Nico’s New Thread - 1.21: AMPS 397, +3 361, +7 290

Discussion in 'Prozinc / PZI' started by Emily Tuomey, Jan 13, 2021.

  1. Emily Tuomey

    Emily Tuomey Member

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    Last edited: Jan 13, 2021
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  2. Emily Tuomey

    Emily Tuomey Member

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    Mr. Bouncy just gave me a black number :oops: +6, 555. Do you ever just get used to the constant rollercoaster of numbers?? I feel like I’m anxious about it all the time. Every other aspect of life I’m super patient, I swear!
    (To be fair I did see this one coming, more or less. This one is definitely in his eyes and behavior today.)

    Does look a bit like his bounce from 1.4.21-1.5.21...
     
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  3. Deb & Wink

    Deb & Wink Well-Known Member

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    New thread very much appreciated. Thanks Em!

    You are getting the hang of this, looking at the trends in the numbers over several cycles, and not focusing on a single cycle.
     
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  4. JanetNJ

    JanetNJ Well-Known Member

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    I think your cat is made of rubber.
     
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  5. Fonzirelli

    Fonzirelli Member

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    Hi, I’m new, but is the Clean Protein (Dr Elseys ) the dry? I am getting suspicious that it’s not low carb like the rep said. I’ve had trouble regulating my Boots and wonder how much the amount / treats I give her of dry Clean protein affects her.
     
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  6. Deb & Wink

    Deb & Wink Well-Known Member

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    Which flavor of the Dr Elsey's? The dry kind, the chicken flavor is lower carb, but the salmon flavor is too high for a diabetic cat. Keep that for you hypo toolkit.
     
  7. Fonzirelli

    Fonzirelli Member

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    Right. I use the dry chicken but the rep just told me last week by email that their calorie count is incorrect as printed/ displayed so I worry they have other values incorrect also. I asked because she LOVES it like kitty crack. And I’ve had a hard time regulating her even though she only gets a small amount.
     
  8. Emily Tuomey

    Emily Tuomey Member

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    A “Superball” lol It’s crazy, I don’t know how he functions at all most of the time. I really don’t. I take it this isn’t the usual diabetic case..??
     
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  9. Emily Tuomey

    Emily Tuomey Member

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    Yes. We have the chicken (Nico isn’t a seafood guy). But it’s not a food staple for him, he only gets ~5 kibble pieces per bg poke as a “treat.” Just to clarify.
     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

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    Nico is not your typical diabetic case. Difficult to regulate and a "superball" too.
     
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  11. Emily Tuomey

    Emily Tuomey Member

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    I don’t know that there is much more in my/our control. It’s definitely taxing on both of us with so much bouncing and large swings— I literally never know what is coming next, sometimes only an hour or two apart. Which means I also can’t really be away from him for more than a couple hours either. He does have a strong tendency for higher numbers rather than low though. From your standpoint it seems like we are making okay progress, right? The vet doesn’t want another curve until April..
     
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  12. Shelley & Jess

    Shelley & Jess Member

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    You might want to try and slow that drop a bit.
     
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  13. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJ the Superball bounce continues. We are on alert for a potential green overnight.. I’ll get back up and test him in a couple hours. We’ve had a 300+ drop in just 3.5hrs :eek::nailbiting: “goodness gracious, kid!” :cat::coffee:
     
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  14. Emily Tuomey

    Emily Tuomey Member

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    Advice?! Medium carb treats? He did just have some Dr. Elsey’s (dry chicken kibble) “treats” but only a couple pieces. Maybe I should give more?
     
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  15. Shelley & Jess

    Shelley & Jess Member

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    Have you fed anything?
     
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  16. Shelley & Jess

    Shelley & Jess Member

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    Cross posted....how many temptations did you give when he was lime?
     
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  17. Emily Tuomey

    Emily Tuomey Member

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    He’s always got wet food available— until 2hrs before preshot.
     
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  18. Emily Tuomey

    Emily Tuomey Member

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    Gosh. 10-12 maybe..?
     
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  19. Shelley & Jess

    Shelley & Jess Member

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    Try giving him 2 or 3. Give the insulin a little carbs to work with.
     
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  20. Emily Tuomey

    Emily Tuomey Member

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    Got it— will go do that now. He’ll be so upset about that (hahahahahahahaha)
     
  21. Emily Tuomey

    Emily Tuomey Member

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    Sigh. More bouncing (when I’d hoped he would settle out from last night).. AMPS, 403.
     
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  22. Shelley & Jess

    Shelley & Jess Member

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    Make a note on your spreadsheet about what/when/how much you fed last night when trying to slow that fast drop - that way you can look back and see how it worked if you need to take control and steer an over active cycle again.

    It's a bit of trial and error to see what works to ease him down and keep him surfing in good numbers and may help Nico not bounce so high.

    I'm going to copy and paste an excerpt from Debs' +2 write up that says it best.

    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.

    The steeper the drop, the higher the bounce.

    It's a balancing act.
     
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  23. Deb & Wink

    Deb & Wink Well-Known Member

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    Thanks Shelley, for helping Em last night. I had forgotten I had made that writeup about the +2 a shared google doc. It's a good one to bookmark.

    I know that some people don't think that dry food/treats take longer to get digested and into the bloodstream, and have an impact on the BG levels. But I do. I like to use the dried bean analogy.

    Throw some dried beans and water into a cooking pot, turn on the heat, and it takes a while to cook them (the slow method). Soak overnight (or heat and pre-soak) them first, and they cook faster (medium length method) . Put the beans in a pressure cooker and the cooking time is cut in half (fast method).

    Same idea with dry vs wet food. Dry food has to get wet first, interact with the stomach acids, before it starts to get broken down in the digestive system and from there get into the bloodstream.

    Canned (or raw) food is already wet, usually in smaller pieces already, so the stomach acids can start to break up the smaller pieces faster, so the glucose can get into the bloodstream faster.

    Gravy type higher carb food, squeezed out of the can into a dish, is the fast "pressure cooker" type method.
    Medium carb food is like the medium length cooking method.
    Low carb food or dry food is like the slow cooking method.

    If a human diabetic needed to raise their BG quicker, they'd drink some high carb OJ. They wouldn't eat a few pieces of dried fruit and wait for those to get broken down and into their system.

    Same idea with our cats.
     
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  24. Emily Tuomey

    Emily Tuomey Member

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    These are both FANTASTIC, thank you!! And, I’m so grateful to each of you for pitching in to help Nico. :cat: I do have wet food (gravy) and syrup for potential hypos in our kit too. So my next question is how should I (or would y’all) determine whether to use high carb versus medium carb, and faster acting versus slow? Again, he has a tendency for high numbers, but just so I’m prepared when/if those low numbers happen, or like last night have to slow a drop? I’m just hoping I can feed on time tonight— he’s been stalking me for the last hour lol, one more to go!— I’ll be back in about 45-50 mins!
     
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  25. Emily Tuomey

    Emily Tuomey Member

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    PMPS, 431. Ughhhhhh :confused: I don’t like it. :( What am I doing wrong....??!
     
    Last edited: Jan 14, 2021
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  26. Shelley & Jess

    Shelley & Jess Member

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    Nothing. You are still learning what works for Nico and Nico is still adjusting to new numbers.

    I've read conflicting information from senior members about this. I like your analogy, makes sense to me. Thanks for sharing your thoughts on this. (Another one to bookmark!)

    General observation, one thing that does seem to hold true is that dry food/treats stick around longer in the system, keeping numbers higher longer than than wet food and the effect may linger through to the following cycle(s).

    ECID, every cat is different - this is where you need to find out what works best for Nico. Even though Nico grazes does he seem to eat more LC at certain times during the day? Does it seem you're putting more food out at around the same time every day? Maybe keep an eye on it, note his eating pattern, see if coincides with a rise in the BG or appears to slow downward momentum. When they graze sometimes it's difficult to see the true impact LC has on the BG.

    This thread https://www.felinediabetes.com/FDMB/threads/do-daas-pz-dosing-thread6.229373/#post-2606373
    Scroll to Post #15 by Marje and Gracie talks about "feeding the curve" and how to prevent kitty from dropping too fast and/or too low.
    It's a long read and not all information in this post applies to you and Nico, but it's a good read with good information and may give you some ideas where to start.
    Halfway down this post Marje has a section "There are important things to consider when you are determining whether to feed lc, mc, hc:"

    Please note, for anyone reading, hypo numbers need to be handled different than discussed in the above thread. The How to treat HYPOS guideline for feeding and testing should always be followed when treating for low blood sugar.
     
    Last edited: Jan 15, 2021
    Reason for edit: trying to link directly to Post#15
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  27. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJSUPERBALL” IS AT IT AGAIN!!! +7, 51. :nailbiting: Good night(!), this kid keeps me on my toes..! Here I was thinking “eh, he doesn’t need more than one mid-cycle test today, then SURPRISE— 51. “Well, crap.” So much for that theory. Should I try to get him up a little??? He’s eating Purebites chicken/duck liver at the moment, but obviously no carbs in that. I could put the sweet potato back into it so he has those carbs at least? I’ll keep you posted!

    And thank you @Shelley & Jess for this— Great information to read over and save!
     
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  28. JanetNJ

    JanetNJ Well-Known Member

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    Give him a little of his regular food to just steer him a bit.
     
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  29. Emily Tuomey

    Emily Tuomey Member

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    Will do! Think he needs another test prior to PMPS probably, yes?
     
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  30. JanetNJ

    JanetNJ Well-Known Member

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    Couldn't hurt
     
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  31. Deb & Wink

    Deb & Wink Well-Known Member

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    When you are guiding the BG numbers, aka "feeding the curve", you would usually start off with the lowest carb food, then increase to the MC, then increase to the HC if needed. Small amounts, so your cat doesn't get too full to eat if the BG numbers still need to be brought up a bit.

    Marje gives a much better explanation of how to "feed the curve" than I ever could. So that thread from Goose about his cat Do Daa is a good one to read and bookmark.

    Nico was so close to earning a reduction with that 51 today, you could consider reducing the dose to 1.75U at PMPS 1/15/21. But he doesn't seem to hold reductions well, so you might want to keep him at the higher 2U dose. Hard to say without seeing the PMPS test.

    Your call Em.
     
  32. Emily Tuomey

    Emily Tuomey Member

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    I’ll for sure be back with a PMPS, but I wholeheartedly agree with you about Nico not handling dose reductions well, and I was planning on asking to keep him at 2.0u if he’s above like 120 or so; if at all safe, of course. I can test overnight (TGIF) if need be. I just hate to set him back again when we were just getting back on track. I’ll let you know. I’m actually gonna test him here in a few minutes (+9) to see what direction we are headed. I’ll post that momentarily too.
     
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  33. Emily Tuomey

    Emily Tuomey Member

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    +9 154. Which is HIGHLY food/treat influenced. I pulled his food up now instead of in an hour so I can get as accurate a reading as possible for PMPS. But, it looks like we should be in good shape for 2.0u if he stays where he’s at!
     
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  34. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, the 2U dose for PMPS looks like what Nico needs. He's headed back up fast from those greens.
     
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  35. Emily Tuomey

    Emily Tuomey Member

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    I seriously don’t understand his body; I really don’t... <shakes head>
     
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  36. Emily Tuomey

    Emily Tuomey Member

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    This is making me CRAZY. PMPS, 373. W-T-F?!!!! I’m so confused by his body, I really am. I’ve removed all suspected, tangible reasons for such a rollercoaster of numbers, so I know it’s just his body and the insulin. But now I’m like “well I’m gonna have to test every couple hours during the day, and especially overnight because these greens/lime greens pop out of [seemingly] nowhere. And he doesn’t really exhibit any symptoms one way or the other, so I can’t rely on that. Suggestions please?! @Deb & Wink @Shelley & Jess @JanetNJ
     
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  37. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJ we are having a very rough day. Very rough. I think we need to consider bumping him back up to 2.25u, I really do. We have a lot of black and red creeping back in, and he is visibly miserable today. Roll that idea around for a bit and let me know your expert thoughts. It’s just really hard to see him unwell, I guess. I know I should just practice patience with it, but I wish we could go back to when his numbers were doing so much better at the start of the holidays. I just feel like we are taking major steps backwards right now, and that is a difficult pill to swallow.

    AMPS, 430.
    +4, 596.
    +8, 490.
    PMPS, 423.
    +5, 263.
     
    Last edited: Jan 17, 2021
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  38. JanetNJ

    JanetNJ Well-Known Member

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    I would not raise it. He was 51yesterday. You just have a very bouncy cat.
     
  39. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJ He’s playing now and come down 100 points. I’m set for 2.0u tonight. I just wish I knew what was happening to make him so erratic at the moment.

    +8, 490.
     
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  40. Deb & Wink

    Deb & Wink Well-Known Member

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    Some of the "erratic numbers" could be because his own pancreas is kicking in and producing some insulin.
     
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  41. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJ PMPS, 423. Lowest number all day, I guess. I don’t anticipate a major drop overnight so am gonna try to just grab one test before morning. Hope that’s okay, we all could use the sleep. +5, 263, and headed to bed. Hasta mañana!
     
    Last edited: Jan 17, 2021
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  42. Emily Tuomey

    Emily Tuomey Member

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    @Deb & Wink @Shelley & Jess @JanetNJ permission to go to 2.25u next cycle? I can’t handle the unending reds/blacks happening here.. it’s not seeming like a bounce (because then he’d have to actually clear that at some point, right?) anymore. And, he was doing really well at 2.25u! Then we had two dose reductions in a row and he just can’t seem to recover, especially with that token dose on 1.11. We’ve been at 2.0u for twelve cycles now— pretty please!! :rolleyes:

    AMPS: 411
    +6: 367
    PMPS: 420
    +4: 397

    upload_2021-1-17_19-21-45.png
     
    Last edited: Jan 18, 2021
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  43. JanetNJ

    JanetNJ Well-Known Member

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    Go ahead just keep a close eye out esp if the preshot is under 300.
     
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  44. Emily Tuomey

    Emily Tuomey Member

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    Got it. Thank you!
     
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  45. Shelley & Jess

    Shelley & Jess Member

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    Em, bounces can last anywhere from 3 to 6 cycles. You got blues in a couple of cycles after that 01/11 token dose and he absolutely cleared the bounce in the 7th cycle later with that green 51.

    Please be careful and monitor closely.

    Did you get a chance to read the thread about 'feeding the curve' I linked above?

    Marje said this in Post #15 of the linked thread:
    For anyone reading this who then thinks, “well, if I just give my cat more insulin, the bouncing will stop”. No it won’t and it’s not safe to just increase the dose to stop bouncing. It’s the process of managing the curve with food specific to your cat that keeps it safe to increase the dose.
     
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  46. Emily Tuomey

    Emily Tuomey Member

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    ^^thats a lot. And really overwhelming. I’m not feeling great about any of this today— please forgive me for not being very receptive or communicative. Today is not gonna be my day. :(

    AMPS, 526
    +4, 370
    +8, 309
    PMPS, 223

    @Deb & Wink @Shelley & Jess @JanetNJ some updated numbers.
     
    Last edited: Jan 18, 2021
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  47. Deb & Wink

    Deb & Wink Well-Known Member

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    FYI, for future reference. You never have to get our "permission" to change the dose.

    You are there, and know a whole lot more about how Nico is doing than we ever will.

    Yes, increase the dose back to 2.25U for Nico.

    Sending some long distance, virtual hugs your way. :bighug::bighug::bighug:
    Hope today gets better for you.
     
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  48. Emily Tuomey

    Emily Tuomey Member

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    Can you explain this some more? His PMPS tonight was 223. I gave 2.25u. Just not sure what I should be prepared for as far as overnight, because he’s under 300. Hopefully you see this!
     
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  49. Emily Tuomey

    Emily Tuomey Member

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    Thank you. I did get to sneak away for a quick trip to Trader Joe’s and a massage therapy appointment, so that helped somewhat. There’s a lotttttt more to the story than just Nico (things that are also out of my control, so my perfectionism/controlling tendencies are going absolutely crazy, and nearing impossible to sit with), so I’m sorry if it sounds like I’m getting grumpy with anyone; it isn’t intentional. I greatly appreciate all of you, and I’ll probably always ask for permission because you guys know best. I’m a newbie. But, I’ll always weigh it with Nico and my gut instincts as well. One step at a time. It’s a marathon, not a sprint, right? <sigh>
     
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  50. JanetNJ

    JanetNJ Well-Known Member

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    Because you hit 51 a few days ago.
     
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  51. Shelley & Jess

    Shelley & Jess Member

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    Thinking out loud again....did you start a new vial of Prozinc yet? You mentioned over a week ago you were getting to the end of your vial.
     
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  52. Emily Tuomey

    Emily Tuomey Member

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    We’ve not. I was thinking that just this morning actually. I anticipate we will be pretty much through it in the next day or so, but I also think it may be the culprit as it was “opened” back in October.. I just couldn’t bring myself to toss it though, as it’s pretty expensive. I just wish I could get him back into the blues/dark greens; he was doing so well!!!
     
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  53. JanetNJ

    JanetNJ Well-Known Member

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    It's only 3 months old. It's still good.
     
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  54. Emily Tuomey

    Emily Tuomey Member

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    I had a feeling that it is/was...
     
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  55. Shelley & Jess

    Shelley & Jess Member

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    I questioned/exchanged the last vial I got from our vet in December. The expiry date was March or April of this year (carries a 2 year shelf life) and it was heavily frosted at the top of the vial. I've got part of an old vial in the fridge from a year ago that has no frost or floaties whatsoever.
     
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  56. Deb & Wink

    Deb & Wink Well-Known Member

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    Heck no. I don't see a bit of grumpiness Em. We can't always be on when you need an answer, so I was trying to say to use your best judgement. I'm not a "night owl" or an "early bird" but I try to get on in the evenings every day. Didn't want you to wait around for an answer when you might not get feedback for quite a while.
    Frosted? Toss it. That says it's been frozen, and the insulin won't work anymore.
    Sounds wonderful!
    I haven't been to Trader Joe's since the pandemic started. Closest one is about 1 hour away from me, so I only go a couple of times a year, and stock up
    on some of their frozen entrees. One of my friends kids is a caterer, and he started up a meal delivery service the beginning of this year. I have 3 options to choose from, house salad is included, quart of soup if you want it. My delivery today was a huge salad with lots of veggies and cannellini & kale soup. Fresh bread to go with it, and I'm all set.

    p.s. Em, would you start a new thread please? This one is getting long at 50+ posts. Link to this old thread at the top please. Thanks.
     
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  57. Emily Tuomey

    Emily Tuomey Member

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  58. Shelley & Jess

    Shelley & Jess Member

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    For those that may not know what frosted means - if insulin is subjected to temperature extremes, such as freezing or overheating, the insulin can precipitate on the vial's walls, giving it a frosty or frosted appearance.

    Bad_insulin.JPG.jpg

    The only other thing I can think of EM, and if you know this already just ignore me :)
    If you draw out excess insulin are you pushing the extra back in the vial or squirting it in the air?
    Lubricant from in the syringe barrel may contaminate the insulin if excess insulin is pushed back in the vial.
     
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  59. Emily Tuomey

    Emily Tuomey Member

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    I read this very thing last night, and yes, I certainly have squirted excess insulin [from the syringe] back into the bottle. I did shoot 2.5u this morning, per @JanetNJ ’s input to see if that might push him out of this rut. Perhaps it’s also time to open his new insulin though. Or maybe give the 2.5u these two cycles today, then open a new insulin vial if he’s still sitting at 250-350 tomorrow morning...?

    I’m planning to test a +3 in a little over an hour, so I’ll be back with that number shortly too.

    AMPS, 397.
    +3, 361.
    +7, 290.
    PMPS, 393.
     
    Last edited: Jan 21, 2021
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  60. Emily Tuomey

    Emily Tuomey Member

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    @Shelley & Jess +3, 361. WHYYYYYY?!?! :banghead:

    Now I’m thinking new vial tonight!
     
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  61. Shelley & Jess

    Shelley & Jess Member

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    Not saying this is the problem, but have learned anything is possible - like Janet mentioning constipation, or is there any chance of an infection brewing or sneaking contraband food, stuff like that.

    Just good to rule out any culprits if possible so you can move forward.
     
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  62. Emily Tuomey

    Emily Tuomey Member

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    Difficult to tell about constipation because he shares a litter box with his sister, but there hasn’t been a decrease in stool in the box when it’s scooped 2-3x per day, so I don’t suspect so. No symptoms of a potential infection afoot, and no possible chance he’s gotten into something he’s not supposed to— food or otherwise. I’ve literally been systematically ruling things out every cycle to see if there was change and nothing. Even when I gave him a higher dose this morning (2.5u), still no change hours later. So unlike my bouncy boy.. I’m left thinking it’s the vial. Did read that silicone presence in insulin will greatly reduce efficacy and may potentially be directly related to heightened blood sugar, not to mention a whole host of other things researchers are studying. Don’t google it, scary! Idk...
     
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  63. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I'm really thinking new vial too Em.

    The old vial may still be ok, so save it just in case. Prozinc does lose some efficacy with time. Some people can use the vial to the last drop. Some people can't.

    As well as starting the new vial, it's time to start a new thread please, as this one is up to > 50 replies. Please.
     
    Emily Tuomey likes this.
  64. Emily Tuomey

    Emily Tuomey Member

    Joined:
    Oct 1, 2020
    ^^ @Deb & Wink I did! Yesterday actually. Just was responding to @Shelley & Jess ’s posts here as well. Let’s move on over, team!
    New vial tonight it is! I’ll be getting a +7 from him in the next half hour or so; I’ll post new numbers in the new thread— ps my autocorrect wants “new” to be “mew” :joyful: kitties much??? :joyful::joyful:
     
  65. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Can’t hurt to try it. It’s always good to save a partial vial just in case the new one breaks.
     
    Emily Tuomey likes this.
  66. Emily Tuomey

    Emily Tuomey Member

    Joined:
    Oct 1, 2020
    I read that yesterday as I was surfing around looking for advice, totally a great tip!!
     

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