BG numbers getting better, dosing question on PZ, using AT

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Sue & Emma, Sep 14, 2020.

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  1. Sue & Emma

    Sue & Emma Member

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    Per Emma's SS, good numbers at 8am. I emailed vet with SS and questions. And stalled on her shot. I do not feel comfortable with 1 unit since BG plummets 300-400 points in 4 hours. Today's 254 makes me want to change to .5 dose. .....Now to include in the mix, today is only the 2nd day she has not eaten that Hills Glucose Support which she gobbled like candy. Only FF since yesterday am. So I am curious what affect that will have. I will take her reading in 45 minutes. Had to let her not eat for 2 hours before this test.

    Am I on the right track? New vet who just bought my old vet's practice agrees, but she's hard to read. She started talking to me without even looking at the chart I sent. I also question her first day doing curve and starting with 2 units. That's the first entry on my chart.

    Thanks for your help!
    Sue
     
  2. Bandit's Mom

    Bandit's Mom Well-Known Member

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    Oct 18, 2019
    Hi Sue, looks like you have a diver in Emma! :woot:

    Just the change from high carb kibble to low carb wet food should make a big difference to her numbers. If you are transitioning her to FF, you should monitor her numbers carefully since her dosing requirements could come down dramatically. 2 units might be too much for her after the food change.


    Have you looked at the sticky on Prozinc dosing methods? Since you are following SLGS:

    "Hold the dose for at least a week:
    • Unless your cat won’t eat or you suspect hypoglycemia
    • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
    After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
    • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
    • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
    • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
    If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change)."

    I am tagging @Deb & Wink who can help you with Prozinc dosing.
     
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  3. Sue & Emma

    Sue & Emma Member

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    Bhooma, thanks for the help. So, since I've changed her diet to FF only, should I stall on any shots? Just keep charting her throughout the day? Obviously if she gets a crazy high number I'll give her .5 PZ. But I was hoping to just test today and tonight and then at 8am tomorrow see where her number stands. She came down alot with the food change.
     
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  4. Bandit's Mom

    Bandit's Mom Well-Known Member

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    That is one option. It might take a few days for the food change to fully reflect in her BG. If you shoot her, you should be able to monitor her.

    It's great that you have been able to transition her to LC canned food! :)
     
  5. Sue & Emma

    Sue & Emma Member

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    Okay, it's been 5 hours since last BG because I wanted her to fast for 2 before this test. BG 261 !! Only a 5 point change! I know that is still high but I want to make sure I understand what the food change did so I can understand the dose to give her. I'll keep on checking today. And if she's not getting really high, I hope to start her new lower dose at 8AM tomorrow. This will keep her on schedule.

    With this new information, should I go with a .5 dose or .25? I'm using the 40 injectors so no half marks.
    Sue
     
  6. Bandit's Mom

    Bandit's Mom Well-Known Member

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    I am actually not familiar with Prozinc - my kitty is on Lantus. So I can't really give advice on dosing. Hopefully @Deb & Wink will see the tag and respond.
    You could play it safe with 0.25u twice a day - with the food change and her dropping so hard. Increase to 0.50 after a few days of the food change and after you have some data on how she is doing at 0.25U

    Btw, does she eat during the day or only at shot times?
     
    Last edited: Sep 14, 2020
    Reason for edit: typo
  7. Bandit's Mom

    Bandit's Mom Well-Known Member

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    @Panic could you help Sue with Prozinc dosing?
     
  8. Sue & Emma

    Sue & Emma Member

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    I think you are asking me if she eats during the day. Yes. I mixed the FF w/Hills to switch her starting last week. But the complete switch was made on Sunday, yesterday. I've had to keep offering her the FF several times during the day because I don't think she's getting enough calories. She's 15.7 lbs and needs to loose weight but we need to take 1 step at a time here. Yesterday she only ate 2 1/4 cans and that spanned a 24 hour period. She was just taking like 3 bites and walking away. Now she hangs out at the bowl at little longer. She is not free ranging because I have a 2nd cat and he eats up the food when she steps away.

    Is that what you were asking about?
    Sue
     
  9. Bandit's Mom

    Bandit's Mom Well-Known Member

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    Yes :)
     
  10. Panic

    Panic Well-Known Member

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    Thanks for the tag, Bhooma!

    Hi Sue. :) I think you'd be alright going back to 0.5u, considering the new diet change and all. If 0.5u feels like too much you could do like Bhooma suggested and start with 0.25u for a few days and see if she needs an increase. Stall if numbers are between 150-200 to see if she can get over 200. If she's under 150 just skip.
     
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  11. Sue & Emma

    Sue & Emma Member

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    You guys aren't going to believe this. the PMPS reading was 147!! Again she didn't eat 2 hours before. But she has been eating thru the day. She ate afterwards and will still get some FF thru the night. It's looking like she enjoys eating a certain amount every 2 hours anyway.

    I'm flabbergasted. Was anticipating a high number and having to make an injection decision. So now husband and I are really asking ?? about her diabetes. She had a uti and got a long lasting cortisone shot. That pushed her over the edge. But we also know she was lethargic (just thought she was being lazy) and drank a lot of water. Also, she limped. But she was eating the Hills Weight Mgmt/Urinary dry the whole time. And with that other Hills Glucose dry being awful, we are beginning to wonder if the food was pushing her over the edge too. She may be still diabetic on her own, but this does raise some food questions for us.

    Thanks everyone for helping me today! We will see what her AMPS looks like and if she needs a shot. But I might just do .25.
    Sue
     
  12. Panic

    Panic Well-Known Member

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    That is a lovely number! Actually, since you're using Alphatrak I think the no-shoot number is 250? I can never remember half the time.

    I think 0.25u is a good choice for when she needs it. She may just need to be weaned off insulin therapy and be good as new soon!
     
  13. Sue & Emma

    Sue & Emma Member

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    Thank you Elizabeth! I think the no shoot number for AT is 150?

    We are very excited in this house tonight. Crossing fingers for good numbers tomorrow.
     
  14. Panic

    Panic Well-Known Member

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    Human meters run lower than Alphatrak, so if the human meter's no-shoot is 200, Alphatrak's no-shoot is going to be a higher number. @Critter Mom can maybe confirm? I think she remembers AT2 rules. :p

    Hooray indeed!
     
  15. Shelley & Jess

    Shelley & Jess Member

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    Jan 23, 2020
    Very excited and fingers crossed here too!! Looking good :)
     
  16. Deb & Wink

    Deb & Wink Well-Known Member

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    Possibly a case of steroid induced diabetes, with that cortisone shot. If that is the case, the diabetes can resolve quickly. Very quickly. Also, treatment for the UTI can bring the BG levels back down rapidly. Food change is the 3rd factor to make a big difference in the BG levels.

    The Hill's W/d is extremely high in carbs. It was what the cat shelter and vets had Wink eating when I first fostered him. Got him off that high carb food, onto wet, and he went OTJ (off-th-juice, insulin being the juice) and never looked back. Even the Hill's M/d is high in carbs, at least the dry is.

    Hope that Emma gets the same sort of effect from the lower carb, cat appropriate food that Wink got.

    The shoot/no-shoot of 250 mg/dL is for insulins like NPH, not for the Alphatrak.

    Decision making (aka shoot/No shoot) number here in the Feline Health forum is 200. ISG groups use 150 for the decision making BG level (aka shoot or not). Until members get some experience under their belt, and understand when THEIR cat has onset, nadir, and duration with a particular dose.

    So, you are able to get BG tests pretty well in the AM dosing cycle. But what about the PM cycle? Could you get at least a +2 and/or a "before bed test" to see how Emma is doing in the nighttime cycle? Please?

    Many cats drop lower at night, since they are more active and are burning up energy to fuel their nighttime antics. So testing in the PM is important too.
     
  17. Panic

    Panic Well-Known Member

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    For both meter types? I've seen people say the starting no-shoot for Alphatrak is 250. Or maybe it was 230. :confused:
     
  18. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, for both human and pet meters. Same decision point for the BG levels on giving insulin, stalling, or skipping the shot. It's only Caninsulin/Vetsulin and NPH (Humulin N Novolin N) that have a higher starting threshold and different guidelines on managing the insulin usage in a cat. Based on the insulin being used, not the meter being used.

    The ISG groups have an even lower threshold for Prozinc, set at 150 mg/dL. Lantus ISG has that lower 150 mg/dL threshold too.
    Look at the dosing protocols. They no longer differentiate for that threshold depending on the type of meter you are using, at least for the higher BG levels, only at the lows. Alphatrak (and other pet meters) have a lower limit of 68 or below that is equivalent to the 50 or below for human meters. "Feed the 40's" or if using an Alphatrak or other pet meter "Feed below 68" to bring the BG levels back to a safer threshold and stave off hypoglycemia symptoms.

    All the protocols we use here specifically state that you should be using a human meter. That is what we have the most data with, and the guidelines were written with the human meters in mind.

    And as people gain experience and get more tests and know how THEIR cat reacts to a particular dose, those thresholds get lowered even more.
     
  19. Panic

    Panic Well-Known Member

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    I noticed that - thought they just didn't have it included. Good to know!
     
  20. Sue & Emma

    Sue & Emma Member

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    Thank you Deb. That was some great information. And I want to thank you guys for the advice on stalling. Emma's numbers have been amazing. So we are not giving her any PZ.

    We are giving me and Emma a break today, and especially her ears since I wasn't doing it right at first. Her numbers look good, she's absolutely had a great day today. And I'm only going to put her FF down at midnight and 2AM.. I will be sure to do testing tomorrow. I would still like a complete picture of her condition.
     
  21. Deb & Wink

    Deb & Wink Well-Known Member

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    Marje updated the Prozinc dosing protocols this February 2020. I made a couple of suggestions but it was mostly someone else that used to post here frequently, but no longer can due to her life situation. Family responsibilities come first.

    A 91 BG at +5, with no insulin for the last 4 12 hour cycles? That is excellent.

    Hope Emma continues to do so well.
     
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  22. Sue & Emma

    Sue & Emma Member

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    Thank you everyone.
     
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  23. Sue & Emma

    Sue & Emma Member

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    Deb, I got that before bed reading. It's midnight here. BG 88. Holding steady through the day.
     
  24. Panic

    Panic Well-Known Member

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    Oooh I love seeing that green!! Keep it up, Emma! (you too Sue!)
     
  25. JL and Chip

    JL and Chip Member

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    And on an Alphatrak meter, correct? Stellar.
     
  26. Sue & Emma

    Sue & Emma Member

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    Yep, Alphtrak meter. Thanks for the warm wishes! We are very excited here. My goal now is to get her on a feeding schedule with exact times. So far I have 8am-Noon-5pm-8pm-Midnight.
     
  27. Deb & Wink

    Deb & Wink Well-Known Member

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    There's a little bit of leeway with the meals. The most important thing is that she has a good appetite and eats a portion of her food pretty near the time of the insulin shot.

    Life happens, and something unexpected may crop up to throw off your feeding schedule.

    Here is something for you to try.
    If Emma is blue at the pre-shot test, and too low for you to shoot insulin, feed her as usual.
    Then, around +3 to +4, try to get another test.
    If the +3 to +4 test is lower than the pre-shot BG, it means her pancreas is producing some insulin on it's own.

    Do you think you could try that?
     
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  28. Sue & Emma

    Sue & Emma Member

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    Sep 11, 2020
    Deb, I haven't needed to give Emma insulin for a couple of days because her numbers are so good and she is active, playing with the other cat, going out on the porch etc. I hope this keeps up for 2 weeks. It's just her eating I worry over now. But that's in another thread.
     
  29. Deb & Wink

    Deb & Wink Well-Known Member

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    You still want to get those BG tests at what would normally have been her pre-shot test times.
    It's part of how we do an OTJ trial.

    Which thread about the eating?
     
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