Previous thread: https://felinediabetes.com/FDMB/threads/6-10-newman-amps-272.264410/ AMPS 250 starting .25 unit increase shooting 1.75 units @Suzanne & Darcy
Well, at least he didn't throw you a low AMPS today. I hope you didn't have trouble eyeballing the 1.75.
Yes, those unmarked doses are hard to draw. I just choose a mental marker and try to be consistent, if that makes sense.
Hooray. I checked a couple of times today and saw the first one - the 207. I was thinking… close to blue. So I checked a few more times and I thought…. Come on, Newman, come out for a snack. So, overall he hasn’t gone down much from his AMPS of 250 to 194, but I am still going to celebrate a blue anyway! It’s only the first day of the new dose.
I know. Change is not my favorite thing either! He's doing well so far. You are doing great! You are there with him, so I feel good about that. You would not believe it, but sometimes I have dreams about the cats on this Board. I wake up at night sometimes thinking... is so and so (cat name) okay... will it be okay... I'm worried... what if it's not okay, etc.
Sorry about those dreams. I could not do what you do here. Your help is so appreciated. I hope that Newman's evening and overnight will go as well as the daytime has gone. The preshot numbers are essentially the same. Like everyone else here, I just want my little guy to feel better.
I hope Newman had a good day today. And you too! I did notice the AMPS and PMPS were both almost exactly the same.
I think he did feel a bit better today. He was more present, less sleeping and his appetite picked up, compared to yesterday when I had to prime him with pure bites to get him interested in his Fancy Feast. He spent some time on the screened porch after his dinner this afternoon and now he is perched, looking out the front window watching the dog walkers go by or maybe just a lizard on the porch railing!
My cats love watching lizards! Also they love the Pure Bites crumbled on top of their food (I think I'll do that this morning, thanks for the reminder ... Chewy had the large bag on sale last week for about half price and I added it on to my autoship order.)
A pretty typical AMPS for Newman this morning, I see. Let's hope he will drop into blues for a longer period of time today.
Good morning, sorry I missed that sale on Pure Bites! Do you get the chicken bites? I am hoping for a good calm day, no barfing and no highs or scary lows!
I didn't get many tests today. His good ear is looking so beat up, I decided to give it some time to heal and just observe how he was acting. He had a good day, some activity and some naps, sleeping in his favorite position, on his back with his feet up in the air. I tried his crinkled ear but he is very protective of it, so I'll not force that. PMPS 271 shot 1.75 @Suzanne & Darcy More testing tomorrow.
Oh. Poor baby! How did you say his ear got all crinkled up? I have one cat who is white who had skin cancer on his ears from the sun. Last December we had his ears trimmed to get all the skin cancer off of them. He kind of looks like a kitty version of a Doberman now. He is kind of protective of those ears now, too. He’s the sweetest guy though. I cannot sit down without him wanting to hop in my lap - to say nothing of the bed! He seems so grateful just to have been rescued from his life outside.
But anyway, you got a mid-cycle test in and that looks like it was enough for today. I know if anything had seemed amiss you would have done more testing. So no worries. He’s a good boy. I’m glad you gave him a break.
He has had the crinkled ear for several years. I have no idea what happened to cause it, he came in from the screened porch and it was full of blood. I had had a dog that had the same thing many years ago probably from shaking her head and her ears were big and floppy. I had it repaired but was told it was for cosmetic reasons only that the blood would absorb on its own. So with that experience, I allowed Newman's ear heal on its own. Who knew I would need it for testing!
I wonder what in the world caused that hematoma? Sounds like it didn’t heal that well on its own if it became all crinkled. I’ll keep that in mind if this happens to any of my cats! You would think they could at least drain it. What did they have to do to your dog’s ear to make it look more normal?
No good guess as to what was the cause in Newman. For the dog, Peaches, they drained it I assume and then they stitched it like tufts on a pillow, if that makes sense. She had floppy hound dog ears and the damaged one resulted in being relatively flat but bumpy. It was not shriveled like Newman's. In hindsight, I wish I had had it repaired.
Newman is determined to stay yellow :-( I'm kind of disappointed. If he doesn't shape up, he'll be due for another increase... maybe if I say this he will hear me and ...
He is the very definition of flat. . Sorry. I hope he’s having a good day though…. Watching lizards or birds.
Yes, I see those flat yellow numbers. I trust that 4 cycles is enough trial to make adjustment? Looking back I see that on 5/27 I got into trouble shooting 2 units. I have handwritten notes and he actually first tested at 137, so I did the 20 minute stall, got the 149 and reduced to the skinny dose. In hindsight, do you think on the 149 I should have shot a much lower dose?
I'm not sure. He did drop on that day. Lately, he seems to be so flat... getting almost no response from the insulin. A cat's insulin needs can and do change over time. I'm going to tag my friend, Tee, to see what he thinks about Newman's spreadsheet. I prefer a more consistent dose, but I do understand that sometimes a lower dose must be shot (especially with ProZinc). Right now, it looks like Newman is not getting enough insulin. @Teetee (UK)
I agree he's very flat, how old is the Prozinc Linda? as i can't see any info on your spreadsheet about a new vial being opened. If the Prozinc is in date then i would say an increase of 0.25u is needed.
Hello Tee, thanks for reviewing Newman's spreadsheet. The vial of Prozinc was opened 5/1. (Good idea. I will note that on the spreadsheet.) I appreciate your input.
If you can Linda try and get in a few more tests today please, especially AM +3, 5, 7, 9 more if possible as i would like to see how he goes with the increase.
Technically, if you are following SLGS, you should hold the dose for a week. I wasn't thinking that you would increase this morning, although I think in this case it will be okay after 4 days on this dose. Modified ProZinc method allows you to increase faster. Of course, you're also supposed to do a curve after a week on a dose. I know that this is not always possible. Try to get a few tests today, if Newman will cooperate with you and present himself for testing
Reach out if you need anything! I am taking my kids out to lunch, and will be running errands a bit, but will have my phone.
Still pink at +3 :-( I wonder why he decided to be pink today. He's not usually like that for no reason. New dose wonkiness?
I hope you had a nice day and enjoyed lunch with your kids. I spent most of the day bookkeeping and tying up loose ends! Newman seemed to have a day that is normal for him. He got the crazies and ran throughout the house, took naps and wrestled with Ozzie. He does seem pretty sensitive to changes in dosage, and bounces but I don't have the experience to say. We are running a bit behind schedule so he was still eating dinner up until 6 PM so I will not be able to get a PMPS until 8:00.
He’s eating? Now? Before you test? Sorry. Just asking? Please forgive me if I am just getting mixed up. I have had about 50 tags in the last hour. And a severe thunderstorm just rolled through here and took out a maple tree in our front yard. Snapped off at the trunk. We’ve been cleaning up outside from the wind and hail.
Wow, it must have been quite a storm. Sorry about the tree. Glad that there was no damage to your house and no one got hurt. Thunderstorms can be scary. No, he was done eating at six, so I just tested him at eight. His PMPS is 337. I plan to stay with the 2 units. @Suzanne & Darcy I have posted all test results from today on the spreadsheet. @Teetee (UK)
Thanks, Linda. You are doing a fantastic job of testing! Let's all put on our famous FDMB "patience pants" and give Newman a chance. Thanks for the clarification on the food. I hope Newman is okay with it!
New Dose Wonkiness doesn't happen using Prozinc. https://felinediabetes.com/FDMB/threads/do-daas-pz-dosing.221698/page-2#post-2493252 @Marje and Gracie Post#180 "New Dose Wonkiness does not exist when using insulins that do not have a depot. In other words.....we only see it with Lantus and Levemir, not PZ."
I know! That’s what I was thinking. No NDW with Prozinc. Funny you should say that because I was just thinking about this. ETA: I was trying to make a joke about it but should have been more clear. My cat certainly never had NDW when he was on ProZinc! It’s not to be expected from a single cycle insulin as opposed to a depot insulin. We started with Vetsulin then moved to ProZinc then Lantus and finally Levemir. We used them all!
Good morning. I'm glad you are here. First, Newman has caught on and he is avoiding coming to me for testing. My son had to wrangle him this morning, just now when I gave up. Now, he has tested at 237. Normally, I feed him and then he comes back again for his morning shot. I lean toward going forward with that, but there is a good possibility that he won't come to me for his shot. And to complicate the situation, out AC is not working and the repair man is expected to be here shortly so there will definitely be "fall-out" from that. I guess I go ahead and hope for the best, adapting where necessary. Finally, would you shoot the 2 units?
Hi Linda, I'm a little confused here. You say you fed Newman his supper at 6pm and tested him at 8pm then gave him his insulin, is that correct? Did he have any food after his 8pm test and straight before his insulin? The correct procedure is Test-feed-shoot all within the space of 15/20 minutes. The test is to see if Newman is high enough to give insulin The feed is to make sure Newman has enough food inside him prior to his shot The shoot is obviously the prozinc. All this should be done within a 15/20 minutes period. It's fine to give Newman a very small snack 2 hours prior to his shot but only a very small snack, a teaspoon at most but his full meal should be at shot time otherwise his preshot tests could be food influenced and you get a false reading. When you feed Newman but don't give him his insulin at the same time then he has no insulin in his body to reduce the BG created by the food and consequently throws his numbers up massively. If you fed Newman at the same time as his shot then the insulin starts working sooner and better to help lower his numbers. This could possibly be the reason why Newmans struggling to become regulated. Also can i ask How do you mix his insulin up, do you roll it in the palm of your hand before drawing it out into the syringe?
I guess if your son is going to be at home today to help you wrangle Newman then yes, I would shoot the 2 units. I'm sorry about your AC. I wonder if Newman will go higher because of the stress of having the repairman around. When you feed him, his numbers will go up a little (have we ever figured out how much?) so he should be starting from a higher point. If Newman is not cooperating, then maybe he is forcing you to do a stall? But it's 8:00 now.
Optimally, you would be able to give him some snacks (or he would come out to graze) during the earlier part of the cycle. I wonder if the repairman being there might prevent him doing that? What does he typically do in that situation? Hide under the bed?
As you are aware, I am trying to adjust the normal feeding schedule to accommodate Newman's diabetes. He is fed dinner between 4:30 and 5:00, but he is a grazer. I always remove all food no later than 6:00 so that I have the 2 hour "no food window." Then, using this example, I test at 8:00 PM for his PMPS, using a couple treats to bribe and distract. After testing, I shoot him and then for the rest of the evening before bedtime, he can graze to finish his dinner food. I have been diligent to enforce the 2 hour fast before PMPS testing. Finally, I roll the insulin vial to mix it.
About all this feeding business... if Newman eats a meal at 6:00 p.m., that's going to be approximately +10 (if it's a day when he's going to get his shot at 8:00 p.m.) So if the test is conducted at 8:00 p.m., it would not be a "food-influenced" test. However, Newman would need to be willing to eat again at shot time in order to have food "on board" to protect him from the insulin hitting too hard. Is this roughly the procedure that's being followed? I'm sorry if I am dense about this. I'm trying to make sure that I get it!
Okay. I think you answered my questions, too. Sorry to be a bother when you're trying to wrangle Newman this morning! I know the whole feeding thing has been difficult with Newman being a grazer and having done this his whole life. The only other thing I would ask is ... does he graze a good bit after his shot? He doesn't seem to be doing dives, so I'm thinking he's taking in enough food in the hours between (in this example of an evening cycle) his shot and bedtime.
He will seclude himself, ready to hide. He eats no food after 6:00 PM. Two hours later, I test for his PMPS. At that time if the test result supports the planned dose I give the insulin. He is then free to eat up until I go to bed.
I never did those test after he eats to determine the immediate effect of food, because I am testing him so much and he has just that one good ear to use for pokes. I think his ear is extra sensitive now and that is why he didn't want to come to me this morning, wise to the anticipated ear poke. He is wincing just the slightest the last few pokes.
Oh, poor Newman. You do go up and down the outer part of the ear a little bit, right? Some people use the paw for testing. I was just talking to a member yesterday and she said her cat was just fine with it. I can't even imagine it. Even Darcy might not have gone for that, and he was really compliant.
Thanks Linda, The thing that i'm concerned about is that you are giving Newman his full meal two hours to his pre shot meaning his BG rises and there in no insulin in him to reduce the big spike that's happening. Why not try a very small snack before the 2 hour window and then if you follow the 15/20 minute Test-Feed-Shoot procedure i'm sure you will see a lot better results with his blood glucose.
Hmmm. Are we seeing big spikes? I'm looking now. I do see that some evenings, the PMPS is a lot higher than one of the later tests.
The insulin is supposed to be administered 12 hours apart. If procedure is to test, feed and shoot, are meals fed 12 hours apart also?
Yes, main meals should be fed at the same time as the insulin is given. Why not try an experiment Linda to see if it helps Newman get his bloods in order. 6 am/pm test his blood (i presume this is your normal time) 6:05 am/pm feed his main meal. 6:20 am/pm shoot his insulin. So at am/pm +3 give Newman a small meal, say 10 grams and do the same at +4 and +5. Then no more food until pre shot not even two hours before and repeat the cycle for 1 week then let's see what happens. Is that plan ok to you? I know he's a grazer but he will learn, many cats including mine were constant grazers but the do learn their new routine very quickly.
Not necessarily. Below is something I copied out of the new to prozinc... know the basics thing... so it's very general and, of course, there's the caveat about the no food for two hours before preshot test rule (which is also in that same document.) Some people do feed only twice a day, some people take the amount of food they want their cat to eat and break it up into smaller meals and feed it like that. We don't really know if Newman is not getting good duration of action with his insulin or if the duration is being shortened by feeding him his big dinner two hours before his PM shot. The only way to determine that would be a trial of a different feeding schedule. On the Lantus/Levemir forum, we counsel people to not feed after nadir because it can shorten the duration of the insulin. The action of the insulin is waning toward the end of the cycle and adding too much food in at that time can shorten duration. Sometimes it's still okay to give a small very low carb snack. Anyway, below is what the "basics" article says. "Feeding Schedules: There is no "right" or "wrong" approach to feeding; rather it's a personal choice. Some people like to feed twice daily, with the shots. Others like to give several small meals during the day (and perhaps the night). We would recommend that you base your feeding schedule on your own particular situation (whether you're able to be around to monitor BG or not, etc.) and your own cat's response to the insulin. It is very helpful if you can determine when your cat's nadir (lowest blood glucose) occurs during a 12-hour cycle. If you work outside the home during the week, this might best be discovered over a weekend when you can be around to do a bit of a curve (feeding at pre-shot time, dosing the insulin, then testing every 2 hours until you see where in the cycle your cat's nadir happens while on insulin). Taking the extra time, early in treatment, to find out when your kitty's nadir occurs can help you determine when to have extra food available for those times when you're not around, so that your kitty stays safe if the blood glucose were to drop lower than is safe range."
Sorry Newman's shot was late. You must have been having problems. You can shoot tonight at 8:15 (30 minutes early) as long as his number is safe to shoot.
This is something along the lines i suggest Linda should try with Newman just to see if there is any improvement.
Here's what my schedule looks like. All times are approximate on any given day, but generally within a 30 minute fluctuation. Newman is allotted 3 cans of Fancy Feast Chicken Pate per day. He is a grazer. A typical day would be as follows: 7:30 am test Feed 1/3 can of food (laced with Zobaline) which he usually eats entirely. At 8:00 am I shoot his morning insulin. 8:00 - 12:00 He returns to complete his morning can of food which I dole out from the initial can of Fancy Feast. 4:30 pm I feed about 1/2 can of Fancy Feast allowing him to graze until 6:00 pm at which time food is removed. 8:00 pm I test for the PMPS value. Based on that number I shoot the evening dose. The 2 hour fast actually starts from the time that he is no longer grazing on his dinner. So if he eats at 4:30 and doesn't eat again after say 5:00 pm, I consider the fast started at 5:00, so the evening procedure may move accordingly. I would test for the PMPS closer to 7-7:30, shoot and then allow him to graze again until bedtime. I think I have covered a typical day. Please ask questions and make suggestions if changes are warranted. I have always fed multiple small portions of food to Newman because he tends to regurgitate. Tee, as Suzanne knows, I am disabled and used a wheelchair, so I have to rely on Newman's good nature to cooperate and come to me. If he is stretched out relaxing on the floor, I cannot each him to pick him up. I have to get him to decide to stand up and allow me to snatch him up, or come to my desk for testing and treating. My son and grandson live with me, but they both go out to work. So I do have some help, some of the time. @Suzanne & Darcy @Teetee (UK) Thank you both.
So that's about 1.5 oz of food for that grazing time. Yes. This vomiting is a problem with Newman (and we especially don't want that at shot time.)
I'm really sorry Linda to hear that and it must make things really difficult for you. Are the cans 3oz size (85 grams)? If so then what i would do is feed Newman one 3oz can at each pre shot and divide the last can into 6 feeding times As in 7:30 am/pm Test Newman 7:35 am/pm Feed Newman one full can. 8:00 am/pm Shoot Then am/pm +3, 4 and 5 feed Newman 15 grams each time and nothing else. This way he still gets his three cans daily. Although i'm concerned about the regurgitation, how long after eating does he do this, do you have any idea or is it just random?
I just thought…. You said at 4:30 you dole out about 1/2 can of Fancy Feast. Fancy Feast cans are 3 oz. So I said 1.5 oz. Of food at the 4:30 snack time for grazing until 6 pm when the food gets covered up. I did not mean the whole day’s allotment. Just the 4:30 - 6 timeframe. Sorry
Pink preshot this morning… seriously, Newman? I saw the pink last night so I guess it’s not surprising. He does have a history of bouncing after blue numbers so I guess that’s what it is.
PMPS 235 Going to feed him, so I'll assume he is going to eat. Any reason not to shoot 2 units? @Suzanne & Darcy
