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    A few more cycles and you will be able to increase, most likely, unless by some chance he starts to go lower. Maybe tomorrow you can try to get a +4 test to see what's going on there. It would be nice to know when the insulin onsets (starts to reduce the BG) because right now you can't tell! He is so flat in his numbers! I'm sorry! Hang in there.
     
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  5. MisterBillie

    MisterBillie Member

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    Hmm, I was hoping I wouldn't have to increase the dose.
    That was my thoughts as well, and also what @FrostD recommended where he wagered that he nadirs around +4 or 5. So maybe tonight and tomorrow I will try to get a +4 test.

    Also, here is my process so far:
    1. Feed him just before the 2hrs mark before preshot. He then fasts until Step 3.
    2. AMPS (AM preshot): Preform a Blood Glucose (BG) test
    3. Immediately after Step 2, feed him a 1/2 can (he usually doesn't finish it, only eating half of it just licks the fluid up mostly).
    4. Administer insulin @ 1.5u of ProZinc while he has just begun eating from Step 3.
    I just hope that he's eating enough in Step 3 to even fill his stomach enough to count as "eating". Also, it's good to know that I don't have to wait longer between Step 3 and Step 4 by the sound of it.
     
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  6. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I would just make sure he is actually eating when I give the insulin. I am sorry his appetite is not great. I sure hope it's just that he feels lousy from the high numbers and that he will feel better soon!
     
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  7. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    What did your vet say about the blood work you had done? She/He wasn't concerned about the values that were out of range? Also, what about the protein in the urine and the red blood cells?
     
  8. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Well, his numbers are too high right now so, if he doesn't start coming down, that's the road ahead. Sorry. Of course, it has to be done safely according to the protocols to keep your dear boy safe! All cats are different and they need however much insulin they need. Some cats on this board get one drop. Some cats get a LOT of units. My cat was over 40 units at one point.. but don't worry about that, he had Acromegaly and so had a "high dose condition." The point is, we need to find out how much he needs. And, having said that, a cat's insulin needs can and do change... that's why it's called the "sugar dance."
     
    Last edited: Jan 18, 2022
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  9. FrostD

    FrostD Well-Known Member

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    Yep, correct
     
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  10. MisterBillie

    MisterBillie Member

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    They did a urinalysis and didn't find an infection or anything. I'll look at the results of the urinalysis tomorrow more closely.
     
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  11. MisterBillie

    MisterBillie Member

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    He tested 270 at +3:38 after the PMPS. Should I up the dose to 2 units? Or not enough data yet?
     
  12. FrostD

    FrostD Well-Known Member

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    Hold it at least through tomorrow, I'm on the fence if he's bouncing or not. Per forum guidelines we'd increase to 1.75U as next dose
     
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  13. MisterBillie

    MisterBillie Member

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    And just to clarify, "bouncing" means the patient has too low of a nadir at some point and then their body's BG count surged as a result?

    Should I try a +2 or +3 test tonight?
     
  14. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I am not seeing tests today except AMPS? Definitely do not increase by more that .25 units. But we need more data to see how low this dose is taking him. I know you can do it!
     
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  15. FrostD

    FrostD Well-Known Member

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    Correct, either lower OR dropped faster than they're used to. Definition of "low" and "fast" vis cat-dependent, doesn't necessarily mean hypoglycemic-type-low.
     
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  16. MisterBillie

    MisterBillie Member

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    Yeah I was super busy today, I will do two tonight after the PMPS hopefully. I'll aim for a +2 and then a +5 maybe.

    I am now able to use the 30ga lancet instead of the 26ga. Hopefully this will reduce the pain for the cat.
     
  17. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    That’s great. I used the 30 gauge lancets free hand. Much smaller. You must be getting good!
     
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  18. MisterBillie

    MisterBillie Member

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    I just did a +2.5 after the AMPS and it was higher than the AMPS.

    How is that even possible?! This is super disheartening. It's almost like it's saline, not insulin.

    I can try another test in two hours, but I see no reason why it'd be a lower number.
     
  19. FrostD

    FrostD Well-Known Member

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    That is likely meter variance, we consider that flat actually. 20% variance for human meters, 15% for pet meters. So actually you just caught onset; they usually get a BG bump from the carbs they eat at AMPS, then the insulin kicks in and starts to lower. Guessing onset is about +2
     
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  20. MisterBillie

    MisterBillie Member

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    Ok, so shall I try a +3 or +3.5 then tonight. Or what is the next best step.
     
  21. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Yes. I would try a +3 or +4. How is it going with the testing?
     
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  22. MisterBillie

    MisterBillie Member

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    Good, my cat now waits in the designated staging area for the BG tests, lol. Here I thought he'd be hiding from me prior to the tests, turns out it's the complete opposite. He meows and wakes me up and leads me to the testing area now.

    The main problem I am having is that he typically will only eat a 1/4 can or less of a 3oz small can in a given sitting, which makes feeding him a full time job. That means I have to feed him like 12 times a day or more. Likewise, this makes it hard to do multiple tests in a day because of the requirement of the cat having to fast 2hrs prior to testing. So the more instances of him being fed, the more potential BG test windows he ruins. The annoying part is that he still isn't eating even close to as much as he should be according to Fancy Feast's feeding guide (he should be eating 4-5 cans a day, but he's only eating less than 3).

    His urine clumps in the litter box is like glue, I am going to need to use a high end scooper made of metal (let me know if anyone has suggestions) to pry these clumps from the sides of the litter box. So far it does not appear the insulin is doing anything as far as I can tell. I might have to force him to fast so that I can have more testing windows.

    Overall, I wouldn't wish this situation on my worst enemy. "Sleeping in" is a thing of the past now. I have yet to have an uninterrupted sleep cycle since his diagnosis. I will never be able to go on vacation or do weekend cabin trips. I might as well sell all my sporting equipment. At this point, I would literally rather have myself be diabetic instead of my cat having diabetes
     
    Last edited: Jan 20, 2022
  23. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    What kind of kitty litter are you using. I have a LOT of suggestions. If you want a dust free litter that doesn’t turn into sludge, try:
    https://www.chewy.com/garfield-cat-litter-super-clump/dp/147769#pdpGallery

    Garfield cat litter clumps fast and like a rock! But it will track like samd.

    Another great, very dust-free litter is Grass Litter. Either Pioneer Pet Smart Cat Litter or Chewy’s Frisco version (are you in Camada? Sorry because Chewy doesn’t ship to Canada.).

    https://www.chewy.com/pioneer-pet-s...erm=4584688617261494&utm_content=All Products


    These two litters are the best clumping litters that I have used. I have/ have had a zillion cats so I have tried sooo many.
     
  24. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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  25. MisterBillie

    MisterBillie Member

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    @Suzanne & Darcy Dr. Elsey's Ultra Cat Litter. I've never had an issue with this litter until very recently. I think it's due to diabetes, it causes sugar in the urine and makes it like glue. I think this problem will occur with any litter until I can figure out how to get insulin to actually work.

    Good to know on the iPrimio scooper being good, that was the one I had in my cart on Amazon and was about to order.
     
  26. MisterBillie

    MisterBillie Member

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    I threw my ReliOn Premier Blu as hard as I could against the wall today during the PMPS in anger. Kept getting Er4 three times in a row when it wicked up the blood drop, never had that issue before until now.

    None of my BG tests are telling me anything useful. I might as well be injecting saline and pricking my cat's ear for no reason whatsoever, the result would be the same.

    Time to shop for a new meter. I wish they made one that also could test ketones at the same time. Or maybe I should just get the Alphatrak 2
     
    Last edited: Jan 21, 2022
  27. FrostD

    FrostD Well-Known Member

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    Ah, not enough blood. It happens!

    The insulin is working, he just needs a higher dose. Patience.

    You listed SLGS on spreadsheet, per that method you would hold the dose for a week or until you can do a full curve (test every other hour for 12 hrs). If you can get 4 tests in per day - the 2 preshots, plus one more in each cycle - you could follow the MPM which allows for faster increases. Ideally, those other tests would be close to nadir. Per MPM you could increase as soon as tomorrow, if you have a meter. With MPM we don't reduce until they go below 50, but in your case I wouldn't recommend that. I would follow MPM til he gets in a better BG range, figure out what you're comfortable with in terms of BG, and switch back to SLGS if needed.

    I wouldn't waste your money on AT. There are several meters out there that use the same sample size (0.3uL) which may make things easier - NovaMax Plus being one of them. It's 0.3uL for BG, 0.8uL for ketones. Those ketone strips are even more painful to waste, but BG strip cost not bad.

    Were you the one that said you're a network guy? I did fair amount of industrial Ethernet back when I was working - you have to put the overly analytical part of your brain aside for a bit. The meters have error, it sucks, but you'll go crazy overanalyzing every little thing - "is it 300? Or is it 240? Or 360?". Doesn't matter. The trends are what you want to look at. High is high, he needs more insulin - ultimately that's the conclusion that matters.
     
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  28. MisterBillie

    MisterBillie Member

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    I am not sold on SLGS by any means, that's just the first method I've come across so far. So as soon as tomorrow, I can try a +2, +4, +6, +8, and +10 test all in one 12hr period? AM or PM? Jesus, my cat is going to hate me. This is going to be terrible.

    I did the 4 tests per day on 1/18 through 1/20. The data didn't tell me anything other than I might as well be injecting saline. What is "MPM"?

    No, that was someone else. I have yet to find a nadir. I would wager there is no nadir to find, this insulin is defective or I must be choosing precisely the exact wrong window to be testing each day. I do not see an actionable solution or a path forward to get these numbers down, other than just blindly upping the dose while I have yet to witness a nadir.
     
    Last edited: Jan 22, 2022
  29. FrostD

    FrostD Well-Known Member

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    Few things:
    The 4 tests would have to be each day.

    I wouldn't bother him with a curve. I would just try for +4 and +5 tests right now.

    You usually test at +2, that's often onset - when the insulin is just starting to work. Of course you're not going to see much difference there, just because of the way insulin works. Nadir is usually +4 to +6. The +6 you got a few days ago tells me nadir is before that. The +3 you got in a PM cycle was a good drop, which is why I wage nadir is +4 or +5 - but you haven't gotten those tests yet.

    Here are the two dosing methods: https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

    Quick summary:
    *Remission is achieved when they are in mostly normal numbers, so 50-99 on human meter, with no insulin. So you slowly work your way down as their pancreas heals and requires less insulin.

    SLGS does reductions under 90; requires you to hold a dose for a week then do a curve. This isn't in the official method, but I personally "accept" scattered test data over 2-3 days in lieu of a curve. Advantage is usually less testing, less intervention with higher carb food when they get into lower numbers. Disadvantage is holding a dose long time while in higher numbers, low chance of remission.

    MPM you cannot give any dry food. Reductions under 50. But because it allows their BG to go that low, you have to test more to keep them safe. It has better chances at remission, allows for faster increases.
     
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  30. MisterBillie

    MisterBillie Member

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    I did a +4 during the PM cycle just now. It was 268... So again, the data seems to suggest the insulin isn't doing anything. So I guess I have to try +5 during another cycle because I feed him after tests. Should I just jump to 2 units tomorrow or stick with 1.75F and do a +3 and a +5 tomorrow?
     
  31. FrostD

    FrostD Well-Known Member

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    I would get one more +4 or +5. If you don't see blue, I'd go to 2.25U. if you do see a blue, go up to 2U
     
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  32. MisterBillie

    MisterBillie Member

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    +5 is 314 after 1.75F units. Unbelievable...

    So up it to 2.25u tonight?
     
  33. FrostD

    FrostD Well-Known Member

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    Yep

    *Or you could wait til morning, I always preferred that since I was awake
     
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  34. MisterBillie

    MisterBillie Member

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    Ok. I'll be awake all night probably anyways.

    Is it possible the nadir is much later than we think, like a +7 or +9?
     
  35. FrostD

    FrostD Well-Known Member

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    Possible, but it would be pretty unusual - plus, the midcycle tests you have do not indicate a late nadir
     
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  36. MisterBillie

    MisterBillie Member

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    Been on 2.25U for a few days now, not seeing any progress. His numbers are getting worse.

    Going to up to 2.5U tomorrow and do more testing.
     
  37. FrostD

    FrostD Well-Known Member

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    You do not have enough midcycle tests to know how low the dose is taking him. If you can't test during the day, then you'll want to do a curve before considering an increase.

    Numbers are about the same considering meter variance, I wouldn't consider them worse
     
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  38. MisterBillie

    MisterBillie Member

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    What tests should I do today so we have a curve? +3, +5, +7?
     
  39. FrostD

    FrostD Well-Known Member

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    Sorry I missed this, but yes a curve is every other hour for 12 hours, or every 3 hrs for 18 hrs
     
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  40. MisterBillie

    MisterBillie Member

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    Testing has commenced. It's looking like his "nadir" is late... The +9 will be lower than the +7 if this trend continues, I will know more in 2hrs.

    Also, by definition there's no way to get him tested exactly every two hours, because it takes 15 mins after the BG test for him to eat. So the +4 becomes a +4.25, and the +6 becomes a +6.5, etc.
     
  41. MisterBillie

    MisterBillie Member

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    Hmm, just as I thought. There really isn't a curve. He's stuck in a state of hyperglycemia. Should I even bother with a +11?

    I can already see the pain in his back legs getting worse day by day.

    Is this glucose toxicity? Should I up the dose even more for the PMPS? SLGS is not working at all, if anything this is the exact wrong approach. Wasn't it Dr. Lisa who said to use a unusually large dose to knock them out of a state of glucose toxicity?

    Should I switch to Lantus? Does anyone know the name of that cat only vet in Cali that claimed 80% remission rates? I might need to reach out to them to see what I'm doing wrong.
     
  42. FrostD

    FrostD Well-Known Member

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    I don't see why you're calling it flat. There is a curve, and actually a nice flatter one. Much better for the cat than wild swings. I would increase another 0.25U.

    Nothing says you have to stick with SLGS. You an change at any time, provided he's completely low carb wet diet and you can do the requisite extra testing.

    Beware quack vets. We're lucky if 1 cat a month goes into true remission here. Many of those vets call remission anything under 150 and do not properly titrate the dose down. What they don't tell you is those cats end up relapsing.

    He's getting nice curves on ProZinc, I wouldn't switch yet, but also no harm in switching. But Lantus is not great at pulling down higher nunes, it's better at keeping low numbers low. So it may take you a little longer to break through toxicity.

    A one time large dose is not wise. You run a very serious risk of a hypo event, and odds are he's just going to bounce sky high after...that shock to his system will make his liver panic and dump stored glycogen and hormones into his system, and the cycles continues
     
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  43. MisterBillie

    MisterBillie Member

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    How do I know this already isn't happening? I'm not sure why +1 is even on the spreadsheet, no one can perform a +1 or +1.5 test given the restriction of not being able to feed the cat 2hrs prior to testing. If he's going hypo @ +1 or +1.5 there's no way to know.

    Edit: I just did a full 24hr curve. Now we have the data. What now, should I up the dose to 3u tomorrow? Or go to the vet to see if another underlying issue is causing the insulin to not work?
     
    Last edited: Jan 30, 2022
  44. FrostD

    FrostD Well-Known Member

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    So I just want to clarify - you don't have to withhold food for midcycle tests. Only the preshots so you have a consistent number to base decisions on.

    Again, the insulin is working. The dose just isn't high enough yet, but you need to be patient and give him a few cycles to see how the dose works for him. Like yesterday you increased to 2.5 and then 2.75, you need to stick with it and not change it. Give him 3 days minimum at 2.5U, then consider an increase...but again you need midcycle tests, I'd be aiming for +5 or +6 if you can.

    You just need to hit a breakthrough dose to get through the glucose toxicity, once that happens he should start to come back down in dose. There is always a chance there's an underlying condition causing insulin resistance, but we don't recommend those tests until they hit 6U (most vets won't run them til they hit 2U/kg)
     
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  45. MisterBillie

    MisterBillie Member

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    Great info as usual, thanks

    Looks like I will be going to 3u tomorrow. Seeing that 190 after a full day of doing curves was very frustrating. Never saw blue again after that.
     
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  46. MisterBillie

    MisterBillie Member

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    On to 3.25u. This is beyond frustrating at this point.

    I'm beginning to think the vet's method of just blindly saying do "X units" where X is a large number is the way to go. I'd rather flirt with hypo, which is controllable and immediately solvable, than drown my cat in sugar for months with SLGS. If anything, SLGS is BUFFING/strengthening his glucose toxicity.

    Is there any scientific data to back that SLGS is better than any other method? Which vets endorse SLGS?

    I'm think I'm gonna do 0.5 increments from here on out, there's no reason not to. I don't see why I would waste time doing 0.25 increments over 0.5 increments. In fact, I might even do 1u increments if this thing really starts going past 4u. How else am I going to break through the glucose toxicity?

    Unless you're testing every hour in perpetuity, you can never know for a fact that you've not missed a nadir.
     
  47. FrostD

    FrostD Well-Known Member

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    You're not really following either method. I hear your frustration, and honestly I'm not sure how much more we can do for you. Need a big pair of patience pants!

    You are increasing faster than SLGS is written, not getting curves. You can follow MPM for faster and possibly larger increases (0.5U until he's seeing blue, re evaluate every 3 days), but honestly you're not getting enough tests during the day. Youd need at least one during the day, ideally before +5.

    Most people in your situation I advise to start with MPM, do the grunt work of extra testing up front to get them into better numbers more quickly. Then once they're there, SLGS is often a better option for most people.

    All I can do is give guidance based on how the protocols are written and the experience I have with cats here. If you choose not to follow it, then unfortunately there's nothing more I can do to assist. I don't mean that any particular way, it's just facts and forum rules. You are always more than welcome to do what the vet wants you to, you know the risks. The problem is no, hypos are not always controllable and easily solvable. Without tests, you have no idea how low he's going and you may not catch it. Hypos can drag out, we've had cats seize for 8 hours straight. We've had cats die. We've had cats paralyzed, left blind. And none of that was due to advice here - that was by too large of doses and lack of monitoring. It's not fear mongering, I just want to make sure you know that it's not that simple.
     
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  48. FrostD

    FrostD Well-Known Member

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    You don't need to know exact nadirs you just need to have enough data to make a reasonable inference.. Also, above 5U we do larger increases, we usually aim for increases being about 10% of the dose.

    Nobody has claimed SLGS is better than another method. In fact, I'm sure we've mentioned that it can take longer to get into better numbers.

    Most vets follow the AAHA guidelines (here's a flowchart), I'm sure you'd find those not exactly satisfactory either. Anything under 300 considered good glycemic control . Doses held for 7-15 days, then a curve. Nadir 80-150, hold the dose. Greater than 150+ no clinical signs, hold for 1-3 months. Clinical symptoms, increase by 0.5-1U and recheck in another 1-2 weeks.

    So, do with that what you will. But in my opinion when seeing a nadir from 150-200, increasing the dose by anything more than 0.5U is a recipe for trouble. It will also exacerbate bouncing in many cases.

    Now if you read the ProZinc insert, they did a study of 176 cats. 71 of whom had hypoglycemic episodes (BG less than 50 and symptomatic - dazed, lethargic, weak). They did another study, 145 cats, 20 had symptomatic hypos. 3 had serious hypos, two of whom died.

    All any us can do is what we think is best for us, our cats, and our situation. We've educated you on how this forum does things; other groups, other vets, etc will all recommend slightly different things.
     
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  49. MisterBillie

    MisterBillie Member

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    Okay, I will follow MPM then. But unlike SLGS, the MPM guide is incredibly poorly written. What exactly is the difference between it and SLGS. It says "if you started with SLGS and switch to the modified method, please skip to “Changing the Dose” below", does that mean everything that you skip is to be ignored and instead you follow everything in SLGS plus what is mentioned in "Changing the Dose" under MPM?

    I was about to create a flowchart of MPM, but I just noticed MPM cannot actually be flowcharted because it contains logical inconsistencies. For example, observe these four bullet points
    • In general, dose changes are made in increments of 0.25u. In sensitive cats, it may be necessary to make even smaller changes.
    • If a cat is having nadirs above 200, then dose changes of 0.5u are recommended.
    • Occasionally we see cats who need the dose held longer than the recommended 3-6 cycles because they are very prone to diving BG numbers or bouncing. Collecting data and learning your cat’s patterns are essential to determining if your cat might be in this category.
    • Conversely, holding the dose for too long can lead to glucose toxicity - when the blood glucose gets “stuck” and even increasing seems to do nothing. If this happens, seek advice on next steps.
    It is impossible to satisfy all of those. Bullet point #1 recommends considering 0.25 or even smaller changes. Then bullet point #2 says 0.5u changes are recommended for cats with nadirs above 200. Which is it? How do I know that the high nadirs aren't caused by 0.25u changes being too excessive? It's not clear if 0.15u or 0.5u is more appropriate for a cat with high nadirs. Likewise, the last two bullet points are completely contradictory as well. Regarding the third bullet point, how do I tell if my "cat might be in this category"? By opting for bullet point #3, it will likely cause bullet #4 to happen. And vice versa regarding bouncing.

    The AAHA flowchart is very clear and I can definitely follow that. MPM is not written well enough to be logically applicable. If someone can work with me and explain MPM in a logical way, I will flowchart MPM and share it here. Until then, all I see when I read MPM is a wall of text with contradictions and ambiguities.

    I can test as often as needed. I already did a full 24hr curve, which really didn't reveal anything useful other than no progress is being made. Then I reverted back to doing midcycle tests, all of which are just high 200-300 range. So to do more 12hr or 24hr curves is not going to yield anything useful on these little baby 0.25 increases.
     
    Last edited: Feb 6, 2022
  50. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
    Yes, lets go with this idea then. But again, MPM does not explicitly state how often and when to test. Terms like "at least one" and "ideally" doesn't compute for me. I missed a couple days there as you allude to, otherwise I have been testing him "at least once".

    I just read MPM like 4 times in a row. The more I read it, the less it makes sense. MPM says you can hold subsequent doses after the initial dose for 3-6 cycles (1.5-3 days). To increase the dose, it also requires that you know "How low has the current dose taken kitty over the last 72 - 96 hours" (3-4 days), which is impossible unless your cat fasts the entire curve and you do a full 24hr curve the entire time for those 4 days. Does that mean I have to wait the 1.5-3 days and then do curve testing for an additional 3-4 days in a row, or can these windows overlap? Lastly, to increase the dose by 0.5u or less, MPM says I need to do (5 tests in a curve)*(4 days)*(2 curves in a day) = 40 tests before each 0.5u increase?!

    MPM should be rewritten to be more explicit. An unordered list is an unacceptable format for something like this. For starters, during that non-curve window of 1.5-3 days, exactly when should I test him and how often? I can test him anytime and any frequency. If I test him at +2 and +4 and see high numbers, then anyone could argue that I missed a nadir at +3 or +5 or +6 or +7. If I test him at +6 and see high numbers, then how do I know the nadir didn't happen at +2, +3, +4, or +5? With these mid-cycle tests, the takeaway seems to be that I'm never picking the correct window. If I pick +4, then I shoulda picked +7 in hindsight. Now that I'm doing +5 and +7 tests, now I need to go back to something before +5?

    Does anyone have an example spreadsheet of someone successfully using MPM on a cat that achieved remission? Maybe I can reverse engineer MPM via their spreadsheet to make it make sense to me.
     
    Last edited: Feb 6, 2022
  51. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Ok, couple of things to baseline again:
    • The only tests that need to be fasting are the preshots. When doing a curve, you let the cat eat however they normally would
    • Remission is a great goal, but is simply not possible for all cats. You may be setting yourself up for a lot of frustration. The cats that go into a quick remission most typically became diabetic due to steroids, infection/dental/other issues. Just being completely frank, I do not see a quick remission for Mister. Possible, yes. But with the dose and numbers he's at, his pancreas is helping zero right now, so it needs time (likely months or more) to heal.
    Look for Panzer on the Main Forum, he is getting close. They just moved with a lot of stress so he had a minor setback. Marie and Red on the ProZinc forum are also very close, and there was Stephanie and Johnny not too long ago. I actually think both Panzer and Red are on a "modified SLGS" because the caregivers didn't like the reduction point of 50 for MPM. You can always choose to modify SLGS by changing reduction point, or saying I'm going to increase faster/larger (with the appropriate testing added in) but you need to define what that means and be consistent. We recommend putting "SLGS custom dosing" in signature, then defining your parameters at the top of your spreadsheet. But the more custom you get, the less we may be able to help.

    As for the guidelines, I understand your feedback. I believe the moderators are currently reviewing all the guidelines, so I will send them your feedback. The challenge is it is difficult to make a one size fits all...cats that react strongly and/or bounce a lot are handled differently than cats that don't. Thankfully, Mister isn't one of those cats, which makes things easier.

    For anyone lurking, guidance below is specific to Mister - a non bouncing cat with gentle ProZinc curves.

    Tests : over the span of 3 days, test between +3 and +6 however makes sense for your schedule. Now that you have a decent amount of data, we know his nadir is somewhere in that range. So Day 1 AM might be +4, PM might be +3. Day 2 AM +5, PM +3 again because you want sleep. Day 3, +6 and whatever else. Based on that, was can reasonably infer what his nadir is. So you're looking at 4 total tests per day minimum. If you want to increase closer to the 2 day mark, then you need to get those tests in a 2 day span instead of 3. Caveat: if he bounces, you need to hold 3-5 days because bounces obscure the baseline numbers.

    Dose changes, assuming MPM:
    Nadirs above 200 - increase by 0.5U.
    Nadirs 150-199 - increases are 0.25U by default. You can consider a 0.5U increase if not consistently seeing blue.
    Nadirs 120 -149. 0.25U increase, never any larger.
    Nadirs 90-120: you now need to hold the dose 4-5 days. 0.25U increases but you need to monitor carefully when you do increase. If that turns out to be too much, that's when you can try the smaller increments.

    Reductions with MPM are 0.25U any time he goes below 50, or you can reasonably infer he went below 50.
     
  52. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
    Thanks, that's helpful. I will try to follow that strictly. And I guess I'm still not sure I know what a "bounce" means... or more importantly, how I know for a fact it's a bounce vs. something else like meter variance.

    And in your example, if he's reading high numbers, then Day(s) 4 through 6 would need to be curve days where I do 12hr or even 24hr curves? Or just one curve on Day 4 is enough, then Day 5 I can increase by 0.5u?
     
    Last edited: Feb 6, 2022
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  53. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    I will reply to this later - there are quite a few examples I just have to find links. For some reason recently we have an influx of cats not handling ProZinc well. Cris and Wolvi on the ProZinc forum, Kaia out on Main Forum.

    It's usually characterized by a fast/big drop, followed by almost equally fast shot back up. More info than you want at this point, but when that happens nearly every cycle it's a duration problem not a bounce (which seems to be Kaia's issue).

    Just peeked at some spreadsheets - CourtneeP on this forum, caught a low last night and up to black numbers this morning. Ace & Chelsea - greens yesterday, high numbers today
     
  54. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Before I explain all of this for you so it makes it easy for you and other new members to understand, the MPM was written with input by several experienced members who also proofread it for accuracy, clarity, etc. Consider that because you are new to all this, you don’t quite understand it which is normal. There’s a huge learning curve and we use alot of vernacular not found in everyday life. We all have the same issue when first looking at a method of dosing. So let’s break it down so you do understand the intent and how to use it. :)

    My answers to your questions are based on the Prozinc Dosing Methods Sticky just so we are on the same page and looking at the same document.

    SLGS is the initial method of dosing that was developed here long, long ago and all insulin users, regardless of the type of insulin they were using, used it. It’s all we had at first. It was formulated by the moderators and members back in the day based on anecdotal information and data that members were collecting data.

    MPM is also anecdotal but is modeled after Tight Regulation (TR) used by Lantus/Levemir/Biosimilar insulins. The TR protocol was developed by Dr. Kirsten Roomp and Dr. Jackie Rand and published in veterinary journals. MPM, like TR, is more aggressive, allowing for more frequent dose changes in response to the BG. As an example, SLGS would have you hold a dose for a full week even if the BG was in the 300s or above where as the MPM allows for the dose to be changed when it’s evident it’s not working.

    The reason it states this is the “starting dose” of insulin is only applicable under either method for the very first time you use the insulin in a newly diagnosed cat. If you started the initial insulin dose under SLGS at either 1u if the kitty is on dry food or 0.5u if on wet, you wouldn’t go back and start over again if you switch to MPM. As an example, let’s say you feed canned food and start with SLGS. The starting dose is 0.5u. Assume your cat is on insulin for a month and, under guidelines for SLGS increasing the dose, after a month, the kitty’s dose has had to be increased 0.25u every week. After four weeks, the kitty’s dose would be 1.25u (0.5 for week one, add 0.25 for week two, add another 0.25 for week three, add another 0.25u for week four).

    The starting dose under MPM (that is if you went straight to MPM without doing SLGS) is 1u. So if you switched from SLGS and the kitty was on 1.25u, why would you drop the dose back to 1u if the kitty had not earned a reduction? You wouldn’t. So you don’t need to consider the information on “Starting Dose” under MPM; that would be the only information you would skip. You wouldn’t skip everything before that.

    I’m a scientist by education and experience and I disagree that MPM can’t be flowcharted but I also don’t believe it requires it. FD can be difficult enough as it is so keep it simple and don’t make it harder :blackeye:

    First, note what it says at the beginning...”general guidelines”. That doesn’t mean every one of these will apply to every cat. So you don’t need to “satisfy” all of them. These list special circumstances you might see that need some flexibility to the standard way we do dose increases. It’s not a hard and fast rule. Every cat is different.

    The first bullet opens with “In general, dose changes are made in increments of 0.25u”. That’s where you start. You don’t make changes in smaller amounts unless you have the data to tell you the kitty needs that particular approach which typically takes quite some time to gather the data. In 12 years, I’ve seen a few cats that needed smaller dose adjustments and my Gracie was one of them (on Levemir) but almost all of these cats are long-term diabetics (as Gracie was).

    The second bullet allows one to make larger dose increases if the nadirs warrant it. This guideline is separate from the one above it. And note...it also says “are recommended”. Perhaps that much of an increase is too aggressive for your kitty. So don’t do it. But there are definitely cats here in the +300 BGs on 5u bid who need that kind of increase as well as cats on a lower dose than that.

    The third bullet is also separate from the other two. It’s all about collecting data and knowing your cat. I learned with Gracie that if she responded well to a dose, I needed to hold it for at least 11 cycles to see if she would continue to do well on it.

    And the fourth is a warning about what can happen if one holds the dose too long. Members, especially new ones, are often reticent to make changes in the dose especially if the vet is telling them that 300 is a good nadir to have. That builds glucose toxicity but many vets are overly cautious because they are not able to be there 24/7 to help a client with dropping BGs. But this doesn’t just apply to cats in higher BGs. If the nadirs are consistently 250-300, that’s too high and over renal threshold for many cats.

    You asked “How do I know that the high nadirs aren’t caused by 0.25u changes being too excessive?” Well, you collect data but that is not what happens. If a 0.25u increase is too excessive, it’s going to cause the BG to drop, not rise. Again, as I said before, it’s unusual for newly diagnosed cats (i.e. cats diagnosed less than a year) to need really small adjustments in dose unless the kitty is just about to remission and we need to taper the last few doses down by drops. You will know if you get to that point because we know what it looks like and when it’s needed. Ask.

    I’ve yet to see a high dose cat need a dose increase of 0.15u. But my bigger question is why are you worried about that now? A high dose cat is one that is on greater than 5u bid. If Mister’s dose continues to climb and you continue to post, members will help you decide how much to increase his dose. For cats that have acromegaly or IAA, once they get over 6-7u, we are increasing by 10% the dose so if a cat is on 8u bid, we’d round up and the dose increases would be by 1u bid.

    But you are putting the cart before the horse. Take a deep breath and follow the MPM basics: 0.25u increases for nadirs under 200 and 0.5u increases for nadirs over 200. As you build data, you might determine that 0.5u increases are too much for him if his nadirs are 200-300. So do 0.25u. Keep.It.Simple.

    The last two bullets are not contradictory. Read what bullet 3 states: “Collecting data and learning your cat’s patterns are essential to determining if your cat might be in this category”. We also have many experienced members to help you look at data and make that decision. Sometimes it’s very hard to see the forest for the trees and an unbiased eye can spot if the cat needs more time at a dose. For example, consider a situation where Mister is seeing nadirs in the 100-150 range, especially when he first starts seeing those numbers, but then he pops up into the 400s because he’s bouncing. The first thing to do is flatten the curve so he’s not experiencing such fluctuations. That would require holding the dose a little longer.

    Not every cat needs to be tested at the same time or with the same frequency. Insulin is not a medication; it’s a hormone. Don’t expect to get the same results from it every cycle and especially not in every cat. Insofar as testing....let your meter be your guide!!! Unless his BG is dropping quickly or into lower numbers, test at different parts of each cycle especially during the a.m. cycle. Figure out when his onset, nadir, and duration are. That will help you learn when you generally need to test. If he’s dropping by onset, you definitely need to test more. If he’s rising, you can test less.

    "How low has the current dose taken kitty over the last 72 - 96 hours" (3-4 days), which is impossible unless your cat fasts the entire curve and you do a full 24hr curve the entire time for those 4 days. Does that mean I have to wait the 1.5-3 days and then do curve testing for an additional 3-4 days in a row, or can these windows overlap? [/QUOTE]
    We don’t test 24/7 and you use the data you have. You also don’t need curves for MPM as you would for SLGS.

    You should test enough early on to determine his onset, nadir, and duration. If you know “about” when he nadirs (and yes, this can change), then you know when to test and based on that, you’ll see how low the dose is taking him over several days. So it’s not impossible. Members do it here every single day. You are missing the point. If you hold the dose for 3-6 cycles and only test at PS, you are never going to know how low the dose is taking him. So you shouldn’t increase. Conversely, if you have gathered some spot checks at different times of the cycles and it’s clear he’s onsetting at +2, you can start testing at that point consistently to see how far he drops. If you’ve figured out his nadir is in the +4 to +6 range most cycles and after four days, you see his nadir is not dropping below 100 at any cycle, then increase the dose by 0.25u. No curve needed.

    No...it doesn’t say that anywhere. It states when you first start out, you’ll want to check at least at PS, +3, +6, +9 for a few days. That’s building data. That’s keeping you from surprises since a new member will not know how the kitty will react to the initial dose of insulin.

    One thing you will learn is that managing FD is as much an art as it is a science. No two cats are exactly the same just as no two caregivers are. That’s why dosing methods are not written to be so explicit. If they were, many members couldn’t follow them as written because of a variety of factors including their work schedule, other family members’ needs, a cat that doesn’t like to be tested, etc etc. I could go on and on. There has to be built-in flexibility.

    The information is right there for you to read. There is a very detailed discussion under “Increasing the Dose”. Again...MPM does not require any curve. No one can tell you when you should test him exactly and how often. It depends on what his cycle is looking like. If you test him at +2 and +4 and you get high BGs, it’s unlikely he’s going to drop so you might want to test at +10. It’s very unlikely he nadired between +2 and +4 if both those BGs were high. I hate to repeat myself but don’t make this harder than it is. It’s never a bad idea to check at PS and +2. If numbers are headed down at +2, how fast? If they’ve come down fast from PS, test again at +3. If it’s slow, test at +4. If the +2 is really high compared with the PS, test at +5 or +6. We can help you decide when to test if you post but this is a learning curve for you; you will ultimately have to learn when you need to test based on his onset, nadir, duration that you see after you have data and based on what your meter says.

    Please read all that, absorb it, and ask me questions. We are here to help and explain things but as you read everything over, keep in mind we have to have flexibility. We have to give general guidelines that members can use to apply to their cat. There is structure but there is also the ability to do what works for your cat. That’s the problem with the AAHA flow charts.....they assume every cat reacts in the same manner. They don’t. Your job is to learn your cat and we can help you learn how MPM works for your cat.
     
    Last edited: Feb 6, 2022
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  55. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
  56. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    You are very welcome. I’m happy to answer any questions you have. We all want the best for Mister.
     
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  57. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
    Hmm so theoretically I am on track to do a 0.5u increase as soon as tonight?
     
  58. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Looking at the data, it is reasonable to assume he has seen blue on two cycles, today looks like a bounce from blues last night. Per the dosing methods as written, I would do 0.25U increase. Should you choose to do 0.5U, I think that will lead to more bouncing.
     
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  59. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I don’t like to disagree with other members that have been around a while and are experienced like Melissa. But…it is what this forum is about…getting different opinions and deciding what works best for you and your kitty.

    You have several cycles where there are no mid cycle tests. Could he have come down to below 200? Sure. I’ve seen cats be higher at PSs and dip lower during the cycle and without a mid cycle test, we wouldn’t have known. If he did come below 200, I doubt it was much.

    However, he actually looks pretty flat to me (every meter can have a 20% variance from test to test); I see no evidence of dive and bounce cycles.
    Normally, I would suggest you raise the dose 0.5u but you are already shooting a skinny dose (which I would suggest you avoid shooting fat and skinny doses). If you raise by 0.5u, you will still be shooting a skinny dose. If you raise to 3.5u, it gets you on a good line to base future increases and decreases on. It’s easier to consistently draw those doses. And, the increase will be slightly more than 0.25u and slightly less than 0.5u depending on how much below 3.25u you have skinnied the dose.

    This is one of those “flexibility” issues I was referencing before. :)

    Does that make sense?
     
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  60. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    I would agree with that. What I am calling bouncing is by no means severe or even really that bad. Just those every few cycles you get where he stays higher than usual, so whatever you want to call that.

    The trend I am seeing is preshots are not coming down, normally I like to see that before larger increases. So same preshot + larger dose = larger dive, which may mean bounce. At some point those preshots have to come down anyway!

    But honestly, no harm either way. Larger increase would not be unsafe; if he does bounce, you just wait him out a bit.
     
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  61. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
    3.5u it is. His PMPS just now was its highest ever. He's back to being a fussy eater again, he only eats like a 1/4 can or less at a time.

    It was mentioned that "You also don’t need curves for MPM as you would for SLGS". So does that mean I never need to do it? If not, then how often should I do curve testing?
     
  62. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    As long as you are getting the varying tests over the course of the 6 cycle minimum, that will suffice. First and foremost, we need to be able to answer "how low is he going, both day and night". So as long as over the course of 6 cycles there are a few both AM/PM checks in the +4 to +6 range, that's top priority.

    The other nice thing is spot checks around +1 to +3 here and there, just so we can see if his onset may be changing - BUT it can also give you a clue how the cycle may go - is he dropping harder/faster than usual?). I think the majority of CGs here do a +2 or so as a standard almost every cycle. We do recommend that +2/+3 "before bed" test as a standard every night, but understand schedules differ. If you're already planning a +4 that night, then no need.

    Lastly, late cycle tests (+8/9 and later, same thing maybe twice a week AM and PM) help as well just to keep an eye on duration. That usually doesn't change on ProZinc, but spot checks are nice.

    Summary: some advisers on the board like more/less data than others, but for now I would be comfortable with:
    • Two x AM late cycle (+8 and later) tests per week (no need to do PM, get your sleep)
    • Two x AM nadir-ish (+4 to +6) per dose (so at these numbers, 2 out of the 3 days should have AM tests targeting nadir)
    • One x PM nadir-ish (+4 to +6) per dose (so at these numbers, 1 out of the 3 nights should have PM test targeting nadir)
    • Two x early cycle test (+1 to +3), either AM or PM, per week. Again, this test is more a compass for you than anything. I am looking at it from a dosing/feeding strategy (i.e. are there dives we need to slow, change carbs, etc), so I only need a few spot checks. On the other hand, you are looking at it from "where's this cycle going? Do I need to test again soon?" so for you, it may become a standard test every day, both cycles.
    If he starts going a little wonky, or as his numbers go down, those likely will change a bit, but I'd let you know of any gaps I see

    Never need to do a curve if you can do that, though some people like to if they have a day off, or once a month or something. You'll find that the lower numbers (greens) end up being curves anyway practically :confused:
     
  63. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I wouldn’t call it bouncing; it looks like a normal cycle pattern to me in most every cycle. He comes down, nadirs, goes back up.

    Preshots are usually the last to come down but in the case where a cat might be bouncing, it depends on how low the bounce clearing is taking the kitty. One certainly doesn’t want to increase if the bounces clear and the BG is dropping lower (e.g. below 100). There is plenty of room here for the increase. :)
     
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  64. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
    Oof, looks like it's on to 4u now. It's been over a month since his diagnosis and his numbers are getting higher. Extremely frustrating.
     
    Last edited: Feb 11, 2022
  65. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Hopefully just glucose toxicity, very frustrating, I've been there.

    If it is hard for you to get vet visits scheduled, I'd put one on the schedule for some blood work at the end of March. Once they hit 6U we recommend testing for acromegaly and IAA (Cushing's too if he has any of those symptoms). Some vets don't like to test until they hit 2U/kg, but in my experience that's wasted time waiting, some cats don't get that high. There is a study out there by the Royal Veterinary Clinic that the acromegaly (IGF-1) test has a higher rate of false negatives if done before 73 days on insulin, so you would want to wait until after that 73 day mark (I think that puts you around March 27th). The IAA is only done at Michigan State University so they would have to send it out.

    You can always cancel the appointment if he hits a breakthrough dose and starts to get reductions. It just takes time to get an appointment scheduled, then it can take up to 2 weeks for results, and then if acro is positive then you have to figure that out. I wouldn't go crazy over it now, just get something scheduled and cross whatever bridge when you get there
     
    Last edited: Feb 11, 2022
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  66. MisterBillie

    MisterBillie Member

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    Jan 12, 2022
    This is terrifying. March 27th is a ways away, what if I reach 6u before that?

    I reached out to the University of Minnesota, which is near me, to see if they do IAA testing.

    What do you mean? They die before getting that high?
     
  67. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    If you reach 6U before that you just keep on increasing. Both conditions are/cause a form of insulin resistance so the solution is to just keep increasing until you overwhelm the antibodies/extra hormones so the insulin can get to the cells.

    As far as we know University of Michigan is the only one (worldwide) that does it but always good to check.

    And goodness no, did not mean to scare you. Some cats with either condition simply don't reach those doses and are managed just fine at lower doses like 7-8U. Really depends. My cat has both IAA and acro, quite a few cats here do. He's doing just fine! From what I can tell, it's usually something else (kidneys, cancer, other old age stuff) that get them.

    Again, did not mean to scare you. Just being proactive so you're not having to sit and wait if tests are needed...I know vets here are booking up to 2 months out, and that's the case a lot of places
     
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  68. MisterBillie

    MisterBillie Member

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    Jan 12, 2022
    And what are the logistics of doing these tests. The local vet does a blood draw and then ships it in a temperature controlled box to U of Michigan where they do the analysis on acro, IAA, Cushing's, etc?
     
  69. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Yes, the vet should look up U of M's instructions for the tests.

    Your local labs should be able to do IGF-1 (acro), those don't have to be sent far usually. I elected to send both to U of M because...why not, already sending one, doesn't cost more in shipping to send two.

    https://vdl.msu.edu/Bin/Catalog/Catalog.exe
    Catalog # 20031 is the IAA
    Catalog # 20005 is IGF-1 (acro)

    You can click on each one to view cost, instructions, and turnaround time.

    Again, don't go crazy with the what-ifs. He may hit a breakthrough dose soon.
     
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  70. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
    Man this is unbelievable! I can't even get him in the 200s now. His numbers are actually getting HIGHER.

    While sleeping through my alarm for the midcycle PM test last night, I had a dream that he has Acromegaly. Now every time I look at his face, I am questioning whether it's getting bigger. One thing about my cat is that he is kinda jacked/ripped/buff despite being lazy. He's thicc, solid, and tight. It's difficult to even pull up his skin to form a tent, there's very little slack in his skin. I am starting to second guess myself and thinking maybe it's possible that I am botching his injections. His fur is medium length, but super thick like the Minnesotan brush. I feel around the injection site for liquid, but haven't ever felt any which tells me I'm doing it correctly... but maybe, just maybe, in cases where the injection was a failed attempt it just gets absorbed/lost in the fur and I am not noticing it. Are there any videos that detail how to perform the other style of injection where you do not tent the skin, I forget what it's called.

    Shall I up to 4.5u tonight for the PMPS? Or even 5u? Let me know at what point I can start doing 1u increases.
     
    Last edited: Feb 13, 2022
  71. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Slow and steady. You did miss a few nighttime tests, but I think you're good to go up to 4.5 tomorrow morning. You will still do 0.5U increments up to 10U, even if nadirs are above 200 (unless @Marje and Gracie or @Chris & China (GA) you think otherwise ?)

    You would smell the insulin, it smells a bit like... fresh rubber? Brand new tires in the store? Lot of people shave the area to make it easier

    I'm not sure what you mean by not tenting, you mean other areas like the flank?
     
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  72. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Gah he just doesn't want to budge

    I see urination issues notes - will you have a urinalysis/culture done? Perhaps it is constipation instead? Does he seem to be in pain?
     
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  73. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Sorry to just reply….I am out of town on a family issue so haven’t had time to check in.

    It’s very important you take him to the vet immediately in regard to the urination issue. While urinary tract infections (UTIs) are not common in most (nondiabetic) cats and the symptoms you describe can be from sterile interstitial cystitis which does not respond to antibiotics, diabetic cats are more prone to UTIs due to the glucose in the urine. An infection can cause the BG to be high.

    With his BGs so high, if he gets an infection, it can make him prone to developing ketones. It’s really I portent you are testing him for urine ketones every single day and have a culture and sensitivity done through your vet to see if he has a UTI and get it treated. Also, male cats are prone to blockages depending on their diet so it’s vital to ensure he is not blocked. If he’s passing any urine at all, he’s not but if he is unable to pass urine, that’s a dangerous situation that needs immediate vet care….as in emergency.

    I also just want to explain a tiny bit about IAA and acromegaly. But first, as Melissa said, don’t focus on this. I have seen cats just have glucose toxicity and they eventually reach a breakthrough dose. But….on the good side, it is possible if it’s a high dose condition, it’s just IAA. IAA is an immune reaction to the insulin and it is self limiting after a year which means the body adapts to the insulin, eventually, and the BG comes down. There is a method to deal with IAA so you don’t have to wait a year :) but just so you know, if you did nothing other than give his PZ, the IAA will go away.

    Acromegaly actually involves a tumor on the pituitary and the tumor can wax and wane so there might be times of better BGs requiring less insulin but often we see the required dose continue to rise. There are some treatments….Melissa used cabergoline, as many do now. There is also a radiation therapy at a couple places in the US which can help to minimize symptoms and bring the BG down.

    It was a good suggestion to raise the dose but please be sure you get a before bed test every night in addition to the PS. The one night where you just got a +1, I can guarantee his BG came down a bit but not likely below 200. The reason I can tell is his +1 was almost identical to his PS when it should be higher due to a food spike.

    I hope that helps. I also hope you can get his urination issue diagnosed right away.
     
    MisterBillie likes this.
  74. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
    His litter box has a couple urine clumps in it from sometime in the night, so he's not completely blocked. My current vet was quick to rob me of $900 (blood test, urinalysis, x-ray), all I got was a prescription for ProZinc and zero answers. This was on 01/06/22. He is sitting on the towel used to do his BG tests preemptively and purring this morning.

    Me bringing in the cat due to the irregular litter box activity is what started this all. The vet seemed very disinterested in figuring out that issue, and instead wanted to go with the diabetes angle. I challenged this many times and said "Okay he has diabetes, great. So can we solve the constipation and litter box issue now?", but they assured me the diabetes was causing those issues. Now it appears it is the other way around.

    Are there any vets in the midwest that actually know how to care for a cat? I am sick of these vets that treat dogs, most of the vets probably know nothing about cats. If a vet treats dogs, I am not going to it anymore. And most of the cat clinics in this area are not accepting new patients. I will relocate to anywhere in the country if anyone knows of a domain expert of feline diabetes.

    Should I bring him to the University of Minnesota vet. Are University vets typically better than like a VCA vet? It's too early to send off the tests for acro and IAA though, so should I wait?

    I bought Ketones strips last night. What techniques can be used to use these? My cat tends to pee in the same exact spot. Yesterday, I tried hovering it over the area he was peeing, but couldn't tell if it made contact. I then pushed it into the freshly soiled clump and the strip came out the same color it when it was unused.
     
    Last edited: Feb 15, 2022
  75. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    In the vets defense, PU/PD and litterbox issues basically go hand in hand with diabetes. It can also be behavioral - for example, Mr Kitty misses the litterbox and doesn't cover his poop when he doesn't feel good (even if BG is fine). Assuming they did urinalyses, cultures, etc to rule out other problems.

    It does seem you are thoroughly dissatisfied with your vet. I wouldn't be so quick to dismiss general practice vets, I hear your frustration. You could always post in the Main Forum asking for vet recommendations in your area, if you're comfortable sharing location. Theres also a Facebook group associated with this forum, lot of people on there that don't always pop over here. Can ask them for recommendations too. I actually found my vet (a wonderful general practice vet) by asking my local Facebook mom's group page for recommendations.

    I can't really speak to vet schools, but I will say from what I understand they do tend to be more up to date on latest research, treatments, ideas, etc. Perhaps they'll do a virtual visit with you?

    Housekeeping notes when you get a chance please start a new thread, this one getting rather long. Just put a link to this post in your new one so we can go back and look at history
     
    MisterBillie likes this.
  76. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    MisterBillie likes this.
  77. MisterBillie

    MisterBillie Member

    Joined:
    Jan 12, 2022
    Thanks for the tips and ongoing help!

    Sure, I can create a new thread... By "long", you mean vertically long? Why are these forums not using pagination? Who is the admin of these forums? Xenforo for sure supports pagination, why is it turned off?

    edit: Part 3 thread here: https://www.felinediabetes.com/FDMB/threads/misters-dosing-pt-3.259606/
     
    Last edited: Feb 19, 2022

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