Need a little help

So from yesterday's low I went down to 0.4U prozinc or how you say it?
Isn't she supposed to go up by now?
Is it safe for me to go to bed? Or wait and do a new BG in an hour?
Should I go down even further?
I just really want her stable now please

 

Being the worry wart that I am I'd wait and test again in an hour. I know the experts have a way of figuring it out better though.

 

I'm as nervous as a jumping flea! I'll stay up.
Go pee with the dog and go fetch some barf for tomorrow and then check again. Seems like she's "waking up" I think.

 

I'm not much at reading spread sheets I do know if theres an established pattern you can make a more precise decision.
I hope I havent messed up your evening if in fact you could have just gone to bed. There will be more responses to be sure.

 

Are you at PMPS right now, with a reading of 4.8? Did you decide to skip, or are you waiting to make the final decision?

 

I'm skipping 10000%!!!! Don't have the guts for anything else!

 

Btw, can you explain PMPS and AMPS?

 

No worries at all!
Would have stayed up all night if it wasn't for you guys

 

Sounds like a plan!

And yes, as @jt and trouble (GA) says, get at least one more test in tonight. She's still going down from the morning's shot, you want to make sure she starts to come back up soon. I think she wants more treats!

AMPS: AM(morning) Pre-Shot test
PMPS: PM(evening) Pre-Shot test

 

She loves treats! I'll do that right away!
Gaaaah not easy for us not americans. Really can't remember pm am and witch is witch

 

Think of it in alphabetical, since AM comes before PM

 

That's a great one! Thanks!
A lot easier here, from PM/24:00 numbers start from 1, at AM/12:00 13 and so on until 24. And everyone is in one timezone! Very important

 

Haha right?? If it's any consolation for the life of me I can never remember if 12 AM is midnight or noon - it's the end of the day so it makes sense to be PM, but also the beginning of the day! But in the middle of the night

 

But since it's AM and A is first in the alphabet it must be 12 noon right? Or am I a lost cause?

 

I think that's you and me both LOL

 

Nooooooo is it wrong?!

 

AM is morning and PM is evening but midnight/noon is confusing since it's in the middle of the day/night. Just forget 12:00

I think 12 AM is actually midnight...which doesn't make sense to me but OH WELL.

Just remember AM is day cycle and PM is night cycle... and day comes before night

 

When does AM become PM?
So sorry for my stupid questions but I really want to learn

 

In US terms AM becomes PM at noon... which is weird but I digress.

In terms of kitty cycles it's just day vs night cycles.

 

LOL I always think of having to get up and..PEE at night.

 

I love that!

 

10.6mmol.
Why does this keep happening?
0,3 or 0,2 tomorrow?

 

So from 12 noon it's PM and after 24 night it's AM?

 

HMM. Well she's earned a 0.25 reduction from tonight if I'm reading the spreadsheet right.

I had to think about it for a minute but yes!

 

So 0.4 with a 0.25 reduction is...?
Numbers really aren't my thing. Maybe I should give her more treats throughout the day

 

0.15 units
Are you using U40 syringes?

 

No idea really. Only gave her these two shots. It's a 1ml syringe with a needle already attached. I'll look first thing tomorrow.
Right now I need sleep so I'm fresh for her 10AM shot
But I'm not shooting tonight. Not nearly high enough for my ballz with this new insulin. Very very potent insulin I might add.. .

 

yes

 

No. U100 syringes

 

I’ve asked @Deb & Wink to look at the dose now that you are using U 100 syringes and Prozinc

 

Hope I haven't ****ed it up

 

I don’t think so because you are using a U 100 syringe The dose needs to be adjusted. Deb will do that when she decides how much insulin Mauer needs. I done use Prozinc so can’t help you there.

 

You actually need the U100 3/10 ml syringe not the 1 ml syringe as it’s easier to draw up small amounts. When you drew up the insulin was it well below the 1 unit mark? You said you gave 0.2 ml

 

Exactly. Only two small lines

 

Can you take a photo of the syringe and show me where you drew it up to please

 

It's up. Didn't know how else to do it

 

That looks like 4 units to me, not 0.2 units.
And the conversion for that is 1.6 units of prozinc.
That is going to be too much for him. He is in danger of dropping too low and having a hypo as 1.2 dropped him to 49 yesterday.
Can you take him to the vet and tell him what has happened. The vet may need to put him on a glucose drip if he drops low.

 

The only other thing you can do is take his BG very hour or more often if he drops low and try and keep him up higher with some high carb food and honey if necessary.
Do you have plenty of test strips, high carb food and honey and feel comfortable doing that?
If he starts to drop too low you would have to go to the vet.

 

How do you see 4 units?
It's a 1ml syringe with 10,20,30,40 and so on I gave her 0.2 two tiny lines under the 10 marker. Half of yesterday's dose on 0.4

 

Each of those lines is 2 units. Were you using the same syringe yesterday?

 

Yes.

 

Each of those lines is 2 units...I corrected myself after you pressed reply.
So what about the day before when you gave 1.2 units, what syringe did you use then?

 

Same syringe only have those

 

Can you show me in a photo where you drew up to for 1.2 please? When you have taken the photo, press ‘upload a file’ which is just below where you are writing this post and it will upload the photo. Thanks

 

So this was in reality 24 units?

 

I think I got it. I'll call my vet right away

 

No need to call the vet at the moment. I will explain

 

My vet says I haven't given her 24U
I'm so confused
Holy cow the levemir was a heck of a lot easier!

 

I can see what has happened and why Mauer was dropping low.
The syringes you are using are U-100 syringes. But each of those little lines on the 1 ml syringe is 2 units each.
On the U-100 3/10 ml syringes the lines are 1 unit each and they have 1/2 unit markings and you can draw up smaller amounts and they are the syringes you should be using
We don’t use the syringes you have as they are hard to give small doses.
To compound the issue, if you are using Prozinc you have to use a Conversion chart to give the correct amount.
So you are not actually giving as much insulin as it looks because you using Prozinc.

So ever since you have swapped to Prozinc you have been giving too much insulin.
The bottom line is Mauer should be OK.
He got 4 units tonight but on the conversion chart that is 1.6 units. That was a lot when I looked at the SS and compared it to the last 2 days but now that we know what has happened it is OK.
Does that make sense to you?

 

No it really doesn't

 

So the first day you gave Prozinc you drew up 14 units on the U100 syringe and thought it was 1.2 units. That gave him 5.6 units Prozinc.
The second day you drew up 8 units And thought it was 0.4 units in the U-100 syringe and that gave 3.2 units Prozinc
Today you drew up 4 units And thought it was 0.2 units on the U-100 syringe and that gave 1.6 units Prozinc

 

Now it makes a little sense. A little...

 

Good!
Now we need to change the SS so it reflects what has happened.
In the U column of the SS can you change the 1.2 to 5.6
The 0.4 to 3.2
The 0.2 to 1.6

 

How do I figure it out in the future?

 

I think the best thing to do is get some of the U-100 3/10 ml 30 or 31 gauge 6mm or 8 mm syringes.
They are the same type of syringe as you have now but have a smaller capacity 3/10 ml compared to 1 ml and they have 1/2 unit markings and each line is 1 unit not 2 units like on the 1 ml syringe.

The other option is to get the U40 syringes that go with the Prozinc insulin and no conversion is needed.

However if you use the U100 syringes you can give smaller doses more easily but you must use the conversion Chart.
We can help you with all of that.
For now, I would go and make yourself a cup of and sit down.
I’d get some tests in during the cycle say at +2 and +4 to start with to see how he’s going with this dose.

 

I think I'll stick to these ones. I've already been though caninsulin and levemir and now prozinc my head can't really follow
I've been sitting down this whole time. Its friday! Cleaning day yay! I'm about to have a freaking migraine over all this crap. It sucks. Big time. I'll test her in a moment so it's +3 and then I'll start my cleaning.
Thank you so much! You've been really helpful!

 

Wow!!!!! Good catch, Bron!!!!!

 

Im not surprised you are about to have a migraine......I’m breathing a big sigh of relief too!
I’m just glad it is all OK.

 

Numbers going down but not too fast.
Gosh it would be easy to just skip the cleaning!
Thank you guys. Don't know what I'd do without you!

 

It was just luck! I felt uncomfortable about it and was wondering how Sasha got the 0.2 so easily on the syringe.
It is really worthwhile asking people to take a photo of what they drew up.
Those 1 ml syringes are a real trap.

 

Pleasure!
259 is Ok. Did you give a small snack?

 

I put her down on the table they're eating at. Think she ate a bit. But she's getting fresh food now.

My vet had taken the 100U syringe in consideration when she gave me the dose. Thankfully. Otherwise it wouldn't have been just a trap but a deathtrap.

 

Just looking at your SS. Don’t forget the PM cycle as well. It is just as important as the am cycle.
You are only getting half the picture if you only test in the am cycle. Cats often drop lower at night.

Don’t forget to change the doses in the U column of the SS.

 

Am I supposed to get up during the night to test?

 

It’s a good idea to get a before bed test in every night, and if that test is lower than the preshot it is a good idea to set the alarm to check that the BG has not dropped low. Cats often drop lower at night.

 

I already do.
Test before first shot, +6 and before second shot. And in between if I'm nervous or seeing something off. Up at 9, test and shoot at 10, test at 16-17, test and shot at 22, off to bed and over the next day.

 

9.1mmol at +6 seems a bit sleepy and eating well. Problem is, how do I figure out the units in the future? And do I give 1.6U tonight, depending on the BG?

 

I think so, but this probably needs a ProZinc person like @Deb & Wink to look over your spreadsheet and think about it. The current 1.6U is not that different from the Caninsulin dose you were transitioning from, so it's kind of starting over on the new insulin. You've gotten some movement (but not too low!) so far on this dose today, so it might not be a bad dose to try for a while.

 

And maybe I can actually give her two shots a day on this dose! Since it's not to low like the other days

 

Sasha, you have those 1ml syringes, but they are really too big for measuring small doses of ANY insulin.
Please, go buy some 3/10 cc U100 syringes to use with the U40 Prozinc insulin.
Or buy some U40 syringes to use with this U40 concentration insulin.

Whichever syringes you decide to buy, you need ones with half-unit (1/2 unit) markings on the insulin barrel, so you can measure the in-between doses better. So you can measure the 0.25U dose changes. That is what we use when changing a dose, 0.25U increments.

If you keep using those 1ml U100 syringes, you are going to overdose Mauer. Let's please keep Mauer safe, with the correct syringes.

You need to be consistent with the dose, and that is going to be nearly impossible to do that using the 1ml syringes.

 

Is it these ones?
https://www.med24.dk/medicin-og-med...nyler/bd-micro-fine-plus-0-3-ml-u-100-100-stk

 

Yes those are the ones!

 

They're ordered hopefully they'll arrive tomorrow morning.
So what dose do I do then?

 

@Deb & Wink can advice your with the dose as I haven’t used Prozinc.
But when you get the syringes, have a good look at them and note where the 1 unit and 2 unit lines are. If I were you I would post a photo of where you think the dose should be before you give it. Just to be sure you understand the lines.

 

I'll do that. Problem is the time difference. I shot 2 hours ago. There isn't anyone awake at this time.

 

I am awake. I live in Australia.
If I know what time I will make sure I am here. We need to get @Deb & Wink to advise on the dose and then I can check it before you give it. How does that sound?

 

Absolutely perfect!! Omg you guys are so kind!!!!

 

You're 8 hours ahead of me, so at your 18:00 I'll give the first shot. I really hope the syringes gets here tomorrow morning

 

@Deb & Wink could you please have a look at Mauers SS and help me with a dose?
Hopefully the right syringes arrive tomorrow and @Bron and Sheba (GA) are helping me tomorrow with drawing it up right.
Please

 

I'd actually like to see a slightly reduced dose, since Mauer dropped so low on 5/13/20 AM/morning/daytime cycle.
For now, I would think that Mauer needs 1.25U of Prozinc. I will be giving you the insulin amounts according to the U40 concentration.

That amount will be adjusted as Mauer's insulin needs change in the future.

The conversion for Prozinc using U100 syringes instead of U40 syringes is 2.5 times the U40 dose.
So 1.25 times 2.5 = 3.125U drawn up in the U100 syringe. Let's not try for that precision right now.
Make the dose 3U in the U100 syringe.

I'm being conservative in the dosing recommendation. That is partially due to my thought that Mauer is bouncing right now. When he clears this bounce, he is likely to need less insulin and closer monitoring.
So please get a blood glucose test during the PM/Night/evening cycle at around +2.

You should get at least one more test in every the PM/evening/nighttime cycle. Without that test, you are missing half your data, and it's really hard to see what is happening. Many people are able to get another test before they go to sleep. Please try to do that additional test every PM/evening/nighttime cycle.

"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)"

@Bron and Sheba (GA) Using the Prozinc SLGS dosing protocol guidelines here. The protocols are written based on using U40 syringes.
Sticky PROZINC DOSING METHODS

If Mauer's BG level drops below 5 mmol/L (90 mg/dL) at any point in the 12 hour cycle, pre-shot test time or in the middle of the 12 hour dosing cycle, that would be an immediate dose reduction of 0.25U. (0.25 times 2.5 = 0.625U in a U100 syringe).

I'm on the east coast of the US, but have not been able to sign on and answer questions until later in the evening, > 19:00 to 20:00 hours eastern daylight savings time. So when it is 19:00 hours here, it is 01:00 hours the next day in Denmark.

@Ann & Scatcats Please introduce yourself to Sasha and her cat Mauer. Mauer is on Prozinc right now, but has used levemir and caninsulin already in his short journey with feline diabetes. He was diagnosed the beginning of March 2020 and his human mother Sasha is doing her very best to get Mauer feeling better.

 

@SashaV and Mauer, Dav jeg heder Ann og er Halv Dansk og bor i Sverige lige udenfor Göteborg. Jeg har det lit mere en svaert nå da jeg er blevet coronasyg og det hele er mer en sinsygt for oss i Sverige. Vi er paa samme tid dog og du har fået god hjaelpe her allereden.
Og saa har du mange gode blod glucose i de blå nummer allereden. Jeg er dog mer vant til at arbejde her paa engelsk og vi skall helst anvende det da vi har peer review og fag medicinsk og saa alle andre, og det er mange, kan hjaelpe.

Hvor gammel er Mauer?

Du er i hvertfald paa ret vej.

 

Hej Ann
Mauer er snart 11.
Er du ramt af covid? Hold da op! Håber du kommer ud på den anden side uden mén
Jeg er så ked af at se hvor svært I har det Sverige det er bare slet ikke okay!
For min skyld kan vi sagtens fortsætte på engelsk, jeg er vist ved at være ret godt med
Dit dansk er super flot! Ikke det jeg er vant til fra en svensker

 

Hi Sasha,
When is your next dose due? Did you get any tests in during the cycle?

 

1 hour! My syringes has arrived!
Not during the PM cycle. I'm usually not a morning person so getting up this early is very new to me, so to be sure I don't sleep in I go to bed right after the PM shot. Yes my life has changed dramatically since this diagnosis
Normally I'd be on US time.

 

Please try and get at least one test in every cycle as we need the database to help Mauer.
So have you read what Deb said about the dose above?
She wants you to draw up 3 units of Prozinc on the new u100 syringes you have just got. That will be less than 1.25 units of Prozinc that you need to write in the units column of the SS. Write in 1.2 please.
When you are ready, can you draw up the insulin and take a photo of the syringe please.?

 

Is this right?

 

Can you turn the syringe around so I can see the numbers on it please?

 

14.1mmol just threw up twice but eating

 

Took her BG, now feeding raw and a half hour to her shot. Is it wrong to feed her before?

 

Yes you have drawn it up correctly.
Try and get a +2 and a +4 at least this cycle if you can and if the BG is still dropping, take one at +5 or 6.
Will you be offering small snacks during the first half of the cycle?

 

The routine is test, feed then shoot in that order. So you are correct.
If you were going to stall because the BG was too low, you would not feed, but wait until you tested again to see if the BG was rising without food.
But today the BG is fine.

 

Yay I got something right!
Sure. She got one after testing. And she's getting fresh canned food after her shot.

 

Problem is, she vomits when she gets to hungry. So before it becomes nausea I feed her. If she holds her number at +2 and +4 when do I test next? Before PM shot?

 

well done!

 

If she isn't continuing to drop, you can next test at PMPS.
You could give her a small snack at +9 each cycle so her tummy isn't empty too long

 

That won't be enough. She gets 130 grams of raw during the day and canned food. And 25-50 grams raw for night. Free access to canned and dry. She's like really hungry at the moment

 

I didn't mean only feed her at +9. I meant you could also give her a small snack at +9 on top of what she normally gets if you think her tummy will be empty and she might vomit.

 

Aaaah
Its It's much easier with these syringes. One big line is one unit and small ones are 0.25 right? And the needle is half the size

 

Except I still have to convert the dose since prozinc is 40U
Maybe I don't get it

 

Shot is in. Only took 2 syringes to not give to much or to little
I'll get the hang of it soon!
I test at +2 and +4 if +4 is holding, I'll test PMPS and hopefully I can stay awake to test that cycle at +2