? Oscar's Thread

Continuing on from:
https://felinediabetes.com/FDMB/threads/time-for-a-dose-reduction.243852/#post-2754609

Oscar dropped a bit low again during last night's PM cycle, so I will be reducing his dosage this evening to 0.5u

His AMPS was 9.9, so to avoid it going too low again like last night, I opted for a token shot of approx. 0.2u as I don't have as much free time at +4/5 to monitor today as I would like.

I have a few questions though.

At the vet's yesterday morning, a different vet checked him over, and when she was looking at his overall numbers, she basically said that the reason they're all over the place is due to me keep reducing the dose so quickly without giving it time to settle in. She suggested I stick at the 0.75 for a week regardless before deciding whether to reduce.
Is there anything to back up what she's saying? I feel that with some of his very low drops, it would have been irresponsible to maintain the higher doses for that long given that ultimately we would still end up where we are now, but just over a period of four weeks rather than two.

Second, I've seen a few members talking about giving a small amount of food at around the +4 mark to slow the drop. Is this worth doing in Oscar's case, or would it be worth waiting until I'm more confident about his dosage, as this might prevent me from getting his true nadir number?

 

I disagree with the vet. If you get a number under 68 on the alphatrak meter you must reduce the dose or you will run the risk of a hypo.
If you stuck to a dose that kept giving you low numbers and didn’t reduce the dose you would run into trouble and may not be able to manage the low numbers.
So you are correct to reduce the dose.
Here is the link to the Prozinc Basics. I am not a Prozinc user so will tag @Deb & Wink to help you with that.
https://www.felinediabetes.com/FDMB...-the-prozinc-basics-please-start-here.164995/

It is a good idea to give your kitty a couple of snacks during the first half of the cycles as well as the preshot meal.
I would suggest giving Oscar a snack at +2 and +4 to see if that helps to stop the big drops. You need to feed the snacks at all cycles though not just sometimes. They need the same food routine each cycle,

With the current cycle, because you have shot a lower than normal BG I would get. +1 and a+2 to begin with so you can catch any drops
You are doing a good job looking after Oscar.
Keep asking questions.

 

You're doing a great job!!
And your vet would be right, if you were using a depot insulin, but you're not.

Withhold food two hours before preshot tests, other than that you can feed small meals throughout the cycles.
The amps where it says NS, you didn't give any insulin? Yet he came down on his own?

 

Thanks, I did think it was strange advice. This is definitely one of the disadvantages to using a practice where it's difficult to see the same vet consistently.

Useful to know, I might start giving him a tablespoon of his normal LC food at +4 then.

Yep, does this suggest he's making his own insulin?

 

The vet would not be right if Carrie was using a depot insulin.
Dropping under 68 on a pet meter warrants a reduction in dose with all insulins.
Depot insulins do like a dose to be kept the same for the depot to fill but if the BG drops under 68 an immediate reduction must be taken.

 

Exactly what I meant, Bron. Thanks for clearing that up

 

I'd think so? But I'm still new, so maybe @Bron and Sheba (GA) has an idea?

 

Sorry for all the questions, but because I'm now shooting under 1u, would it be recommended that I get some U-100 syringes and use the conversion table? It's quite tricky to get the dose exactly correct with my current U-40 syringes.

Would these be fine? They don't need to be specific pet-safe ones do they?

http://www.alldaypharmacy.co.uk/pro...syringe-0.5ml-0.30-(30g)-8mm-PACK-OF-100.html

 

As I don’t use Prozinc i will tag @Deb & Wink to help you with the syringes

I am not sure he is beginning to produce his own insulin yet but Oscar is certainly needing less insulin so is doing very well

 

The usual recommended syringes are fine, half units 0.3ml I believe it is. I've never used 40U syringes.

 

I would use the U100 3/10 ml syringes with 1/2 unit markings And use this conversion chart.

 

Thanks for posting the conversion chart. Looks like I need to buy the ones that say "Demi" then to get the 1/2 unit markings.

 

Yes that’s correct. Make sure they are the U100 3/10 ml ones.

 

Those are the right ones I use them too.

 

These are the ones I've picked up from Boots today.



So for his evening shot, just to double check, this is where I need to bring the plunger up to, to give 0.5u of ProZinc?

 

To 1.3 yes. Might be difficult to measure.
I'd might shave a little of the top there. But you've got the idea.
I put the chart in my ss when I used prozinc, it was nice to have on hand

 

Thanks Sasha, yep I have it saved!

PMPS of 14.7, dose of 0.5u, let's see how we get on this evening!

 

I'm excited to hear what Deb has to say! I think you and Oscar is on the right track

 

Hi Carrie,

Yes, there is. It can take about 3-5 days for a new dose to settle (and these vets agree with this general principle). That's OK advice for a cat that's running overall in a range where there's little or no risk of the cat dropping too low on a given dose but that is most definitely not where Oscar's at now!

I completely disagree with the vet's recommendation that a cat should continue to be given a dose where there is a significant risk that it might drop the cat too low (and in Oscar's case this is supported by his data), and I could not disagree more vehemently with the vet if they were to insist on holding a dose that dropped a cat below the lower bound of the normal reference range. (I would consider this to be wrong-headed and dangerous advice.) The rational - safe! - course of action is to reduce the dose, allow the reduced dose to settle (unless a further reduction is earned) and then assess its efficacy. The dose can always be increased thereafter if required.

And you would be 100% correct in that judgment.

I also agree with your decision to administer a token dose when you knew you couldn't closely monitor Oscar.


Mogs
.

 

Carrie, Those are the correct syringes, the 3/10 cc ones. What are labeled demi where you live.
With a U40 insulin, 0.5 times 2.5 = 1.25U measured in a U100 syringe.
I would have shaved a bit off that dose too, like Sasha said to do.

Agree with Mogs and others that the vet telling you to keep the dose the same for 1 week, when Oscar has been dropping really low is, ummmmm how to put this diplomatically. Putting your cat at severe risk of hypoglycemia and possibly seizures or worse.
So lets keep Oscar safe, and keep that dose lower for now.

p.s. I think you have some of the dates wrong for the month of March. You have 2 for the month when it should be 3.
p.p.s. With the way that Oscar is going with his BG levels, I see him as a good candidate to go into remission aka diet controlled or OTJ.

 

I'm good at that trick. (I have a spreadsheet for my civvie, Lúnasa.)


Mogs
.

 

Anti-jinx!!!




Mogs
.

 

@Deb & Wink @Critter Mom

Thanks both for the reassurance. She definitely made me feel like I was doing something that was detrimental to his treatment, so I'm glad that's not the case.

Numbers seemed good last night, AMPS of 12.8(230)! Second dose of 0.5u this morning, here's hoping today goes well

PS: Spreadsheet fixed, good spot!

 

Very nice PM cycle, Carrie.

Quite the contrary: holding too high a dose just because 'that's how it's supposed to be done' could be detrimental to a cat's very survival.

Oscar is your cat. You hold the syringe.




Mogs
.

 

Hold steady, give that dose reduction time to do it's work.

Hey, any time we say something, it's fine to push back and say you can't do what we suggest.
After all, you know your cat and life responsibilities and schedule better than WE ever will.