Help regarding Duke's numbers please.

So far Duke has had some nice numbers dropping down into the healing zone just about everyday but how do we get the blue numbers lower down so that he has more green during the day and lower pre-shot numbers.
I realise that this is a marathon and not a sprint so am i just being impatient and wanting too much too soon.
Thanks.

 

I'm sure others will chime in. His numbers look GREAT! But on an insulin like ProZinc, you're pretty much in the ideal sweet spot. The preshots are the last numbers to come down, but realistically they'll probably still be blue.

If you're following the Modified ProZinc Dosing Method (sticky here), you could let the nadirs get a little lower (68mg/dL on the AlphaTrak is the cutoff, any lower and it's hypo territory). This is completely personal comfort level, and you'd have to stay on top of testing.

 

Hi Teetee, hopefully an expert will respond to you soon. Just wanted to say you are doing a heck of a job with the testing! The numbers look good. I, too, am feeling a little frustration that I am not making much progress. I'm getting blues now and the yellows. I'll be switching to Lantus in a couple of weeks so hopefully I will see a little more progress. Your kitty is pretty. Looks like he has a black mustache where my Susie has a white one. Good luck with Duke!

 

I agree with what Melissa says above that, "you're pretty much in the ideal sweet spot".
Remember that insulin dosing is based around the nadirs, not the preshot numbers. And since you are using Alphatrak you don't really have much scope for the numbers dropping lower than they are now. Numbers below about 3.6 are getting into hypo territory (according to the AT manufacturer). And Prozinc can occasionally throw a lower number anyway...

Duke's body is healing, that is evident from the improvement in the numbers to date. And if this is how things stay for him then you are still in a really good position. Many on this forum would love to have the numbers that you have now!
But, since Duke seems to be in a continuing pattern of improvement then it may well be that his insulin requirements decrease further as his body heals further. The preshot numbers are trending downwards...
And if you scroll back through Duke's SS just look how far he's come....

Eliz

 

Very much so.

Duke's doing really well, Tee!


Mogs
.

 

Thanks Melissa, i hear what your saying about getting his nadir a little lower and as i'm testing regular i may increase his dose by just a drop or two when i get the nerve to do it. I never increase or decrease his dose by much as you can see on my spreadsheet as i know he's very near to the dose he needs at the moment.
It frightens me watching the numbers coming down, yet rewarding when he reaches the greens.

Thanks Summer, it is frustrating and i know that i test a lot because i'm so worried that Duke will drop too low and go into hypo.
Susie has a nice full white moustache whereas poor Duke only has half a moustache, i sometimes call him half a moustache Duke. lol.
Hopefully the Lantus will help Susie get into the lower numbers.

Thanks Eliz
I think Duke's done amazing so far as well, i suppose i'm looking for reassurance really and i agree that others would love his numbers, many a time i look at other spreadsheets and think crickey i'm glad Duke's not up there or bouncing about like that.
As you and Mellisa stated there is not really any scope left for bringing his numbers down, perhaps a drop or two, but it's getting the nerve to do it.
You should see me loading the syringe, glasses and a magnifying glass trying to make sure i get the exact same place everytime.
I'm just being too impatient i think Eliz, wanting too much too quickly, his body as you say is healing and that's what counts.

Thanks Mogs, apart from the fur shot last night, well i presume it was as he didn't drop at all in the first two hours but at least he was still 10.2 mmol/L (184 mg/dl) this morning. I'm assuming this is about duke's natural level at the moment so it's a massive improvement to when he first started insulin.

 

There is something that i forgot to add.
Duke's numbers are consistently higher during the PM cycle and rarely drop into the greens. What i'm going to try today is giving him less roast chicken treats after his testing because he does have quite a lot throughout the day or other than that should i increase his PM dose slightly to bring the AM and PM numbers more in line.
He has Wild Freedom food for his AM/PM meals, same amount each meal but different flavours rotated so i don't suspect his food is causing it.

 

Bump

 

Hi Tee,

By way of general info, most cats tend to run in a slightly different range in the night time compared to daytime. Based on what we see here, most cats tend to run lower on the PM cycle but for other kitties it seems to be the opposite (looking at you, Duke).

Can't help on the dosing question.


Mogs
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Just keep doing what you’re doing.

 

Thanks Mogs

 

Tee, why don't you try posing your question about dosing on the Prozinc forum.

 

Thanks Janet.
I'm so pleased to see you.

 

Hi Summer.
I just thought that i would continue this thread, but as you say i should have created a new thread.

 

Eh, I’m still around. It feels different though. Not used to talking about her in past tense.

 

CC will always be present tense in your heart.




Mogs
.

 

She's in your heart, mind and dreams Janet and always will be. You haven't lost her, she all around you.

 

I would do a +3 etc. for tonight.

 

I'm on it Dyana, he's dropped pretty sharp so far for +2

 

I don't have experience with Prozinc, but I would not touch his dose for a few days. As others have said, his numbers are so close to the 68 cut off using the AlphaTrak, that I would just try to get some more night time time tests and see how he does.
Are you using a caliper to measure the dose? I have found syringes (even in the same batch) to be off by as much as 1/2 unit and at least 1/4 unit. I think you will be more consistent with the dose using calipers if the different markings on the syringes are causing any issues.

 

That's certainly been the case for the BD 0.3ml demi U100 syringes I've used over here.


Mogs
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I have tried using calipers but i find it too awkward so i use +3 reading glasses and a magnifying glass and then i use various markings on the syringe to get my dose. For his 0.875 dose i go to the bottom of the leg on the number 1 and 0.750 to the top of the leg on the number 1.
It might not be actually 0.875 but as long as i know where i'm at i can get the dose pretty accurate. (so far) but the smaller doses will prove a challenge.

 

I bought some U100 syringes last week Mogs but i daren't use them after what i have read on here about them.

 

I'm not sure how big your magnifying glass is, Tee. If you fancied trying something smaller, maybe try a jeweller's loupe. I have this one (you can get them cheap as chips on eBay):






https://www.ebay.co.uk/itm/LED-Illu...sh=item23886c1b1c:g:NLoAAOSwDrpb6i1x#payCntId

When I became more aware of the sometimes huge offsets in the syringe markings, I went through a batch and found one where the zero graduation was in the right place. I then used that as a yardstick with which to check the offsets on all other syringes. Also, when I got a new box, I would inspect every syringe and try to put them into separate groups based on the degree of offset of the graduation marks. That way, I could better gauge measurement tweaks for each group, and I had the reference syringe with which to compare them. (Like you, I would have found the dosing caliper too awkward to use, and I'd have ended up having panic attacks had I tried to use one.)


Mogs
.

 

That look a decent magnifier Mogs. The one i use is a pocket magnifying glass and i slip it in behind my glasses so i can adjust the syringe without having to put anything down.
Mine's something like this.
https://www.amazon.co.uk/geshiglobal-Foldable-Jeweler-Jewelry-Magnifier/dp/B07KR6ZSCK

 

I didn't realise they could be that far out and i doubt that i will ever use them now. I did download the templates for the syringes but they seems a bit of faff to use.

 

Your pocket magnifier would be pretty much the same deal as my cheapo loupe (assuming the lenses are of similar power).

I used to use 2 pairs of reading glasses stacked one in front of the other to set the dose, then I'd check it with one pair of glasses (which I need anyway ) and the loupe.


Mogs
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Been there Mogs, Lol.

 

I know. It took me a frustrating week to get somewhat used to using them. I was at the time, doing a teeny dose and needed to be accurate. Eventually, I was happy I had that in my tool box and used them.

 

I have a few pairs in my toolbox from my engineering days, maybe i will practice a bit and give it a go again for if and when i might need them.

 

Tee, the U100s are fine to use, but it is just important to be aware that they are not as precise as the U40s. Once we know that, we can find ways to work round the problem. And some people absolutely love their calipers for measuring insulin doses. (Note: Some people measure the the syringe barrel, and some find it easier to measure the distance between the end of the plunger and where that meets the syringe barrel.)
But, I'm very low tech and just keep a syringe that I've selected for its average and clear markings and use that as a template to compare other syringes to. I've painted the end bright neon green so that I don't accidentally throw it away (it has happened in the past... ), and just keep it with my test kit.
When I draw up a dose I first draw the plunger to the dose I want in the 'template' syringe, then I draw insulin into a fresh syringe, compare the two, and adjust as necessary.
My close vision isn't great so I have a magnifier on a stand on the kitchen worktop along with my diabetes stuff. And I use that so I can see the syringes clearly. My girl is currently on very fiddly doses (numerous very subtle variations of 0.5 of a unit), and this makes measuring them much easier. (It's also been necessary to measure very much smaller doses at times, both my cats were on 0.1 of a unit for a while.)

The principle of keeping a template syringe as a reference would also work for U40 syringes. Although U40s tend to be more accurate than U100s there may still be 'some' discrepancy in them, and having a template would just enable you check that each syringe does have same markings.

BTW, since you do have both U40s and U100s you could have a little play with them, maybe using some coloured water, and see how they compare when you try to measure an insulin dose. (You can squirt the doses out onto a white plate and/or onto kitchen paper for comparison). A one unit dose in a U40 and a 2.5 in a U100 'should' be the same.

Eliz

 

Hi Eliz, thanks for the info.
I have just had a look at the U100 syringes and i'm surprised at how for out they are, the first picture shows the plunger pushed all the way in, as you can see the plunger is about half way up the rubber bit from the zero line and the second pic shows the plunger at the zero line leaving a gap between the bottom of the barrel and the plunger. It must be about 0.25U out, do you agree?
Not the best pics i know. Third pic shows better with the plunger all the way in.

 

Or cover a sheet of printer paper with a film of Vaseline and wipe off the excess. When you expel the 'dose' of coloured water from the syringe onto the coated paper it will bead up. Makes for much easier estimation/comparison of the fluid volumes - and it's reausable! Just wipe the coated paper dry after each use.


Mogs
.

 

I do. And I've seen bigger offsets. The ones with crooked and/or smudged graduation marks are even more fun.


Mogs
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Yes, thanks Mogs. I'm sure i've read your post about this before, thanks for reminding me.

Oh dear.
Having said that and i'm not sure about the U100 syringes yet as i have to learn about the conversions and study the chart but does the 0.25u on the U100 syringe convert back to 0.1u on the U40 syringe?

 

So i have just opened a new box of Prozinc U40 syringes and gave Duke's his usual dose this morning but his numbers stayed a little higher than usual so i thought i would check the syringes, low and behold the new batch have markings in a different place. On the old batch the plunger goes to the top of the zero line and on the new batch the plunger goes to the bottom of the zero line. I make it bit more than full line width, not a lot i know but enough to make a difference, so i will up his dose to 1u on the new syringes but the dose will remain the same if you know what i mean, lol.
It's hard enough trying to get the same dose consistently without the syringes being wrong.

 

Yes, if you draw up ProZinc (U40 insulin) to the 1/2 0.25 mark on a U100 syringe that equals 0.1 units of the ProZinc

 

Is that right? just looking at the conversion chart and it says that the 0.5u mark on a U100 syringe equals 0.2u of ProZinc.

 

0.5 mark on U100 would be 0.2 of ProZinc and thus 1/2 of 0.5 (0.25) would be half of 0.0 which is 0.1,.

The 1/2 is a typo, it should have been 0.25

 

Phew lol.
Thanks for that.