Dosing advice

Discussion in 'Prozinc / PZI' started by NancyJH, Jun 14, 2020.

  1. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    I posted Lenny’s spreadsheet and need dosing advice. I usually gave him 1-1/4 to 1-1/2 units of prozinc. I tried giving him 1-3/4 units for a few days to see if I could get his numbers down lower. I kept getting high preshot values so my vet suggested going back to 1-1/2. I’m not sure how much I should give.

    He also ate two big meals at shot time and 1/4 can of fancy feast six hours past shot. The last few days I tried giving him a small meal about two hours past his shot and another small meal four hours later. I’m not sure if that’s messing up his numbers or not.
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Have you read the Prozinc Dosing Methods Sticky? At the top of this forum?

    That 67 on 6/8/20 AM cycle was an automatic dose reduction if you are using SLGS. So the dose should have been reduced to 1.25U and HELD there for a week, unless you got another BG reading < 90 mg/dL. Another BG <90 earns him another dose 0.25U reduction.

    Feeding a diabetic cat much past the nadir, much past +5, is going to usually cause the BG numbers to rise up quicker in the later half of the cycle. You might think aobut movign that +6 feeding to +4.

    So feed after the pre-shot test, at +2 and at +4. Think Lenny will go for that?

    The other thing, you need to get at least ONE more PM cycle test, besides the pre-shot test. Many people do a "before bed" test, to see where the BG levels are headed.
     
  3. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    I think I can move his feeding times earlier than the six hours I’ve been doing. I might not be able to have his last one at four hours, I might try a little closer to five. He was always an all day grazer and it’s hard to limit his eating. Also, I read that people give “snacks” throughout the day. What is a snack — food or treat — and can they be given all day or stop at the five-hour mark?
     
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  4. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Try for the +5 hour feeding then. Do what works better for your schedule, but also doesn't raise Lenny's BG levels too high in the last half of the 12 hour cycle.

    A "snack" is a smaller meal. Think 1 teaspoon or so of the regular low carb wet food. Or it can be a treat, like PureBites or Halo freeze dried chicken or some home cooked chicken breast. Anything pure protein is fine for a diabetic cat. Even a little bit of cheese is ok. It's better if you can keep those "snack sized" mini-meals before +6. The insulin gets "used up" and feeding after that point simply raises the BG levels. The bulk of the food should be given with the shot.

    Anytime you test, a little "treat" of the freeze dried food or pure meat is ok, no matter the time. Think of a "treat" vs a "snack" as being smaller in size. To me, a treat is like a few pieces of something pure meat, the size of a kernel of corn. Or the "treat" may be a special food you don't feed at regular meal times. For instance, my civie Dancer gets a bit of the Tiki Cat wet food as a mid-day treat.

    It's only the pre-shot tests that should have no food influence for 2 hours before that test. All other tests, we expect some food to be on board. But it IS BETTER to test and then feed for all the tests.
     
  5. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    I need more dosing advice. I’m giving Lenny his middle of his shot meal five hours after his insulin so it doesn’t interfere too much with his preshot levels. The last few days have been terrible although his middle of the day values are pretty good. I’m not sure if this would still have an effect or not because it was five days ago but after I fed him his evening meal on the 17th he threw up. I waited an hour and recede him and retested and his number was 432. I only gave him one unit because I didn’t know how that would affect anything and during the night it was 276.

    the next morning it was very low at 180. I still gave him 1-1/4 unit and fed him hi carb food. His numbers were good during the day but shot up to 479 at night. Since then my preshot values have been high. What should I do? Thanks
     
  6. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    He needs an increase in dose. He's been at that 1.5U dose for most of 14 days, with only a few times at those good "tree green" numbers. You need to see him in those greens, above 68 much more often. You need to get him out of the blacks, reds, and pinks and into better numbers.

    Very low would be < 70 at pre-shot. 180 is not low. It IS LOWER than you are used to shooting insulin and probably makes you nervous to shoot that low. But 180 is still a safe number to give Lenny insulin.

    Although the 1.5U dose dropped his BG levels down to the 67 back on 6/8/20, Lenny hasn't gotten good numbers since then. The exception being the night he threw up, you delayed the PM shot 1 hour, and then the next days AM cycle test was lower, that 180. If he is in the yellow ranges, above 200 at pre-shot, you need to go ahead and give him his full dose. Then you need to lower that decision point threshold, to 190, then 180, then 170,........................ until you are giving him his full shot even if he is at 150.

    You do not need to stall for 1 hour before you retest and decide to give insulin. A stall without feeding and retest of 20 minutes would tell you if Lenny had a rising number or not. If not, then you stall another 20 minutes without feeding and test again.

    At a BG of 180, Lenny does not need to be fed HC (high carb) food. That is only for much lower numbers, < 70 or so, or if his BG levels are dropping fast at the beginning of the cycle.

    You need to get at LEAST one more BG test in the evening (PM) cycle. With the sporadic testing in the PM cycle, it's extremely difficult to see what is happening then. Try to get what we call a "before bed" test each and every night. Would you do that please?
     
  7. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    Yes I can get a before bed test on Lenny. What do I do about his nadir being below the 50% preshot number? How can I avoid such a swing in his numbers? Thanks
     
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  8. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    You can try front loading the food, meaning feeding him not olny after the pre-shot test and insulin but around +1 and or +2. Sometimes that helps.

    Marje wrote up a very good thread on "feeding the curve". Posted in one of IrishPat's threads. You might search for it. Think it was about 6 weeks ago.
     
  9. JOJI and Kit

    JOJI and Kit Member

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  10. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    Thank you for your help. I will try front loading the food to try to avoid the dips. I usually feed him the Fancy Feast pate food or once in awhile for a change Friskies. I know dry food is not recommended but would it be OK if my overnight snack would be maybe 10-12 pieces of Glycobalance?
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    The reason the dry foods are not recommended, is because they are all high in carbs. That Glycobalance? Somewhere between 29 and 32% carbs, depending on how you do the nutritional calculation.

    Remember, you are looking for <10% carbs.
     
  12. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    Help! I’ve tried increasing his dose and changed his eating habits. I’ve been feeding him a small amount 2 and 3 hours past his shot and then a larger amount 5 hours past his shot. I’m still getting high numbers. What am I doing wrong? Thanks
     
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  13. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Was 6/25/20 PM dose really 2.75U, or was that a typo?

    Are you using the SLGS dosing protocol for the Prozinc? or the MPM protocol?

    Neither your SS or your signature says which protocol you are following.
     
  14. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    I’m not sure what all that means. I’ve been giving pretty much the same dose all the time with just minor modifications
     
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  15. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    2.75 was a typo — it was 1.75
     
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  16. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    The signature is those tidbits of information at the end of your posts, with Lenny's and your name, dx date, meter used, insulin used, food fed.
    The SS is the spreadsheet (SS) where you record Lenny's BG levels, the insulin dose and other useful information.

    The protocols are the guidelines we use for dosing and how and when to do adjustments, based on the nadir.

    Please see this document, one of the "Sticky" or pinned posts at the top of this Prozinc / PZI ISG (Insulin Support Group) forum.
    Sticky PROZINC DOSING METHODS Simply click on the blue text, to open that document.

    Most people with fairly new diabetic cats, use the SLGS (Start Low, Go Slow) dosing method.
    As you get more experience and test data, then you can try the MPM (Modified Prozinc Method).

    Dosing advice varies depending on which dosing protocol, which dosing method you are using. You probably want to open that dosing methods documents and familiarize your self with it. A hard copy is a good idea, so you can refer back to it easily when you have questions.

    The glossary for the message board can be found here >>>>>> FDMB Glossary.

    Did that help clear things up?
    You may not have done anything "wrong". It takes time to regulate and then get the BG (blood glucose) levels under control.

    Why the larger amount at +5?

    p.s. Trying to be a bit of a detective here, trying to figure out what is going on with Lenny, to help you better.
     
    Last edited: Jun 26, 2020
  17. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    Lenny’s been on prozinc since October when he was first diagnosed. I don’t have the full spreadsheet filled in. I always gave him a big meal twice a day at shot time and 1/4 can of fancy feast at 6 hours past shot. I’ve changed his food to about 1/8 can 2 and 3 hours past shot and then 1/4 at five (moved it up from 6). He definitely needs food more than just at shot time. He just got 1/4 can but now with my other small meals he’s actually getting 1/2 can after his shot. Is that too much? It just seems that lately his numbers have been higher than several months ago at 1.5 units. He usually ranged in the mid 300s at shot time.
     
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  18. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    That's fine. The more recent data is what is important.

    If Lenny is not gaining a lot of weight, then it's not too much food. As long as he is at his "ideal" weight, neither too heavy or too light, he's ok.

    Sometimes, a cat can develop a bit of insulin resistance, if the amount of the insulin has been held at a particular dose for too long. Lenny has been at the 1.25/1.5/1.75 unit doses back and forth over a long period of time now, months.

    The pre-shot tests are only part of the picture. You need to take those pre-shot tests, in combination with the lows or nadirs, into consideration when adjusting the dose. It's mainly the nadir tests, those lows, that determine the dose changes. Lenny may be "bouncing" a bit, from those blues he has been getting. It usually takes 3 to 6 12 hour cycles for a cat to clear a bounce. His body isn't used to those lower numbers, so a self protection mechanism kicks in, to bring the BG levels back to what it considers a safer level.

    Blacks almost ALWAYS mean bouncing, from a low number somewhere. Those lows may only be in the low blues or high greens, or even the yellow ranges, but they still cause the self protection mechanism in a cat's body to kick into action.

    You really do want to see Lenny in the greens and blues at nadir. More of the yellow range at pre-shot test time would be good too. How to get there is the question.

    You've followed the suggestion to front load the food for Lenny. But what we don't know, is what the BG levels are earlier in the cycle. Would it be possible to test Lenny BEFORE the feedings at +2 and/or +3, to see what the BG is? Please? Try to alternate, but I think if we could see some +3 tests, with your new feeding schedule, that will give us another clue to what is going on.

    More importantly, how is Lenny feeling? Are all 5 P's (peeing, pooping, purring, preening, playing) and his appetite doing well?

    I'd give it a few days, for the bounce to clear, before you increase the dose again. But I do think that ultimately Lenny will need a dose increase.

    Have you planned a curve, testing every 2 hours from one pre-shot test to the next pre-shot test for this weekend? Either Saturday or Sunday?
     
  19. NancyJH

    NancyJH New Member

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    Apr 13, 2020
    I’ve been feeding Lenny two hours past his AM shot and again at 4-1/2 hours. At his evening shot, I’ve been feeding at 2 to 2-1/2 hours past shot. It seems to be eliminating the low mid cycle numbers. I had two bad days — one where my evening preshot number was 104 and another day where I thought I was going good but had a fur shot. I’m not sure if I’m back on schedule yet or if it takes longer for those two things to settle. I need to increase his dose so if things settle, I’ll go to 2 units. I’m going to try to do a curve this weekend. Do my numbers seem to be doing ok with just an overall decrease needed?
    Lenny is doing well. I actually think he’s more active when he has higher numbers.
     
  20. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    With the fur shot only being 3 cycles ago (12 hours per cycle), you're not really back on target yet. I'd give it 1 or 2 more cycles, to see if Lenny clears that bounce from the fur shot.

    Lenny's BG levels are still kind of high. You want to see the lower blues <150 and greens <99 at mid-cycle. Those BG levels, especially the greens, give the pancreas a
    rest and time to heal.

    Definitely need to see a curve, as soon as you are able to do one. Busy weekend coming up for many folks, with the holiday.
     

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