Discussion in 'Prozinc / PZI' started by Goose, May 8, 2020.
Do Daa's PZ Dosing Thread5
Above goes to the previous thread.
Thank you for starting a new thread.
Healing of the pancreas only takes place in the BG range of 50-100 so any number higher than 100 that you get that might be within 20% of 100 is potentially a healing number. Blues are not healing numbers but certainly can be keeping him below renal threshold.
It looks to me like that big drop yesterday triggered the bounce to blacks last night. I’ll let you decide what your goal is but if you want to work towards remission and getting him better regulated, then he needs a dose increase to 4.5u. If blue nadirs with bounces are acceptable for you, then you might choose to hold the dose.
We'll start the new dose of 4.5u tomorrow so both amps and pmps match. We were considering it a day or so ago but keeping him in greens almost seems like an impossibility when he hasn't even settled at any given dose.
Thanks for the input!
You’re welcome and good luck with the new dose.
171 @ +9 to 523 @ pmps (?)
Well, he had an amps of 256 and I had a feeling he might fall so we kept him at 4.25u today and he hit an 83 at amps +4. He was low blues most of the day and then way up to 523 at pmps.
Dosage increased to 4.5u. Greens most of the afternoon and bounce to black at pmps.
Did you feed him through those greens because he really lost duration and skyrocketed to pink!
Yes we noticed the increase from 83 to 334 in 2 hours.
Yes he was fed through the greens. Though he only eats a couple of small spoonfuls of wet food each time, still only 1 can per 24hr period. No additional food given. Since we can't control/watch him 100% of the time, he *might* have snuck some other food if someone didn't take it all off the floor, other than that possibility, his food parameters haven't changed.
Thanks for the update.
When he has Greens, say high 90's or so, should we feed him at those numbers or should we let it drop within reason and of course our ability to monitor him?
It’s important to see where he is in the cycle, if he’s dropping, how fast he’s dropping, how his BG responds to food, and his typical patterns.
If he’s dropping quickly and early, yes, you want to feed what is appropriate to slow him down to keep the nadir from dropping low. Conversely, if he’s late in the cycle when duration is waning, just a small amount of LC might work great to get him to “surf” (stay flat) in good numbers that will result in a PS you can safely shoot.
If he’s really carb sensitive, you need to take that into account. For a carb sensitive kitty, feeding extra LC might work as well as HC for less carb sensitive kitties.
Does that help?
Just FYI info in general.
+2 for us is 11am/11pm
+4 for us is 1pm/1am
We've started to get him wet food at +2 am/pm to try and lessen that sudden drop at +4 he seems to have often.
We are also experimenting with not feeding the numbers every hour and we'll see how that goes. With this method used today, he was green/blue in the afternoon with a low pmps of 233, tho it will take more experimenting to see if this will actually work.
A great place to start but how do you know whether it’s having an effect if you don’t know what he is at +2?
The goal is to manage the curve with food. I wrote this for Pat with Brady and it’s long. Take some time to read it and digest it and ask questions.
When we see a cat with dives and hard bounces (and I do believe that kitties that dive fast have harder bounces than those that just go lower), we try to get the curve to flatten out with food. We call this “using food to manipulate the curve”. The process is like this:
manage the curve with food ----> flatten the curve ------> adjust the dose (if necessary and it usually is).
This process or method is feeding so that we prevent the kitty from dropping too fast and/or too low. You can imagine if you aren’t careful with it, you can overfeed the kitty so it’s important to:
recognize this is a process that doesn’t change things overnight
requires that you, in general, feed the same amount of food kitty needs to maintain its current weight (assuming kitty is not under or overweight); obviously, if you’ve fed Brady his food for the cycle and then he fools you and takes another dive, you might have to feed a little more depending on where in the cycle he drops again.
requires consistency and some extra commitment at the beginning
requires that you know your kitty; what are his onset, nadir, duration......and does he ever get any overlap or carryover.
Typically, unless the kitty is taking a huge dive or drops below 50, we try to use LC to manage the curve with food. Obviously, if he is coming down really fast early in the cycle and we know LC doesn’t slow him down, you have to up the “ante” (i.e. the carbs). However, we do not typically feed a higher carb food at shot time unless you must have the insulin start its onset from a higher number, for example, in the case where you might not be able to monitor.
There are important things to consider when you are determining whether to feed lc, mc, hc:
where are is he in the cycle? If it’s early in the cycle and he’s dropping fast, you probably want to use higher carb food; if it’s nadir or later in the cycle and nadir is above 40, you might want to try LC.
how carb sensitive is he to carbs? Some kitties never need more than LC food even when they take a steep dive or go lower. Others need the big guns if they drop fast early in the cycle. This is going to be up to you to figure out and experiment with.
It’s also important to know why we manage the curve with food. The goal is to get the curve to flatten, as shown in the diagram above. If we are consistent and do it right (and it’s ECID and trial and error as to what is “right”), then kitties will typically flatten out at a higher BG. Flattening prevents those dives and huge bounces. Flattening also will allow you to get more insulin in the kitty safely. This can, in turn, allow you to hold a specific dose longer. However, for a bouncy cat, more insulin, when safely done, can help bring down the numbers. It also helps to offset the spikes that very carb sensitive kitties get in response to food.
For anyone reading this who then thinks, “well, if I just give my cat more insulin, the bouncing will stop”. No it won’t and it’s not safe to just increase the dose to stop bouncing. It’s the process of managing the curve with food specific to your cat that keeps it safe to increase the dose. That entails:
knowing your cat and having the time and commitment to experiment with feeding
feeding the correct amounts of food at specific times to bring the over all curve up
flattening the curve at a higher BG
How do we do this?
start by dividing the kitty’s normal food portion into four minimeals each cycle which are fed consistently at PS, +1, +2, +3, at first. As you get more data, you might need to adjust those feeding times especially if your kitty onsets later and you might find you have to feed at different times to address the difference in cycles.
determine if kitty needs to be fed the same amount at each meal or if he/she needs to be fed different amounts at each meal. As an example, I studied Gracie’s SS when she was on lantus and figured out when she onset and when she took her steepest dive. I then determined I really needed to “frontload" her cycle with food. This had me fine tuning not just the times I fed her but feeding the majority of her food at PS and +1 and a little less at +2 and +3. Over time as I got more data on how she did with that, I changed the amounts of food and also changed the feeding times. When I switched her to levemir, I had to do the same thing all over again.
test more at first to catch the drops. And did I say test? When you are first starting manage the curve with food, I would suggest you test every cycle at PS, +1, +2, +3 because that is most likely when the dives will occur. You need to figure out exactly where he drops so you know exactly when and how much to feed to prevent the drop. Don’t get complacent if he’s higher at +1 than PS and think “I’ll test at +3”. This will not be forever. This is just to find out where he drops so you can then manage the curve appropriately to flatten him out. Over time, as you start at a lower and lower PS, the dives should stop and you can get back to regular testing. Now is a good time for you to try it since you are working at home.
realize that even after it works, he might, at some time, revert back to his diving. Gracie did occasionally. I would start testing more to find out where she was dropping and then I could get proactive to adjust feeding the curve to prevent the drop. (Keep in mind, once I started managing the curve with food, I always did but patterns change from time to time and you have to be flexible and realize what worked for one pattern, might need a bit of fine tuning for another).
In summary, learning to manage the curve with food involves learning how Brady responds to different carbs at different times during the cycle. You have to be a scientist and an investigator. Write everything down (note the response you got to what you fed, how much you fed, and when you fed it). What kind of a bump does he get from LC, MC, HC early in the cycle and late in the cycle? Using this info, you can guide the cycles. Again, remember you might find that you have to steer the cycles differently. Gracie had a different a.m. cycle than p.m. and so her feeding schedules were a bit different. Any time you make a change, leave it for 3-4 days and give him time to adjust before you make another change.
That’s a lot of info at once but you can bookmark this and come back to it.
One other thing: when you make changes, make them one at a time. I never increased the dose and changed the pen the same cycle (not saying you do but I’ve seen people do it). You’ll never know what the cause/effect is if you are making more than one change at a time.
Ask me questions when you have had a chance to read it and decide what you want to ask.
A lot of good information here!
Thank you. I hope it will help the dives which will help the bounces.
Greens until the black....
He ate an entire can of FF pate from amps until +5.
He had wet food at +2 and again every hour starting at +4 and still went to 600 after the 285 to 69 drop. He had almost no food from +8.5 until pmps.
Thank you. He got close to earning a dose reduction! You can expect that any bounce leading cycle will be a very active one like today. The dive between AMPS and +4 caused the hard bounce.
He did get close with the 60. He had food at amps and +2 but still was quite low at +4 and still another black . Hope he gets out of this type of cycle.
I hate to sound like a broken record, but until you check him earlier and feed the percent carbs he needs to slow the drop, this will continue. But...you hold the syringe and the lancets so it’s up to you.
He is being given food at +2 after amps and +2 after pmps. He's also being tested 7 to 8 times a day.
I hope you have read the long post I left. Feeding at +2 might not be what he needs or you might be feeding the wrong carbs at +2 to slow his drop.
I’m not suggesting you test more each day. I’m suggesting you test at the appropriate time to catch the drop and then feed it the right % carbs. That is what managing the curve with food is all about. If you are not willing to even try it, then he will continue to do this. And as I said, he’s your cat so it’s your decision. You will then have to accept that this is how his curves will look......a constant dive/bounce. I’ve seen one cat in ten years that overcame this kind of pattern without food management and she was on Lantus.
Sorry...I didn’t get a tag so didn’t know you posted yesterday.
Still here. I printed out the long post of yours above to read more thoroughly. Obviously he's still up and down, (amps/pmps) just not large amounts every day.
As long as he’s seeing green, and until you read through the info, we should hold the dose. I’d sure like to see him see more normal numbers, though.
Blues at the moment, haven't had a green in 3 days.
I did read it. I just printed it out to re-read again and digest better...
and Normal #'s would be nice.
On 5/30 he had food at amps, +1.5 and +3 and still managed to go from 359 to 60 in 4 hours (at +4), obviously he popped to 574 pmps
We've been feeding his lower amps numbers lately to help even out the numbers at +4 when it seems for him the insulin starts to take effect.
When they drop fast, you have to feed the right % of carbs to control the drop. That means you have to know how fast the drop is. I hate to sound like a broken record, but if you aren’t going to test at +2 and figure out what % carbs he needs, then you will continue to see this pattern.
Looks like he’s trying to flatten out a bit.
Had to Reduce to 4.25u because of the 41 @ pmps +5. Then he popped up to yellows today with a red at pmps.
Good you reduced. The SS hadn’t been updated with that info when I posted.
He's been at 4.25u for 4 days now, it looks as though we'll up his dose back to 4.5u starting tomorrow.
Yep. Looks like a failed reduction. Happens all the time. It is not unusual for a kitty to go up and down around a dose.
Back up for Daa, Thanks for posting!
Thoughts on his SS?
It’s looking really good!!! I would hold this dose if it were me.
One thing on the SS. You need to move the PMPS back into the PMPS column and change it to read “103 @ 12; 217 @ 13”. That tells us you stalled an hour and shot at +13.
Another thing I will say about that is you should have shot the full dose on time and monitored. If you weren’t going to be home, you could have done what you did but if you were there and had supplies and could test, stalling is for you and not him.
Finally, I’m hoping you got a couple tests last night to be sure he didn’t drop back down when the dose kicked in. When you get closer to a good dose and when bouncing minimizes, you can see the numbers rise at the end of the cycle but then come right back down at onset. That’s what you want to happen.
He’s looking so much better!
SS Updated & Fixed.
I don't feel comfortable shooting him @100. I read on here that Prozinc users usually don't shoot at 90. I bumped that to 100ish points and still am not going to shoot him around that number. He bumped up to 360 @ +4 on (6/12) and bed time it was. He hit a 275 @ amps this morning which was almost identical to that of 6/11. A new bottle of insulin (#6) was started on Wednesday, I'm sure that has something to do with it also.
Thank you for your assistance!
I hope he is deciding to Hold the low numbers!
He’s spending alot of time bouncing but in between, he’s getting fairly good numbers. It boils down to whether you want to be more aggressive, which requires more testing, to try and tweak the dose a bit to get more green or if you are good with his current pattern. The nadirs he’s getting are reasonable to hold the dose.
I think we are going to continue to hold the dose. I'd like for him to have more greens regularly, but as I mentioned before, we are testing him up to 11 times a day especially when greens happen at pmps +4, and that's a lot and it effects everyone after a while.
I’m glad to see you are getting more +2 tests at night. On 7/15, pm cycle, that’s a pretty big drop. Remember the higher they are, the more they will drop. The more and faster they drop, the bigger the subsequent bounce. Even a drop from 351 to 247 in two hours is big enough to cause a bounce in some cats.
On 7/17, his BG went back after he had been bouncing. This is a sign to you (high before the break) that it is likely he will clear a bounce.
He had a No Shot pmps number tonight of 77 then 1/2 hr. later he was re-tested and it was 62. We delayed the shot until pmps +1 and he was still 65. He received NO insulin tonight...
This is only the second No Shot all year. A new bottle of Prozinc (#7) was started this morning........
Goose asked me in a PM to take a look at the SS and make some comments.
I think the 4U dose is too much, if you have to carb him up to bring his BG levels back to a good, safe level.
Not sure what "custom" dosing protocol Marje has you using. But never the less, I'd reduce the dose to 3.75U for the AM cycle on 8/6/20.
Do Daa will undoubtedly bounce because of the second skipped insulin dose in the last 9 days.(7/28/20 and now 8/5/20). But I'd reduce the dose anyway, and then wait out the subsequent bounce.
A cat not eating well, is often a cause for lower BG levels. Any ketones Goose?
Is 60 your current shoot/no shoot BG number? I remember you had it really low, but forget exactly what it was.
Looking for other opinions folks. So tagging a few people.
He is tested for ketones 2 to 3 times a week and everything is fine according to the little test strip. His Reduction number is 50 and we don't/won't shoot him below 100-110.
It has been unusually hot (85+) and humid (70%+ ) here lately for about 3 to 5 weeks and he hasn't been really eating a lot partly because of this reason.
Do Daa seems to be getting to eat an awful lot of gravy for someone who barely has any numbers under 50.
Ideally you don't want to break out the HC until numbers drop below 50. 51-70 you typically want to maintain with small teaspoons of LC until numbers can stay above 70 on their own. Like previously stated, it also depends on the time when you're seeing numbers below 70 - even though you don't want to use HC at say 55, if you're extremely early in the cycle with a considerable drop from pre-shot, that is when you normally need to attempt MC/HC because you're no where near nadir so there is more drop to come.
If you are being forced to "prop up" the numbers early on with gravy before 50 hits, that's a pretty good indication the dose needs dropped too, even if he hasn't "technically" earned the drop by going under 50. We don't want Do Daa to have to rely on HC food to get by.
He's had quite a bit of gravy lately because he isn't eating enough of his FF pate or the Clean Protein dry food, mainly it seems because of the heat and humidity here lately. So instead of relying on the syrup at low numbers, he's been getting gravy to, at the very least, maintain the numbers as they slowly go back up to something safer. We figured that the number would eventually increase and it did: pmps +3 293. A 216 pt increase, but it took a really long time to see any of this actually start to affect his numbers.
So is the bigger issue you can't get him to eat the pate as readily as the gravy? Would you have an easier time if you switched his Classics with FF Roasted/Chunky/Flaked? Those are also low-carb.
It's possible too that Do Daa doesn't respond as well to carbs as other kitties and that's why the gravy doesn't bump his numbers up faster. Perhaps he needs a higher percentage to work with (still under 10% but maybe instead of FF Classic's 0-3% he would do better on 4-7%). @Deb & Wink thoughts? Just throwing ideas out.
Or it could just be he needs a lower dose for now.
Honestly you got me, I'm a little puzzled myself. We will start at 3.75u in the AM.
So the FF Roasted/Chunky/Flaked are also quite low in carbs but enough to use them as another option?
Lately he hasn't been easily eating the pate and only some of the CP, so to make sure he had something in his system, gravy has been the easiest things to give him as oppose to pure sugar like syrup. The weather like it has been seems to also be playing a role.
Here's a picture of the carb numbers (snagged it from another thread from yesterday where we were talking with a cat momma whose kitty refuses pate). They fall under the low-carb category so you could use it instead of Classics pate. What gravy food are you using right now for Do Daa?
I'm curious to see what the lowered dose will do for him. Good luck Do Daa!
Yes, the weather sure makes the kitties a little more sluggish to eat. I often can't get my cats to come out for a midday snack, it's too hot for them to bother getting up!
Thank you for the pic. So the numbers represent what, exactly, as there are no headings over he columns?
Currently the gravy he is getting is Friskies Extra Gravy, Chunky with Beef.
Do Daa says thanks!
Whoop, didn't realized they weren't included! Numbers are Protein - Fat - Carbs. So the last one is what we're looking at.
Okay, so most of Friskies gravy foods average about in the 13-15% range which is only medium-carb. High carb is 18%+ . Usually Fancy Feast Gravy Lovers around 20% is good to keep on-hand for hypo situations.
We do have many Fancy Feast Gravy Lovers cans here also, just that the cans are so small and obviously don't have the amount of gravy that Friskies does. I didn't know there was that much of a difference between the two, it's good to know.
Red amps/pmps with some blues today. We'll try the 3.75u for a couple of days and see what's up.
@Panic , can't see the image you linked at all.
Do Daa is bouncing from no shot last night.
p.s. Housekeeping chore. New thread needed please, since this one is at 60+ replies now.
Hate asking, but keep getting bugged about needing people do this.
Still up for me, it's just a screenshot of the FF Roasted/Chunky/Flaked carb info from the Dr. Pierson's chart. All in 4-6% range.
Ah yes, with how much you've been using that makes sense. I never went through an entire can during a "gravy time" situation. My civvies always got to finish them.
Yeah, we all figured he was going to bounce.
New Thread done!
We have been going through too much gravy for him at the moment.
New Thread7 is up and going.....