? Feed, shots 3x/day?

Discussion in 'Prozinc / PZI' started by Valher, Jun 7, 2020.

  1. Valher

    Valher Member

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    Apr 18, 2018
    Boo likes to eat every 8 hours. I've tried to use small meals in between the 12 hour shots, but then he isn't very hungry for the shot or is super hungry in between and just doesn't seem to be working. His levels today were all over the place. I'd like to go back to feeding every 8 hours and try shots 3x per day. He's currently on 2 units every 12 hours. If I stay at every 12 hours, I think I'll have to increase dose. Could I do feed every 8 hours and 1.5 units at each feeding?

    Suggestions? My vet isn't very responsive to discussions lately and they want me to come in for a curve and fructosomin test, which I see no reason to pay for since I'm testing at home.

    Learned everything from this forum - Thank you!!

    Valeska
     
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  2. Panic

    Panic Well-Known Member

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    You got a 99 today at nadir - I wouldn't want to be shooting three times a day at all. Is it just because of his eating habits? How big of meals are you giving him during AM/PMPS time? You can give him slightly smaller meals and feed more to him later - for example, instead of giving him a whole can of FF for breakfast, only give half, then a quarter at +2, etc.

    Today he had a great response but he wasn't used to that 99 so he bounced - it looks like a perfectly normal chart to me.

    Are you testing daily or just what you've filled in to your spreadsheet? It seems half finished is why I ask.
     
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  3. Deb & Wink

    Deb & Wink Well-Known Member

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    NO!

    Prozinc usually lasts 10-14 hours in a cat. You do not want to overlap the doses when using Prozinc and do TID dosing.
    It's better to shoot Prozinc every 12 hours, and increase/decrease the dose as needed. TID is not something I've EVER seen done with Prozinc, only the shorter lasting insulins like NPH and Vetsulin/Caninsulin. And then, only if the BG's warrant it.

    Do your own curve at home. Test from one pre-shot to the next pre-shot, testing every 2 hours, feeding normally.

    You need a row for every day on your SS please. Plus, you need the Units of insulin given in the U column for both the AM and PM cycles. Please fill in that data, so we can see what is happening. Even if you did not test, you should still have a row for each day. Start with May 2020 and go forward from there. It's really hard to see what is going on with Boo Herm, with the SS data you have now.

    Plus, if you are not testing before every pre-shot, you don't know if Boo Herm's BG levels are high enough to give him insulin in the first place. Please, let's keep Boo Herm safe, and test before each insulin shot. We'd hate to see that you needed to rush him to a 24 hour emergency vet with a symptomatic hypo.
     
  4. Valher

    Valher Member

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    Wasn't testing daily, just what is in the chart. Going to start daily now, before meals plus random.
     
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  5. Deb & Wink

    Deb & Wink Well-Known Member

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    Ok, understood on you not testing daily.
    But you were giving him insulin every day? Insulin shots both AM and PM cycles? Yes? Than that goes on the SS. Makes for a more complete picture. Let's my ancient brain see the patterns better, without skipped rows for each day.
     
  6. Valher

    Valher Member

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    Thanks!! He just started on insulin again late May and it took me a bit to get back into the testing routine. He was in remission for 2 yrs, so also forgot that I was supposed to test before the shots. Thought the "U" on the sheet was for urine/ketone test - oops!! I do make notes on the side, but will do better!
     
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  7. Valher

    Valher Member

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    I can do that! :)
     
  8. Panic

    Panic Well-Known Member

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    There is a newer spreadsheet they made that has the dates in place already. I had to ask @Marje and Gracie to set it up for me because for whatever reason I couldn't update mine. You can start a conversation with her and ask for her to set you up a new one if you like. :)

    Let's start with the daily testing and maybe spread out the food in smaller portions so he's more apt at eating at meal-time. It's also not a HUGE huge deal if he doesn't eat first thing, as Prozinc doesn't hit very fast. As long as he still has his appetite and is going to eat later you should be fine.

    That would make sense! XD Oh now I wish they had a ketone column haha.
     
  9. Deb & Wink

    Deb & Wink Well-Known Member

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    Getting the memory back in gear, when your cat comes out of remission after 2 years is going to be a challenge.
    Have you read the "Sticky" at the top of the forum? They were rewritten in January 2020, so since you were last giving Boo Herm insulin.

    So every 8 hours for food?
    Remember that Boo Herm should have no food for 2 hours before the pre-shot tests, so we can see those are not higher from a food influence.

    A couple of links for you, on setting up the SS and what the columns on there mean.
    Don't know if it would be better to simply start the SS from scratch, although there must be a way to add a new tab to the existing SS.
     
  10. Valher

    Valher Member

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    I'll just keep giving him some smaller snacks in between the 12 hour doses (but not within the 2 hours before the test/meal). I updated the chart for all doses since 5/17/20, when I started dosing again. I'll keep testing and see what happens in a week or so. He's seems fine energy-wise, I'm just hoping to get him regulated. I'll read the sticky again.Thank you for the help!!
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Thank you very much for the SS (spreadsheet) updates and entering a row for each day. It really does help my old brain see things better, helps me to see the patterns on the SS and what is happening with the doses and such.

    You got Boo into remission once, here's hoping you get him back into remission again.

    Do you know what brought him out of remission? Pancreatitis? Another infection/inflammation (think teeth or UTI), change in diet to a different food? Weight gain? Steroid use by any chance? Something else?

    So looks like Boo is bouncing a little bit, from that low of 99 on 6/7/20 AM cycle. Cats can bounce for 3-6 cycles, so let's see if Boo's BG levels settle back down in the next few days, before you increase/decrease or hold the dose.

    I don't see what meter you are using. Could you add that to your signature please? Makes a difference in the low BG numbers if you are using a human or a pet meter. Put the meter on the SS to please, if you would. Helps to see that information as we are looking at the SS data.

    Dose increases are done in 0.25U increments (usually). There are exceptions of course, depending on the nadirs. Right now, I don't think that Boo meets any of those exceptions, since the 2U dose brought him down to that 99 mg/dL BG level.
     
  12. Valher

    Valher Member

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    Once we ran out of our reserve stock of FF seafood pate in late March, early April, we couldn't get any FF from area stores or shipped. We got other wet food and tried to stick with the low carb, but he immediately started drinking more, then getting extra hungry. We were dealing with a very sick dog who went over the RBB on April 12th, so it took me longer than it should have to deal with it. He's back on FF and I just read that it shouldn't be all seafood cause mercury, so have some beef, chicken and poultry too. I would say combo of food, age and perhaps stress from losing his dog buddy.

    Today and yesterday were better, but still high imo. I'll keep testing!
    Testing with an Arkray. I'll add it as requested.

    Thank you again for your help. ❤️
     
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  13. Deb & Wink

    Deb & Wink Well-Known Member

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    So sorry to hear you recently lost your dog. What was his/her name?

    So, you feel like Boo could use a dose increase? How about upping his dose to 2.25U? Let's see how he does on that.
     
  14. Valher

    Valher Member

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    Thank you. Our dog was Baron Von Woof and he was the sweetest thing. An adorable mutt we adopted in 2009. We adopted Boo in 2005 so they've been together a long time.

    I will start the 2.25 tomorrow!
     
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  15. Valher

    Valher Member

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    I've been at the 2.25 since Wed am, but his levels are still high. Feeding right now is 7:30 am w shot, 1:30 pm, 7:30 pm w shot, midnight. I leave the food out but remove it 2 hrs before the shots (then feed immediately before the shot). Is it too early to raise the Pz to 2.5? And, should I keep with the feeding or move the +6 feedings to +4?

    You'll note I added a column on my SS for weight. It reads like he lost a little weight, but either my or the vet's scale is off because I'm sure he's gained a bit since mid-May.

    Thank you again for your input, it's super helpful. Valeska
     
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  16. Deb & Wink

    Deb & Wink Well-Known Member

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    It's not too soon to raise the dose BUT you really, really, really, really need to be getting at least 1 more test in during the PM cycle. Many cats drop lower at night, since they are more active. A "before bed" test is a good one to get. Or drink a big glass of water before you go to bed, and test him after you've used the bathroom. :joyful:

    Yes, probably better to move the +6 feeding to +4. The +6 feeding is likely causing Boo's BG levels to increase more in the later half of the 12 hour cycle.
     
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  17. Valher

    Valher Member

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    Thanks, I'll do that! I can do a +2 and +4 before bed tonight and move the feedings. Thanks again!
     
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  18. Valher

    Valher Member

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    Just a quick note, I was giving the PZ shot just after feeding at 7:30 (Boo was still eating). Previously, when his levels seemed a bit more steady, I was waiting 1/2 hr between feeding and the shot. So I switched back to waiting the 1/2 tonight. Waiting the 1/2 hr is what the dr instructions say, but it's way more convenient if I feed & shoot at the same time. Unfortunately, this has very little room for convenience!

    Today: 1 can FF 7:30 am & 11:30am, am pz at 7:30; pm 1 can FF at 7:00 and 11:30; pm PZ at 7:30 (1/2 hour after fed)
    Tomorrow's plan: 1 can at 7:00 and 11:30 am & pm; PZ at 7:30 am & pm

    Crossing my fingers that will help stabilize him! Also getting a keto blood tester so I can watch that. Thanks again for listening & have a great night!
     
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  19. Valher

    Valher Member

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    Going back to 2.25, the 2.5 got to 53 last night and but was high again this morning. His daytime at 2.25 isn't too bad, but then he ends up in the mid to high 300s at the AMPS. I wonder if it's too much insulin overnight. Does anyone dose lower in the evenings? I'm almost tempted to start over at 1.25 for everything. My poor kitties ears! I just can't seem to find a good curve.
     
  20. Deb & Wink

    Deb & Wink Well-Known Member

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    With Prozinc, there is no reason to wait for 30 minutes (1/2 hour) between the feeding and the shot. Test, feed, shoot the insulin in a 5-10 minute window if you can manage it. With other in-and-out insulins, like Vetsulin/Caninsulin or NPH (humulin/novolin) there is a need to wait between the food and the insulin shot, since those insulins onset faster. No need to do that with Prozinc.

    He's bouncing off that low from last night. Give him 3-6 cycles to settle down again, to more normal numbers. Good call on reducing the dose when Boo hit that 53 last PM. You followed the protocol very well.

    And Boo is bouncing up high from those lower blues this AM, 6/15/20. Blacks = bouncing, almost every single time.

    You are doing great at getting more testing in. Those additional tests showed you that Boo needed less insulin, when he dropped to the BG of 53.
     
  21. Valher

    Valher Member

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    Thank you!! I can't thank you enough for your input. I'd be a basket-case without it!
     
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  22. Deb & Wink

    Deb & Wink Well-Known Member

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    You're probably a bit of a basket case even with the help! Most of us were, when we first got here.;)

    Keep asking away. Keep learning and keeping Boo safe.:)
     
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  23. JanetNJ

    JanetNJ Well-Known Member

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    Normally you give the same am and pm, but perhaps only give 2 if the preshot is under 250.
     
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  24. Deb & Wink

    Deb & Wink Well-Known Member

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    I think @JanetNJ may have meant if pre-shot is <150, to give less insulin.

    A BG of 250 is the decision point (shoot, no-shoot) for NPH insulins, not Prozinc.
     
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  25. JanetNJ

    JanetNJ Well-Known Member

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    She came to the very bottom of normal (53) shooting 2.25 at a preshot of 215. I suggested lowering just a 0.25 but when it’s low like that to keep safe. I guess it’s fine as long as she can test, but we usually suggest a slight reduction with prozinc when it goes under 90. If she’s ok with it going lower and has a hypo kit ready to go just in case then that’s fine to keep the dose higher at lower preshots.
     
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  26. Deb & Wink

    Deb & Wink Well-Known Member

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    Since Boo has trace ketones, more aggressive dosing is needed. Setting a pre-shot of 250 is too high in this case, IMHO.
    Cats with ketones need to eat, eat at least 1.5 times the normal amount, get enough insulin, and treat any infections/inflammations ASAP. Adding more water to the foold to help keep the cat better hydrated and to flush those ketones out of the blood is important too.

    One of the things you do NOT want to do when a cat has ketones, is to reduce the insulin dose too much.

    Low numbers can be managed by the caregiver at home. DKA caused by ketones is an expensive multi-day hospital stay at a vet clinic. Ketones are the bigger worry at this point.
     
  27. Valher

    Valher Member

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    OH! I thought he was fine at .2. Shoot. Well, he certainly eats more than he needs - he gets 4 cans FF or more a day. I'm not sure he would eat more - he usually has a little bit left when I pull it 2 hrs before dosing. He also gets tiny salmon snacks at testing. I plan on sticking with the 2.25 units PZ until that evens out (unless you suggest something different?), unless he is under 200, in which case I'll just wait a bit to dose (rather then reduce the dose). He still drinks a ton of water and pees a lot, but I will add water to the food, too. Is that a reasonable plan?

    There hasn't been any indication of an infection, should I take him to the vet for testing anyway?

    Thank you again! Valeska
     
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  28. Deb & Wink

    Deb & Wink Well-Known Member

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    Sounds like a plan. As you are able to test more, and gather more data, that pre-shot of 200 can be lowered gradually. Think of 190 as being close enough to the 200 and you should be safe to shoot. Even a 180 is withing the 15% margin of error or meter variance for a hand held glucometer.

    Let's see when this bounce clears, which can take 3-6 cycles.

    A normal diabetic cat would have zero (0) ketones. So although that 0.2 reading on the blood ketone meter is very low, you do not want it to increase any.
    Best way to do that, is to make sure Boo eats, and eats well. 4 cans a day of Fancy Feast is 12 ounces. Sounds like a good amount.

    If his appetite is ever "off" or diminished or he refuses to eat, then you need to immediately test for ketones. When a cat is not eating well, they catabolize (burn off) fat and muscle reserves, and ketones are a toxic byproduct of that process.

    Is Boo maintaining his weight? Or losing weight? Weight loss would be an indication he is not eating enough. You could hold him in your arms and step on a human scale to get a rough idea of his weight. An ounce or two either way could simply be a full or empty bladder. I see that you have a column for his weight on your SS. Looks good, and I think I remember you saying he had gained a bit of weight in the last month.

    A vet visit would be up to you. Perhaps a call into your vet, to discuss the trace ketones is in order?
    How are his teeth? Any gum disease or bad teeth? Has Boo had a dental?
    UTI's are another common inflammation/infection, especially in an unregulated diabetic cat, since the sugar rich urine provides an environment to feed those bacteria.
     
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  29. Valher

    Valher Member

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    He's maintaining weight, but I'll check it again tomorrow. His teeth and gums are good and he doesn't act like he has a UTI (will pee on the carpet if he does). Skin and fur are better than before we started dosing last month. I think I'll just keep testing and if it goes up or won't go down, I'll take him in. Is there any particular time that is good or bad for testing Ketones? I did it at +7 AMPS today.
     
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  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Well, for humans, it's best to test for ketones in the morning, after someone has fasted. So perhaps testing a cat the same time, in the morning, would be good.
     
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  31. Valher

    Valher Member

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    Ketones were at .4 so we're off to the vet this morning!
     
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  32. Valher

    Valher Member

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    Per the vet, no ketones were in the urine, but it had a few red and white blood cells so we now have antibiotic shots added to the daily pokings. Looks like we caught something early! They did a frutosamine test (without asking me first) showing highs and lows as expected. She looked at my chart and discussed dosing and she agreed we should stay at 2.25 to see if we can even out the curve before dosing higher. Only checking AMPS, PMPS and before bed today, cause we both need a break! :)
     
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  33. Deb & Wink

    Deb & Wink Well-Known Member

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    Ketones show up in the blood hours before they will show up in the urine. Since Boo's ketones have increased, it's a good idea to test his urine or blood for ketones every day, so you can catch those ketones rising and stave off DKA (diabetic ketoacidosis).

    Glad you did a vet visit, since the urine had some blood cells in it. Inflammation or infection is nothing to fool with, when a cat has ketones.

    Hope they didn't charge you for the fructosamine test. Since you didn't agree to one.
    That works. A bit of triple or double antibiotic ointment on the ears can help them heal.
     
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  34. Valher

    Valher Member

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    They charged, but I paid this time. They're a good clinic overall and working hard to service their clients during this pandemic, and I can afford to pay a bit extra. Have a great night! V
     
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  35. Valher

    Valher Member

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    Hi Deb: Had a .7 blood ketones this am and Boo isn't eating or drinking much. He is alert and seems comfortable, so I'm hoping it is the antibiotic causing the lack of eating/drinking. I've gotten him to drink a bit with tuna juice, and he's eaten about 1 can of food total. His glucose is 119, so I'm planning on skipping tonight's shot. He can bounce so fast and without eating I'd rather skip than give a token little shot. My plan is to keep testing keto and if not steady or lowering by Monday am to bring him back to the vet.

    If you have any suggestions, please let me know & thanks! Valeska
     
  36. Deb & Wink

    Deb & Wink Well-Known Member

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    Skipping the shot with ketones like that is the WRONG thing to do. Absolutely essential that Boo gets his dose.
    At least SOME insulin is needed.

    You may need to hand feed him, to get more food into him.

    Not enough insulin + not enough food + infection/inflammation = ketones = DKA.

    Please, do not skip the dose entirely.
     
  37. Valher

    Valher Member

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    I'll test again and try to get him to eat more and see where we are.
     
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  38. Deb & Wink

    Deb & Wink Well-Known Member

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    Thank you.
     
  39. Valher

    Valher Member

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    He's at 166 and .6 for blood ketones. He really doesn't want to eat - not even his favorites, but I got him to drink a bit of cream. I can feed with syringe if needed. Sometimes he'll eat a bit more after a shot. If I give him a shot now, any thoughts on dosage.

    I'm ver grateful for your help!!
     
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  40. Deb & Wink

    Deb & Wink Well-Known Member

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    With those ketones, as close to his regular dose as you can give him.
    Yes, if you need to syringe feed, please do so.
     
  41. Valher

    Valher Member

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    I gave him 2 units (instead of 2.25) and fed him about 1/3 of a can. I'll make him eat more in 45 minutes or so. He's pretty riled up atm.
     
    Last edited: Jun 20, 2020
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