Nico - link to new thread in comments

Discussion in 'Prozinc / PZI' started by Emily Tuomey, Jan 5, 2021.

  1. Emily Tuomey

    Emily Tuomey Member

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    So to catch folks up, last night Nico’s PMPS was quite high, in the 400s, after a token dose in the morning and a day of lower numbers. He was great overnight and came in with a +10 of 297. About an hour and forty five minutes later he had dropped to 226 for his AMPS. I did give him a full dose of 2.25u as advised. I guess my question is, is it normal to see a drop from a +10 or +11 to AM/PM Pre-Shot numbers? What causes that? It’s new for Nico. Just curious.

    Previous thread(s): https://www.felinediabetes.com/FDMB/threads/nico-1-5-new-thread-link-in-comments.240600/

    @Deb & Wink @Shelley & Jess @JanetNJ
     
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  2. JanetNJ

    JanetNJ Well-Known Member

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    Could have just had some food wear off... Or he was active. Activity and exercise lowers numbers. Make that cat play. Lol
     
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  3. Emily Tuomey

    Emily Tuomey Member

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    Now that he’s had better numbers he’s so much more playful, and myself and his sister keep him on his toes— I AM LOVING IT!!
     
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  4. Shelley & Jess

    Shelley & Jess Member

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    End of a bounce clearing cycle and BG showing it's true 'colour'?
     
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  5. Emily Tuomey

    Emily Tuomey Member

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    Well... back into the reds as of +6 today (416). “For now, Em. For now.” :(
     
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  6. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJ you guys, my sweet boy is miserable tonight. I don’t know what’s going on with him.. just a wicked bounce from that minimal token dose yesterday, maybe? I could cry, he feels so crummy... I wish there was more I could do for him. PMPS, 514. :oops:
     
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  7. JanetNJ

    JanetNJ Well-Known Member

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    Sorry he isn't feeling well. He's not constipated is he? Is he eating ok?
     
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  8. Emily Tuomey

    Emily Tuomey Member

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    Not constipated. Appetite is good. He’s eaten everything put in front of him today. He just gets that “I don’t feel well, mom” that all babies get when they’re sick look. (Adults definitely get that look too— working in pediatrics you get trained to see it, without them having to tell you verbally) He is laying with me, so at least he’s being social, inactively, and not hiding. Just hoping that now two usual (2.25u) doses will bring him back and kick that bounce to the curb. What are your thoughts on keeping tabs on him overnight? I think maybe just somewhere in that mid..
     
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  9. JanetNJ

    JanetNJ Well-Known Member

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    I'm glad to see the numbers came down a bit overnight.
     
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  10. Emily Tuomey

    Emily Tuomey Member

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    I guess down is an understatement. Lol. I had anticipated getting a +6 but missed my alarm, got up briefly at +9 and he was 39. :eek: Medium carb treats have him up to 54 at +10. Stay tuned!
     
  11. Shelley & Jess

    Shelley & Jess Member

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    That black last night looks like a "high before the break".
    Late PM cycle 01/04 thru to AMPS 01/05 looked like he was trying to clear the bounce but didn't quite make it - by 01/05 AM+6 he shot back up and by PMPS he was black.
    Just mentioning it so you can keep an eye out for that same sort of pattern in the future if it happens again. Nico sure is on a mission and keeping you on your toes! Good catch last night Em.

    Definition of High before the break as posted by Marje and Gracie taken from this thread https://www.felinediabetes.com/FDMB/threads/slgs-method.228857/#post-2562710

    “High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.
    • He was bouncing
    • He was due to clear the bounce
    • His BG was wobbling a bit like it might be clearing but then the numbers shot way up.
    • BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle.
    Still, the above pattern is classic high before the break. One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.
     
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  12. Shelley & Jess

    Shelley & Jess Member

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    Nico earned another dose reduction last night. New dose 2.0u. Please keep a very close eye on that cycle today if you already shot.
     
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  13. Emily Tuomey

    Emily Tuomey Member

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    This is great information to have. I’d be lying if I said I hadn’t thought that maybe his numbers yesterday would earn him a dose increase (back up to 2.5u). Clearly it’s good I/we didn’t jump the gun on that. I’m still kicking myself for missing that alarm to get a +6 from him during that PM cycle, but that being said I’ve got a watchful eye on him today. Will start with a +3, in a little over an hour, just to make sure he’s still doing okay. My inclination is he will be just fine.
    Will plan for 2.0u tonight, unless something changes. I’ll check back in soon!
     
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  14. Shelley & Jess

    Shelley & Jess Member

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    That 50% drop 01/05 PM+3 was the early warning. It's why I'll always recommend those early cycle tests between +2 & +3 regardless of the PS.
     
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  15. Emily Tuomey

    Emily Tuomey Member

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    I guess it’s a good habit to get in to. I just hate poking him like 8-10x per day, especially when his ear is still a little sore. I just took a +2.5 and he’s at 236. Not sure what that means as far as what’s to come a little later in the day today.. thoughts? I’ll be sure to get another read in a couple hours to see where he’s at, hopefully he does okay; he has a strong tendency for higher numbers, not lower, so my guess is he will stay out of hypo range today.
     
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  16. Shelley & Jess

    Shelley & Jess Member

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  17. JanetNJ

    JanetNJ Well-Known Member

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    wow... that escalated quickly! lol
     
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  18. Emily Tuomey

    Emily Tuomey Member

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  19. Emily Tuomey

    Emily Tuomey Member

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    I know, right?! — it’s always seemingly out of the blue too!!
     
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  20. Emily Tuomey

    Emily Tuomey Member

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    We are on high alert around here.. (though again, I’m sure he will be totally normal come evening. And by normal I mean, ~200 pre-shot.) +4.5, 51. We just played, he had lunch and some protein treats, now he’s grooming so behavior is a-ok. Just keeping a watchful eye, as his nadir is usually +6ish. I’ll grab another test then, and try not to be totally distracted by what is happening in DC at the moment. Crazy!
     
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  21. Shelley & Jess

    Shelley & Jess Member

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    You need to test in again in 30 minutes to make sure he doesn't keep dropping.
     
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  22. Deb & Wink

    Deb & Wink Well-Known Member

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    It's possible that Nico's pancreas is starting to function a bit on it's own, and putting out it's own insulin.

    Testing is a good way to take your mind off the insanity of what is happening in DC.
     
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  23. Emily Tuomey

    Emily Tuomey Member

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    Not dropping. 64 just now. +7.
     
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  24. Deb & Wink

    Deb & Wink Well-Known Member

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    Hold steady in those greens Nico.
     
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  25. Emily Tuomey

    Emily Tuomey Member

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    I think we jinxed him. But, we are in good shape for a 2.0u dose in 2 hours, I think! +10, 144.
     
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  26. Deb & Wink

    Deb & Wink Well-Known Member

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    When a cat's BG level drops particularly low, then a bounce is likely to happen. I think that is why Nico is rising at +10.

    After that low last night, down to that BG of 39, and the lows for today, I think you want to reduce the dose. Maybe not by a lot. But a 0.25U dose reduction is in order. So yes, down to 2U is what you want to do. Nico EARNED that reduction. With both the low from last night, and the low of 51 from today.

    You don't want to dose based on the bounce Nico may have after a low. I know it's difficult, and your instincts are saying to keep the higher dose. But you have to overcome those instincts and base your decisions on the dosing based on the nadirs or lows that Nico gets on a particular dose.

    BG numbers in the reds and blacks, almost always indicate a reaction to a low and those high numbers are saying Nico bounced.

    I don't think we "jinxed" Nico. I think his body still needs more time to adjust to those lows.

    In the beginning, Nico was running mostly in the blacks and reds, because you had not found that "breakthrough" dose, that would bring his BG numbers down into a better range, into the pinks, and yellows. But once you started to be more aggressive with the testing, switched to the MPM dosing protocol, and found that "breakthrough" dose, Nico has been doing so, so much better.

    It hasn't been a super smooth process for Nico, but with a diabetic cat it often isn't smooth, and there will be more frequent ups and downs.

    We focus on the BG numbers a lot here, when we make recommendations. But you are there to observe his behavior and can see trends in his eating, drinking, peeing, etc. So you take those factors into consideration, and look for trends, and not focus on a single cycle or a single day before you decide to make a change. But there are certain safety safeguards that do need to be paid attention to, such as lows < 50 mg/dL. "Feed the 40's."

    So hold that lower 2U dose for a few cycles, if at all possible. I'm even seeing another reduction in Nico's near future!:)

    :bighug::bighug::bighug:
     
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  27. Emily Tuomey

    Emily Tuomey Member

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    You called it. PMPS, 335. SIGH. I’m tired.. :(:confused::oops: 2.0u given.
     
  28. Emily Tuomey

    Emily Tuomey Member

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    Last edited: Jan 7, 2021
  29. Emily Tuomey

    Emily Tuomey Member

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  30. JanetNJ

    JanetNJ Well-Known Member

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    how different your chart looks from the beginning. :) I'm predicting another reduction in your near future.
     
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  31. Emily Tuomey

    Emily Tuomey Member

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    YAY!!! And not dropping fast at the moment either, +3, 139. :cool:
     
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  32. Deb & Wink

    Deb & Wink Well-Known Member

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    I'd take another dose reduction for Nico, after that BG of 63 at +6 today, 1/8/21.
    So down to 1.75U dose.
    Hope you see this suggestion, before the PM (evening) shot.
     
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  33. Emily Tuomey

    Emily Tuomey Member

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    I did actually! 303 for the poor guy’s PMPS, but 1.75u given/started this evening despite. Nervous for what high numbers that dose reduction will bring, but I’m trying to be cautiously optimistic...

    TGIF, guys!
     
  34. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJ hoping you guys can weigh in on this for me today. We had a GREAT number for AMPS (154), which I was super happy about. But now we are showing numbers in the black zone (again), and it’s only +4 (540) :banghead:. I’m incredibly worried about what’s to come for the rest of today.. :nailbiting: What is up with him?? I did second guess my shot this morning, but it wasn’t wet so thinking it wasn’t a fur shot. (And, I did a repeat test to rule out a bad strip too.) But what else could/would cause him such a steep increase in that short of a time frame?? At this rate by PMPS he will like unreadably high for sure. Just sucks. I don’t want him to be miserable (though his behavior is great at the moment, he’s romping through the house currently!) I’ll look for your responses in a bit.
     
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  35. Emily Tuomey

    Emily Tuomey Member

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    another “high before the break” today maybe..???
     
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  36. JanetNJ

    JanetNJ Well-Known Member

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    boooo I don't like that number. lol
     
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  37. Emily Tuomey

    Emily Tuomey Member

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    me either. I’m sad :oops: Is it too early to say he needs to go back up to 2.0u???
     
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  38. JanetNJ

    JanetNJ Well-Known Member

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    lol yes... let's see what happens tomorrow.
     
  39. Emily Tuomey

    Emily Tuomey Member

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    How often would you recommend testing today/tonight/tomorrow?? I’m home, and pretty flexible.
     
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  40. JanetNJ

    JanetNJ Well-Known Member

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    tonight i'd do the preshot and get a before bed reading. Tomorrow, whenever you want. hahaha
     
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  41. Emily Tuomey

    Emily Tuomey Member

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    Still black. Very, very black. PMPS, 559. Was secretly wishing he’d surprise us tonight. Not so. I’m sad for him. :oops: He’s not acting like he’s feeling bad though, aside from a tad more thirst this evening. Hope he’s gonna come back down tomorrow. I’ll do one more test before bed. Thanks @Deb & Wink @Shelley & Jess @JanetNJ.
     
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  42. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJ 300 this morning (AMPS). Not a great starting out point, but better than the 540 or 559 yesterday.. Will test him Mis and let you know.
     
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  43. JanetNJ

    JanetNJ Well-Known Member

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    That's not bad! It's what my cat was today too.
     
  44. Deb & Wink

    Deb & Wink Well-Known Member

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    Hoping that Nico goes lower today, and feels better.
     
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  45. JanetNJ

    JanetNJ Well-Known Member

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    I would have retest ed looking for a 299. Lmao. Sometimes it works. Hahahaha
     
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  46. Emily Tuomey

    Emily Tuomey Member

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    Definitely thought about it, hahahahaha!!! We could just pretend it was 299 LOL
     
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  47. Emily Tuomey

    Emily Tuomey Member

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  48. JanetNJ

    JanetNJ Well-Known Member

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    Ha ha go ahead. You always monitor closely anyway
     
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  49. Emily Tuomey

    Emily Tuomey Member

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    I mean I won’t if you guys think we should stick it out longer, for more adjustment I hopes his body will come around. I just don’t know that it will..
     
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  50. Deb & Wink

    Deb & Wink Well-Known Member

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    Ayuh. (Mainer for yes).
     
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  51. Shelley & Jess

    Shelley & Jess Member

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    I exercise my right to wait and answer when we see PMPS ;)

    Seriously, the only thing I personally don't like is increasing on a night cycle....but this really isn't an increase more of a failed reduction. The recent 2.0u didn't take him too low :)

    Maybe this will help settle your thoughts, from Prozinc MPM dosing
    • If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
     
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  52. Emily Tuomey

    Emily Tuomey Member

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    I LOVE ALL OF THIS!!! (At least I’m not a failure.) Honestly though, I think we just weren’t ready for two reductions so close together; I really do believe we will be able to reduce him successfully at some point in the near-ish future, I guess now was just not that time. I’m so clearly not an expert, nor do I pretend to be one. His behavior has been pretty good considering.. a little increased thirst yesterday but no lethargy, anorexia, etc. You’d never know he was running 500+ numbers if you saw him, which I’ll mark as a win in my book! Dang, I just love that little guy, I’d do anything to help him. We are fort masters today.. rainy day in Seattle. @@Shelley & Jess about a half hour or so til PMPS, will you be around? I told myself that a good compromise might be that if he’s [somehow magically] near 200 I’d be okay shooting 1.75u again tonight, if not 2.0u. Anyway, I’ll be back in 30-40 mins!
    upload_2021-1-10_18-17-35.png
     
    Last edited: Jan 10, 2021
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  53. Emily Tuomey

    Emily Tuomey Member

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    @Shelley & Jess update: PMPS, 370. 2.0u? Go from there? Or wait to see what he does overnight with 1.75u (though like you said previously, he’s not had any hypo numbers at 2.0u, even overnight)?
     
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  54. Shelley & Jess

    Shelley & Jess Member

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    I'd do the 2.0u.

    ETA - what time you hoping to test, looks like I might be up with my little missy tonight too.
     
    Last edited: Jan 10, 2021
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  55. Emily Tuomey

    Emily Tuomey Member

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    Oh no. Low?? I usually try to get him between 11pm and midnight (PST), so +4 or +5. I can do it earlier and post if you’ll be up, just let me know! I’m like 95% sure he will be just fine though. ;)
     
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  56. Shelley & Jess

    Shelley & Jess Member

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    Your +4 sounds good.

    Not low, 104 @+2 but finally trending down after a few less than ideal cycles. Think she's been going through a bit of an IBD flare, and like Nico today you wouldn't know anything is wrong except for the numbers.
     
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  57. Emily Tuomey

    Emily Tuomey Member

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    Awe sweet girl. I have IBD (Crohn’s) myself, so I totally get that— those flares can be brutal, in anybody!! (Sorry, probably just a bit tmi but I’m an open book, so sometimes I over share about it - lol!) Is she on prednisone (also like me) for management? Anyway, sorry for the random rambling. I’ll be back in just a couple short hours with Nico’s latest number— I always wage a guess because I’m usually so far off it’s comical, certainly wouldn’t put any money on it; just for my amusement. :joyful: gotta keep a sense of humor! Tonight’s guess for +4... 275! :joyful::joyful::joyful:

    Well @Shelley & Jess, I was wayyyyyy off.. +4, 420. OUCH. Here’s a thought though.. he’s on the dregs of his current PZI vial, could this attribute to some of his numbers from the last two days??? I think it was filled in October... Just throwing it out there as a possibility. His numbers just seem WAY off to me to be merely coincidental. ??????
     
    Last edited: Jan 11, 2021
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  58. Emily Tuomey

    Emily Tuomey Member

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    Y’all, it’s not good... :arghh: What is going on with my guy??? AMPS 492. :(

    EDIT:
    +3, 382.
    +5, 299. :)joyful: @JanetNJ!!)
    +8, 179. :D
    PMPS, TBD
     
    Last edited: Jan 11, 2021
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  59. Tillie and Valentino

    Tillie and Valentino Member

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    Could he still be bouncing? I'd love to hear the pro's opinions, but that would make sense I think. I read on here that bouncing can take a few days sometimes.
     
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  60. Shelley & Jess

    Shelley & Jess Member

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    Is that really a Yellow 299 or are you pulling a Janet??? ;)
     
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  61. Emily Tuomey

    Emily Tuomey Member

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    IT REALLY IS, CAUSE NOW AT +8 HE’S BLUE (179)!!!!! <happy dance!!!>
     
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  62. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, that is a strong possibility. Prozinc does get less effective the longer a vial has been opened.

    YEAH!!! on the blue today.
     
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  63. Emily Tuomey

    Emily Tuomey Member

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    THANK YOU!!

    Also, @Deb & Wink @Shelley & Jess @JanetNJ we are stalling LOL (his body is CRAZY!!!) PMPS, 96. Whhhhhhat’s the plan now lol?! 2.0u over 150??

    UPDATE: PMPS (+12.5), 109. More stalling...
     
    Last edited: Jan 11, 2021
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  64. Emily Tuomey

    Emily Tuomey Member

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  65. Emily Tuomey

    Emily Tuomey Member

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    @Shelley & Jess Micro dose? Like 1.0u? Test every couple hours overnight??
     
  66. Shelley & Jess

    Shelley & Jess Member

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    I wish he was coming up a bit. He's flat, those numbers are basically all the same.
     
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  67. Emily Tuomey

    Emily Tuomey Member

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    I know... that’s why I’m not sure. He’s eaten now, should I test again? I mean I know that’s food influenced now though.
     
  68. Shelley & Jess

    Shelley & Jess Member

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    I don't even like 1.0u right now.
     
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  69. Emily Tuomey

    Emily Tuomey Member

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    Well we are at your mercy.. I’m too new to know anything about anything, so I’ll give whatever you think is appropriate. It looks like both times he’s been like this before it was a 1.0u or 0.5u dose.
     
  70. Shelley & Jess

    Shelley & Jess Member

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    A 'true' token dose is 0.5u. That's what I'd do for Jess and get back on track tomorrow.
     
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  71. Emily Tuomey

    Emily Tuomey Member

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    Ok. 0.5u it is. How frequently do I need to monitor overnight then with him? Or could I do 0.75u?
     
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  72. Shelley & Jess

    Shelley & Jess Member

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    You've never shot when he's stayed this flat and low for the hour stall, he's always had some sort of rise....his limes have been overnight....thinking out loud here....
     
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  73. Emily Tuomey

    Emily Tuomey Member

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    Keep it comin’...
     
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  74. Shelley & Jess

    Shelley & Jess Member

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    The only thing I'm comfortable with is playing it safe. 0.5u. Final answer. :)
     
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  75. Emily Tuomey

    Emily Tuomey Member

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    AND SLEEP WITH ONE EYE OPEN!
     
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  76. Emily Tuomey

    Emily Tuomey Member

    Joined:
    Oct 1, 2020
    @Deb & Wink @Shelley & Jess @JanetNJ I’ll get a new thread going at some point (when I’m lucid lol) tomorrow, as I know this one now requires quite a bit of scrolling to get here. Just a quick overnight update before AMPS in just 3 short hours: (recap, PMPS +12 96, +12.5 109, +13 99. 0.5u token dose given at +13.) +2 145, +4 150, +8.75 195. He seems to have flattened out. Can someone elaborate on what that means when you have a chance? I did a quick search on here, so I sorta get it, but that’s brand new territory for Nico and I’m not sure I know wheat it means in terms of him specifically or in terms of Prozinc versus other insulins. I’m a bit sleep-deprived so I’m gonna dash and see if I can slide in another 2.5 hours before Nico’s morning routine and “work” [from home]. Hope y’all slept well— I’ll be in touch shortly!
     
  77. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Good call last night
     
  78. Emily Tuomey

    Emily Tuomey Member

    Joined:
    Oct 1, 2020
    AMPS, 370. 2.0u given. :cat: We are tired.
     
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  79. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Take a nap. Test at +4 lol
     
  80. Emily Tuomey

    Emily Tuomey Member

    Joined:
    Oct 1, 2020
    Headed to Napland now, population 1. LOL Nico’s +4 is high, 478. :banghead: That boy’s disease is gonna be the death of me, I swear! :blackeye:
     
  81. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Bouncing. On the trampoline for Nico.

    Patience my friend.:bighug:
     
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  82. Emily Tuomey

    Emily Tuomey Member

    Joined:
    Oct 1, 2020
    BIG BOUNCE DAY! AMPS, 370. +4, 478. +10, 519. PMPS, 496. Hoping he clears it overnight. At least this mama gets a good nights sleep tonight!
     
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  83. Emily Tuomey

    Emily Tuomey Member

    Joined:
    Oct 1, 2020
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