? Need Dosing Advice!

Discussion in 'Prozinc / PZI' started by PPCW, Feb 26, 2021.

  1. PPCW

    PPCW Member

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    May 26, 2017
    Hello Everyone,

    A little history about Coby. He was diagnosed back in 2017 and quickly went into remission. His routine blood work in January showed he is diabetic again. He is receiving sub-q (125ml) once a day. BUN is slightly elevated. His pancreatic number is a bit high as well.

    This time around, I started with 1U (SLGS) and gradually went up to 2U then I swithed to MPM. due to lack of control with SLGS. The current dose is 2.5U. The first few cycles showed improved numbers. Especially 2/24!

    It seems like he is starting to bounce on 2.5U.

    He is 6 cycles in on 2.5U. Should I stick to 2.5U for a few more cycles to see if the bounce will clear and the numbers may return to 2/24? Or should I increase to 3.0U?

    Thank you for your advice,

    Patricia & Coby
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

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    I'd suggest holding the dose for another cycle or 2. It does look like Coby is bouncing.
     
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  3. PPCW

    PPCW Member

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    Thanks Deb! I will hold the dose for a couple more cycles.
     
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  4. Deb & Wink

    Deb & Wink Well-Known Member

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    I see that Coby got down into the blues last night 2/26/21. Bet he bounces again for today's AM cycle, 2/27/21.

    It does look like he is clearing those bounces faster these days. That's a good sign.
     
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  5. PPCW

    PPCW Member

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    Hopefully he doesn’t bounce too badly during the day. I hope we are close to finding the right dose. I need some sleep!
     
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  6. PPCW

    PPCW Member

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    Decided to go up to 2.8U this morning as he is going back to black pre-shot. I was going to give him 3U but he is so prone to deep dives then high bounce. I will give him a couple cycle of 2.8U then 3U.
     
  7. Deb & Wink

    Deb & Wink Well-Known Member

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    Hope that dose increase helps to get Coby out of those high black and pink BG ranges.
    It usually takes a couple of cycles to see the effects of a dose change.
     
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  8. PPCW

    PPCW Member

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    The preshot number this evening is lower than the morning. He got 2.8U again. Not sure if I should go to 3U tomorrow morning. According to MPM, the increase should be 0.5U if nadir is higher than 200.
     
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  9. Deb & Wink

    Deb & Wink Well-Known Member

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    Are you using U100 syringes or U40 syringes? Can't remember. A note at the top of your SS would be helpful.
     
  10. PPCW

    PPCW Member

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    I am using U100. Not sure what happened in yesterday's morning cycle. I am sure I didn't give a fur shot. I didn't test +6 last night because I was just too tired.
     
  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Thought so. But sometimes it's hard for us to keep track.
    That's ok. We all need to sleep some and take care of ourselves, so we can take care of the rest of our families.
    Then you probably didn't.

    Coby is looking a little better BG wise today. How is he feeling? The 5 P's and appetite?
     
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  12. PPCW

    PPCW Member

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    The numbers on 2/24 was like a dream :(. Now back to black.

    He is feeling OK. Sub-q helps with hydration so he doesn’t drink like a horse. He gets plenty of food and weight is maintained. His arthritic pain is managed but sleeping is still his favorite activity for an almost 17 year kitty. Just need to find the right insulin dose!
     
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  13. PPCW

    PPCW Member

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    Had an interesting yesterday. Went to dark greens during the day and had to stall twice for PMPS to get up to 200. Gave 2.5U based on past data. Numbers probably went into blues after +5. Decided to give 2.5U again since AMPS is not above 300. I am hoping for a gentle dip into the blues or dark green during the day!
     
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  14. Deb & Wink

    Deb & Wink Well-Known Member

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    So now it's time to gradually lower that "decision point" BG number. Sometimes we call that the "shoot/no shoot" number, but it's really not the only option.
    You've shot a 195 BG before.
    So think about reducing your decision point BG to 180 -185.
    You should be able to gradually lower that pre-shot "shoot/no-shoot" number lower and lower.
    It's knowing how low a particular dose drops your cat, how well she responds to food, when the low usually occurs, etc.

    Expect a few "bobbles" up and down during the first few cycles at the lower dose.
     
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  15. PPCW

    PPCW Member

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    I have no problem shooting with low preshot. The decision is the dose. I think 2.5U last night was a good decision but I should have done 3U this morning.
     
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  16. Deb & Wink

    Deb & Wink Well-Known Member

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    I beg to disagree. I DO think the lower dose, the 2.5 U dose was correct for last night AND for this morning.
     
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  17. PPCW

    PPCW Member

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    I debated over 2.5 or 3U and ultimately decided to go with the lower dose in the morning. But seeing his PMPS @580 last night, it was hard to convince myself I made the right decision :(.
     
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  18. Deb & Wink

    Deb & Wink Well-Known Member

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    Give it time please.

    I know it's hard to see your cat in high BG numbers. But put on your "patience pants" and wait for the bounce to clear.
    Coby dropped to the that 87 again today, 3/5/21 and that is another earned dose reduction. If you don't want to drop the dose from 3 down to 2.5U, that's ok. OUr protocols say to reduce by 0.25U.

    So his new dose should be 2.75U and you will have to "eyeball" that dose, since it falls between the lines on the syringe.
     
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  19. PPCW

    PPCW Member

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    Thank you for your encouragement!

    I went with 2.75U tonight. 3U drops the BG too fast and bounce back for PMPS.
     
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  20. PPCW

    PPCW Member

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    Yesterday was a good day! Low numbers and gentle curve! But his BG has other ideas of course. Back to black AMPS :eek:.
     
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  21. Deb & Wink

    Deb & Wink Well-Known Member

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    Coby seems to really hate those blue BG levels, and bounces every time.

    Come on down Coby, and stay down please.
     
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  22. PPCW

    PPCW Member

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    Old man and stubborn :p!
     
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  23. PPCW

    PPCW Member

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    Coby had a wild day cycle yesterday. Started with black to dark green midcycle. What a steep drop. The night cycle was flat and didn't bounce like crazy. It is still hard to tell if 2.5U or 2.75U is better at this point.
     
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  24. Deb & Wink

    Deb & Wink Well-Known Member

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    I think the 2.5U dose is a good call for now. If Coby doesn't hold the dose reduction, then bump up the dose again
     
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  25. PPCW

    PPCW Member

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    His day and night cycles are on the opposite ends. The day cycle sems to last longer with low PMPS but the night is short with very high AMPS. The only variant I can think of to account for this difference is he gets a small amount of kibble before 10pm but none during the day.
     
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  26. Deb & Wink

    Deb & Wink Well-Known Member

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    So try without the dry kibble at night. See what happens.

    Yes, such a simple change can make a difference.
     
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  27. PPCW

    PPCW Member

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    I tried no kibbles at night back in February. He was too bouncy to see the effect. He didin't have any kibbles last night and had a yellow AMPS. Hopefully, it wasn't just a one-time thing. I will keep the no kibble routine and fingers crossed!
     
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  28. PPCW

    PPCW Member

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    The night cycle continues to be stubborn. I couldn't decide if 2U or 2.25U for last night's cycle since I had to stall for an hour to get PMPS to 184. Maybe I should have given him the full 2.5U because of his history of high numbers at night. I decided to give 2U because it is getting difficult to wakeup to catch any potential hypo event.

    The experiment continues: no kibbles and smaller/frequent meals at night.
     
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  29. PPCW

    PPCW Member

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    Experiment 1 - Correlation between high night BG and kibbles/meal size

    Hypothesis 1: If Coby doesn't have kibbles at night, night BG will be lower resulting in lower AMPS.
    Hypothesis 2: If Coby has smaller more frequent meals and no kibbles, night BG will be lower resulting in lower AMPS.

    Result: night BG and AMPS remain high while he didn't get any kibbles and with smaller meals.

    Conclusion: hypotheses - rejected. Night BG and AMPS remain high.

    Experiment 2 - Correlation between low day BG and night high BG w/ high AMPS

    Hypothesis: If night BG is high, it is a bounce to the low dark green day BGs.

    Experimental design: gradually lower day insulin dose to produce a more gentle curve.
     
    Last edited: Mar 20, 2021
    Reason for edit: Spelling
  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Hypothesis 4: You aren't catching the nighttime nadirs.

    Cats are more active at night, so their BG levels can drop due to their burning off more glucose due to the increased activity levels.

    Hypothesis 5: Prozinc isn't the best insulin for Coby.

    Try another insulin.
     
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  31. PPCW

    PPCW Member

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    Hypothesis 4:
    The nighttime nadirs have been more difficult to pin down. Sometimes it is before +6 and sometimes at +6. Plus, I need to get some sleep for work. He is actually more active during the day. He goes to the litterbox or drink a couple times during the night and comes right back to bed next to me.

    Hypothesis 5:
    Prozinc is too expensive to throw out with half of a bottle left. I will definitely give it try when Prozinc is done. Maybe he will much more regulated by then.

    Coby had low numbers last night which continued with AMPS. I gave 1U. Hopefully he is able to hold the BG down today!
     
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  32. PPCW

    PPCW Member

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    Since March 20, the dose has been lowered to 1.4U. More blues and yellows. The night cycle is flatter and results in lower AMPS but the day cycle is still more acitve. 1.4U seems to be the dose for night but still uncertain about the day.
     
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  33. Deb & Wink

    Deb & Wink Well-Known Member

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    Coby may still be dropping lower in the PM cycle. A test or 2 around the +8 to +10 hour time frame would be useful information.
     
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  34. PPCW

    PPCW Member

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    Agree. Just need to will myself to get up at +8.
     
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  35. Deb & Wink

    Deb & Wink Well-Known Member

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    I remember those nights. It's tough to be sure, especially if you have an early morning wakeup, in order to get somewhere.
     
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  36. PPCW

    PPCW Member

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    I get up around 4:45am, feed my cats first, go out to feed my feral kitties in the neighborhood, come back to test/feed/insulin Coby, then get ready for work! I just can't fall sleep again after getting up for a +8, +9 and +10 :(.

    But he had a great cycle last night!
     
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  37. Deb & Wink

    Deb & Wink Well-Known Member

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    Maybe sneak in a test for Coby, before you feed your cats and then the ferals?

    Yes, he did have a great cycle last night. Maybe do another dose reduction?
     
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  38. PPCW

    PPCW Member

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    I think I should tell my other cats to wake me up at certain hours LOL!

    I was going to do a dose reduction this morning but wasn't sure. Hopefully he doesn't bounce tonight from the dark green.
     
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  39. Deb & Wink

    Deb & Wink Well-Known Member

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    They are better than an alarm clock!;)
     
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