? Need dosing opinion for Magic (ProZinc)

Magic recently transitioned from Vetsulin to ProZinc and I'm having a hard time trying to figure out what's going on. I'm hoping some of those more experienced here may be able to share some insight.

4u of ProZinc (or Vetsulin) doesn't seem to do much for Magic and he stays around 400-500+ range. 4.5u takes him too low. The vet doesn't want him to drop below 100. So, I've been sticking with 4.25u. I realize that he bounced from going low on 9/3. I am confused by what happened last night (9/6) and this morning.

At PMPS he ate two cans of Fancy Feast Tender Beef and Chicken Pate. Instead of raising after eating, his sugar dropped all evening long and was 147 this morning. Since today was a critical workday and I had to be in the office, I decided to give him a reduced dose of 3u (to prevent him from skyrocketting) and have a family member closely monitor him.

What I can't figure out is every time his blood sugar had bottomed out it's always been AFTER he's eaten a substantial amount of food. You can see the same scenario on 8/29 with Vetsulin.

At AMPS and PMPS he gets two cans of Fancy Feast which he now devours. It's normally 50% eaten within 15-20 minutes, about 75% by 40-60 min and the remainder is usually gone within about 90min of serving.

I'm just trying to figure out how to stop these random massive drops - they scare the crap out of me.

Thoughts? Ideas? Is it just his body getting used to the new insulin formulation.

 

@JanetNJ , @Marje and Gracie ,

Any ideas? I'm hoping there's a method to the madness that you can see that makes sense.

 

At the risk of causing the "experts" to assume someone has already addressed your issue, I would like to comment:
If my cat had a BG number I was uncomfortable with (and I am o.k. with 70's/80's), I would not feed Karo unless I observed other symptoms along with that. I keep both medium and high carb wet foods around, and I would first feed the medium, followed by high carb but only, if needed. And then test again.
I have picked up from this MB that consistency is everything. What I do on the SLGS method is keep a dose for several cycles, not increasing or decreasing based on an AMPS or PMPS or fear of what her nadir might be in a few hours. The pancreas needs time to make adjustments while healing so I try to keep the food and insulin consistent. I totally understand your fear, however.
Hugs,

 

I do have several ideas but it’s late here and I’m just seeing this so if you don’t mind, I’ll give you some thoughts tomorrow and you can decide if they might help or work for you all. Thanks for your patience, Denver.

 

IMHO, it’s unsafe to wait until a cat is exhibiting “other symptoms” to give Karo. At that point, it could be too late. The other issue with your suggestion is there are some cats that are allergic to the ingredients in some of the MC and HC gravies. Sienne’s cat, Gabby, was like this. My kitty, Gracie, could not tolerate a food higher than 13% calories from carbs because it completely ruined her duration. I used karo when she was really low and needed her up fast.

I’m not really sure what you mean by the first part of this statement. SLGS has one holding the dose an entire week and then doing a curve based on the nadirs, not AMPS or PMPS. If you are holding a dose less than a week (unless a reduction is earned) or not taking reductions when the BG drops below 90, you aren’t doing SLGS (and there is no “modified SLGS”).

 

Hey Denver,
Maybe Magic is just trying to get adjusted to the new insulin? If you take a look at Nico's sheet right after we switched, you can see he's kinda all over the map. Granted, not as high as he was on Vetsulin, but one day he'd be in the 240's then he'd come all the way down to 130 and hover.... His body was like woah, what's this now? I just tried to keep his dose steady, and watch his numbers to make sure he didn't go too low. Or else I would have come on here for help lol.
But hopefully Janet or Marje can give their thoughts since they are the more experienced folks.
Good luck!!
Bella

 

Before I go into what I’m observing, usually when we move from one insulin to another, we keep the same SS with all the data on that tab. I can do this for you and it’s really helpful for us to be able to look back without having to switch tabs. Please PM me so I can get editing rights to put these all on one 2021 tab. Thank you. Also, am I correct in assuming you are following SLGS as recommended in the PZ Sticky on dosing methods? You’ll find he does better if you are following a specific dosing method. And I’d recommend, if you haven’t done so, that you read all the stickys on the PZ ISG.

First, what you saw on 9/6 was what we call the “high before the break”. He started a bounce on 9/4 after the green BGs the night before. On 9/5, he started to clear it but didn’t get any lower than the 100s which is not atypical. Then you saw the high before the break on 9/6 a.m. cycle and he cleared the bounce to just the 100s. Here is another example where the kitty went up into black BGs (I have other examples but they aren’t as similar to Magic’s as this one).
Milo’s SS look at 8/7; you can see he then cleared the bounce

Unfortunately, we have not ever figured out why this occurs but it occurs with a real frequency in diabetic cats clearing a bounce. My own kitty did it frequently as well. Many times, it’s a signal that a dose reduction might be forthcoming but not always. However, because it can also cause the bounce clearing to be more active, it’s best to monitor the cycle following a high before the break.

He started another bounce the a.m. cycle of 9/7 and even though you are seeing some pink and red BGs and might think those would be a high before the break, if you consider that meters can have a 20% variance from reading to reading, he’s pretty flat. In other words, for also night, 80% of 436 is 349 so he didn’t really change much from +2 thought +6 last night or even this morning. I can’t explain his 230 at PMPS last night. There are times when we don’t really understand why the BG did a specific thing; I know that isn’t helpful but because we are dealing with a hormone (insulin) and not a medication, it isn’t always predictable.

On 8/29 when he was on Vetsulin, I explained this in a previous thread (I added the bold today).

What we have found with insulins is, typically, just feeding a large meal all at once doesn’t work with the insulin as it onsets. Vetsulin had a quick onset so you had to feed before you shot but if you did not continue to feed as it was continuing to it’s peak action, and add a bounce clearing on top of it, you are going to get the kind of cycle you saw. On 9/3 PM cycle, you fed at PS and +4 but he would have done better if you’d been feeding minimeals in the hours between.

PZ onsets later than Vetsulin and each CG needs to find out where their own cat specifically onsets. We can say, in general, that PZ or Lantus onset at +2 but some cats will onset earlier or later. For Magic, to effectively manage his cycles, you’ll need to understand where his onset, nadir, and duration occur and also realize they can shift around a bit.

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose

The BG will often drop quickly at onset in a cat that is not yet tightly regulated. That sudden drop can start a bounce; the BG does not have to drop low to initiate a bounce; it might just drop quickly and that’s what you’ve seen. By feeding the curve with minimeals (you might have to use an auto feeder which many, many members do here), it helps to work with the insulin. You also have to figure out what % LC food works best for Magic. As an example, as many new members do, when we came here we thought the lower the % calories from carbs the better so we went with foods that were 0-3% calories from carbs. Subsequently, an experienced member and moderator, told me they had found out over the years that many cats actually do better with carbs in the 6-10% range. We started feeding Gracie foods that had that range of calories from carbs and she did much better but we also had to feed minimeals.

Feeding minimeals is an art as much as a science. Some cats do well with minimeals at PS, +1, +2, +3 and others need a totally different schedule based on their onset, nadir, and duration.

I hope this helps. Please ask questions. It’s alot to absorb.

 

Absolutely. Thanks for the insight.

 

@Marje and Gracie ,

Thank you… I do really appreciate the help. I split the spreadsheet mainly for the convenience of my vet but I’ll merge it back together later this week. I kinda figured the data from that first month on Vetsulin was pretty much wasted time and data, isn’t it? I’m trying to follow SLGS for adjustments but also incorporate the advice of my vet. He tends to do larger increases which scare the bejeezus out of me. To say I’m overwhelmed is somewhat of an understatement but I’m honestly really trying.

So, would something like a 6am/10am, 6pm/10pm feeding schedule make sense for him then? I figure then I can give him his normal four 3oz cans and just leave them out between.

I’m thinking I should leave him at the 4.25u a little longer and tweak his feeding schedule and see where that gets me before I try an increase to 4.5u. (It feels like his correct dose is somewhere between 4.25 and 4.5 just from what I’ve seen so far with how he behaves). What are your thoughts?

 

You’re very welcome. I’m happy to help any time

Thank you. No, I don’t ever believe any data is wasted. We see patterns that you might not be able to pick out that can give us some clues to Magic even if it’s from a different insulin.

I can certainly understand you being overwhelmed. It’s really tough at first and especially if you are working with your vet and here. I had the same experience; I loved my vet and had no reason to not trust her but then something happened in her office one day with another client of hers who had a diabetic cat that made me realize she didn’t have a really good grasp of FD and how to manage it. Each of us must decide on our own which way we want to go but we rarely have had members’ vets that approach dosing the way we do. It’s tough to straddle them and do both; especially with SLGS.

It’s no criticism towards your vet (or any vet) but most vets are taught to hold a dose for a week, run a curve, and if more insulin is needed, raise the dose by 1u. We have found too many cats get quickly overdosed with this method. That’s also what my vet wanted us to do; it would have killed my baby from hypoglycemia. She was always a pretty low dose cat.

According to your remarks, that’s what you did the evening of 9/3 and look what happened. Onset is way before +4 so you have to be feeding, again, more like PS, +1, +2, +3. The way it works is you take his normal total amount of food he gets per cycle and then divide it up into the number of minimeals you want to feed as a starting point. I found with Gracie, I had to front load it a bit so her minimeals at PS and +1 were a little more than +2 and +3 (that’s when she was on Lantus; I had to come up with a different method for Levemir). That’s why I say you will likely need an auto feeder if you don’t have one.

The thing about feeding a curve or any food management is that it’s trial and error. What works for one cat, might not work for another and the only way you know is to experiment.

I know you are trying. I can tell how much Magic means to you and how much you want to make it better for him. It’s also tough when you are juggling that, working, family, etc etc. We do understand but each of us also has our own “bumps in the path” that make your circumstances a little different.

Let us know how we can help.

 

On 9/3 he’d actually eaten about 1.75 cans on Fancy Feast at PMPS. At +4 when I noticed he was lower than expected I got him to eat the remainder. Then I started having to add additional food to get him up.

 

Right but he only ate at PMPS and +4

I apologize….forgot to answer this. Under SLGS, you’d hold the 4.25u for a week, run a curve and see where his nadirs are, and then adjust accordingly to the guidelines. Tweaking his feeding is great but I wouldn’t hold a dose that might not work for him if the curve indicates he needs more insulin or if he drops below 90 before the week is up. A drop below 90 earns an automatic reduction of 0.25u.

 

Never thought of it quite like that but yeah, I guess you are right. Thank you.

I'm trying adding a second feeding at +2.5s and see where that gets me. Magic has a follow up with the vet this afternoon.

 

How did it go?

Insofar as the feeding, it can take a bit of time, feeding consistently, to see a result so don’t give up if you don’t see progress in a cycle or two. I honestly believe he’s going to need more mini meals than just at PS, +2.5, +4 but we will see how he does.

 

I was expecting a hassle and getting shutdown but Vet appointment went well. He was extremely happy to see a lot less ‘black’ on the spreadsheet and was somewhat amazed at the difference in duration from Vetsulin.

He said he’s ok with me adjusting the dose as long as I’m monitoring closely and that if I can keep sending him the spreadsheets by email he won’t need to see Magic face-to-face unless something drastically changes. I showed him the SLGS adjustment criteria and he said that I’m good-to-go.

He agreed that we should increase the dosage to 4.5u and see where that gets us.

I discussed feeding with him and he said they’ve never done anything other than twice daily but he said as long as I’m monitoring it’s ok to see what happens. I’m still trying to figure out what times would be best since it’s really hard to figure out when his nadir is.

 

I’m glad the appointment went well and he saw no issue with SLGS. Great that you don’t have to take Magic in every time.

Just one note: under SLGS, you wouldn’t have yet raised the dose. Magic is bouncing again and you might be seeing another high before the break.

Yes….with Magic diving and bouncing, it is hard to tell just yet what his onset, nadir, and duration are.

 

Spreadsheet is fixed

So far... knock on wood, fingers crossed.... Magic has had some good numbers on the increased dose today.

 

Thank you!

Yes…. but remember what I said about the high before the break (the break = clearing a bounce). That’s what happened I’m glad the vomiting didn’t cause him to drop more than he did. I hope he’s feeling better.

 

You and me both! I thought for sure we were going to have train wreck. Fortunately he still felt like eating and really surprised me.

I worked from home today to keep an eye on him and he got a good brushing at lunch so hopefully that should quell his need to groom. Though it’s actually a good sign he did get a fur ball since he hasn’t even tried grooming in weeks…. Just wish he’d done it in the kitchen instead of my living room

 

This product is great for hair balls …and so many other things. My two are very plush and never have hairballs (I give them this twice a day). It also is good for cats that have motility issues.

 

Thank you!! I just ordered some for Magic.

 

You’re welcome. My cats love it.