Dosing Review/Question

Discussion in 'Prozinc / PZI' started by Sugarkitty15, Jul 11, 2020.

  1. Sugarkitty15

    Sugarkitty15 Member

    Joined:
    Apr 14, 2020
    Hello!

    I need a little help navigating our current situation. Squeaks was at .25U/2x a day. Yesterday, his nadir was 89, according to the SLGS, I should reduce by .25U but that would mean nothing and I was previously told about the drop dose to wean off. I've basically been giving him a "fat dose" (the first line of the syringe) since PM shot yesterday. Should I start trying the drop dose or stay with a fat dose for the next week? I realize we're due for a curve but since he had a few nadir's below 90 with dose reductions, he hadn't been on the same dose for a week at a time yet. Thanks in advance for your help!
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I'd recommend that you try the drop dose Betsy. Or an OTJ trial.

    Just to see what Squeaks BG levels are, if you are able to test tonight at +3 or +4, that could give you an idea of how Squeaks would do without insulin, and maybe help you decide on the OTJ trial or the 1 drop dose.

    You haven't been able to give Squeaks his PM dose the last 2 days, because of his very low pre-shots. But his morning AMPS has still been very good.
    If Squeaks doesn't hold the good BG levels after that tiny 1 drop dose of insulin, you can always restart with the 0.2U dose.

    Squeaks looks like he is so, so very close to being ready for an OTJ trial.

    Here are the instructions, just in case you decide to try that. They are generic, and cover many different insulins, so concentrate on the info for the in-and-out insulins, like Prozinc.

    OTJ Trial Guidelines (These are the criteria we use when following an OTJ Trial.)

    Here are the instructions for an OTJ trial: If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc). The trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range. Start the trial on the next green pre shot.

    If you are posting in the Lantus/Levimir forum, please start a new thread each day which says ‘[Cat name] OTJ trial Day 1 BG xx’ (where xx is the BG reading for that cycle PM), then day2,3 etc. If you are posting in the Main Forum, we don’t require you or need you to do that separate post for each day. In fact, if you have never posted before over in the Lantus/Levimir forum or use a different insulin, you are fine staying in the Feline Health (Welcome & Main Forum). Or in the specific ISG (Insulin Support Group) for your insulin. We’ll cheer you on!

    1. Test at your normal AMPS and PMPS times. Remember, you want a 2 hour fast before those AMPS and PMPS test times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

    2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If the numbers are blue or higher (100-199 human meter, 130-230 petmeter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

    3. Your cat may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

    4. After 2 weeks, 14 full days, if everything is looking good, we have a party!

    Sometimes, the trial doesn't work the first time and we have to give a little more support by starting the cat with a tiny dose of insulin again. I had to do that with Wink. We simply start the cat back on a tiny dose of insulin to support the pancreas with healing for a bit longer. Our goal is a strong remission and it's better to be safe now then sorry later that you rushed it. With just a little more time we will probably get that strong remission we are looking for.
     
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  3. Sugarkitty15

    Sugarkitty15 Member

    Joined:
    Apr 14, 2020
    Thanks so much @Deb & Wink! I'm comfortable doing the 'drop dose' for a few more days as I started that at PM shot 7/13. What types of things should I look for to signal he's ready for a OTJ trial?
     
  4. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    BG levels can help to indicate it's time for a trial.
    • If the pre-shot tests are all < 100 mg/dL.
    • If the mid-cycle numbers (or any time during the cycle really) drop below 50, that is a sure sign the dose needs to be lowered. The only dose lower than 1 drop is no insulin.
    • That +3 to +4 BG test being lower. Since food raises the BG levels, that test time tells you if the pancreas is putting out insulin of it's own, if the BG remains low.
    Improvement in the symptoms of diabetes.
    • The urine puddles in the litter box are back to a normal size.
    • The amount of water being drunk is greatly diminished, back to a normal amount.
    • If the appetite is back to normal. Meaning Squeaks is not ravenously hungry ALL the time.
    • Improvement in any diabetic neuropathy symptoms (back leg weakness), funny gait. Able to jump up on the sofa/chair/ kitchen counters again. Diabetic neuropathy symptoms can persist past the time that a cat is ready for an OTJ trial, or has gone OTJ, so don't rely on this one too much.
    • Got his purr back.
    • Playing again, acting more like his normal self again. It's harder to tell that Squeaks is diabetic, with his behavior.
    It doesn't have to be all of these signs. But the majority of them, most of them occurring will say it's time for an OTJ trial.
     
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  5. Sugarkitty15

    Sugarkitty15 Member

    Joined:
    Apr 14, 2020
    Well, his +4 after AM shot was 52 and all of his symptoms you mentioned above have approved and are back to normal. I think we're ready for OTJ trial!!
     
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  6. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Let's do it then!
    Trial started with PMPS on 7/15/20.

    Hope you feel better tomorrow.
     
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  7. Sugarkitty15

    Sugarkitty15 Member

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    Apr 14, 2020
  8. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Squeaks is still looking ok.

    If you get the chance this weekend, or your next day off, when you see those blue pre-shots, try to get a +3 or a +4 BG test.
    If that +3 to +4 number is lower than the pre-shot, it tells you that Squeaks pancreas is putting out insulin on it's own.
    Bringing the BG levels back down, when the food has been processed and moved through the cats system.
     
  9. Sugarkitty15

    Sugarkitty15 Member

    Joined:
    Apr 14, 2020
    Oh good, I was just coming to post on here too! lol. Ok, good to know--I was a little worried that he was blue still but I should be able to get a +3 or +4 tomorrow if his numbers are still blue. Thanks!
     
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  10. Sugarkitty15

    Sugarkitty15 Member

    Joined:
    Apr 14, 2020
    @Deb & Wink Do you think I started the trial too early? His +3 after food was a little higher than his AMBG.
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Let's give it at least a couple more cycles, to see if Squeaks levels out and goes lower during the OTJ trial.

    Maybe 1 more AM cycle on 7/18 with a +3 or +4 and then if he is still too high, back on the 1 drop.
    How does that sound to you?
     
  12. Sugarkitty15

    Sugarkitty15 Member

    Joined:
    Apr 14, 2020
    Sure, that sounds good!!
     
  13. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Back on 1 drop of insulin I see.
    Hopefully that 1 drop will bring Squeaks BG numbers back into the greens numbers. (<99 mg/dL).
     
  14. Sugarkitty15

    Sugarkitty15 Member

    Joined:
    Apr 14, 2020
    Yes we are! I hope it does as well. Once we get back to the greens, how long should I maintain that before I try the OTJ trial again?
     
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  15. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I'd say to try for 1 week at the green BG levels, before you try the OTJ trial again.

    Hey, didn't hurt to try that OTJ trial for a bit. You never can tell when it will work for some cats.
     
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  16. Sugarkitty15

    Sugarkitty15 Member

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    Apr 14, 2020
    Perfect, thank you! For sure, it was good to try for a few days!
     
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