Ineffective insulin

Discussion in 'Prozinc / PZI' started by dnelle06, Jan 18, 2022.

  1. dnelle06

    dnelle06 New Member

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    Oct 20, 2021
    I am at the end of my rope. I am not sure what to do for poor Artie. He was first on vetsulin up to 4.5units and was unmanaged. we switched to Prozinc and are at 3.5units and can’t seem to get a consistent number. Most mornings he’s in the 500 PS AM around 9 am sometimes drops to 380s around 2pm and back up to 480-520 by 4 pm. 580s by PS PM shot.

    His curve today has been crazy. He started off way lower than ever. No food past his parking shot. Am PS 366 , 1:30p 342, and now 4:30pm 474. How can his numbers go up already?

    Yesterday’s curve was similar only staying down for an hour tops . Should I raise the dose?
     
  2. Hshray

    Hshray Well-Known Member

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    Feb 26, 2021
    Do you have a spreadsheet?
     
  3. dnelle06

    dnelle06 New Member

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    Oct 20, 2021
    Sadly no. I use pet diabeties app.
     
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  4. dnelle06

    dnelle06 New Member

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    I could work on putting it into a spreadsheet
     
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  5. Hshray

    Hshray Well-Known Member

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    @Bandit's Mom is usually over on the Lantus forum but helps a lot of people put spreadsheets together. She may be able to help or point you to someone else who can. They’re really helpful for us to be able to see exactly what’s going on with your cat and whether it looks like it’s getting too much or not enough insulin etc.

    I’m using Lantus now, but I used Vetsulin and then Prozinc at first too so I’d be curious to take a look.
     
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  6. FrostD

    FrostD Well-Known Member

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    Spreadsheet is easiest, but in the meantime any sort of screensots? Like a weekly or monthly view?
     
  7. Bandit's Mom

    Bandit's Mom Well-Known Member

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    Hi and welcome to FDMB! :)
    I can help set up your spreadsheet and signature. Will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.
     
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  8. Bandit's Mom

    Bandit's Mom Well-Known Member

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    I am responding to some of the information you sent me via PM for setting up your Signature and SS, here:

    Not sure if using human freestyle lite strips with an alphatrak could affect the accuracy of readings? You might want to look at using a human meter. Walmart's ReliOn Premier is only $9 and the strips are $18 for 100 strips.

    Also, Fancy Feast Classics, Roasted, Chunky and Flaked are low carb but other variants are too high in carbs (Grilled in Gravy). As is the Purina One dry food. You could see a significant improvement in his numbers if you switch him to low carb food.

    You can check carb% of many canned foods here:
    https://catinfo.org/chart/index.php
     
  9. dnelle06

    dnelle06 New Member

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    Oct 20, 2021
    Thanks that food carb% page will be very helpful. I can try to human meter. Early on I had one, a different brand, and compared side by side for a few weeks and it was pithing 10pts. I believe the strips for freestyle lite are the same manufacturers as the alphatrak strips, obviously coded differently. However I will give the human meter a try. I will fill in the previous weeks details and get this posted asap.

    Any recommendations for a dry food that's low carb - non prescription? I am trying to avoid the prescription as it is quite expensive.
     
  10. dnelle06

    dnelle06 New Member

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    Spreadsheet updated for this year... Should I go back further? Sadly I work during the day so couldn't get many curves done.
     
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  11. Bandit's Mom

    Bandit's Mom Well-Known Member

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    A human meter reads lower than a pet meter but is just as accurate. Most of us use human meters since the strips are much cheaper and we test a lot.

    If you can get Artie to eat only low carb wet food, that would be great since wet food provide cats with much needed hydration that dry foods don't. There are a low carb few options in dry food as well - Young Again, Dr. Elsey’s Cleanprotein (chicken flavour) and Wysong Epigen 90 - none are prescription, but are on the expensive side. We've found that even low carb dry food raises the blood sugar in some cats - even though they are low carb.

    Looking at the data on your SS - can you get a before bed test at night? Some cats go low at night and stay high in the day. When you get tests only in the day, you are only getting half the picture.
     
  12. Bandit's Mom

    Bandit's Mom Well-Known Member

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    Not required. Was no insulin given in the AM of 1/14 and 1/15?

    It's hard to say without tests in the PM cycle, but it looks to me like Artie needs more insulin.
    @JanetNJ
    @FrostD

    Not sure if you have seen our Prozinc / PZI forum and the stickies at the top with a whole lot of information including PROZINC DOSING METHODS.

    ETA: If you switch him to a low carb diet, which I recommend you do, you might want to hold the dose while doing that and get enough tests to see how his BG is responding to the removal of carbs from his diet.
     
  13. dnelle06

    dnelle06 New Member

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    His Am dose is around 9:30 am and so his PM dose is are 9:30 pm which is usually before bed. I can get some tests post PM dose.
    I will remove the dry food from his diet and wait a couple cycles and report back. Thank you all!
    His Brother Marvin is not diabetic so I will separate them for feeding.
     
  14. Bandit's Mom

    Bandit's Mom Well-Known Member

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    If your schedule permits, you could slowly move the shot times ahead, so you can get a test before bed.

    You might want to switch Marvin also to a low carb diet at some point. Not only is it good for him, you also wouldn't need to worry about Artie getting into his food.
     
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  15. Bandit's Mom

    Bandit's Mom Well-Known Member

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    Just realized you've posted in the Prozinc forum! :banghead::rolleyes:
     
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  16. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    It does look like he needs more insulin, but I would hold this dose as you transition food
     
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  17. dnelle06

    dnelle06 New Member

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    Oct 20, 2021
    Got the relion meter- tonight we do low carb only no dry food- the strip reading is very different 606 on the cat meter 526 on the human meter. Even for him that’s so high
     
  18. FrostD

    FrostD Well-Known Member

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    Those are all the same number when you consider meter variance. Be careful the next few days, it will take a little time for all the carbs to work their way out but hopefully you see BG down considerably
     
  19. dnelle06

    dnelle06 New Member

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    Thank you. I’m trying to get his numbers when I can. Yesterday he had the lowest numbers yet!
     
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  20. MarthaL

    MarthaL Member

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    Nice to see the Blacks going away and some Blues :cool: and Yellows appearing. It looks like the low carb wet food only diet is doing its thing! Fingers crossed that the trend continues.

    I hope you have read the PROZINC DOSING METHODS sticky that Bandit's Mom mentioned. As Artie's numbers come down you need to know how to handle lower than normal pre-shot numbers. I had to "stall" many times and post a message asking for advice on what to do as Spy Kitty's pre-shot numbers came down.
     
  21. dnelle06

    dnelle06 New Member

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    Yes!! Thanks so much for checking in! They are dropping. Strangely he hasn’t had anything different than normal and his numbers gave not been consistent. Is he still shedding the carb heavy food he used to have? Abs yes I have read the prozinc dosing for when numbers get lower.
     
  22. MarthaL

    MarthaL Member

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    My main mentor on this forum gave me this information: "I've seen the full effect of removing all dry take anywhere from a few days to a week or more." Your SS says you stopped all dry food on 01/20 so it has been twelve days now. That does not mean that Artie's numbers will not continue to improve but, I do believe it means that it is now safe to change Artie's dose (up or down) based on his numbers (according to the Prozinc Dosing protocol). I will leave that up to a senior member (@FrostD) to make any recommendations in that regard.

    Do you have your Hypo Kit together?
     
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  23. FrostD

    FrostD Well-Known Member

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    Technically yes it is safe to reevaluate the dose know that transition is complete, BUT...I would actually hold this dose for now. The blues and yellows you're getting now lead me to believe he is probably hitting (safe) green and then bouncing.

    Is there a day sometime soon you can do a curve?

    Also, I would not shoot that full dose unless he's above 200, especially if you can't be around to test. 150-199 I would shoot maybe 1-1.25U, 125-149 either skip or 0.25U, below that skip
     
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  24. dnelle06

    dnelle06 New Member

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    Love this community. Thanks for much for this advice. It’s way more information than my vet has ever been able to provide. I plan to do a curve tomorrow.
     
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  25. dnelle06

    dnelle06 New Member

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    Curve will have to wait. His Am PS was low
     
  26. FrostD

    FrostD Well-Known Member

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    Whatever tests you can get will still be very helpful, especially in the +4 to +6 window
     
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  27. MarthaL

    MarthaL Member

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    For my two cents worth, I would encourage you to test as often as your schedule and Artie allow. The more data you have the better others can help guide you in your care of Artie. I did a lot of daytime testing since I was at home, and I was amazed at what a senior member could "deduce" from all that data, and then educate me on what those numbers most likely were saying (nothing is ever 100% certain!).

    With Artie starting to get PS numbers that are below 200, it would be helpful if you could test an hour before PS (when possible). That will let you know if Artie's BG is trending up or down before his shot. Very helpful information when you are getting new lows at PS. The more data you have the more "tailored to Artie" the advice you receive will be.
     
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  28. MarthaL

    MarthaL Member

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    Just checked in on Artie's SS. You have now gone over a week without a Black. :bighug: I always celebrate even small milestones!

    Can you get some more testing in? Things seems to have dropped off since January. @FrostD noted the most important window of +4 to +6, but if your schedule does not permit that, then testing at any time will provide useful pieces to the puzzle. With more data, you will probably not need to make such big dose reductions when you test in the high blues. And if you are unsure what to shoot, you can stall 20 to 30 minutes (without feeding) and post on the main Feline Health forum with a title like "Help - Stalling". A lot more eyes are on the Felline Health forum compared to the Prozinc Forum, and when you are stalling you need a quick answer. If you have enough data in your SS, a senior member can help you with that decision. And answers almost always depend on whether you are around to test until Artie hits his nadir.
     
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  29. MarthaL

    MarthaL Member

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    Good to see some more testing! @FrostD can you comment on whether dnelle06 should still be going down to 1U for the blue numbers she has been getting? It's like a ping pong game between 3.5 U and 1 or 1.25U.
     
  30. FrostD

    FrostD Well-Known Member

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    Yes and no lol

    What's happening is you're breaking through some glucose toxicity, which is great! I should think all the carbs are gone by now. The downside is it's causing a bit of bouncing, which makes it unpredictable.

    What's a little wild is it looks like nadir has shifted. It is quite rare to have a +9 nadir on ProZinc, it's a bit of a bounce break so that is likely part of the explanation.

    What we can see now is sometimes the 1/1.25U I recommended works (2/2 for example), and sometimes it doesn't (the other times). When it doesn't work, its because he is bouncing. The bounce combined with lower dose lets the numbers get high. Now, the flip side is there is always a risk he doesn't bounce, like on the 2nd. We don't know how low he went that day, but the two blue preshots tell me it was probably green somewhere, just hopefully not lime (he probably would have bounced immediately from lime). The trouble is right now, we have no way of predicting his bounces. A +10 or +11 won't even help right now.

    For now, I'm inclined to hold everything way it is for another 3-4 days then reevaluate. You could try increasing to 3.25U if you'd like, but given all these blues (and im assuming some greens in there) I personally would not unless I could monitor all day...it may also worsen bouncing. You could also try sticking to 1.25U if between 150-199 if you're comfortable, that appears to be a good balance between the risks of bounce vs no bounce. I really would try to get a before bed or middle of the night test especially when you get those blue preshots.

    Your signature still says 1/4 cup dry food...is that still being given?
     
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  31. dnelle06

    dnelle06 New Member

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    Wow this is wonderful. Thanks guys. I need to change the signature. That is not being given anymore. Previously his nadir used to happen around +9 or +11 I assumed it was from the dry food but super frustrating leading me to think it wasn’t working right having such a late onset.. now it’s interesting that without the carbs that’s still super late with nadir. I am also okay riding out the bouncing even though I am not sure why it’s bouncing. If I shoot 1.25 with a blue I will be better about getting a reading in the night. I am able to do some more testing today before I go back to work tomorrow. I’m hoping for a more leveled out day!!
     
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  32. MarthaL

    MarthaL Member

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    I notice your test numbers seem to be a day behind. You just posted an AMPS of 467 for 02/06. Was that for Sunday or for today (Monday) which is 02/07?
     
  33. dnelle06

    dnelle06 New Member

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    Oh no! I’ll check it out
     
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  34. dnelle06

    dnelle06 New Member

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    I am not sure at all when things went wrong. I’ve done it every day.. maybe it’s been wrong since the beginning. Oops
     
  35. Mark E. Burgess

    Mark E. Burgess New Member

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    Last week, I started my 12-year-old cat on insulin. Every 12 hours, she was recommended 3 units of ProZinc insulin (using U-40 syringes). I also changed her meals to two cans of Purina Pro Plus - dietetic management each day (though she's only eating about 1.25-1.5 cans - she's still getting used to mealtime vs. grazing). This weekend, I started checking her levels as well. Can anyone shed some light on the findings? I'm guessing her dosage needs to be reduced, but could she be in remission soon?
     
  36. FrostD

    FrostD Well-Known Member

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    We're more than happy to help, could you start your own thread please? We'd need to see any data you have
     
  37. MarthaL

    MarthaL Member

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    Still following Artie's SS. I see you got a AMPS of 217 so were able to shoot a full dose of 3.5U. It would be soooo helpful to get as many tests today as possible.
     
  38. dnelle06

    dnelle06 New Member

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    Hi. I tried my best with working a full day away from home. Tried to pop in and out whenever I could get away. It seems that he never went even close to his preshot numbers and nadir again way late in the day.
     
  39. MarthaL

    MarthaL Member

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    Good job with the testing today! And what wonderful numbers Artie! I think there is a lot to be learned from your numbers today. @FrostD what do you think?
     
  40. FrostD

    FrostD Well-Known Member

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    Hmm. I rather think she's bouncing from low numbers, these random oddly low preshots are a bit of a clue. It's late now but can you get a +4/+5 tonight?
     
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  41. FrostD

    FrostD Well-Known Member

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    It's interesting, I suspect the flat yellow was fighting off a bounce which is great, it's progress
     
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  42. dnelle06

    dnelle06 New Member

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    Unfortunately I think a bounce is in the future . 134 amPs :( I didn’t see this request for a nighttime shot or I would have set my alarm, sorry about that.

    should I try .25 shot or skip? I didn’t have time before work for a long stall sadly. I wish I worked from home for Arties sake.
     
  43. FrostD

    FrostD Well-Known Member

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    So that 134 means he definitely saw green overnight, question is how low. I would proactively reduce to 3.25U as new dose.

    Today, if you haven't already shot - 0.25U or skip. If you won't be home, I'm leaning skip.
     
  44. dnelle06

    dnelle06 New Member

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    Okay. I’ll skip. I will be around a lot this weekend and can test more.
     
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  45. FrostD

    FrostD Well-Known Member

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    The good news is something is happening! Bit of a breakthrough finally
     
  46. MarthaL

    MarthaL Member

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    Nice PS numbers lately Artie! Keep up the good work!
     
  47. DL and Pinky

    DL and Pinky Member

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    Hello dnelle06,

    I hope your husband is okay. You have a lot to deal with, and I just wanted to offer my support.

    Laura
     
  48. dnelle06

    dnelle06 New Member

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    Thanks for your support in all ways. He’s got a bit of a mystery case for the doctors. I hope they figure it out soon. Also 8 weeks pregnant, so yes. There’s a lot on my plate :) . Artie has been consistent. However I had to shoot an hour late this evening and he’s low instead of high. Any ideas why? I realize you have very little data to examine. I will try to get a couple overnight tests.
     
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  49. FrostD

    FrostD Well-Known Member

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    Unusual preshots on ProZinc (in an otherwise consistent cat) are a clue he's probably dropping lower when you're not testing. Not a criticism right now! Just explaining my logic. So those 2 pinks were a clue he probably went lower overnight, and now especially combined with the 175. I see a 1 in the column, if that's what you shot I think that was good idea (I probably would have done half dose, but it's really up to you, your comfort, ability to monitor, etc).

    I would reduce next shot to 3U to be safe. Possibly 2.75U if you really can't be around, because it's possible he's going well below 90.

    Congrats! Diabetic cat + pregnant and/or with newborn is a lot, I've been there (my kids are 2 years old, and just turned 1 last week). Especially first trimester, so exhausted. Is this your first?
     
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  50. dnelle06

    dnelle06 New Member

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  51. dnelle06

    dnelle06 New Member

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    Hi guys. I’ve been gone most of the day but just tested when I got some since he’s been bouncing and this morning was 201. He just tested 66 +7. He’s acting completely normal.
     
  52. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Give tsp of high carb food, and reduce by 0.5U please (usual reductions are 0.25U but given your situation the larger increase is safer).

    Test again 20 mins after giving the HC
     
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  53. dnelle06

    dnelle06 New Member

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    went up to 77.
     
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  54. FrostD

    FrostD Well-Known Member

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    Grab one more test if you can to make sure he doesn't drop again after food wears off
     
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  55. dnelle06

    dnelle06 New Member

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    109! Making his way up
     
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  56. dnelle06

    dnelle06 New Member

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    Hi all. Back after along time. The spreadsheet shows a large gap that family and friends wrote the stats on paper while I was out of town. The results are quite consistent with the following weeks of red and black. Artie has been up and down and up and down , peeing anywhere he can like he wants to irritate me. He poops in the liter box but seems to be finding anyplace to pee other than his litter box. In frustration of his lack on sugar control with insulin I was curious what would happen if I stopped. Interesting results.. he has barely come out of yellow since stopping. His partial curves have showed little to no change after meals. Does anyone have an advice? I know this was super risky,
     
  57. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    ProZinc itself is the problem - I'll explain in a bit.

    The numbers are still too high, I would not let him go without insulin any longer. Very serious risk of DKA. The 76 was a clue he went much much lower the night before, so some sort of reduction should have been taken. All those lower than usual preshots are clues he went lower and probably/definitely needed reductions.

    I believe the ProZinc is just too harsh for him and he will just keep bouncing and bouncing. We say give it 3 months of a good effort, it's been more than that and I'm not really seeing any progress.

    Time to ask about Lantus or its generics. You would need new syringes, we can help with that when you're ready. It may take some time to see progress on Lantus, because it's strength is flat cycles, not necessarily bringing high numbers down. So know that going in, it usually takes 1-3 months on Lantus to see at least some progress.

    In the meantime, do try to get at least a before bed test in. His low numbers are most often at night.
     
  58. dnelle06

    dnelle06 New Member

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    Oct 20, 2021
    Thank you all for your help. With my first baby coming in two months and financially not being able to afford a move expensive insulin I am going to have to look into an alternative. Either rehoming him or another sad option. His quality of life isn’t great cooped up in my basement and his nueropothy in the back legs making most things difficult. If anyone has suggestions for rehoming a diabetic cat please send them my way. I would much rather do this than doing what my vet suggests which is euthanasia.
     
  59. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Believe me, we understand. It can take some time to rehome diabetic cats. I'll tag @Chris & China (GA)
     

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