Dosing Advise for Maggie

Hi FrostD,
I know it’s too early to discuss Maggie situation when he’s on 2.75 since it’s not enough data to determine the situation yet and i know it’s not recommended to give different dose for AM and PM. I noticed if Maggie on 2 or 2.5 then his number is high but if 2.75 or 3 then his number will go low. This is what i have a hard time to regulate and find the right dose for him. Have you seen other cats in the same situation and what is your recommendation for his situation ?
 
He's currently sitting in a perfect range at this dose, we'll see how the next few cycles go.

Did you give the full 2.75U this morning? We recommend not shooting if preshot is under 200, or at least stalking without feeding and waiting to see if they come up to a number that's safer to shoot. Please do check him often today to avoid very low numbers.

What you'll want to do is give full dose if he's above 200. You've sometimes shot lower and been ok, but that was luck because he was bouncing. But other times, like that night he had the 33, it wasn't ok. So under 200 you'll do a sort of "sliding scale" as we call it. So you'll do preshot, get a lower number, stall for 20 minutes without feeding, retest to make sure his BG is rising. As long as it is rising -
150-199 I would do 0.75-1U.
125-149 I would do 0.25U.
I would skip anything under 125 for now.

This sliding scale will likely change over time, I'll let you know my thoughts as I watch his spreadsheet.
 
Yes. i did give him a full 2.75 PM dose last night when he was 164 and a full 2.75 AM dose this morning when he was 126. so i've been doing this incorrect then since i thought we don't look at the preshot to determine the dose and have to keep holding the dose consistently for at least 6 cycles :banghead:

so for today PM dose, if the pre-shot is under 200 then don't feed at his dinner time and wait for 20 mins to check the BG again. If he's continues to be under 200 then do as below but if he's above 200 then give 2.75 after food ?
- 150-199 I would do 0.75-1U.
- 125-149 I would do 0.25U.
- skip anything under 125 for now.

If we do this then how do we know if the dose is right for him since we will change the dose up and down dramatically from 0.25/0.75/1 to 2.75 ? I checked his BG @+3 was 242 and i did give him 1 can of food for lunch. Will check again @+5 or +6
 
Just dropping a link to the dosing sticky again, it's discussed here (and I did mention the lower BGs on June 8th as well) - https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

His normal dose is determined by nadir. Eventually, when he's (hopefully) regulated, you will give the same dose 99% of the time, even at lower numbers. The trouble is while they are still getting regulated, they don't always have a set pattern. He's bouncing today so it worked out, but the other part of the trouble is we don't always know if they're going to bounce from those low numbers (like that night you got a 33).

The sliding scale is just for now until he settles down more. It will take some adjustment trying to get the optimal scale, so for now I've given you something a little more conservative to be safe.
 
thanks again FrostD. I guess with the date I highlighted in tan (4/29, 5/2, 5/6, 5/14, 5/16, 5/17, 5/20, 6/5, 6/10, 6/11, 6/22, 6/23) were the one that I supposed to do the sliding scale but did not which caused him went into hypo and bouncing around ?

What's about 6/12 (night) and 6/13 (morning) ?, he was over 200 with full 2.5 dose and he still went into 65 (6/12) and 99 (6/13). would it save to give him full dose when he's in 200-250 ?

Sorry for flooding you with questions
 
I would actually ignore everything before 6/12 since we know the dose was too high for awhile, then there was the reset, etc. But I'll explain a few anyway --

6/5 - Yes the recommendation would have been a lower than usual dose, but he did not hypo because I believe he was bouncing - so the higher dose cut through the bounce.

6/10 - AM - I think this was just luck. Doesn't look like a bounce, could have been, I wonder about possible furshot. 6/10 - PM - this one in particular highlights the dose being too high - if those tests are right, he bounced, and the dose still cut through that bounce and had him go hypo.

6/11 - same thing, fortunate that he was bouncing anyway, the full dose cut through.

6/22 - in this case the full dose at 164 worked out. He didn't bounce (at least I don't think) and he didn't go too low. This day in particular is why I'm saying I expect the sliding scale will need adjustment, but better to start a little more conservative.

Today - he bounced, and the full dose kept him flat yellow.

One other option you have, if you have the schedule flexibility, is delaying shots (without feeding) for up to an hour or so. If it's clear hes bouncing - very rapid rise - can probably give the full dose to help stop the bounce. The trick there is you'll probably need guidance to learn to see the pattern of a bounce beginning.
 
thank you for your explanation. Yes, i would love to learn more about the pattern and want to help him into remission if possible. I do have a flexible schedule and i'm able to monitor him closely during the day.
 
Please remind me to check his spreadsheet tomorrow to watch the bounce...caught up with a few complicated kitties and I'm worried I'll forget to check in
 
hi ForstD, can you please check Maggie number for me ? i increased Maggie to 3 units this morning. i don't think it's a bounce since it does not look like he's going any lower. he's keep dancing around 2.5-3 units :eek:
 
Yes I think an increase was good. He is bouncing from the blue yesterday - that was a rapid rise to PMPS and he's so high this morning.

Very normal for them to float between doses! Remember insulin is a hormone and is affected by a lot of things, so needs change.
 
Maggie number start to come down this morning. I will see if I can do the sliding scale for him tonight if the number is still below 200 but he's very food motivate. he's screaming to ask for food even before 30 mins of his meal. will try to see if I can not hold him of for food then will do the dose reduction :(
 
Well there really was no indication he was going to break that bounce! Nice numbers today though. Hopefully he doesn't go too much lower
 
yeah, this is the problem for a while that i'm trying to figure out if something i did wrong or not but it seem 2.5 and 2.75 is not enough insullin and 3 is too much insullin. not sure what else to do if he go too low again
 
Based on today I think this dose is ok for now, just as you said will have to be careful because 3 seems to get to be too much for him sometimes. Sliding scale can help, just have to figure out what it is first lol
 
hi FrostD, do you know why Maggie jump across several band of color like today ? he went from 183 to 418 in couple hours. I'd seen him doing this a lot before
 
Maggie at 145 now before AM feed and shot. I am going to hold her food and shot for 1 hr now and will check again on her number. If he stay below 200 then will do the recommended dose. If go up high over 200 then will give full shot
 
Maggie is at 130, 2 hrs after his normal time without food and insulin. I am going to give him 1 can low carb and 0.25 now?
 
Sorry I wasn't around, holiday weekend here. He broke the bounce and had a nadir around shot time. So I'm glad you shot. Looks like he might be bouncing again but the shot is holding it down a little.
 
I did the sliding scale but instead of holding him off for 1 hr and i forgot to hold him for 2 hrs without food and insulin. His normal shot at 7 am central and i did not give him until 9 am

@7 am - 145
@9 am - 130. 1 can of food and 0.25 unit of insulin
@11 am - 270
@1 pm - 265

This mean i wont give him his pm shot until 9 pm central time correct ?but of course still follow the rule below or above 200?
 
You can move the shot back by 30 minutes once a day, so.you could do 830 tonight, then 8 tomorrow night, etc.
 
Naidr tells you if your dose is good. Since we know he's seeing nadirs around 130-140 on his good (non bounce cycles), we know these higher numbers are bounces.

If nadir starts to trend up, that's how we know it's not enough insulin.
 
Maggie is below 200. I delay 30 mins and give him 1 unit
@8:00 - 162
@8:30 - 179 - give 1 unit and 1 can of food
 
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He's coming off the bounces quickly which is great! I'll check in tonight hopefully to see how the partial shot did
 
It look like small dose is not enough for him to last 12 hrs? He’s always high in the afternoon. Also the low number in the morning because of his 3 units in pm ?
 
No, I think the 3U is good for him right now. He ended dup bouncing today so the 1U wasn't enough. But he bounces late in the cycle (and breaks them late in the cycle) so you had no way of knowing it was coming. For now keep doing what you're doing, because it's too risky to give full shot with a low preshot. If he doesn't bounce you'll be in trouble.
 
Since he needs more than 2.75 but less than 3, should i do skinny 3 instead then if he still below 200 then reduced. Do i still need to do sliding scale every time he below 200? If i keep doing sliding scale every other day then he wont get back to his normal 7 am and 7 pm ?
 
At this point I would not stall anymore (unless he's too low to shoot), because he bounces so late or breaks the bounce so late it won't help you. You can get back to your normal schedule by (1) moving one shot a day back 30 minutes or (2) moving each shot back 15 minutes.

125-149: I would try 0.25U if you can monitor. Otherwise, skip.

150-174: I would try 0.5U if you can monitor, otherwise potentially skip or 0.25U.

174-199: Try 0.75-1U if you can monitor, otherwise 0.5U.

You can shoot full dose or close to it if you want, but again my concern is if he doesn't bounce. You could easily get into hypo situation.
 
thanks FrostD. I will adjust him back to his normal time. So this mean I have to base on his pre-shot number to give him insulin which this is not the normal case for others ? I hope he will eventually break the fluctuate cycle of being up and down all the time or else it's impossible to get him anywhere near to be in remission :(
 
Eventually the goal is to shoot the same dose at any number above 90-ish, but it takes awhile to get there.

You'll see the sticky does say until you collect more data under 200, it's best to try reduced doses until you figure out what is safe - that's where we're at, figuring out what is safe but also keeps him from going too high/too low.

Your full dose is still based on nadir, we still want that in the 90-120 range.
 
Hi Frost, i know every cat react different but do you have a case from someone else similar to Maggie and already have data so i can study the trend ? Maggie’s been in this situation of staying with the dose for 2-3 weeks then hypo since last year. His vet and I have a hard time to figure out how to stable him without going up and down the dose since last year and we switched him from vetsulin (gave by previous vet) to prozinc (current vet). We also do full blooded work and all the test for him monthly to make sure no underline condition contributes into his diabetic fluctuations but we still can not find his breaking point yet. How’s long do you suggest to keep what we do to know his trend? Anything else that you can suggest for him? Thanks
 
He is pretty normal for a cat on ProZinc. All those hypos we're from giving the full dose at lower numbers, hence my sliding scale recommendation. The hypos were causing bounces and changed doses, so sort of shooting yourself in the foot.

Our goal with the sliding scale is to keep his BG as flat as we can, and nadir 90-120. This dose is really good for him right now, just have to figure out the sliding scale.

If after 2-3 months he still isn't improving, that's usually when we recommend a switch to something like Lantus/semglee/it's generics.
 
Thank you FrostD. Will keep him on 3 unless below 200 otherwise. he's still keep bouncing for the last 2 days :nailbiting:. Sometimes I just feel stuck and helpless when I don't see much improvement on him. I guess it's what it's and nothing else I can do at this point for him other than keep going forward :(
 
Ok that was a bounce break - again,.you can tell because his prior PS starts very high, then he slowly came down overnight. He nadirs pretty much at +11 when that happens.

What I would like to try next time - only if you're comfortable and can monitor - stall without feeding, retest in 20 mins just to make sure BG is flat or rising a bit. If it is, try shooting 0.25U if 100-149. What should happen is he will rise a bit before the shot kicks in, then once it does it will hopefully keep him on the flat side.

Right now looks like he's headed into a bounce, aided by a skip(not a criticism! You did the right thing).
 
Let me try to wait for him to break the bounce again and if I see him in a low range like this then I will do the stall. should I stall when the number anything below 200 ? or what should be the right number for me to stall him ?

After the stall for 20 mins, I will consider the rule as below ?

Below 100 - skip

100-149 range: will try 0.25U

150-174 range: will try 0.5U

174-199 range: will try 0.75-1U

Above 200: will try full dose
 
Correct. Skip under 100.

For now, stall only in the 100-149 range. You can stall 150-174 if it makes you more comfortable to make sure he's flat or rising before shooting.
 
Maggie drop from the bounce again :nailbiting:. I am giving him more food to get him back and will keep a close watch on him now. i hope he wont bounce too high in the PM. If he's low in PM before shot then i will do the stall
 
You are still using an AlphaTrak, correct?

He may be headed for a reduction soon here. On an AlphaTrak, you reduce if he goes below 68. That 73 was pretty close.

Hes showing a lot of progress this past week!
 
Yes I am using Alpha Track. You mean if he low to 68 and does not matter how high his number after that then i need to reduce his dose to 2.75 on the next shot? Will 2.75 good for him, he seem get high number when he’s at 2.75 but low in 3
 
Correct. If he goes below 68 (or you can reasonably assume he did), it's a dose reduction of 0.25U. May or may not need to rework the sliding schedule, we will see.

It's very common for them to float between doses like this. Sometimes they need a little more, sometimes a little less.
 
He’s getting low again but let me see if he’ll go to 68 or not with extra food need. Will give him food went he get there
 
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