Dosing Advice Needed

Hello. I posted over in another forum and it was suggested I try over here. If you all could take a look at the link
and offer some opinions it would be a great help. My cat Blue is a newly diagnosed diabetic and I'm still learning.
Thanks!

Here is the link: Won't matter if you should respond over there or right here as I'll be checking both.

http://felinediabetes.com/FDMB/viewtopic.php?f=3&t=10923

I posted his curve over there as well.

Edit: I'm going to give him his dose - lowering it from 3.0/2.5 Units to 2.0 for right now. His shot is past due and his last reading was 305 a few minutes ago. Hopefully things get back to around decent levels. Still would like advice should this happen again. Thanks.

 

Welcome!

My kitty is on ProZinc and I still haven't got him regulated. But, in the past when a dose has taken him into low bg readings (without hypo symptoms), he rebounds. When that rebound response is triggered, his next couple of cycles seemed to run high and/or flat. It may be that your kitty responds the same way to rapidly lowering or too low blood glucose levels.

Do you have other bg test data? Do you test before shots usually? Setting up a google spreadsheet is a good way to keep track of things, and what many of us here do.

 

Thanks for the welcome!

Yes, I've kept track of everything the past week. He has only been home 2 weeks since diagnosis. Most curves have been highs around 300 and lows around 50, but this is the first time he fell to nadir within 5 hours. Usually it takes 7-9 hours. I think I'm going to make a switch to another insulin if this keeps up - possibly BCP PZI or Glargine, but I'll give it a few weeks to do it's magic.

How long has your kitty been on the PZI?

Is lessening the dose for the next shot interval the recommended protocol when there appears to be 'rebound'? From the info I've gathered it seems to be the best bet. As mentioned, I gave him a 2.0U dose tonight instead of his 3 or 2.5.

I just tested for ketones and he is negative. :smile:

Thanks for the response.

 

Welcome.

I'm not sure switching to BCP insulin will achieve the results you want. It can take upwards of 4-6 weeks for ProZinc to kind of "settle," in the interim the nadir may move around and things may otherwise change a little.

Is there any chance you can put together a profile and spreadsheet [and link in your signature perhaps]? The instructions for this can be found in the Tech Support forum here:
viewforum.php?f=6
These will help us help you better. :smile:

What food are you feeding exactly? You are using ProZinc insulin currently?

Your curve looks OK basically [maybe a bit of an earlier drop and nadir which happened to us when we switched to ProZinc and could also be caused by too high of a dose] but the nadir is a little lower than one would like especially why you are starting out.

IMHO, your one curve does not seem to show rebound. The rebound I'm familiar with happens quick, like within an hour. Maybe someone else knows different? You can read about rebound here:
http://petdiabetes.wikia.com/wiki/Rebound

Also, make sure to read the info in the PZI reading & resource links sticky at the top of this forum.

BTW a nadir of +7 is just fine.

On the one curve you have, did you give another shot at the +12? If you did then that shot might have been a "fur shot."

 

Hi and welcome,
It would really help other people help you if we had more details on your kitty. The absolute best way to do that is set up Blue's "Profile" and to set up a "spreadsheet" . Help to accomplish these are on the "tech forum". Feline diabetes is a marathon, these items will really help everyone, especially you, figure out a good dose for Blue.

Folks are very hesitant to give specific advice without knowing your history, so I've scanned your previous posts, and from that I've gathered:
that he is newly diagnosed approx 3 weeks, he was in hosp 5 days for DKA, he is on Prozinc, initially 4u, now down to 2-3u on a 12/12 schedule. He is a big cat, 17 lbs, eats well, Fancy Feast, and eats no dry food(?). The switch to canned occurred at home, after the vet released him from the hosp on 4u PZIR (prozinc). He is likely experiencing rebound as you have had bg of 35 and 400's. Age? You have done a good amount of research and learned a lot, and are considering a switch of insulin. No other health issues? Am I close?- please add/correct anything else important. (and please figure out the spreadsheet first- because its really important)

In the meantime a couple thoughts I had for you.
Home glucose meters are not precision instruments, so sometimes you will get a crazy number, and if you are worried & suspicious of that, you should retest, and if it is quite different, test again to see which one is right. It is normal to see variance even from the same drop of blood. The lower the numbers the closer the variance, the higher readings are more likely to show greater variance. There is a blood glucometer available that can also test for ketones in the blood. If he is prone to ketones, you might want to consider it. Sorry I don't know the name.

It is important to watch glucose levels at home when you stop giving dry food to a cat receiving a set dose of insulin. It almost always reduces BG and insulin needs; and can put a cat in a hypo situation. As you are seeing, no dry frequently = less insulin.
Have you read the stickies about how to deal with hypo?

Newly diabetic cats can revert to being off the juice. Sometimes the food change and a bit of insulin, can give the pancreas time to kick back into gear. Aren't you glad you home test?!

Pzir is a good insulin, and it is very effective for you (bg=35) with good duration, so I wouldn't rush to switch just yet. What you need is to get the dose adjusted. (and to do that we could really use that spreadsheet ) You may also need different syringes which help you fine tune a dose- more about that later.

Check tech forum ...

 

Thanks for helping out with Blue Cat everyone!

:thumbup

I think I'm going to have to put together a spreadsheet. ;-)

In the mean time I'll answer your questions:

Gator and H: Yes, Blue rec'd a shot at +12 which had no effect. I was thinking Somogyi myself and I'm fairly certain that it was not a 'fur shot' as we always check for insulin in his fur after his shot - but I suppose it's possible. He is on PZI human recombinant. Initially 4.0 units which I've dropped to 3.0/2.5 since the switch to a canned food only diet.

Blue has been eating Walmart Special Kitty, Wellness turkey & salmon, assorted Fancy Feast. All canned and all hi protein/low carb according to labels and Janet and Binky's food charts.

Nancy and Cody: Thanks for researching my previous posts. Yes you're right on. Blue has had no Ketones since he's been home and I'm familiar with hypo and what steps to take. Blue is 13 years old. He has had bouts with Feline Herpes Virus and is currently taking 250mg Lysine/day after initially loading with 500mg. He was also placed on Clavamox for a possible infection while in the ICU. He is on his last dose of Clavamox today - so he has been home two weeks today. Everything else you mentioned is correct - nice job.

I recently ordered the 3/10cc U-40 syringes from Hocks.com as no one around here seems to carry them besides the way overpriced animal emergency center. Is there a syringe out there that can fine tune dosage even more than that syringe?

My ultimate goal is to get Blue into remission ASAP - but realize it can be quite a process.

I'll get to work on that chart... and want to thank you all for the info. I think I've learned a lot in a short time from FDMB and felinediabetes.com, but have so much more to learn.

I'll get to work on that spreadsheet

 

A lot of the other beans around here use U100 syringes with u 40 insulin (prozinc is u40). There is a conversion chart which you have to read carefully so you dose correctly. The u100 syringes you want have more lines of demarcation, and so you will see others referring to .2u dose increments. please get someone else to tell you about exactly which ones to buy. They are inexpensive and available everywhere.

I am NOT the best to discuss u100 syringes because I have a cat with acromegaly (a pituitary tumor) which means Cody needs much larger doses of insulin and I dont need to think about..2, .4, .6, etc, but most of the others do see a difference with small changes.

From my memory, and again it hasn't been an issue for us, ketones typically can show up when you have 2 or more of the following: not enough insulin, infection, not enough food. So the infection could have been an explanation.

Also fluids help clear them, so many of us add extra water to the food, and some of us give subcutaneous lactated ringers solution, or at least keep a bag on hand for an emergency/travel.

What can we call you?

 

ProZinc right? I think I remember seeing some online place that sold something named "PZI human recombinant" and it as not really ProZinc, this is why I'm double checking with you.

Yes, the syringes that are linked in the sticky at the top of this forum are the ones that will give you the greatest amount of control [IMHO]. Make sure to print out the conversion chart and use it:
viewtopic.php?f=24&t=1979
Some say they can get the same thing from Walmart [but where I'm at they require prescription]. But basically what you want are U-100 31 Gauge 3/10cc 5/16 inch Needle 1/2 Unit Markings. If you go the U-100 syringe route the 1/2 unit markings are very important. then the 1/3cc size is next most important. The gauge and length of the needle are not so critical.

As you are probably aware, sadly the labels aren't good for much.

Looking forward to seeing your spreadsheet. It will really help the folks here get you the best input. :smile:

 

Sorry, just had another important thought. It is important to know the strength of your insulin. If it is indeed ProZinc then it is U-40 strength and my recommendation to use U100 needles with the conversion chart remains.

HOWEVER, if it turns out that it is a compounded insulin, many times the compounded insulin will come in U-100 strength. In that case you would use the U-100 needles WITHOUT the conversion chart.

This is another reason I want to double check exactly which insulin you are using. :smile:

 

Thanks for all the help everyone... Blue and I appreciate it.

The exact insulin is produced by Bohhringer Ingelheim and is trademarked Prozinc. In parenthesis under Prozinc is says "protamine
zinc recombinant human insulin". It's definitely U-40 as it states "40 units per mL".

What confuses me is that on the label from the pharmacy it says PZI U40 (IDEXX). I thought that I read that IDEXX was the old bovine
PZI and originally thought this was a bovine insulin. I believe IDEXX has been discontinued? I'm thinking that they vet pharm still uses the old label. Someone please correct me. :?

Once Blue gets stabilized a bit I will def tweak his dose with the U100 syringes. Much thanks for that suggestion as it will simplify things. For now I'm waiting on the U40 3/10cc from Hocks with the 1/2 U measurement.II will print out the conversion chart when I go that route. I will also look into the 'subcutaneous lactated ringers solution'.

This place is loaded with great info and help. I can't thank you all enough. Sites like this make are what makes the 'net so
'awesome'. :thumbup I know my Vet has learned a thing or two from here as well. She is great as she is willing to learn a thing or two and work with me on this.

Thank you. (Still working on the chart)

Call me Kivstev, Steve, Blue's Slave ;-) all are good.

 

The PZI Vet brand insulin from IDEXX has been discontinued. There may still be bottles of it in the market however [but this is unlikely]. ProZinc is the "replacement" insulin for the old PZI Vet. Good to hear you are using ProZinc. You are right it is a U40 insulin and if you are using U40 syringes there is no need to convert. You will only need to do a conversion if you switch to U100 syringes with the U40 insulin.

If you are thinking about LRS, I like the 21g x 1" Terumo needles. I now buy the needles & IV admin sets from shopmedvet.com. You can get a lesson from your vet tech. You should be able to buy a case [12 x 1,000 ml bags] of the LRS from a local pharmacy. More info here:
http://members.verizon.net/~vze2r6qt/su ... ompare.htm

 

Yeah I thought so. I'm going to have to talk to the original emergency Vet pharm and tell them not to use that label on the boxes because it adds confusion as to what exactly is inside.

Thanks for that link too. Will look into that.

 

BTW I recently bought LRS from Sams club pharmacy - a case for $23, prescription needed. Weird though, they couldn't get the tubing and needles, so I paid a lot more for them online.....

Steve, when your vet thinks we're crazy, Cody gets fluids for megacolon, keeps him 'moving'.

 

Nothing crazy about that! I had a cat with megacolon - we had the 'mega' part taken out. Had a good response to that surgery, but would have been nice to have that option.

Back to Blue Cat - Finally finished his spreadsheet pc_work - but feeding details were left out for now. Thanks to all who take a look at it. His numbers are fairly high now - hopefully will drop soon should it be rebound. no Ketones as of yet.

Thanks all!

 

Good work on the SS! On to the profile [the more info you can include in the profile the better]. :smile: Nancy did a wonderful job pulling together the earlier run down. Once you get the profile up then you may want to start another topic here in PZI to make sure it gets attention.

It can take up to a couple weeks for the food change from dry & high carb to work it's way out.

The 300 to 30 dip on the 28th on 3u is a bit worrying.

How are you feeding - timed feeding or free feeding?

Indoor only cat?

Does the appetite vary from day to day or does it stay pretty much the same? I ask this one because I've noticed with H when he eats a lot to try to make up for the time that he was not eating well that it is hard to keep up with his insulin needs. I'm not sure if Blue may be mowing it down right now because he is feeling skinny? Is 17lbs ideal body weight for Blue?

For the UTI, was a urine culture done?

You are doing great with the testing! Keep up the good work.

 

Yea, those profiles are no longer available. However, there are instructions in the Tech Support Forum. I have not tried to use the tools they have in there. The last time I looked at the doc for setting up profiles it kind of starts off with how to make one if you had an old profile, then a couple posts down it starts in as though one is starting fresh. The important thing are the questions. As I understand you might be able to use the old tool then copy and paste into a google doc.

Heck, I don't even know how to change my account name! :smile:

When you are not home you can leave food out too. I add a bit of water to the wet food to keep it from drying out and getting the crusties. Some folks freeze the wet food in ice cube trays. If blue can have food out all the time and not get fat then the grazing thing is best not only because it minimizes the effect of food on the curve but it is also closer to how they would supposedly naturally eat.

As Nancy noted DM is definitely a marathon.

I'm hoping some others might be along here to take a look at your SS. I really don't have much more input for you at this time, but I will be interested to see how the 2.5 goes here. You are kind of on the cusp of the food change and it's just a little hard for me to say much more at this point. You may need something in between 2.5 and 3, and you are on track to improve your syringe situation here shortly it sounds like.

Do you have a no shoot level? OR how would you say you are approaching no-shoot or shoot less situations?

 

I did find the SugarCats coolification profile in that thread. I believe I can use that.

I did pick up some 100U syringes today and printed out that chart. They are the ones that you described in an earlier post. Thanks again!

If his BGL is low at shoot time, then I basically try to mimic Dr. Hodgkins' Tight Regulation sliding scale chart (with adjustments) that I found. Hopefully I've learned from a mistake or two the last week:

Basically:
<150 BGL No shoot
150-170 .5U
171-185 1U
186-200 1.5U

Time to test again soon: I would think that if this Rebound that it should start to dip. We will see....

 

Bah! 392 :-x

Strongly considering going back up to 3.0U... but probably will stick with 2.5 again unless anyone has any ideas in the next 20 minutes.

Shot him a 2.6 (6.5) with the new 100U syringes. They work well.

 

Seeing what 3U gave you 3 days ago, I might stay with the 2.6U for one more day to make sure you are still not in a symogi rebound (sp?), but I am far from a definitive source for dosing information. I am often asking myself!

 

I agree, although Blue was in the 170-180 range when I gave him his 3.0. Live and learn. On the 28th though he was at 300 and dive bombed to 30 on the 3.0U. I don't know what to attribute this to. Hopefully he lessens a bit when I test him tonight at +3. :?

Thanks - all responses help!

Edit: 357 at +3 tonight. Frustrating....

 

personally i think you are trying to rush things waaaaay too quick here. no one gets steady good numbers two weeks in to a diabetes diagnosis unless it was something like a steroid induced diabetic.

seriously, you cannot and should not expect to see good steady numbers for several more weeks. and rushing things ends up with kitty at the ER or your heart racing like crazy some night trying to save your cat's life with syrup.

slow down, take a deep breath, and hold steady for a bit and try to get Blue off this crazy roller coaster he's on. remember, roller coasters don't make most people or kitties feel very good.

 

Thanks - advice noted and taken. I'm trying not to rush anything by keeping his dose at a 'reasonable?' 2.5U. I've dropped the dosage from 4 to 2.5 over the last couple weeks because of those swings. I'm just not understanding why the doses the last few days have had such little effect. As of late it hasn't been a rollercoaster - just high (too high for me) and steady. I'll try to be patient while checking for ketones. Not sure how long is long enough at these levels?

 

Steve,
Yes, welcome to FD, it can seriously be frustrating.... and yes, its amazing how much you can live & learn...

I'm tired tonight, so I had trouble figuring out that ss, but it is pretty clear that 3u is too much. It may take awhile to recover from the multiple rebounds, so I still think I would hold the 2.6u max dose for a few days, just to settle.

other things that could be messing with your numbers:
food variations for example I'm pretty sure the wellness poultry and salmon is one of the higher carb wellness flavors. ( I also cant help but be suspicious of the glycemic index of food with carrots in it. carrots have a high glycemic index, which means they break down to their sugar building blocks faster than food with low glycemic index.) This is part of the reason I feed DM. Its 5% carb, mostly all animal protein, and consistent. I have the "as fed" if you want it.

Injection technique- are you pretty sure you are shooting into the space between the muscle and fat/skin layer? I've been doing this for years and I still get nervous with every shot. since you are trying to move it around to different spots, some are easier, some lift easier, some have more fat, and the thick scruff may absorb poorly.

I (and others I seem to remember) have noticed that when the testing blood drop is "clearer " looking the number tests higher, and when the blood drop looks darker thicker red, it tests lower. Can't really tell you why...

You might consider a timed feeder if you want to keep the food coming at a steady rate. Petsafe.net has some to view.
http://www.petsafe.net/Products/Feed-an ... matic.aspx Cody can break into the 2 meal feeder, but he's crazy!

Activity level affects numbers.

Does Blue snore?

Did you ever try miralax with your megacolon kitty?

 

his body needs to figure out what to do with the dose, thus the lack of effect the last couple days. up until just a couple days ago he would get too much, drop too low, rebound back to high, drop, not get any, get too much again, drop too low, not get any, etc.....see, no routine? his body has no idea what it is getting or doing or supposed to be doing.

if this were me, i'd hold a steady dose for at least 4-5 days (assuming pre-shot numbers are at or above 200), let things settle down some, keep ketone testing just in case, and collect some good data based on stability at that point. if ketones come into the picture then things may need to be reevaluated.

 

Blue is handsome, looks like one I petsit....
I found this in something I saved- maybe it will help you attach his picture:

 

According to J&B's list the Turkey and Salmon is 5% carbs as %Kcal. Not high at all! As for the carrots I have fed multiple flavors of GF Wellness [without mixing with our Home Cooked] and although it has carrots H does not have a problem with it. And there are many others here who feed Wellness without problems. The devil is in the details and there can't be that many carrots with 5% carbs as %Kcal.

From a DM perspective the Wellness flavors to avoid would be: Sardines, Shrimp & Crab and Chicken & Lobster. Other than that, according to J&Bs list the rest of the flavors are under 9% carbs as % Kcal and are fine for DM kitties. I have the as-fed as well and have run the numbers on a couple Wellness flavors and J&Bs list seems up to date [as of about 9 months ago] for Wellness at least on the couple that I have double checked.

The only beef I have with the Wellness is that it tends to be higher in fat, but so is the Purina DM unfortunately.

 

I wouldn't interpret the #s either to mean that he is not responding. You've seen some high drama responses so far, so you may have higher expectations based on that.

Today for instance you got a decent curve with a drop of about 90 pts and then back to about the same PS. It doesn't *look* like much because it's all pink #s, but a few more points difference on either side it would have been from red to yellow & back.

And I think the 357 at +3 is actually pretty good (not the # itself of course, but relative to the PS). With Bix, when things were going well, his PS would be about parallel with something in the +2/+2.5 zone, and then by +3 he would be starting to drop, which is about where you are tonight. Bix's biggest drop would be from +3 to +5 ish, and then a bit more drop over the next hour or so til nadir. If there is a BIG drop by +2 and maybe even by +3, it can sometimes be a sign the dose was too high. Not necessarily anything worrisome, but the way PZI works onset isn't really til +2-ish, so you wouldn't expect a big drop too early.

It does look like this dose may not be enough, but it looks pretty certain that 3u is too much, so I'd probably hold it at 2.6 for a couple days (barring ketones), and if you aren't seeing improvement then try 2.8. I see a couple spots with possible pancreas action, so that might be part of what makes the #s more confusing.

You may already know this, but when you get a low PS, you can retest in an hour or so, and then shoot when the # is high enough, rather than skipping the shot entirely.

Overall I think things look really good actually. The #s are wonky of course, but there is some good stuff in there, and you have some good bracket data on doses that are too low vs. too high. It's just some patience and fine-tuning from here to get him in the upper greens for as much time as you can. Just keep a close eye on the ketones, and if you see any trace of them I would go ahead and raise the dose a little. With Bix sometimes I had to raise the dose to get action, it seems like sometimes they get stuck in higher #s and need a little extra help to come down. You may find you need to do something like go back up pretty close to 3u to get him back in good #s, but then back off immediately to something like 2.6 or 2.8. Not advising you do that now, just mentioning it in case the #s don't improve soon. But hopefully he'll give you some nice #s though in a cycle or two on this dose.

 

You people are so awesome! (Don't take offense at the 'you people' as I'm not very prejudiced) :lol:

I'll respond with more to say tonight, as I came home for lunch to test Blue and need to get back to work. I just got a 199 reading so there is a dip after quite a time in the 300's. Now I just have to figure out what it means and will test him again in about 4 hours. Bye for now and thanks...

 

Yay, good news!!! You are looking for around a 50 - 60% drop from PS to nadir, so this looks to me to be in the ballpark. If tonight's PS is dramatically lower, I'd consider easing off the dose just a hair, maybe to 2.5 or 2.4.

 

Maybe too much good news? :? Yes I'd say whatever that rebound was is now over as he tested a 38 a couple hours ago. I'm feeding him well since I obviously don't want it any lower than that. I think it is safe to say I should back off on the 2.6U tonight no matter what the PMPS level is? I can't be with him all night and that low number stresses me. Sure glad i didn't up his dose this morning or there may have been some real drama around here - pays to be patient sometimes!

J&B: I will keep in mind to wait a bit if tonight's PMPS number is on the low side. Thanks I never really considered doing that as I thought it might screw up any type of consistency. Hopefully you are correct and there is some pancreatic function going on. :smile:

N&C: I think the problem is that the pix I've been using are from a 12 megapixel dig cam and that in order to get under the 9 kb limit the pic would be too small. I'll back off on the pixels and put a pic up later. Thanks.

C+M: I was planning on holding steady for a bit at his current dose to see how he responds, but these swings tell me I should back off on the dosage - even if Blue is above 300 @ PMPS. Agree?

N&C (again): I'll keep that in mind about shot location, but I'm fairly certain at this point it was some rebound going on. Blue used to snore when he was overweight, not so much any more. He was about 22lbs at some point - sorry Blue - bad daddy. Thanks for the feeder link. As for MegaColon kitty she got lots of enemas before her colon surgery. She had a bit of diarrhea for a few weeks and was great after that. She's no longer around, but died and a ripe age of 16 non-related to her megacolon.

So what now? I'll take a reading or two before Blue's preshot and post them. I'm most likely going to back off the dose unless I can understand a reason why I shouldn't, but unsure of exactly how much until I see some other numbers. Wish us luck - and thanks for the support everyone! What did I do before the net? ;-) ;-)

Edit: 66 @ +10

 

"C+M: I was planning on holding steady for a bit at his current dose to see how he responds, but these swings tell me I should back off on the dosage - even if Blue is above 300 @ PMPS. Agree? "

definitely back off some. even if you see a 300 it could be rebound still.

i'm not sure how far to back off though. myself, if this were me, i'd back off to at least 2.0 but that's just me. see what others say and hopefully they see this before your pm shot comes due.

 

Yes, absolutely lower the dose regardless of PS. Glad you have a breakthrough, though it s*cks when it gets scary like that! My rule of thumb is that you lower the dose immediately anytime you see a # below 50. There is some disagreement on the exact #, etc., etc., but that's what I would do.

What's always confusing (to me at least) is the variations they get in response, so a couple times a while back you shot 2.5 and it looked like it might be too much, but then in the past few days it has looked to be not enough. I have found you just have to hold on lightly to whatever dosing you have in mind, and respond to the #s as they come. 2.5 might indeed have been too much a while ago, too little these past few days, and now too much again. It's a puzzle, you just gotta kinda roll with the punches.

Even back on 3/30, when you shot 2u that night it was either too much, or his pancreas was kicking in. But 2u hasn't looked to be too much at other times.

I'm not sure about the dose either. I'd probably be tempted to shoot 2u if the PS is over 180, and get in some spot checks before bedtime. If I would not be able to check, I would probably shoot a little less than that.

PZI is pretty forgiving on shot times. 12/12 is nice when you can do it, but you can vary from that when you need to, and it's definitely advisable if the PS is too low at 12. More or less if you shoot earlier than +12 you might lower the dose a bit to account for extra overlap, and if you shoot later you might raise it a little.

 

BGL is 87 @ PMPS time. My plan is to wait and test again in 2 hours? :smile: I'm guessing that this is not very typical? Hopefully another rebound is not the future since he got pretty low. Darn cat is messing with me. :lol:

Feel free to give opinions on what is happening and how I should proceed with this. I've gone this route before and would like a consensus this time. Thaaaank you!

edit: Just refreshed the last two responses form J&B and C&M. Thanks for weighing in. I'm thinking of testing in two hours and if it's around 200 give him a 2.0U. At least that's what I'm thinking now... that may change depending. (nervous laff) Keeping him at a steady dose every 12 isn't very wise at this point - even though I wish it were that easy. Trying not to bounce him around, but like you say very unpredictable at this stage.

You may like to know that Blue is feeling very chipper.

 

BGL 127 @ +14 (thank J&B) - Still not shooting. Riiight? :-| Test again @ +16 and then I'm done for the night... I think.

 

Given that he's had some drama-drops, I would be inclined to wait til closer to 150 to shoot. Technically if you are past +12 and you are over 100 and it's a clearly rising # (which it is) you don't *have* to wait for 150. Generally a late shot will not have the oomph that a +12 one will, so if you want to go ahead and shoot (I'd reduce the dose further) it's probably ok. You might want to do something like just shoot 1u so you can get some sleep, and sort things out in the morning.

Just keep in mind that you are now at +14 (or whatever) not +2 - it's counted from when you give the shot. Peeps may freak out if they think you are giving a shot tonight at +4 or whatnot.

I don't like to advise to lower the dose a lot because then you can lose the progress you've made and risk ketones, but at the same time, get the sleep you need, and don't put yourself in the position of shooting something that will keep you lying awake or spot testing all night. Nothing *wrong* with doing it that way, I have at times myself, but also you don't have to overstress yourself. Sometimes on the board we get pretty perfectionistic, trying to find the perfect dose that will give you the absolute perfect nadir, but sometimes that really adds to much stress.

Not sure what you meant by "gone this route before & would like a consensus?"...? Happy to throw in my 2c, only not sure which question/route it refers to.

 

Thanks J&B, I fixed that +2 (+14) mistake.

What I meant about this 'route before' is when Blue was fairly low on the 28th of March and I gave him a full 3.0U dose which kind of bottomed him out that night. A few nights later the same thing happened but he didn't quite bottom out - but had some low numbers.

He has never shown any clinical signs of hypo. Reading Dr. Hodgkin's Protocol she mentions that cats on this diet are much less likely to hypo. Is that pretty much the rule unless you vastly overdose? Also, does that protocol hold true for the current form of non-bovine PZI?

In any case, I'll probably test one more time at +16 and shoot him a 1 or 1.5U depending on where he is. My girlfriend can take over in the morning in five hours til I get up.

I would guess that I'd be one of those 'picky' ones trying to find the perfect dose/perfect nadir if I could figure out what is going on in his innards. :smile: Thanks for your two cents! I do realize it's an educated guessing game at this stage and not perfect science. I really hate to take away any progress at this point by changing doses and times, but what other options do I have w/o risking very high numbers overnight?


How the heck do I chart a +16 PMPS dose? :lol: I'll figure it out...

 

The diet and much less likely to hypo argument is probably one of if not the most controversial elements [in these parts] of her protocol. As for "much less likely," how much 'less' is acceptable to you? Recent human studies have shown long term cognitive consequences of hypo. From my viewpoint, hypo is nothing to tempt fate over. Some here are more caviler than other about hypo. I'll just say I'm very chicken about it and it is not worth it for me or in H's case to press things too far. Your assessment of things may vary.

As for "that protocol hold true for the current form of non-bovine PZI?" I don't think anyone can absolutely say anything 100% but my assessment would be that the type of PZI insulin would have no bearing on the chances of hypo and I'm sure as heck not going to be the one to test that hypothesis.

 

I hear ya G&H! Glad to see you're still following our little little drama - at least it seems like a drama from where I am.

Edit: Shot Blue a 1.2U for PMPS (+17) He was at 203 BGL. A bit conservative? Those 100U syringes are coming in very handy.

Goodnight all, and thanks... really.

 

Ahhh, that route. One thing we often tell newbies is to start with a no-shoot of 200. Once you have some data on that, then you can move it down to 180, and with more data and comfort level you can lower it to 150. The difficulty comes in with ketones. Taking the slow & patient route is great, but if you have a ketone-prone cat you probably want to be more aggressive.

Ultimately you are the holder of the syringe, so you have to do what feels safe to you. With Bix, I undershot many times, and when I got a lower PS I would reduce the dose WAY down. Then when his #s were sky-high after that , next time I wouldn't reduce that far. Everyone was telling me to shoot more and I'm sure rolling their eyes at my timid shooting, but it was what I needed to do, so that's what I did. Thankfully Bix has never had ketone issues, or even really bad symptoms from the diabetes, so I had the luxury of doing that.

I advocate for more aggressive dosing now because I learned from experience that the big reductions were counter-productive. But on the other hand, with the exception of during the switch to low-carb food, I never actually had doses that were too high, I was just scared of the low PSs.

Not sure what my point is :lol: except that there is no shame in lowering the dose to one you feel safe with, even if you suspect it won't be enough. Then you get some data, prove to yourself what works or doesn't work, and then use that knowledge to decide next time.

I'm certainly no dosing expert, just like to share my long-winded 2c . Honestly the cats I've seen do best here are the ones where their beans shoot on the aggressive side rather than on the timid side, which is one reason I've taken to giving more aggressive advice (combined with having followed along with some DKA crises that in some cases ended badly). I wouldn't take the hypo risk lightly, but I also wouldn't suggest that anyone repeat what I did - live in daily terror of it :lol: - and undershoot consistently.

I've never really understood that, and I agree about not putting it to the test!!! Without a vast overdose though, when there is some degree of overshooting, cats seem to do just fine when their beans can manage it with feeding small amounts and testing until past the danger zone of peak/low #s. I wouldn't suggest anyone do it intentionally, but I wouldn't have a big fear of it either. Someone recently mentioned their civvie tested at 40-something (!!!), so it's hard to really know what #s are truly hypo. That LO you got is d*arned scary, but the upper 30s might just be borderline scary.

I usually shoot with a nadir in mind, and aim for the dose that I think will give me that nadir (I like 60 - good #, but some margin for error there). To some extent with PZI you can evaluate doses by the % drop from PS to nadir. With Bix, I liked PSs around 150 and nadirs around 50% of that. If the PSs were too low or the nadirs getting lower I would lower the dose a hair, if things started creeping up, I would raise a hair. He was more consistent though in his #s than most cats, so I guess I had it easy.

You won't lose progress necessarily by changing doses & times. Where you might lose progress is if he stays in high #s for a few days, it seems to get harder to get things back under control once you lose it. I wouldn't worry too much about 1 night of higher #s. I don't want to say anything that might jinx things :mrgreen: but my suspicion is if you can keep him in good #s for a few days you will find that his pancreas is helping out - it looks to me to be sputtering, but I'm definitely not an expert.

 

Hey there. Maybe I missed it somewhere in the reading (I think I got caught up) but at least for us, if we get a low DD (we've gotten 40's with no signs of hypo), we usually get a high PS in the next 2 cycles that react well to our usual dose instead of an increase in dose. Some weird seesawing always happens after that, so the no shoot rule is usually the best indicator. Good Luck!!

 

I'm determined to get that thing (pancreas) started and humming again. It will happen.

 

Thanks! Yeah Blue cat had no signs of hypo when even in the 30's or that 'low' number. Lost some sleep that night. I can't imagine not testing Blue cat and just shooting a standard 'blind' dose like many people do... scary.

 

One approach might be to save "aggressive" for if you see trace ketones. If he is ketone-free, while I wouldn't be *overly* cautious, you probably don't need to be super-aggressive either. You probably need some down time from all the excitement! :mrgreen:

 

I got lost on when today's shot is. If last night's was 5 hours later than usual and today's 4 hours later than usual, I think that makes it +11? Otherwise it's really confusing to judge how the dose is working. You would expect that a +17 shot would be much less effective than a +12 shot, and a +11 would be about the same as a +12 or possibly slightly more effective. So when you are viewing the data, you want to also have in mind how many hours it has been since the last shot.

He actually did surprisingly well on the +17, which could be a sign this dose is even still too high. Hard to say for sure really from that cycle. Sometimes when you see an inverse curve that means the dose was too high. I am always suspicious of that if the PS is lower than the mid-cycle #s. In his case though it could be a sign that his pancreas is working, since you've seen that before on no insulin. Or those yellow #s could have been a touch of rebound I suppose, though they seem low for rebound.

I would try to get a spot check or two this cycle if you can - if he goes higher and then comes back down by the PS you might want to go down to 1u. If the #s go low again, then definitely reduce further. Vs. if the #s go higher and the PS is even higher, then you'll want to raise back up to something between here and maybe 2u. Just guessing on the doses, but that's the framework that I see it in. When their pancreases start kicking in it can end up being a series of pretty quick dose reductions.

 

J&B: Would be nice in the pancreas had signs of working... I'm just not sure what is happening since he is barely into his 3rd week on the PZI. As I mentioned, he is doing very well and is one happy cat... so who can complain about that.

I shot him up at +11 (thanks for correcting that, the doses on the 1/2 hour confused me) when he was at 266 with a 1.2U. He dropped to a 64 @ +4 which is a 204 pt drop in four hours if you're counting at home. I'm not sure what that means at this point, but I don't think it's bad and I'm glad I went conservative. I'm feeding him well (and he's hungry) since I don't want much more of a drop (this feels like deja vu!)

Depending on what I see @ PMPS time, I doubt I would be likely to dose much more than a 1.2U unless he hits the high 200's.

Is it me, or is it really tough to see any pattern here? @-) The 200+ point swings are nutty. Sometimes they happen, sometimes not, etc. I think I'll take the advice of keeping it low and then adjust upwards if necessary considering his good numbers at this point. It'd be nice if the panc hit me on the head and told me that it's working or trying to regulate... time will tell I hope.

 

Many cats have improving numbers for a while [even beyond the initial two weeks] after they have switched to an all wet, low carb diet. Also in at least one of the ProZinc studies it seems to take a little getting used to [for the kitty], so things may change around here for a while [up to 4-6 weeks]. So stay loose. :smile:

 

4 to 6 weeks of this? I cants takes much mo! :lol:

 

I'd consider lowering the dose to maybe 1u. 64 is a little low for a +4 - not scary low (actually it is an awesome #), but sometimes he nadirs late, so I would read it as a sign the dose might be too high. It's possible that is because you shot a little early, but +11 for many cats doesn't seem to make any difference from +12. You really don't want much more than a 65% drop, more than that is one sign you might not need to shoot quite as much insulin.

The patterns actually make sense to me, although I can't articulate it. I see probable evidence of pancreas action. What I have seen with other cats (no hard facts on this) is that when they get in good #s for a bit their pancreas will start taking over. When they hit higher #s for a bit, their pancreas will start to doze off.

I think you are in a good place, and it looks possible that you are on a dose reduction path. Some of it may be liver training too, they have to relearn that the blues & greens are a good place to be, and then once they get the picture, they will stay in those #s better on their own. Not sure that is what is going on, but could be a factor on the days when you see higher #s (i.e. liver is throwing a hissy-fit).

I wouldn't worry about it too much - trying to make all of this stuff mathematical or predictable will drive you nutso. I used to make charts & do elaborate calculations, etc. Some of it helped me, but really, "stay loose" as Gator said is the best approach I think. It all can change so fast, sometimes you have to throw out what worked a couple days ago, and just roll with the new data.

 

How about a 53 @ +6? ;-)

I would have liked to get him back on his usual 7:30AM/PM schedule, but that is not going to happen with these numbers right now. 50 @ nadir is about my comfort level considering the rebound from a day or two ago. Don't want to trigger that. He seems to do very well clinically with low numbers - as I've read that most cats do.

I'm not going to look at the old numbers for now as you guys suggest. What I plan on doing then is shooting him up whenever he gets back up to the 150-180 BGL mark - most likely 1U. Then we'll see what happens. Does that sound reasonable? If anyone has better ideas I'd love to hear them.

Thanks for the advice and info people. :thumbup

Edit: Ok I lied and looked at the old numbers from today and remembered he dropped 200+ points in 4 hours on a 1.2U dose - so maybe go less than 1u or maybe wait til he hits 200 or maybe I'll etc etc etc ... :lol:

 

Ugh. This is crazy. 356 @ Plus 10. Poor cat is still on a roller coaster. He was 266 at AMPS, the went to 53 @ +6, and now 356 +10 where I gave him a 1.2U dose. I figured I'd keep it low and steady and see what happens. Looks like another rebound?

Really wondering once again if this is the right insulin for him. I understand that it takes a bit to smooth out, but this is ridiculous. :YMSIGH:

 

We had the same problem with Ari. At +10 it seemed like all effects of the last shot vanished and she's zoom. We ended up going to TID (shooting every 8 hours) which is working well. I have the hope that we'll be able to get back to 12/12 soon, but I understand your frustration completely.

 

Your plan sounds good to me! On a 150, yeah, I would definitely hesitate to shoot as much as 1u. It seems like it's all sort of an unknown now, with doses that you would have thought would be too little now being too much.

Sorry to pick on your SS - what you should do is put the actual PS (the 266 & 356 I think they were for today) in the PS column, then it's clear that was the # you shot off of. Then the 64 would go in the +4 column - right now it looks like you got that at +7 or wherever it is now. Does that make sense? It's confusing because in PZI Land we don't care that much about 12/12 though the SS is set up for that.... sorry to be so picky, I'm just worried that peeps will misunderstand your #s, and then you might get suggestions that don't match the data.

I'd stick it out with PZI a little longer, and maybe try lowering to 0.8u or 1u and holding steady with that regardless of PS (lowering further if you get low #s) and see where things land. I think he's actually doing really well - I know the #s are frustrating, but you are still feeling things out and that is part of it on any insulin (people get wonky #s on the other insulins too, and it can take weeks to get things consistently better).

As people like to say, diabetes is a marathon not a sprint. It probably doesn't feel like it, but his #s are better than many cats, and the bounces should settle down once he spends more time in good #s, and if you can dodge the super-low #s. A lot of us saw #s in the 500s after a day of blues, so 350 looks pretty good from here.

 

Steve, you are going to make yourself crazy. You have just started at this and are actually doing OK.

My kitty H has a lot going on with him and his appetite is our greatest enemy at this point. If I focused on his appetite I would not be able to do what I need to do for him let alone do what I need to do for me which allows me to do for him [wow - that kind of makes sense]. Sometimes you get the chicken and other times all you get are feathers. I've found that to keep my own sanity I've had to take a step back and just accept that under the circumstances I'm doing my best for H which is a million times more than most would do for their kitty.

You are doing good Steve and you are doing awesome for Blue. You are in the right place and are getting advice no vet would ever bother to give you. So crack a beer and give Blue lots of love. cat_pet_icon

 

Thanks. Did Ari zoom after her numbers went real low, or were they 'decent' numbers before she zoomed? That number 356 in PINK took my by surprise. I still suspect that the liver wakes up at around 40 BGL and shoots it up high(er) than the PS level. If I get time I'll have to check out your SS.

 

OK. I think I got my hopes up too high for some balanced levels. Was hoping I was done checking for Ketones for awhile. Oh well. He is still acting great so that's more important than the numbers I suppose. Danke!

 

So true. Thanks again for the wise words. I need some sleep I think... Patience is a virgin someone once said... Archie Bunker maybe? :lol: Blue is acting great, and as I mentioned that is great to see. To heck with that pink number.

Good night all and thanks for putting it in perspective for me. I need to look at some of your SS's at some point. I'll hopefully learn something. ;-)

 

Steve,
Regarding the ss
When I tried shooting 3x/day I had to come up with a new way to use the ss, so I used a new row for every shot, and labeled them #1, #2, #3.

You could record those numbers you lost by using more than one line in a day. If you go to +15 for example, you could just keep adding numbers into the right side of the chart with nothing in the pmps space. Then when you finally shoot you could put x x x x in the spaces you didn't use, and start a new row for the next preshot. Take a look at Cody's March ss and it might be clearer what I mean. (just don't have heart failure on our doses).

Has anyone mentioned that sometimes a recovering pancreas will produce a bit of insulin in response to food. I don't know if that could be playing any factor in your numbers, but it might be interesting to watch for.

I'm glad you lowered the dose again- looking good!

 

Late to the post. I just posted over on the other link.... then read this thread ohmygod_smile

For what it's worth... I'm posting this photo - maybe it can help when ppl are lowering their doses?

 

Michelle,

I think those are BD syringes? Anyway, no matter.

Just thought I would post a pic of the syringes I like since you provided a good opportunity. The top one of the one you posted are the ones I'm not to partial about. The half unit markings are narrower than the full unit marking and in my brain make getting consistent very small doses impossible. And I think maybe some other reasons I did not like that my shot memory cannot think of currently. But I know you were posting not as a guide to syringes but as a guide to measuring and that picture is a good guide for that.

Below are the type I like. These are the the layout of the GNP and Monoject syringes.

 

Gator - I like the syringe photo you posted. I wish I found those when I needed them. You're correct.. I had just posted that photo for a guide to measuring. I actually used the bottom photo w/out the half unit marks. I dunno, just thought this photo would help in some weird way. I need to get to bed, or go make some haha

 

Thanks for the advice M&P and G&H and N&C on the chart and the syringes. The BD ones posted on the top picture ARE the ones I have now. So far no probs as I just draw to the 3 Unit mark on the U100 to get a 1.2U dose of U40. I don't think I'll have a problem if I adjust the dose. At first they seemed confusing, but I'll order the ones G&H posted if I have a prob. The info on the chart you posted N&C requires further study, as it made made my head spin and I have limited time since I'm @ lunch now.

Thanks for moving your post over here M&P - i haven't checked the other thread like I said I would. ohmygod_smile

Blue just measured a 101 BGL @ +4. So i think that looks good. I'll comment more later when I have more time.
Thanks all.

 

I do what Nancy said and use a new line for each shot and mark how many hours. I've found for Ari that +6 is usually (not always) her nadir and I work from there. Almost always after getting a nice green number (when she hasn't seen any in a while) we'd get a big fat pink or red number. If it is after that and you're not seeing them all the time (and you're not sending her in the 40's), shoot your normal dose and move on and see how the next PS . Compared to Ari, a 356 as a high number really isn't all that bad. Especially since you're working out a good dose. Right now we're playing the game that 2 units every 8 hours works great for 2 shots, but the 3rd takes her too low which then sends her sky high. So now I'm sticking with the 2 units to get her back to good numbers then I'll shoot 1.8 and see if that holds steady. It's a lot of narrowing down and my girl is sensitive to a .2 unit change. One of the good things about TID (for us) is that if I get a high cycle, I don't have to wait out until the 12 hours comes around to shoot. It can be an exhausting schedule at times, but when you're trying to get a difficult cat to regulate, it does help. Also, because she has so many tests per day, I was able to see that something bad was going on with Ari before she showed any clinical signs because of the wild BG swings she was having.

 

Just took a look at those TID spreadsheets from M&P and H&A - Very interesting and impressive. I suppose that once I think I have some things figured out that is always an option. My girlfriend works very close to home and I wouldn't be much of a problem should the numbers eventually show that TID would be a good bet. Acutally 8/4/12 is very doable. I've read up on the sliding scale protocol as well and it looks promising.


So far today I'm happy with Blue's numbers, so that must mean I'm due for a pink very shortly. :lol: He's doing well it appears but I found some kitty puke in the kitchen. Appeared to be a hairball w/ food. I'm going to look at some other SS's now - and see if I can figure out the patterns. I do realize every cat is different.

He's still eating very well and acting well. He's a bit lazy today it looks like - most likely due to the fact it's 85F degrees.

Good ideas and info everyone. You're certainly helping speed up the learning process. You guy's rock! drinking24

Edit: I almost forgot - a special congrats to someone who's kitty may be almost there... :thumbup (don't want to set up a jinx by naming names.)

 

Hey Steve:

Yeah, if you notice that Blue keeps hitting those pinks by +10/+11ish and TID is doable... wouldn't hurt to give it a try. Just remember it can be emotional and challenging. It's all about timing and finding those pinks & yellows to shoot. Sometimes it means shooting at +7 etc. Having to face those scary moments when you shoot and think... OMG, did I just shoot then wait it out to make sure sugarkitty doesn't go hypo nailbite_smile I've had a few of those nights! Just try to be consistent with your dosages. Jumping around a lot will keep a sugarkitty on a rollercoaster.

I've also realized with prudence - taking all these bg's can drive you nuts. She's actually had a few bg's in the mid 200's that I have not posted b/c I want to keep my SS blue & green ;-) kind of a visualization thing I'm doing for my own sanity :lol: but she always drops down to the lower 100's or more, so I am still walking the fine line whether or not she needs a bump of insulin. I just want to give her a break on her poor ear! I know it's ideal to have sugarkitties in the 60 - 100 range to fully heal their pancreas, but I am wondering if it makes a difference with older kitties? She's 14yrs old and when her bg's are somewhere between 80ish to 150ish... she very happy. Anyways, I will still be keeping on top of it... I actually tried to give her a shot the other day before I realized she would drop pass 100 and she wouldn't have it. She was like... no way woman cat(2)_steam then I stuck myself with the damn needle ohmygod_smile thank goodness there was less than 0.1 if even that... but it was just the needle that got me :YMSIGH:

Sending you good vibes Blue!!!

 

I'm not sure Blue is often shootable by +8, so I'm not sure TID would be the best route for you. I'd probably consider trying some shooting at +10 or so, or really whenever you can catch the upswing where the #s are past 150 but not yet in the pinks - if it's +8, great, but from the #s I see he often looks too low then. I like the nadirs you are getting, and personally I wouldn't want to see you to lower the dose with the intention of getting a shootable # at +8.... Not saying TID wouldn't work for you, but it doesn't look as needed to me as with some cats who get a lot of zoom in the later half of the cycle... Just my 2c

 

my bad, i didn't make myself clear and i am so sorry about that ohmygod_smile

when i had mentioned about shooting at +7 i was talking about only if you are doing TID. it would be more of +7.5 or +8.5 but definitely make sure kitty is raising before you shoot. seems that Blue is hitting low 300's by +11ish/PS so he's is showing good numbers. he may even hit yellows by +11ish or PS. just keep in mind that on 4/5 at 1.2 units of PS266 had brought him to bg of 53. you gave him 1.2 this morning with PS of 270, so he maybe hitting that range again. since he's doing so well, if it were me - i'd try to test around +11ish to see if you get yellow then shoot a thin 1.2 (1.10ish maybe 1.0 - again depending on his low today.

 

Hi J&B and M&P. :smile:

I couldn't make it home today to test at hours +4 and +5 so I most likely missed the low, but I just tested at +7 and he's @ 101 - surprisingly (to me) he seems to be holding consistency. I had planned on giving his ears a break anyway. As far as going to 8/8/8 right now I'm going to hold off to see where this goes - maybe fine tune the 12/12 as much as I can and see if 8/8/8 would work better once I have this 12/12 tweaked.

This weekend I plan on being more thorough with the testing to try to see where exactly that nadir is happening with the 1.2U. My thinking is if he's consistently hitting nadir over 50 I 'may' consider raising the dose to 1.3U to see if I can lower those pre-shot numbers. At least that was my thinking before reading your posts. ;-) Of course, that all hinges on the fact that his pre-shot numbers remain pink(ish). (I read Dr. Hodgkin's Protocol again to convince myself not to be afraid of some low numbers, but don't want to risk rebound either!) To tell you the truth, I think that if Blue were to go hypo he would have done it already - I think his liver is paying very good attention! :mrgreen: Even when he had those 'low' numbers he showed absolutely no signs of hypo. I sure don't want to go there again tho!

If the above plan didn't work out, I suppose I could try shooting him on the upswing or 'possibly' try the 8/8/8 within a few weeks. Obviously for convienience I'd like to keep him @ 12/12 if possible - but would no doubt go to 8's if it was to his benefit - (darn cat!) :lol:

Shooting on the upswing heading toward the pink around +10: It seems to me that's a good idea as well, but wouldn't that really mess up the 'routine'?

Thank you both so much for your insight on Blue's numbers. Please let me know what you think of the 'plan' I mentioned above. Thank ya!

Also, how much do you think feeding him less on the 'upswing' could lower his PS numbers? Is it even worth a try?

 

If it were me - I wouldn't consider raising his dose to 1.3. You are getting good numbers with 1.2 right now. I would try to get him in the yellows then work down to blues etc. Again, every cat is different and I am sure someone else will chime in, so go with what feels right to you. You know your Blue better than we do. I've just found with Prudence if I stayed consistent with my doses... it brought the PS down. Look at Pru's SS again and you will see that I've even shot at a PS of 353 with 0.2 units. I've tried to get her body used to the 0.2 and shooting at the right time to bring things down. I just feel that upping & lowering doses back and forth will keep numbers kind of off.

As far as feeding... how are you feeding now? free feed or just before shooting?

 

OK thanks. I'll cap it at 1.2 for a bit and see if the numbers continue to drop over the next few days/week. I wasn't going to change it (increase or decrease) for awhile in any case.

Right now, Blue eats @ -2, AMPS, +2, and I leave him food while I got to work. If I come home @ +5 I'll feed him some then, but usually he will not eat again until -2 PMPS and then at PMPS. He'll have some more between +3 and +4. Hmmm. So basically he is free feeding. :lol: As I mentioned, I'm currently cutting back a little on the food before PMPS to see if it effects his PMPS numbers. Though I just saw that my GF just fed him a while ago so that screws up my experiment. :-x

 

Another 'hmmm'. 156 @ PMPS - Did not expect that. Dosage suggestions? Maybe a .5? Maybe wait an hour and test again?

 

I'd wait a 15 minutes to 30 minutes then test again.

 

I think the site went down for a bit so I didn't see your post til now. I did test at his usual +1 - but no shot given yet. He was at 169. Will test again in 15 min. (+2 usual +PMPS)

I was tempted to shoot a low dose at the 169, but prefer to wait til he approaches 200 and give him the usual 1.2. Maybe a slim 1.2 or 1.0? Sound Reasonable?

I thought I had everything planned out but the extended blues did surprise me. At this point I shouldn't be surprised at anything!

edit: 176 @ the usual +2 ( no shot). I'm really not comfortable shooting him unless there is a clear upswing toward 200. 156, 169, and 176 does not indicate a clear upswing to me considering margin of error. Sorry Blue, I tried to give your ears some time to heal up but apparently they're in for a rough time tonight. ohmygod_smile

Edit 2: Shot him 1.0U at PMPS +3 - he was 218. In hindsight I wish I would have shot him a bit earlier, but played it safe. I think that is a good compromise since I didn't want to stray too far from his usual 1.2U dosage and do not to risk rebound. Things are changing fast it seems, so I guess that is always a possibility. Also, I think that maybe I will be able to stick to the regular schedule more or less. That is one reason I didn't want to shoot a low dose at PMPS.

I will most likely test him once or twice overnight and then GF can test at -2 AMPS to see where it goes. Now that I shot the 1.0U - I'll be tempted to keep him there a bit should the numbers not get out of hand.

Please feel free to post what you all would have done and whether you're in agreement with my dose/timing. As always it is appreciated - especially any criticism.

I've been reading lots of posts and looking at your SS's. I am often tempted to offer opinions, but I'm much too noobish at this point. :mrgreen:

 

I totally agree on not raising the dose just yet. The #s are so good overall, I would stick with 1.2 for a few days (or I think 1u is fine too if the #s don't start trending upwards), lowering if the nadirs start getting down into the low 50s or PSs start coming in under 150 - as you can see, improvement may already be in the works! I might try a slightly lowered dose on a 150 PS given his history, maybe 1u or so, and if that doesn't give him good #s then go back to 1.2u.

As far as tonight's shot, it is all a learning experience & data gathering. So after this you will know how this dose did, shot at this timing on this PS, and that will help you make decisions next time. If you had wanted to you could have shot on any of the #s you got (#s were clearly rising based on the 101 to 156 rise), but I totally agree with not shooting on the PSs that are lower than 200 until you have more data - he is a "dropper" ;-) so really, why risk it if you don't have to.

Personally, I wouldn't worry too much about finding his nadir. From what I can see it moves around - sometimes from the dose probably being too high, others could be pancreas action, or just still adjusting overall to the insulin. So I'm not sure that any one (or several even) curve would actually pinpoint it for you, might as well save the test strips for something else IMO.

I wouldn't worry either about tweaking BID per se or planning ahead for possible TID, i.e. I wouldn't think long-term. I would focus on keeping him in the upper greens and low blues for as many hours as you can. When it appears that cats are going to be long-timers, then to me it makes sense to sit down and figure out what strategy will work best for your lifestyle, keeping them in acceptable #s, etc. When they look to have a sputtering pancreas, what makes sense to me is to focus on as much extended time as possible in non-diabetic #s (knowing that you won't keep them there 24x7, but if you can get a few hours ride most days, that is awesome). For some cats that means going TID or shooting as-needed, for Blue I think sticking with BID is fine, or if you want to shoot early when it looks needed, that makes sense to me too.

 

I have been told by someone that a "safe" upswing should be around 40 points after about +7 to be sure you aren't seeing normal variation.

Yes the +10 shooting does get crazy and I couldn't do it. You end up shooting at all different hours. I don't work and I'm a night owl, so I was OK with 8/8/8 (8:00,4:00,12:00), but he frequently/usually wasn't high enough at +8. (but he was at +10), but then he was due again in the middle of the night, and I just couldn't think clear enough in the middle of the night to not screw up the shot. Then the next shot would be when you are at work...

I have a feeling if you keep doing what you are with a 12/12 that his pancreas is healing, and he is going to keep improving. It might be worth a try, not feeding between +8 to +12. Or it might be ok to feed a very light snack, which might stimulate his pancreas- experiment (and than expect it to change :lol: )

When I first mentioned it, I was not referring to YOU trying TID, but rather to how you might be flexible with the data on the spreadsheet. It seemed at the time that you weren't ready to shoot even at +12,(and you said you lost data cause there was no place to record it), so I was suggesting that you use the right side of the ss to record your +13, +14, +16 or whatever; and then use a new row for the next shot once his number was shootable. In other words, you can use multiple ROWS for the same date. That's what I was suggesting you look at on our ss. Hope I made that more clear this time ohmygod_smile ohmygod_smile ohmygod_smile

edited to add-
I just looked at tonights data and this is a perfect example. The way it reads, I think you shot 1u on a PMPS of 176, when actually you shot 1u on 218 at +15 (not pmps+3 which is what you called it). You could have put the 169, and 176 into the right side of the ss with nothing or 0 written in the PMPS space.
Then you could have put the 218 on the next line as the PS and you are starting over at +1. I bet you are going to see longer durations as he recovers.

Oh and i was also told that the numbers can suddenly jump up in 20 minutes. and sure enough they were right, so if you are really trying to catch the upswing you need to test frequently, (another reason it is very labor intense to shoot TID)

 

I only have a minute, but wanted to jump on here real quick. I think you're doing great at 12/12. Blue is showing awesome numbers :thumbup depending on how the 0.8 works today, you can probably stay between 0.8 or 1.0 then work down from that. As far as feeding - Whatever you're doing... seems to be working I wouldn't change it. Sending you good vibes Blue! cat_pet_icon

 

Wow, you got an 85 nadir off the late shot of 1u, pretty darn good!!!! I agree with your decision to try 0.8u then on a normal shot, since that should have more oomph to it than a late shot. Hope you see good #s today, Blue is doing AWESOME!!!!!!!!!!!!!!! Go kitty!!! :mrgreen:

 

Snuck away from work to test Blue so don't have much to say right now except THANK YOU for all your help and good vibes and wishes. I won't be happy until Blue guy is off the juice, but at this stage I'm pleased things 'seem' to be headed in the right direction... more to say later.

drinking24

edit: having a beer or 5 tonight and watching a movie. I've had enough drama for awhile and really don't want to test tonight, but may check on Blue @ +6 or so to see where he is on the 1U. I keep waiting for the pinks to show and won't be surprised when they do - I won't be happy, but I won't be surprised. ;-)

N&C: I'll get that SS corrected to avoid confusion, and you made perfect sense each time you spoke about it. It's me rushing around - not you being unclear. :lol: The 40 point 'safe' swing def seems like a sound rule to go by. If I had more data I would think that I could rely on 30 at some point - just not yet.

M&P: Your Info and vibes are much appreciated! Both are helping...

J&B: I'm glad to see that you agree with my thinking as far as dosages. You're right, it's still a bit of experimentation to see how he reacts while trying to keep his numbers in the 'zone' without crapping out. ( Reminds me a bit of my internet gambling days.) I'll take your advice on the nadir, too. Until I can get a steady dose for a few days I'm not going to worry about it. I'll check around +6 to +9 though just to make sure he's good.

Thanks to you all for being so helpful. I study every word you font very carefully. It's also important to know that I'm doing something positive from folks that have been there. Blue and I and Mitla Cat and GF are sending out GOOD VIBES to all of you as well. Your kitties are lucky to have you, and vice versa I'm sure.

 

Just something to keep in mind - You had mention on Blue's SS that GF said Blue was eating a lot at pm. Eating a lot could be triggered by low bg's, but shooting the 1.0 he should be fine. Blue could of been lower than 85 maybe he was riding in the 60's around +7... just wanted to point that out to you. Not sure what time PMPS was? but you may want to check at +4 You're doing great! :smile:

 

Agreed, when Cody's numbers are dropping (250 wupppeeee :lol: ) he starts begging for food like he's gonna starve to death. When he starts drinking from the fish bowl we have the other problem :shock:

 

Thanks for pointing that out. However, I should have been more specific in the notes. He was eating 'very well' pre - PMPS - so late afternoon. He gets his shot at 7:30PM. So he was somewhere between 150-200 and rising when he was real hungry.

I tested Big Blue @ PMPS +5 tonight (Well, technically it's morning) and he was @ 128. I prefer it to be slightly lower, but can't complain. He'll most likely drop a bit more hopefully into the green. At least I can get some sleep! 'nite all!

Off topic: Love the AccuCheck Softclix Plus Lancet. Always gives a reliable and measured stick. Much much better than the ones I've used from OneTouch and Relion.

 

Thought I would mention that if you withhold feed at one time then with a normal cat they should want to eat more at the time food is available which has a compounding effect of the food on the BGs. Sometimes one may want this, other times maybe not.

 

Thanks. I'll keep that in mind and look for it. His appetite is good no matter the numbers - green/blue/pink. He loves the Wellness and FF. He's giving me a 'look' when I feed him the Special Kitty Walmart stuff tho.

 

Steve,
When you get to the bottom of page 2 posts, it's probably time to start a new thread- it gets too hard to follow. As you see, folks make topics like "Blue- 4/10" AMPS xxx" If your profile is up to date, then new readers can get the fast facts. :smile:

 

Yes, I knew that about 20 posts ago, but wanted to be polite and respond to the posts directed at me. :mrgreen:

OK. Last post here! I'll start fresh thread when the time comes. - Something like "OH MY GOD! I had A Pink Number 4-10-2010!" :lol:

Thanks for all the input everyone. You've been incredibly helpful!

/End of thread :smile:

 

Good luck with that!