Help with looking over SS and Prozinc dosing advice.

Continuing thread...
https://www.felinediabetes.com/FDMB...dsheet-and-dosing-advice.245623/#post-2778104

@Deb & Wink @JanetNJ

Jax was prescribed 2 Units of Prozinc 3/10/2021. Unsupportive Vet told me didn't have to home test and not to feed any meals in between shots and much more not so great information.
I came here and learned so much and am still learning everyday. I started home testing asap and with great advice started feeding small meals/snacks at certain times of the day which helped A LOT!!
Jax has been on an increase on 2.25U since 4/13/2021. His numbers are still high and all over the place. I do feel like the increase helped a little with behavior. I am going to do another curve tomorrow 4/20/2021 which will be 1 week since the increase. I would love some input on whether or not I need to go up to 2.50U which I feel like is going to be a Yes. I know it can take some time to regulate and find that perfect dose. I just want to do everything and anything I can. Thank you all for all the help and advice.

 

Let's see the curve results first. Then we can decide on a dose change.

 

Ok sounds good, thank you.

 

Id do 2.5. We want to see some blues.

 

Thank you Janet. I'm going to finish today's curve and I can start the 2.5 on Thursday. I'll be home so I can monitor him. I do feel the increase and the extra meals really have helped with Jax's behavior overall and he isn't dropping too much too fast with the small meat at +1. Hopefully we can figure out his right dose and get him regulated. Thank you again.

 

I'm going to increase Jax to 2.5 tomorrow morning. At what number do I not give insulin? I just want to be prepared for any situation. Thanks.

 

If he is down in the blues, I'd still shoot if Jax were my cat. Jax has never been down into the blue BG range, not even the high blues. If he did happen to be in the low blues, than STALL without feeding, retest (without feeding) in about 20 minutes. Rinse and repeat, for up to 1 hour with Prozinc. A 1 hour stall still lets you shoot at your normal time for the next 12 hour cycle.

If he is in the greens, then STALL. If he happened to be in the neon green BG's then you would need to stall for longer and look for a rising BG number, preferably >100 mg/dL.

Any pre-shot in the yellows, pinks, reds, or blacks is a shootable BG. "Shoot low to stay low."

 

Ok got it, thank you, this is great information.

 

I think starting tomorrow I'd up that dose. since you aren't really even close to the blues, I'd go ahead and do 3 starting tomorrow as long as you are home to monitor

 

3 units? I just started 2.5 yesterday. Is 3 units considered a lot? His numbers are all over and still high but I get nervous with going higher and higher with the dose.

 

you know what... ok wait another day or two on the 2.5 if it worries you. I just feel like your cat has a little insulin resistance and wanna get ahead of it. if the number comes down into the blues in the next couple days then I'd raise to 2.75. If not I'd do 3. Or you can jump to 2.75 tomorrow and see what happens... but I don't think that .25 increase was enough.

3 is large for a newly diagnosed cat... but they need what they need. We are looking for the breakthrough dose to get out of this resistance. Once we do you're probably going to see the numbers and dose come down pretty quickly.

 

Ok that sounds good, thank you so much.

 

When he was first diagnosed the vet started his dose at 2U. Do you think that was too much at first and it should of started at 1U?
It's only been 1 1/2 months since he's been diagnosed and it can take time for him to get regulated, I'm just trying to figure everything out and do whatever I can. The insulin seems to be helping as far as behavior. He's mellowed out.

 

we do recommend that they start at 1 because for some cats 1 can drop their number a lot. For others it barely makes a difference... and you don't know until you try it. No use in going backwards though... 2 wasn't enough. Like I said, you don't know until you try it. It's safer to err on the side of caution esp in the beginning before you know how they respond to insullin.

 

See Kim, you've been given lots of alternatives. The final choice is always yours, but I agree with Janet that another dose increase is needed.

If you look at the Prozinc Dosing Guidelines, you'll see where it talks about the nadir being over a certain number, and needing to increase by 0.5U increments instead of only 0.25U increments.

In the long run, Jax needs more insulin, and the sooner the better.

 

Ok I will start 2.75 today.

 

So it's looks like I have to increase Jax to 3U. I can start Thursday. Any idea why his numbers are going up between +7-+10 and than dropping a little at PMPS?

 

Some cats can have what is called a "double dip", where their BG levels have 2 lower values during the 12 hour cycle.
Or it could be because of when you are feeding Jax.
Plus, any numbers within 15 to 20% of each other are within meter variance. For example, 287 + 20% = 344 so that 287 and the 351 you got a couple of hours later are close enough to be within the margin or error, the reliability, the meter variance of a home use glucometer.

You need to think about looking at trends over several days, not simply the numbers within a single 12 hour cycle.

Doesn't really make a difference why the numbers sometimes show a second low during a cycle. Jax is still way too high, and needs to get those BG numbers down into the blue and green ranges. "Too high, is too high and needs more insulin."

 

Ok I’m going to increase to 3U starting Thursday.
Jax has his in between snacks at AM +1, +5 and PM +1.

 

Sounds like a plan

 

How long does it take to see a difference in BG levels after an increase?

 

Around 3-6 cycles. Some cats take longer. ECID

 

Looking like I have to increase Jax again. Should I go up to 3.25? It’s getting so frustrating having to keep increasing him and his numbers aren’t getting any better. I understand he needs what he needs but it feels like so much. His behavior has improved SO much so far with the insulin and snacks during the day. He’s sleeping through the night, he’s not screaming all day, not going through cabinets and draws and not in the sink constantly so the insulin is doing something just not enough for his numbers.
I do appreciate all the help and advice. Thank you

 

If it makes you feel better my cat didnt even see a yellow number until about 2 months in.

You haven't seen any blue numbers yet so you could do 3.5

 

Ok, I can start 3.5 on Tuesday AM. I'll be home to monitor and test him through the day. I do appreciate that. I know it takes time and every cat is different. It's just the amount of insulin he's up to already that makes me nervous. He's a small cat and he has lost a couple pounds. Thank you for all the help I appreciate it so much.

 

he's super cute and tiny... looks like my cat Lita. They need what they need. Looks like y our cat has a bit of insulin resistance. What will most likely happen is he will stay pretty much the same until you find the break through dose. ... and once you do the dose will drop probably pretty quickly. For my cat it was 3 units. Maybe 3.5 will be his dose. lets see.

 

Great, sounds good. Thank you!!

 

With the nadirs still being so high, it's fine to increase by 0.5U. Look at the dosing protocol, for where it says to do those larger increases.

 

Jax threw up a little clear liquid when he woke up this morning and did the same thing a few mornings ago. It's such a small amount that if I didn't hear it I wouldn't of even known. Is this common while on Insulin or with diabetes in general? He also hasn't had a hairball in a while.

 

Does he have food overnight? That usually from a buildup of stomach acid. If he eats overnight it’s less likely. OR he could have a hardball he’s working to get out.

 

No food overnight. He eats his last snack at 7pm before bed.

 

OK so he may need a little more food overnight. You could either give food right before you go to bed, or some people set out a timed feeder so that they have access to food, but that will close 2-3 hours before the preshot test.

 

I feed him AM +1, +5 and PM +1. ( That was greatly recommended to me since he was dropping too much too fast) Been doing great on this schedule but Would it Ok if I did AM +2, +6 and PM +2? That way he'd be eating closer to bedtime.
As far as increasing him again. He hasn't got into the blues yet. I know the prozinc dosing says to increase by .5 but would you recommend going up to 3.75 or shoot to 4?
He is doing great and behaviors are highly improved just have to get his numbers a little lower.
Thank you for your help. I'd be lost without the help of everyone on this forum.

 

You can feed any time except two hours prior to the preshot tests.

i feed am, lunch, dinner, before bed. My cats are all grazers and come and go throughout the day and night.

 

Ok got it. Great, thank you. What do you think about increasing again?

 

yep, looks like you are ready to try another increase

 

Ok would you do 3.75 or 4?

 

I don't see any blues yet, I would go for 4.

 

Agreed.

Agreed.

 

Ok, thank you!

 

It's been about 4 days since I increased Jax to 4U. I feel like he was doing better before the 4U. His numbers are still high but more pinks. He has been drinking tons and tons of water. It's a little over the 2 month mark of his dx date. What do you think is the best thing to do now? Increase again up to 4.5? Is there anyway he can be getting too much insulin?

 

Extremely unlikely Jax is getting too much insulin. Not with nadirs barely down in the yellow BG ranges.

A few night time tests would be helpful, to see if he is going lower then. But I doubt it.

I’d increase again if he were my cat.

 

Ok yes I figured that would be the answer. Thank you.

 

I increased Jax today to 4.5U. Hoping to see a change in the next few days. How many units can you go up to?

 

Cats can have high dose conditions, like IAA (insulin auto antibodies) or acromegaly. Once you get to above 5 or 6 units, it's time to think about those tests.
Sticky Acromegaly and Other High Dose Conditions: What We Know

Acromegaly in Cats
Insulin Resistance

There have been cats here that have been on VERY high doses, over 20 units.
If your cat does have a high dose condition, there are better insulins than Prozinc to use. Levemir specifically, since it does not "sting" at high doses.

 

I raised Jax to 5U yesterday 5/25. Today on 5/26 he's reached his lowest numbers yet since I've been home testing. Over 2 months in. 198 & 167 First times he's ever been in the blues. I know that it's probably in the 200's in "cat's blood" but I can't help but be emotional about it. I'm hoping that this means something and we are on our way to regulation.
@JanetNJ @Deb & Wink

 

All paws crossed here for Jax’s new dose making a long term difference.

 

I don’t want to jump ahead but should I still give the 5u if he’s in the blues pre-shot ?

 

Hello! Popping in so you have a reply.

Depends on a few things - your confidence/comfort level in handling potentially low numbers, your ability to stick around and test (including lots of strips), and that you have a hypo kit.

Given that you shot a full dose tonight, I'd say #1 doesn't sound like too much of an issue! So it's more is your hypo kit stocked, and can you stay around to monitor? If yes, I would shoot the full dose if he's above 150. 100-150 I'd consider a half or token (0.5-1U) dose. Below that no shot. If you can't stick around/test/have hypo kit ready, all I can say is go with your gut. Much better to have him stay higher than go too low.

If you see this, a +5 tonight would be good, that seems to be his nadir. That'll help us see how low he's going. I would also get a +11 (so 1 hr before AM shot), so that way if he's on the lower side you have time to post and ask for help.

 

Looks like you're seeing a bounce right now, but he's coming down nicely. Actually looks like a few bounces this past week. Many times bounce-breaking cycles drop them lower (and often trigger another bounce....). Don't let it worry you, he'll even out over time as he's spends more time in lower numbers.

 

Thank you so much for your reply, I appreciate all the information and help. I'm still so new to all of this. I'm trying to do everything I can and am just hoping for him to be regulated soon. He's already up to 5U I'm hoping he doesn't need another increase.

 

I'm up to 12U as of this morning

Have you picked a dosing method yet?

 

oh wow 12U. Awww your kitty is a cutie he looks so tiny like my Jax. I'm not sure about the dosing method. I've been taking all the advice on increasing from the lovely ladies on this forum and going by the prozinc dosing guide.

 

He's actually a bit of a big boy! Picture makes him look teeny lol

There's two dosing methods for ProZinc that are in the sticky. There's SLGS where you do a curve once a week and potentially increase based on that, and do reductions any time BG goes under 90. The Modified ProZinc Method (MPM) allows you to be a bit more aggressive and increase more quickly, but requires closer monitoring.

 

Oh yes ok I guess I'm a mix of both at the moment. I won't increase unless I know I'll be home for a few days to monitor and test throughout the day. I usually will wait about a week before an increase if I see no difference in numbers or I get an Ok from someone on here that I've been chatting with.

 

First time in the blues for dear sweet Jax!!!!!! Exciting to see that. Next is to try for some greens, but you likely have a ways to go yet before reaching that milestone.

Keep up the good work.

We’d love to see a few later pm tests.To make sure he’s not dropping lower in the evening.

 

I haven't been on here in a while. Jax was at a standstill and then he was bouncing a bit but the last few weeks he has been mainly in the yellows and blues for the first time. Tonight for PMPS he was 97 which was a total shock to me. I quickly read through the Prozinc dosing guide and it said to skip the shot if he was that low. There were other options but I went with that. I was in a bit of a panic not knowing what to do. I'm hoping I didn't make the wrong choice.
@JanetNJ , @Deb & Wink

 

You can also stall for an hour or so and see if it’s going up

 

Looks like it’s been an hour. Why not test now and see what it is. If it’s gone up you can shoot at least a partial dose.

 

If this happens again I will stall. It’s been 2 hours. 5:30 is his dinner and shot. I was just so shocked seeing that number for the first time and for his insulin time.

 

If and when this happens again if he is below 150 is it best to give a partial or skip? And how much would be a partial?

 

I might do half but it’s your call.

 

Ok, is ok to skip though? Or can 1 missed dose mess everything up?

 

it will probably be high tomorrow, but it’s ok as long as your cat doesn’t have a history of ketones.

 

Yes he was high this morning. 402. I figured that as well. Ok thank you for your help. I appreciate it.