Dosing Advice

Discussion in 'Prozinc / PZI' started by Ickes, Apr 1, 2019.

  1. Ickes

    Ickes Member

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    Dec 17, 2018
    I have updated my spreadsheet for Noah and I am needing some help. He seems to run low for several hours around once a week and I have to stall his insulin. I have tried to check midway through cycle...some numbers are great then he bounces in the 400's. I have checked ketones and have been negative. Would like to be able to get him on good dose. Is bouncing like this normal with prozinc? Should I go up from 2 units or stay for a week. The vet said to stay on a dose for a week to regulate. I am so frustrated. He is eating the same food and treats (canned and plain chicken breast I bake for treats) so it's not his food causing fluctuation. Any advice would be appreciated. He is doing great otherwise. He has even been playing and running.
     
  2. Candy&Company

    Candy&Company Member

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    Sep 12, 2018
    ...WHOA, his SS is all over. I agree it's not only the food - it's mood, personality. Can I ask - what does Noah eat and how much - dry, wet, wet plus water? Who is Noah's "person" - you or your significant other?

    I ask because, it seems like once Mao died, Fena EXPLODED in personality and wants, etc.
     
  3. Candy&Company

    Candy&Company Member

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    Sep 12, 2018
    Also... what happened in the last few days? It shows on the SS...
     
  4. Candy&Company

    Candy&Company Member

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    I'd move him to 4 units, AM and PM.. then watch, close. Slowly increase, .25 (1/4) for 4 days - watch. Then .50 (1/2) - watch close, etc. Slow and steady increases, and watching, winds race.
     
  5. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Absolutely not!!! Do not do this.

    You are currently at 2u. Going up by two full units would be dangerous! I'll write more in a minute, but wanted to make sure you don't do this! :eek:
     
  6. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Is the "4 u" a typo? The current dose has been 2 u.
     
  7. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Okay, now that I'm breathing again...:rolleyes:

    Ickes, have you had a chance to read the stickies at the top of the Prozinc forum? If not, I would suggest taking some time to do that. They will explain how we approach changing doses here.

    First of all, you're doing great with being consistent about getting your pre-shot numbers and mid-cycle tests when you can. That gives some helpful data. It does look like Noah could use some more insulin. And Candy was right about the slow steady increases, just not the big jump in dose.

    Vets say to wait a week between changes because they make bigger changes all at once. We use smaller increases, so can move more frequently. So from here, it does look like Noah needs more insulin. I would say to move to 2.25u for 3-6 cycles (a cycle is 12 hours), and then if the numbers warrant it, move up to 2.5u, and keep going like that until you see good numbers again. But you need to see the mid-cycle numbers to know if the numbers warrant it.

    My hunch is that the 3.5u was pushing him too low, and after several days of that, it may be what caused the long green/blue cycle. So remember that dose increases are based on the nadir, not on the pre-shot values, so you need some mid-cycle numbers before making a dose change. The pre-shot numbers don't tell you if a dose is working. They just tell you if it's safe to shoot.

    Next, food: you said you're feeding him canned and baked chicken. Feeding plain meat is not a complete diet for a cat. It lacks many of the essential nutrients they need to be healthy. Are you also feeding him a cat food? or are you adding supplements to the chicken? If you want to make his food yourself, I can suggest some supplements to add to make it a complete food. If that's just for treats and he is getting a cat food, then that's fine to just feed the chicken, just not as his full diet.
     
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  8. Ickes

    Ickes Member

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    Dec 17, 2018
    He eats Purina canned dm..I have literally tried everything else and this is what works best for his ibd issues. He has been doing really well with that. He had pancreatitis in December and almost died and since then it doesn't seem to matter what dose of insulin he gets he goes really high then really low. When his sugar is 74 at insulin time what should do? I thought maybe he was bouncing due to to too much insulin that is why I brought his does down. It just doesn't make sense. He eats about a 1/4 of can every 4 hours. He gets sick if he only eats twice a day. The vet told me to feed him twice a day that treated him in December but he got sick and our local vet said the small feedings are fine just give him the same amount. His weight has been steady I monitor that. He eats about a can and a half a day maybe a little more sometimes if he is really hungry but not much more. I mostly take care of him although my husband helps alot and my parents help when I am at work. Everyone is very careful about food because I have 2 other cats and they have to eat in a room with a door on it so he can't get into it. It does make him mad a times if he knows but we baby him and give a little bit of chicken and try to feed them when he is eating. Nothing new or out of the ordinary. On 4 units he was doing well mostly but then on 2/14/19 for no reason he dropped to 43 on 4 units and was only 146 at time of insulin. I thought 3.5 was the perfect dose but he seems to go low on every dose and then I have to stall his shot which would be fine but it makes me nervous if I am not home and he goes low or if I can't wait to give him a shot because I have to go to work. My parents are here but its a big responsiblity I would prefer not to leave on them. It just seems like he should be able to be somewhat regulated on a dose! He will stay low for 2 to 4 hours when he goes low. I tried to write in the notes when I had to stall his time. He is a very very scheduled cat changing his insulin time is torture due to him eating on time. He eats at 9 am, 12:30 to 1 pm, around 5:00 pm and 9 pm then starts all over again. He knows when its time to eat. There have been time I have given him a little diabetic dry thinking oh no he will be high and he's not. He even one day got into another cats regular dry food when I wasn't home (which rarely has ever happned) and I was so upset but he never went high! In fact he went really low a few hours later. It just makes no since.
     
  9. Ickes

    Ickes Member

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    Dec 17, 2018
     
  10. Ickes

    Ickes Member

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    Dec 17, 2018
    Thank you for posting this....I was going to say going up 2 units is dangerous...was going to start going up to 2 1/4 today and I also need to back him up slowly to get back on 9 pm and 9 am schedule instead of 1 am and 1 pm due to my sleeping is a mess because of it and my work schedule. I will do what i have to do for my little guy. I love him but 9 and 9 works better. Again thanks for posting and I will wait for your advice when you get time. My plan is to move to the 2 1/4 today or 2 1/5 but have heard going up slowly is better. He just seems to fluctuate and bounce no matter what I do :(
     
  11. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I echo Djamila's advice to read the ProZinc guide in the yellow stickies at the top of this forum's thread list. Even if you've read it before it's helpful to review it periodically. We can get mired down in SS numbers and forget about the guidelines. :)
     
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  12. Ickes

    Ickes Member

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    Dec 17, 2018

    I just saw this...I will read the stickies...I haven't for some reason got very used to this site. It has been very helpful but a little hard for me to navigate. With Noah's care...we just lost our little finch...we are devestated....my son was diagnosed with crohns disease in November and Noah almost died in December. It has been a bad few months but things will get better. I was told our bird wouldn't live long 3 years ago and he had a great life. He was the best. So thankful my time with him but I miss him. My son is doing great on meds now and looking like total remission so thankful. Now to get Noah on track. He is doing so much better and recovered from pancreatitis. He even plays. I will follow your lead on the 2.25 as many have said the same thing. Hopefully I find his perfect dose. I think you may be right about 3/5 pushing him low. Thank you very very much for the advice. I will be sure to check mid cycle before moving his dose to see how long he goes.
     
  13. Ickes

    Ickes Member

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    Dec 17, 2018
    The 4 is not a typo....my vet insisted he needs 4 units. The big hospital that sent him home in december had him on 5 units. it's crazy...I want his blood sugar low but not 43! I can't be with him 24 hours a day and my parents are with him while I am at work but he doesn't really show signs of low blood sugar even when its that low. Going to go up 1/4....2 1/4 and check him at nadir and see if I can find the perfect does for him. I dropped back down when he went low and stayed low for hours to see if I could find the right dose...not sure it was the right thing to do.
     
  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    With respect: your vet is wrong. Please try to relax if you can, read the ProZinc guide and ask a ton of questions. We can help.

    I'm sorry you lost your beloved little bird.
     
  15. Ickes

    Ickes Member

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    Dec 17, 2018
    Thank you so much. I miss my bird so much. It really hurts. I know my vet is wrong but it helps to have someone to talk to about it. I paid 14,000 for a top notch pet hospital and in december and while they did save Noah's life from the pancreatitis they are wrong about his insulin dose...sent him home on 5 units and feeding twice a day he would have died. I don't trust the vets entirely. So thankful for this forum. You all have been such a help to me. I hope I can eventually help someone too. One more question...shouldn't his curve be highest at time of insulin, lowest midway then start to come back up? His curves have been lower at the end then the middle. Vet just says nothing to worry about but I don't understand. His feeding schedule is the same everyday, same food, and same insulin schedule to the minute almost. Some days might be 15 min late on shot but rarely. Just think a curve should be lowest at middle of cycle.
     
  16. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Typically the curve will look like a smile, yes. However that's when a cat is well regulated, and Noah is not yet. Go ahead and do that little increase to 2.25u. We want to get him away from these high numbers soon and safely.
     
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  17. Ickes

    Ickes Member

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    Dec 17, 2018
    Ok started the increase yesterday. Will check him mid cycle and then Thursday or Friday move him up to 2.5 if number warrants it. Every time I think he is going great and gets a low number on any dose he seems to bounce. I would do whatever to get him regulated so I will try again and follow the small dosing and say a prayer that I find the perfect dose. My mom says it doesn’t seem to matter how much insulin. It seems like sometimes his body either works or absorbs the insulin better. I try to move the spot so he doesn’t get scar tissue build up but just seems to always be a problem. Hoping this time works.
     
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  18. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I think you may need to adjust your expectations a little too. There is no such thing as the perfect dose at this dance. The dose will always fluctuate somewhat. If you look at my spreadsheet, you'll see that while Sam's dose is usually somewhere around 2u, it floats up and down a little depending on the week/day/phase of the moon/whatever.

    You are absolutely right that some days they do absorb and use the insulin better than other days. And great job moving the testing spot. Especially for our kitties that are long-term diabetics, moving the site is important.

    I'm curious why you are moving up to 2.5u instead of 2.25u?
     
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  19. Ickes

    Ickes Member

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    Dec 17, 2018
    I do see your point about perfect dose... I guess I mean best dose not perfect. My vet had never given me the option of changing dose. She said to give him the same amount to regulate him. I didn’t realize it was ok to give him different amounts if necessary. I am just looking to get him I’m a good range not perfect but not up and down. When he was first diagnosed February 2018 we had trouble but he was doing great from about June until he got pancreatitis is December. I didn’t see all the jumping around with his blood sugars. He was on 4 units eating fancy feast pate but he can’t eat it anymore. Just trying to get into a routine but he keeps dipping low every week no matter the insulin dose if you look at his spreadsheet. It’s crazy! He has went as low as 43! Scares me. I am giving him 2.25 now then will move up to 2.5 after a few cycles.
     
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  20. Ickes

    Ickes Member

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    Dec 17, 2018
    Any advice on dosing? I checked Noah at mid cycle as he goes lower midway and more towards the end although I tried to check as often as I could. I have been told I check too much and too little so I tried to get times to see if he was going low and by the numbers he hasn't went lower than 228. I am frustrated because he has went low on 2 1/5 before but now it looks like he needs his insulin increased. What do you think? I know he is a hard one. I also have to back him up 15 minutes a night as the schedule he is one now due to going low and stalling does not work well with my work schedule. I can't keep him on this time. I have learned that when I stall I need to not feed him but wait 15 min and recheck to see if numbers are going up on their own. Everything I read and my comfort is not to give him insulin until he is in the 200 range. I read the stickies on prozinc as suggested and waited the 3 12 hour cycles and checked mid cycle to be sure he wasn't going low. It has been 3 12 cycles actually more so I will up him tonight. In your experience is moving the shot up 15 minutes ok? That's what my vet said to do. If not what should I do. I need to train someone else besides my husband to do his shot but that is just not something I have been able to do. Any advice would be appreciated.
     
  21. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    It does look like he's ready for another increase. Are the doses that say 2 1/5 supposed to be 2.5? Or did you really lower to a little less than 2 1/4 and decide to just write it as 1/5? Regardless - from whatever dose you are giving right now, go ahead and increase.

    As for the time change, given the numbers you're seeing, you could either move the dose 15 minutes every cycle until you get to the time you want, or you could probably even get away with moving 30 minutes. Prozinc has some flexibility. You just want to make sure the number is high enough to shoot safely.
     
  22. Ickes

    Ickes Member

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    Dec 17, 2018
    Oh my goodness! I was so tired when I did his spreadsheet I have no idea why I put 2 1/5! Yes it is 2.5. I changed it. I did go up another small increase to 1.75. Just a little under 3. He has had a really good day number wise. Even seeing 100's which is rare for Noah. Hoping he doesn't bounce. He is a tuff one to regulate as he always seems to bounce. Praying he doesn't because he has been such a happy guy today. He just feels lousy in the 300's and even went up to almost 400. I am most confused when he has his low days should I give him insulin. Stalling is hard when I have to work or we have somewhere we have to be. Should I stall or give him less insulin when it is lower and a little more when its higher. Sorry for all the questions but this is new to me. My vet says to give him the same amount every day but he fluctuates and has really good days then goes high. I just want to keep him as in 100 to 300 range as I can. I gave him 2.75 this morning and his sugar was 238 and he has done well all day. I appreciate all the help.
     
  23. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    That's great that he hit some blue numbers! Just remember that bouncing is an inevitable part of this journey. Some cats more than others, but there's really no way to avoid it altogether. The trick is just to know that you're doing your part correctly with a healthy diet and appropriate dosing, and then when bouncing happens, it happens. You just wait it out.

    As for dosing, earlier in this journey, you were making some dosing changes just based on the PS numbers. Now you are getting the mid-cycle numbers, so we'll be able to help you make wiser choices based on the impact of the insulin. So you're on the right track, and doing great! You want to keep the dose as consistently as possible, but there are times when a much lower PS will mean lowering the dose a little. You've been at this long enough though that you shouldn't skip doses. Stalling is the best option, but if you cant' do that, you can give a partial dose. Something is better than nothing.
     
  24. Ickes

    Ickes Member

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    Dec 17, 2018
    Thank you for all the help. Makes me feel better that bouncing isn’t something I do wrong. His body just doesn’t seem to like the low numbers. He was back up this morning and is hanging in the 300’s again. Just so frustrating because he felt so good yesterday. I hate that. Will just do what I am doing and hope he comes back down.
     
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  25. Candy&Company

    Candy&Company Member

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    Sep 12, 2018
    ......wow did I miss this, YES, this was supposed to be a post for another thread entirely. *sigh* I'm SO sorry about that, I need to pay muchmuch better attention, my apologies - and so glad that people caught it, thank you!
     

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