Please Help with Dosing - Buddy

My cat Buddy came out of remission about a month ago. Since then his numbers have been all over the place. The vet keeps raising his insulin. (Started at 1u of ProZinc, now he's up to 2.5u). There have been several days lately when his PM Pre-Shot is too low to shoot and then his AM Pre-Shot is super high. The vet advised to continue 2.5u only in the morning. My gut tells me this is wrong. Should I actually be lowering his dose?

Buddy's spreadsheet
https://docs.google.com/spreadsheets/d/1i1EHjvWjQTO7veoZcvlAS8VA5kmBNnvkpcviFx77J9I/edit?usp=sharing

 

Previous post ( intro post 2020)
https://felinediabetes.com/FDMB/threads/12-22-20-new-member-buddy.240394/

I can tag a prozinc user for you but first
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.)repeatedly



What dosing method are you following?

@JanetNJ

@FrostD

https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

 

I am not a Prozinc user but your instincts are correct. Cats need insulin twice a day.
Most likely the insulin was raised too quickly. We recommend raising it in 0.25 unit increments.
If you are having to skip a dose because the BG is too low, I would lower the dose and see if you can then give it twice a day.
I would go back to 2 units and see if you are able to shoot twice a day.
Try and get a test in during each cycle so we can see how low the dose is taking Buddy.
Is he eating OK? Are you giving snacks during the cycles?
Are you testing for ketones in the urine? This is a good idea for all cats who are not regulated.

 

Buddy's appetite continues to be great. I feed him 3-4 times a day, but I make sure to test before I feed him, or test him 2-3 hours after his last feeding.
I have tested his ketones a couple times (negative) but I don't often catch him using the litter box.

I reduced his dose to 2 units for the past 3 days, but I got concerned because his numbers read HI (off the meter / 600+) at last night's PMPS and this morning's AMPS, so I raised his dose to 2.5 units this morning. Which dose should I continue giving?
His spreadsheet is up to date and in my signature.

 

Hi Diane, thank you for your advice and question. I've added the info to my signature.
I was unsure what you meant by "dosing method" so I searched here and just read up on it. So far, I've followed the advise of my vet-- and admins in the Facebook Feline Diabetes Support Group -- for dosage changes. I would like to follow the START LOW, GO SLOW (SLGS) method. That one sounds good to me. I am new to this, since Buddy went into remission very quickly when he was DX'd, so I really need help with dosing and when to change doses. I fear he is not responding as he should, or I am not giving the right dose, as his numbers have been all over the place. His spreadsheet is up to date and in my signature now.

 

Will you able to get any tests in during the pm cycle? at the moment we have no idea what he is doing for half of the time.
He could very well be dropping low at night and bouncing in the morning in and that could be why you are seeing high BGs in the morning. We really need to be seeing what’s happening at night with the BGs.
Are you leaving food out overnight for him?

We are not associated with the diabetic fb page you are getting advice from. I think you need to decide who you are going to get advice from and stay with that organisation. Getting advice from several places is just confusing and will not work out.

I would recommend going up or down in 1/4 unit increments not 1/2 unit increments when you are changing the dose. If you are going to follow SLGSyou hold the dose for 7 days unless the BG drops under 90, in which case you decrease.

It is always harder to get a cat regulated the second time around so patience is needed. I had a kitty that fell out of remission after 2 and a 1/2 years and it was hard to get her regulated again.

 

For reference of anyone reading, here is a link to post in ProZinc forum since there are two similar threads going

https://www.felinediabetes.com/FDMB/threads/help-with-dosing-for-buddy-g.255792/

 

Hi Jessica can you please add SLGS to your spreadsheet so members won't have to ask you. Go to the top where your name is and tap on it, a drop down will appear ,tap on signature and add SLGS and it save

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

Tagging
@Janet for you again, she's a prozinc user

 

Thank you for your response and questions!
I sometimes leave the dry no carb food out at night. I can stop doing that. His nadir is usually 6+ or 7+, which would be 2 or 3pm and 2 or 3am... so should I set an alarm to wake up at 2am to test him?

After some more reading last night, I'd like to follow the MODIFIED PROZINC METHOD.

Thanks for letting me know that the 2nd time is harder to regulate. I feel better knowing that, at least, that it's not unusual.

 

Thank you Diane for your help! After more reading last night, I'd like to follow the MODIFIED PROZINC METHOD... that looks close to what I've been attempting to do. I'll add it to my signature and spreadsheet.

 

Yes, in order to do the Modified Method you'd have to get him off the dry completely, even though it's low/zero carb