Mauer SS/Dose

Discussion in 'Prozinc / PZI' started by SashaV, May 18, 2020.

  1. SashaV

    SashaV Member

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    Apr 25, 2020
    Hi guys!

    How many cycles do we need to do before adjusting the dose?
    Mauer is too high, a bit sleepy otherwise no clinical symptoms.
    I've been testing a lot to see how low she goes, shes doesn't go below the renal threshold.
     
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  2. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Sasha, it depends on which dosing protocol you use, and also what Mauer's BG levels are, as to how many cycles it should be before adjusting the insulin dose.

    Any 12 hour dosing cycle with a BG level <5 mmol/L (<90 mg/dL) is an automatic 0.25U dose reduction, with the SLGS or the MPM dosing protocols we use here.

    With SLGS, which is the only dosing protocol you can use right now with Mauer, the number of cycles to hold a dose is 14 cycles. You have to use the SLGS dosing protocol because you are still feeding Mauer dry food. Plus, you need to give the SLGS dosing protocol a decent chance to work. One month is suggested.

    You need to be a little patient here, with the dose adjustments. And you also need to get some additional testing in during the evening/PM/nighttime dosing cycle. To see how Mauer is doing in the evening cycle. You have good test data in the morning cycle, but have very little data in the evening cycle.
     
  3. SashaV

    SashaV Member

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    To be specific how many additional testing would you like to see during PM?

    Why do cats drop lower during the night cycle?

    I'll hold the dose, and test more :D:)
     
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  4. SashaV

    SashaV Member

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    Apr 25, 2020
    Two identical numbers in a row!
    Wtf?
    I'll give her insulin now and get up in 4 hours to test her again.
     
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  5. Deb & Wink

    Deb & Wink Well-Known Member

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    Always the pre-shot test, for every cycle.
    At least one more test in every cycle. 2 tests if you can manage it.
    A test around +2 often gives you an idea of where the BG levels are headed.
    A before bed test let's you know that your cat's BG levels have not dropped too low before you head off to sleep.

    You still don't know when Mauer's onset, nadir or duration is. So testing at +10 and/or +11 can often tell you that type of duration information. Varying the mid-cycle test can help you find the nadir. Try a +5 one cycle, a +6 or a +7 another cycle. To fill in the blank spots on the SS.

    Chris wrote about the +2 test being an indicator of what direction the BG levels are headed some time ago. I modified it and added a lot of notes. Copying it here so you can see what I mean.

    With Prozinc by Deb & Wink

    More than a number range, think of the percentage of the drop at +2, that may tell you if your cat is going to drop much lower. Think of that +2 as being an indicator of what direction the BG levels may be headed.
    With Prozinc, if you see a 40%, 50% or greater drop, between the pre-shot and that +2, that's a serious heads up warning.
    If you see a 20-25%, 30% drop, not quite so worrisome. But still be cautious.

    Your cat drops 2 color ranges between pre-shot and the +2, pull out your hypo kit and plan on staying up to test.
    Your cat drops 2 color ranges between pre-shot and the nadir, that is to be expected. But you don't want the drop to be much more than 50% between pre-shot and nadir with Prozinc.
    Cats tend to bounce high if the drop is 50% or more from pre-shot to nadir.
    So you steer those mid-cycles with food, to slow down the steep drop and stop the bounces from being too high.

    It's a balancing act.

    The +2 is like an "early warning" for most cats!
    If the +2 is about the same as the PS, it's usually a pretty normal cycle...dropping down to nadir and then rising back up again. (About the same means taking meter variance, that 15% variance that hand held glucometers are allowed to have into account)
    If the +2 is higher than the PS, that usually signals a bounce, and those are the cycles when you can usually take a break from testing.
    If the +2 is lower than the PS, that's your "Early warning" that kitty might be going much lower later in the cycle so it's important to plan on getting another test or two (or 6) in.

    It doesn’t work every time or with every cat. But it does hold true most of the time, so keep this in mind for next time.

    It also kind of depends on what BG pre-shot your cat started out the cycle with. Lower than normal, keep a closer eye on the cycle. Lower than you are used to shooting, a number you may not have given insulin before, keep a closer eye on the cycle. Stalled and number rose some, but you did a reduced shot, maybe another test or 2 to see how much the number is rising.

    It makes a big difference if your cat starts the cycle in the pink 300-399 mg/dL range (16.6 - 22.16 mmol/L) then if they are in the blue 150 mg/dL range ( 8.3 mmol/L).

    p.s. Food notes in the Remarks column can be very useful. Helps to interpret what is happening in the cycle. Notes are done on AM and PM cycle basis and notations need to be with the + time format.

    Because they are more active. Cats are nocturnal mammals, so they are up and about at night more than during the day. Extra activity burns up more glucose, so the cat's BG levels drop lower as they use more energy. That is one reason.
     
  6. SashaV

    SashaV Member

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    I've been testing before bed the last month or so. I go to sleep right after the PMPS shot, witch is why its difficult to test PM cycle. Yeah I need the 10 hours sleep and an hour in each end to sleep and wake up :oops:
    I got up last night to test. And today I may have made a curve although I wasn't planning on it.

    Is it a bounce I saw when she got back in the red? She didn't eat in the meantime but got a small snack, so I can't wrap my head around why she rose that high without any reason.

    I'm planning on being patient and holding the dose, unless anyone with good reason tell me otherwise :D
    In the last 24 hours shes been holding quite fine I think, despite eating a tiny bit dry food.

    This must be my life's challenge. In some way I'd wish it would have been me. Or I had diabetes in the first place, just to being able to relate.. and understanding how it works, feels seeing the signs quicker..
     
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  7. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, that was a bounce when Mauer got back into the red BG numbers.

    Answered on your Feline Health thread, about increasing the dose.

    I think you could safely raise the dose before the normal 14 cycle SLGS protocol.
    Mauer was doing a bit better on a slightly higher dose.
     
  8. SashaV

    SashaV Member

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    Apr 25, 2020
    Deb, I might have ****ed it up.
    AMPS was 14, so I didn't think she could hold the 1.5U so I gave her 1.2U.
    She went weird on me last night. Wouldn't eat but ate snacks, drank more than usual. Maybe the raw meat was too hot for her liking and the dog was barking.
    But today there's nothing everything is as usual.

    Was it a mistake to give her a smaller dose or should I just have followed the plan?
    To be honest I'm a bit afraid of the "good" numbers and to bump her too low :oops:
     
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  9. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    No worries.
    Live and learn. Our cats are always surprising us with what they do.
    There is no insulin "depot" or storage area with Prozinc insulin.
    So you can increase the dose on the next cycle. I see you already did that.
    Or wait. It's really up to you Sasha. You make the final decisions for Mauer. We simply try to guide you and make recommendations to the best of our abilities.

    You want to see Mauer down in the blue and green numbers. Those green numbers are giving Mauer's pancreas a rest and time to heal. So the low numbers may be scary, but they are what Mauer needs.

    But you don't want to have a BG level that is very low, down into the neon green numbers. You don't want to see Mauer down THAT low. If/When you do, you give some food support to bring the BG levels back up quickly above the 2.7 mmol range (the 40's mg/dL). You test and feed until you see the BG levels above 4.4-5 mmol/L (80-90 mg/dL) for a couple of hours past normal nadir time.

    We have a saying here. "Feed the 40's" that only makes sense when we are talking in mg/dL terms.
    For you that saying would be "Feed the 2's". Doesn't sound as good saying it that way. But hopefully you get the idea.

    It's a holiday weekend here in the US. There will not be as many people around to help.
     
  10. SashaV

    SashaV Member

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    Apr 25, 2020
    Thanks Deb!
    I increased the dose PMPS. I realized during the day that she should have had the full dose. But now I know.

    I know it's my decision, that you're not vets and it's only recommendations from your own experience. But I'm so grateful this site exists and you guys use your time to guide us!

    I know the green is the best and blue the next best thing. It's just so scary :oops:

    Thank you again for all your help, and happy holidays :bighug::bighug:
     
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  11. SashaV

    SashaV Member

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    I think it's time to increase dosage again. She doesn't drop enough, but going steady in the pink and yellow.
    Besides the BG everything else is just great.
    Should I increase by 0.25 or?
    Hope you had a wonderful holiday :bighug:
     
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  12. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, time to increase the dose again by 0.25U.
     
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  13. SashaV

    SashaV Member

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    Its time for increasing!
    She's stable in the yellow with no clinical signs.
    She took the move very very well! I expected some really high numbers, but she was so cool throughout the whole thing!
    Tomorrow we'll have been in our new home for three weeks so I think it's time for an increase.

    Current dose and BG are on the spreadsheet. God I love that spreadsheet!!!!
    I'm thinking 2 units? 0.25% increase from current 1.75.
    Depending on you, @Deb & Wink I'm thinking new dose from Saturday?
    Tomorrow I'll have some new people coming over, with their new puppy, stressful even without the increase :nailbiting:
     
  14. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, Mauer is way past due for an increase. Bump up the dose to 2U when you get a chance. The 1.75U dose has been held way too long, and Mauer isn't getting into the blue or green numbers on that dose.

    You shouldn't wait more than 1 week before deciding on increasing the dose. Please ask sooner next time, ok?

    The website is being updated, and there is a temporary backup site while that happens. For emergencies.
    PLEASE READ - Site downtime!

    Robert & Echo suggested that people bookmark the temp backup site. https://www.limestonemedia.com/feline/FDMB/
     
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  15. SashaV

    SashaV Member

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    I know she's way past due for an increase, but she's been in a new home, lost three animal friends, and I've tried my best to keep everything the same and still her brother Miver is having an flare up in his idiopathic cystitis due to stress. So my worry has been that I didn't get reliable readings and therefore I though it best to keep her on the current dose so she didn't drop too low.
    But I'll ask sooner next time I promise
     
  16. Deb & Wink

    Deb & Wink Well-Known Member

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    Moves can be quite an adjustment for everyone in the family, human and furry alike.

    It's a deal.

    Is her brother Miver doing better?
     
  17. SashaV

    SashaV Member

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    Apr 25, 2020
    How soon after the adjustment can I rise dosage again?

    He's doing better after I put him on pain meds to lower the inflammation. Hopefully a week on metacam is enough.

    It's been a huge adjustment for everyone of us, but darn it's been good! Now I need fencing in the backyard so the cats can come out and exercise. Hopefully that will lower Mauers numbers even more.
     
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  18. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Sasha --

    Please be very careful with using Metacam. Any of the nonsteroidal anti-inflammatory drugs can cause renal failure in cats. What kind of inflammation is Mauer dealing with? If you want to use a general anti-inflammatory, adding omega-3 (fish oil) to his diet may take longer for you to see a response but it's a lot safer unless your kitty is allergic to fish.

    You may want to read over the SLGS section of the dosing methods sticky. You want to hold doses for a week, do a curve, and then decide whether you need to raise the dose.
     
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  19. SashaV

    SashaV Member

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    I'm aware that in other parts of the world, metacam is considered dangerous. But I also understand you only have one dose, in Denmark we have 2. One for cats and one for dogs. Cats is only 0.5mg. Dogs and the one used other places in the world for cats its 1.5mg.
    Do you have some research on metacam?
    Cause here its standard procedure as pain meds.

    Haha I might need to. She got 2 units this morning and +2 her number was higher than AMPS. Stupid cat :eek::nailbiting:
     
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  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    This is the information on metacam from the US Food & Drug Administration. The dosing is more aggressive in the US but I tend to want to make sure everyone is aware that it can be problematic. If a cat has kidney issues and the caregiver is unaware of the potential for the drug to cause problems, it could be a disaster.
     
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  21. SashaV

    SashaV Member

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    I know. Then I wouldn't even give it. But thankfully none of mine has any kidney problems. But thanks for the warning, incase I didn't know :bighug:
     
  22. SashaV

    SashaV Member

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    What the heck is going on with Mauers numbers? She's fine, eating, awake and her usual self, but her BG is like a rollercoaster o_O
     
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  23. SashaV

    SashaV Member

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    What a day! Up and down...twice!!
    What's happening?
     
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  24. Deb & Wink

    Deb & Wink Well-Known Member

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    You're seeing "the curve". Kind of like a gentle "Mona Lisa" smile.

    Not a low curve, where the numbers drop into the lower blues and greens, but a curve none the less.

    Mauer is showing you a better reaction to the insulin.
     
  25. SashaV

    SashaV Member

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    Apr 25, 2020
    Are you trying to tell me that what I saw was a good thing? How?
    I was expecting lowered readings, not much but slightly lower, not this bouncy dance.
    I'm excited to see how she's doing today.
     
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  26. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    One thought that may help to put the numbers in perspective -- you have no idea how long Mauer has been diabetic. Chances are he has been diabetic for more time than you've been giving him insulin. As a result, his body isn't used to what are normal numbers. It will take time to get him there.

    In addition, the switch from Lev to Caninsulin to Prozinc in all likelihood hasn't helped. You gave Lev about a month. It generally takes longer to see better numbers with a depot-type of insulin and I'm not sure what your dosing strategy was. You gave Caninsulin about 2 weeks. I'm not a fan of that insulin but it's to enough time to see a response. And now you're using Prozinc for about a month. Treating diabetes is a marathon, not a sprint. You need to give the insulin time to have an effect on a pancreas that hasn't been working. Each time you switch insulin, it can be like starting over.

    Given that the depot-insulins take a bit longer to show results, one of the basic ideas we urge new members to consider with Lantus and Lev is patience. Being consistent and being patient are key. I know it's hard. We all want our kitties to be better instantly. It's unlikely that will happen -- at least in an instant. So, take a few deep breaths, appreciate that our cats like to be unpredictable, and realize that it's your cat that's leading this dance, not you. We just get to follow along.
     
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  27. SashaV

    SashaV Member

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    She was on caninsulin for over a month, and it did absolutely nothing.
    Then levemir, witch made her sick. She stopped eating, was nauseous and vomiting. So my vet told me to switch back to caninsulin while we made a new plan

    That plan being prozinc. It's true my spreadsheet only has levemir, caninsulin and prozinc and in that order, but it was caninsulin, levemir, caninsulin then prozinc. Just so she didn't go without insulin while a new plan was in the making.

    I am seeing it as a marathon, which is why I preferred staying on a low dose while moving and settling in, rather than upping dosage and potentially hit a low and not realizing it, due to lack of testing.

    I've been watching her very closely, and I see improvements.
    For example in December when I woke her she was fare gone, slept a heck of a lot, drinking a lot, and I believed she had arthritis in her hind legs, since she was licking herself after she peed in the litterbox, and she was making huge lumps in the litterbox.

    Now she's easy to wake, drinking lot less, peeing less - and if she licks herself after, and the dog is constantly in her butt, I know its because she's spilling sugar in her urine. No testing needed, I know right away. I got my old Mauer back, even though I didn't realize she wasn't really there. The changes happened so slowly that I didn't even think about diabetes :banghead:
    Since her diagnosis its clear she's been diabetic for a while. Possibly even years.

    So I'm quite aware that this isn't a sprint. It's the new everyday life. Huge changes has been made, my life has been turned upside down. Her life has been turned upside down. But we thrive. We need stability in those numbers, other than that, life is great.

    Consistancy is my middle name. Patient...what is that?:eek::nailbiting::banghead:

    I don't really know why I barfed all over the keyboard I'm sorry. I really do what's best for her, levemir just wasn't. Caninsulin either.
     
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  28. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Since you understand that it's a marathon, trust me, we all appreciate just how frustrating it can be. And we all barf on the keyboard.
     
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  29. Deb & Wink

    Deb & Wink Well-Known Member

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    That stability takes time to achieve.
    We all wish it could happen sooner, but it doesn't.
     
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  30. SashaV

    SashaV Member

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    Apr 25, 2020
    Still high, and bouncy.
    Can it still even out or can I raise dosage to 2.25?
     
  31. Deb & Wink

    Deb & Wink Well-Known Member

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    It's time for an increase. So yes, raise the dosage to 2.25U. Next cycle please.
     
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  32. SashaV

    SashaV Member

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    I'll raise. Feels like poker :D
     
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  33. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, sometimes it is like poker, or some sort of betting game.
     
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  34. SashaV

    SashaV Member

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    I simply don't get it. Since the increased dose she's been pink, rarely yellow as on a lower dose. Why was she lower on a lower dose? Is it just me or shouldn't be the opposite?
    Litter clumps a bit smaller but otherwise no difference.

    New pet came today until august 7. She usually doesn't care about new pets, but since it can add stress and therefore BG I thought I'd mention it.

    I tumbled out of bed to test last night to get more PMPS testing in.
     
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  35. Deb & Wink

    Deb & Wink Well-Known Member

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    Sometimes the increase can cause a temporary 1 or 2 cycle increase. It happens. Be patient with the new dose.
     
  36. SashaV

    SashaV Member

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    Apr 25, 2020
    She dropped!
    I usually shoot in her neck, today I tried over her shoulder.
    She drank a lot right after her AMPS.
    Could the difference be the changed injection site?
    Do I have a no shoot number?
     
  37. SashaV

    SashaV Member

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    Oh Deb!

    So she dropped even further!
    How nice we got below the renal threshold!

    PMPS she ate dry a short while before, so my test might not be accurate so I decided to go safe and decrease by 25%, so back to 2units.

    I shot in her flank/shoulder again, maybe that's what's making the difference?
    It might possibly be a mistake that I lowered her PMPS on my own, but if that's the case I'm quite sure you'll tell me so :D

    I was or am scared she without the dryfood would be lower, and due to cats get lower during nighttime and she new injection site...I got worried :nailbiting:
    So I know you read threads during my nighttime and I was on my own I preferred going safe. Or what I feel is safe. It might not be the same :banghead:
    I don't know if it makes sense?

    I go to sleep now, and get up +3
    Depending on the test possibly +6 too.

    I really don't know what I'd do without you and your guidance. You make a true difference in this confusing world :bighug:
    Be safe!
     
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  38. Deb & Wink

    Deb & Wink Well-Known Member

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    We can't always be here when you need help Sasha, so you make the best judgement calls you can. You are there and able to watch Mauer and keep her safe. That is important too. You know Mauer better than we ever will.

    Very nice to see Mauer in the blue ranges (100-199 mg/dL) at mid-cycle.

    Yes, the change in shot location can make a difference. Some anecdotal reports say that shooting in the scruff area (the neck area) causes the insulin to be absorbed differently. I forget if those reports said the insulin was not absorbed as well or if the insulin was absorbed slower.

    Whichever the case may be, the change in shot location seems to be a good one for Mauer. Keep those BG levels down girl!!!!

    If the reduction in dose does not keep Mauer's BG levels lower, you can always increase again. But give it 3-6 cycles at a minimum before you decide the dose reduction is not working for Mauer. OK?

    The more you learn, the more confidence you gain, the better decisions you make and the better Mauer does. Keep up the good work Sasha!
     
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  39. JanetNJ

    JanetNJ Well-Known Member

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    Yeah for getting blue numbers!!!!
     
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  40. SashaV

    SashaV Member

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    Oh well..
    She's high. So high I can't get a number.

    What's the reason I need to keep the dose for I few cycles?

    I was hoping for yellow AMPS but well...
    Back on the horse!

    Exactly you can't always be here, so I must make decisions based on..my gut?
    I learn more and more every day thanks to this forum. And I'm confident Mauer will have a good and safe life, specially with this amazing forum on the side! :bighug:
     
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  41. JanetNJ

    JanetNJ Well-Known Member

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    Ugh I hate those high numbers. Why did you decide to lower the dose? You may have been just about ready for a small increase to 2.5. I want to see more beautiful blues!! :)
     
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  42. SashaV

    SashaV Member

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    Simply because I was scared that she'd drop too low. Nighttime new injection site.
    I hindsight I could have given her the shot in her neck and not been afraid she'd drop. Then she could have stayed on the 2.25.

    I hate those highs too. Simply awful. And completely my fault. I know better now.
    However she's holding her number fine today. It would be awesome if the number was blue, since it isn't, I'm just glad its holding and not rising.

    I think my anxiety plays a role here. I worry about the low, and more comfortable with the high, yellow. And I know its wrong. Im working on it. I know she won't die from being in the blue. I know blue is best. But then I panic.

    I wish I knew what it feels like
    I'm actually going to the doctor tomorrow. To check my own longterm BG.
    One positive thing about our sugarcats.. we can test our own BG at home :D
     
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  43. JanetNJ

    JanetNJ Well-Known Member

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    I hear ya. It's scary when they first start getting into lower numbers. Ultimately we want her to spend some of her day in the blues and dark green numbers.
     
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  44. JanetNJ

    JanetNJ Well-Known Member

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    So let's get that dose back to 2.25. We want to work that number closer to 100 to get into those healing numbers.
     
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  45. SashaV

    SashaV Member

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    You mean don't wait the 5-6 cycles?
     
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  46. SashaV

    SashaV Member

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    I'm staying on the 2U at least for now.
    Yellow AMPS for the first time in 2 weeks.
    Hope that's the right decision :)
     
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  47. JanetNJ

    JanetNJ Well-Known Member

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    I wouldn't wait... Your cat was far from the numbers where we would say he earned a reduction. Normal on a human meter is 50-120 your cat only got to 151 so still above normal. I wouldn't reduce unless low into those dark green numbers. You hold the syringe though so it's your call.
     
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  48. SashaV

    SashaV Member

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    I'll do the 2,25U tomorrow morning!:D
     
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  49. SashaV

    SashaV Member

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    She's lower but not low enough.
    When do I raise?
    I'd call this the resting *****face :D:p
     

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  50. JanetNJ

    JanetNJ Well-Known Member

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    Whenever you are around to test again the 2.5 sounds like a good idea.
     
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  51. SashaV

    SashaV Member

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    I'll raise her tomorrow and see what happens.
    Thank you Janet :bighug:
     
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  52. Deb & Wink

    Deb & Wink Well-Known Member

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    Would you please start a new thread in the AM and link this old one in at the top? Please?
    Playing traffic cop here (the mods bug us about threads that get longer than 50 replies).
     
  53. LoveforTucker

    LoveforTucker Member

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    HAHA Shes a cutie!! RBF or not! ;)
     
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  54. LoveforTucker

    LoveforTucker Member

    Joined:
    Jul 5, 2020
    same here! I LOVE my sleep time, LOL PMPS is usually around 6pm, I'm in bed by 730-8, but I"m up at 5am everyday too.
     

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