Sticky PROZINC DOSING METHODS

Discussion in 'Prozinc / PZI' started by Marje and Gracie, Feb 13, 2020.

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  1. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    PROZINC DOSING METHODS
    If you're new to the FDMB, please start on FELINE HEALTH: The Main Forum where you'll learn all about hometesting, the basics of feline nutrition, and feline diabetes. Please be sure you read “New? How You Can Help Us Help You!

    This document is a compilation of information provided originally by Jill & Alex (GA), Sue & Oliver (GA), Djamila, Kris and Teasel, Libby and Lucy, and Marje and Gracie.

    Many here choose one of two methods to hopefully achieve regulation: Start Low, Go Slow (SLGS), a less intense method with fewer blood glucose tests required, or The Modified ProZinc Method. Both approaches were created and developed by laypersons using human meters. Reference numbers given for blood glucose numbers are from blood glucose meters calibrated for human use.

    These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting this Insulin Support Group.

    Guidelines listed for each of these approaches are not intended to portray the ONLY way you can use PZ insulin. The guidelines on this website suggest how to best use PZ insulin when following one or the other of the methods mentioned above. Be aware there are other feline diabetes message boards on the web using different dosing methods/protocols successfully.


    ***All reference numbers are based on using a US human meter to monitor your cat’s BG. Using a pet meter is not recommended.

    GIVE “START LOW, GO SLOW” A CHANCE TO WORK FIRST.

    In the beginning, the best approach is to start at a low dose of insulin and increase slowly, based on your home testing. We consider that gathering data over time - with small adjustments in dose, if indicated, (always reflecting the home-testing data in the cat’s spreadsheet (SS) - is the best way to approach this “sugar dance.”

    Remember: Your kitty most likely didn’t develop diabetes overnight. We often say that treatment requires “putting on your patience pants”. So give your kitty’s system ample time to adjust to your testing and insulin dosing strategy before you consider making changes too quickly.

    After - and only after - you have collected at least a month of data and are confident with home-testing, you might consider the modified method to use ProZinc/ PZI (the acronym “PZ” is used for both here on) if SLGS is not getting good results. If the modified method does not give you results, you might want to consider the alternate methods provided later in this sticky. If you should wish to use an alternate method, it is strongly encouraged that you post for assistance before beginning.

    For all dosing methods, the following points are extremely important:
    • In the case of a fur shot (when you try to inject, but the cat moves, or you were tricked by thick fur, and the insulin ends up on the cat instead of in the cat): Never reshoot when this happens. There’s no way to know how much got into the cat so it’s too risky to do a second shot.
    • Never give an extra shot because of high numbers. It is so hard to see our fur babies in high numbers. However, giving extra shots results in overlapping nadirs and are just too dangerous. Follow the protocol for increasing the dose, keep your kitty away from carbs, and be patient.
    • Be as consistent as you can. You do still need to live your life, but so much as you are able, try to keep the timing and routines consistent from day to day. The more stable you are, the more stable your cat can be.
    • Why do spot checks or curves?
      Meowzi surprised her caretakers one night! Luckily, they caught the low by doing a simple spot check.
      PMPS 241; +4~132; +7~20; +7.25~31; +7.5~47; +8~89; +9~93
    • Special consideration for cats with a history of DKA: If your cat has a history of producing ketones or DKA, it is especially important to try not to skip insulin shots and to keep their numbers in good ranges. Any of the dosing options should be used with special caution for any cat with a history of DKA (e.g. SLGS might not be the best choice as the doses are held longer and a DKA- or ketone-prone cat might need more frequent dose adjustments). As always, consult your vet and the members of the forum if your cat has had DKA or has a history of ketones.
    START LOW GO SLOW (SLGS)

    The Start Low, Go Slow Method (SLGS) with PZ for Diabetic Cats has been adapted from the FDMB's original 5 Steps to Regulating Your Diabetic Cat. Adaptations were necessary to accommodate the action, nuances, and exceptions of PZ. SLGS is intended for those members who do not want to start out with or use the Modified ProZinc Method of dosing (discussed below):

    Requisites when following the Start Low, Go Slow Method:

    • Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox.
    • Test regularly for ketones and know about Diabetic Ketoacidosis (DKA).
    • Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter. If you still wish to use a pet meter, you will use the same reference numbers for making dosing decisions as you would with a human meter. For example, with a human or pet meter, a drop below 90 requires a reduction.
    • Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding.
    Starting Dose:
    • 1u BID if kitty is not on a wet/canned low carb diet
    • 0.5u BID if kitty has been switched to a wet/canned low carb diet
    • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
    • Generally, shots are to be given 12 hours apart.
    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
    As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

    Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

    Reducing the Dose:

    • Anytime the BG drops below 90 mg/dL, reduce the dose by 0.25u at the next shot.
    Lather, Rinse, and Repeat!

    How to handle a lower than normal preshot number when following SLGS:

    Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
    Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
    A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

    • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
    • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
      • a.) give nothing
      • b.) give a token dose (10-25% of the usual dose)
      • c.) feed as usual, test in a couple of hours, and make a decision based on that value
    • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
    • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
    • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
    Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin once you have data and understand your cat’s cycles. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

    With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Prozinc users following the Start Low Go Slow approach:

    If the preshot number is far below usual preshot numbers:

    • Do you need to stay on schedule? Then skip the shot.
    • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
    • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
    If the preshot number is near kitty's usual preshot numbers:

    Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.

    We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.


    MODIFIED PROZINC METHOD
    This modified method was developed by FDMB experienced PZ users and written by Djamila. It is a fine-tuning of previous methods used for PZ Dosing by experienced FDMB PZ users. Again, while we encourage you to start with SLGS for at least a month, if you are available to closely monitor your cat’s BG and intervene when necessary, you may choose to start with this method. Some prerequisites for using the modified dosing method include:
    • Kitty should be monitored closely the first three days when starting PZ. Initially, blood glucose levels should at least be checked at pre-shot, +3, +6, and +9. More monitoring may be needed.
    • It will be necessary to test kitty's blood glucose levels multiple times per day.
    • Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
    • Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
    • You will need a glucometer made for human diabetics.
    • Use U-40 syringes or, if you wish to use U100 syringes with half-unit markings, first read the detailed info in the “New to the Group: the Prozinc Basics. Please Start Here” sticky.
    • Feed a high quality low carb canned or raw food diet.
    • Feed small meals throughout the day, although, some kitties will adapt well to free feeding.
    Starting Dose: (if you started with SLGS and switch to the modified method, please skip to “Changing the Dose” below):
    • 1.0 unit twice per day; if your cat is very small or the blood glucose numbers are only slightly elevated, you may want to start with 0.5 units. A bigger cat doesn’t usually need a bigger dose.
    • shots are generally given every 12 hours
    • if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
    It is recommended to hold the starting dose for 3-5 days (6-10 cycles) to give the cat time to adjust. During this time, the blood glucose should be monitored several times each cycle.
    • If there is a significant drop in blood glucose that results in a number below 50 on a human meter (or 68 on a pet meter), then the dose should immediately be reduced.
    • If the numbers stay high though, don’t be tempted to move the dose too quickly. It can take a little while for your cat’s body to learn to use the injected insulin and increasing the dose too quickly can result in overdosing.
    • If the numbers are staying flat and high (above 200) for the first three days (six cycles), increase the dose on the next cycle.
    • If the curve is showing a smile shape with a noticeable drop through the middle of the cycle (greater than or equal to 50%), you should wait a couple more days before changing the dose.
    Changing the Dose: (general guidelines)
    • After the initial adjustment period, subsequent doses should be held for 3-6 cycles and data collected to determine next steps. Changing doses faster than that, or trying to use a sliding scale, nearly always results in bouncing and wild unpredictable variations in blood glucose, or BG getting stuck high and flat as if nothing is happening. Small steady dose changes work best.
    • PZ typically lasts 10-14 hours in most cats, and one cycle affects the next, so when changing dose, it can take a few cycles before you really see the impact of the change. It’s not uncommon for the first cycle after a dose increase to be a little higher. If this happens, try not to get discouraged. Wait a couple of cycles, collect data, and see what the BG does.
    • Conversely, if you decrease the dose when you shouldn’t, it’s not uncommon to see a good first cycle because there is still some impact from the previous higher dose. Subsequently, the following cycles may result in the numbers starting to rise. If this happens, move back up to the previous higher dose.
    • Dose changes are made based on the nadir, and the amount of drop between the pre-shot number and the nadir. Doses are not based on pre-shot numbers so do not increase the dose without seeing mid-cycle numbers.
    • Pre-shot numbers are important so that you know the cat’s BG is high enough to safely inject, and so you can monitor the change between the PS and nadir; however, again, they do not determine the dose by themselves. Adjusting the dose based on PS numbers alone frequently leads to overdosing, underdosing, and bouncing.
    • In general, dose changes are made in increments of 0.25u. In sensitive cats, it may be necessary to make even smaller changes.
    • Precision in drawing the dose of PZ is very important. Insulin is powerful and even slight variations can make a difference.
    • If a cat is having nadirs above 200, then dose changes of 0.5u are recommended.
    • Occasionally we see cats who need the dose held longer than the recommended 3-6 cycles because they are very prone to diving BG numbers or bouncing. Collecting data and learning your cat’s patterns are essential to determining if your cat might be in this category.
    • Conversely, holding the dose for too long can lead to glucose toxicity - when the blood glucose gets “stuck” and even increasing seems to do nothing. If this happens, seek advice on next steps.
    Increasing the dose: (numbers based on using a US human meter):

    Questions to ask before increasing the dose:
    • When does the current dose reach it's peak (nadir)?
    • How low has the current dose taken kitty over the last 72 - 96 hours?
    • What? You don't know when your kitty reaches nadir on this dose?
    • You don't know how low the current dose is taking your kitty?
    Nadir checks will provide the answer! It's your job to find out how low the current dose is dropping kitty before increasing the dose.

    Once you know your kitty's nadir over the last several days/nights, you'll know if an increase is needed. If you don't know how low the current dose is taking your cat you run the risk of your cat becoming over dose as well as experiencing a hypoglycemic event... not what any of us wants to happen. So, please recognize the importance of getting those nadir checks (day & night) BEFORE you increase the dose.
    • If nadirs are 100-200, increase the dose by 0.25 unit.
      • hold the new dose for 3-6 cycles unless the BG drops below 50. If the BG drops below 50, decrease the dose by 0.25u on the next cycle.
      • if your cat is new to nadirs under 200, you may notice that she/he feels a little sluggish and sleepy when first getting into healthier numbers. This is normal and will get better in time.
    • If nadirs are more than 200, increase the dose by 0.5u. Dose increases should be made every 3-6 cycles and should continue to increase until nadir numbers begin to come down.

    • If nadirs are 50-100, hold the dose for additional cycles.
      • If the nadirs start to rise, then increase the dose by 0.25u.
      • If nadirs stay in green numbers (50-99), continue to hold the dose.
    • If nadirs are under 50 on a human meter or under 68 on a pet meter, decrease the dose on the next cycle.
    Reducing the dose:
    • If your cat is in the first 3-6 months of diagnosis, reduce the dose by 0.25u anytime you see a BG below 50 on a human meter or 68 on a pet meter.

    • If your cat is between six months to a year of diagnosis, look at the overall picture of your data to determine if a 0.25u reduction is warranted on a single number below 50.
      • Prozinc can be a little volatile at times, and there will be the occasional random drop. If you have a consistent body of mid-cycle tests that indicate the low number is unusual, you may consider holding the dose and continuing to monitor or you may choose to just shave a little off the dose.
      • If the low number appears to indicate a general downward trend of numbers, then it may indicate that you should indeed lower the dose.
      • If your cat is more than a year since diagnosis, a single number between 40-50 should not mean a full 0.25u reduction. You may shave a little off the next dose, or just hold the dose and continue to monitor.
      • Additional numbers between 40-50 in the days following would indicate the dose should be reduced.
      • Any cat, regardless of time since diagnosis should receive a reduction if there is a number below 40.
    • Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.

    • 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.
    How to handle a low pre-shot number:
    • Sometimes your kitty will surprise you with a lower than normal PS number (but above 50). When that happens you have four choices:
      • Skip the dose: If the number is below 200, and your kitty is newly diagnosed (less than three months), your best option is to skip unless your kitty has ketones or is post-DKA (see below) and you should post here or in the Health Forum for help.
      • As you gain more experience and data, your goal is to gradually learn to shoot lower and lower numbers (never below 50). You can use other options below as you are learning to shoot below 200. Ultimately, with data, experience, and knowing your cat, you should be able to shoot PSs above 50 provided you are available and able to monitor.
        • If your cat has been diabetic for awhile and the PS is much lower than normal, you may still need to skip if you have to leave the house for many hours and can’t monitor, but in general we don’t recommend skipping if your cat has a good body of data, so see the other options.
      • Stall: Do not feed your kitty but wait 30 minutes and test again. (Note: we generally stall without feeding because food will falsely cause the BG to rise. It’s important to not shoot a food spike
      • If after stalling the number is rising into safer ranges, you can then give the full-dose shot. You can stall as long as you need to (in 30 minute increments), but keep in mind that the next shot needs to be 12 hours later, so be mindful of your new shot time. If it’s getting too late, try the next option.
      • Reduce the dose: How much to reduce can be a tough decision. Some of it will depend on how well you know your cat, how confident you are in testing, if you’ll be around to monitor, etc. This is a good time to ask for advice. If no one is around and it’s your first time, reduce the dose by 50%. If you have been at this awhile and know your cat’s reactions well, you can do a smaller reduction. If your cat is below 150, do not give a dose at all unless you can get regular BG tests throughout the cycle.
      • Give the regular dose: this is recommended if you are able to monitor closely and/or if your cat is a long-term diabetic (more than a year) and you have a lot of data to know it’s safe. Long-term diabetics with solid data can often safely shoot below 150 (and should if possible to do so safely).
    If the BG is in the 40s at PS:
    • Stall without feeding for 20 minutes and recheck the BG.
    • If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
      • Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?
    • Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.
    If the BG is in the 30s at PS:
    • Feed a small amount of HC food/syrup and a drop of syrup/honey and skip the shot, testing 20 mins after the meal to ensure the BG is coming up.
    • Be sure, even when you skip, to continue testing regularly until the BG is at a safe number and remains there more than two hours after eating.
    Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.

    Sometimes there are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines. Please ask for guidance if any of these or other circumstances present themselves or are of concern. If ketones are present or your kitty is post-DKA, it is best to not skip shots but please post for assistance.

    A few other things:
    • Sometimes the dose will require fine tuning by adding just a little more or a little less to the dose. We call this giving a Fat (a little more) or a Skinny (a little less) dose. This is helpful when your cat is very close to being in normal numbers. On your spreadsheet you can show it by putting the number of units followed by F or S. For example, if a cat gets 2u but the caregiver gives just a little more than that, the spreadsheet would show “2F” .
    • Find a pet sitter you can trust. This can be tough, but there are going to be times when you’re going to need help whether because something comes up in your schedule or because you suddenly need to leave town or spend the night in a hospital (heaven forbid!). Finding a pet sitter now and getting them trained before you need them will go a long way towards your peace of mind. If you don’t have a friend or neighbor who can help, try services like Rover or check with nearby vet offices to see if they have a vet tech who also does pet sitting, or if they do boarding. While nothing compares to your love and care, it is essential that you have a plan for backup should it become necessary.
    • Take care of yourself. This can be stressful, especially at the beginning. I promise, it will get easier in time. If you are just starting on this journey it may be hard to imagine right now, but in a few weeks, this will all be as routine as brushing your teeth. Make sure you are taking care of yourself. Visit friends. Get your sleep. Do what you need to do to keep up your own energy, health, and sanity. And know that there is a broad community here to support you.

    ADVANCED INFORMATION FOR EXPERIENCED PZ USERS

    As with all the stickies on the PZ forum, this document has had many authors who gave their time, energy and expertise: Bobbie And Bubba, Carol & Murphy, Elizabeth and Bertie, Kris & Teasel, Rachel, Robin&BB, Ruby&Baco, Sharon14 and Sue and Oliver (GA)
    Remember that your cat’s blood glucose is a moving target. What has worked for several cycles may suddenly be too little or too much. It is a good idea, especially in the beginning, to try to keep the same dose for 6 cycles. But that is not always possible long term if the cat runs consistently high or suddenly is too low. So in this document are some options for you to try.

    We strongly encourage you to post on this forum for the input of more experienced members before you attempt any of the advanced dosing options for PZ shown below, and whenever you have questions or concerns about your cat's diabetes treatment and/or other health problems, please consult your veterinarian.
    ADVANCED DOSING OPTIONS
    If you are 100% certain you have given SLGS and/or the modified method a fair shake and:
    • have ruled out any and all treatment errors/ missteps and have a SS already showing ample data (a month’s worth, at minimum),
    • have your cat on low-carb meals to achieve/ maintain optimum weight,
    • you know for certain that your cat is NOT getting into any contraband food sources,
    • you have already ruled out any hidden additional health problems with your vet that could complicate treatment ...
    then you may want to consider trying one of the advanced dosing options shown below. Before you proceed, please post on the forum for advice from experienced members of this forum and consult your veterinarian if you have any questions or concerns about safe treatment of your cat.

    SLIDING SCALE DOSING

    If your cat is having pre-shots in different ranges and it seems dangerous or ineffective to shoot the same dose for each pre-shot, you can consider shooting different doses for different ranges. (For example, giving 2 units on a 400 mg/dL {22 mmol/L} pre-shot can produce different results than giving 2 units on a 200 mg/dL {11 mmol/L} pre-shot.) Note: It is best to have an experienced member look at your spreadsheet history and suggest some ranges/ doses. Once you are comfortable with the concept, you might adjust on your own.

    11/13 OR 13/11 DOSING

    If your cat consistently has a lower AMPS or PMPS (or vise versa) AND IS NOT BOUNCING CONSISTENTLY, you might consider shooting early for the higher pre-shot number and later for the lower pre-shot number.

    If the AMPS is high or normal, but 12 hours later the PMPS is too low either because of long duration and/or the nadir is late, you have two options:
    • 1. Shoot the am dose one hour early (+11 relative to previous night’s pm dose) and leave the pm dose at normal time which will then be +13 since the am dose.
    • - OR -
    • 2. Leave the am dose at its normal time and shoot the pm dose one hour later which will be +13 since am dose. Either way, you need to see this as an issue and pattern over a few cycles to go this route
    This technique can also be used if the PMPS is high and the AMPS is too low.

    The hope here is to smooth out the cycle and have two shootable numbers every 12 hours. It would, as always, be wise to seek advice from your vet or on the forum about this technique.

    NOTE: If you are confused about bouncing, ask on the forum. You do not want to use this technique if your cat is continually bouncing from lower numbers.

    MICRO DOSING/ CHASING THE DOSE

    When your cat is consistently in numbers too low to shoot at shot time (and you are continually stalling or shooting late), and the cat is already in low BG levels throughout the 12-hour cycles, you might consider micro-dosing. This process should be guided by your vet and on the forum by experienced members, and will require more frequent testing.

    You may be shooting at times other than the 12/12 schedule, perhaps whenever the blood glucose levels rise enough to require a small dose of insulin. You will need to pick a number somewhere near the 150 -180 mg/dL {8.3 - 10 mmol/L} range at which you will plan to shoot, being sure that the number is indeed rising. The dose at these low numbers will vary with each cat and its patterns, so advice should be solicited. But you may be considering doses below 0.25 and even considering a “drop” of insulin. At this point, U100 needles marked on the half-unit and the conversion chart are required.

    It may also be important during this period to offer small frequent meals. You can also experiment with the lowest carb foods to help bring down the numbers. (To avoid the toxicity of excess mercury, we suggest you avoid feeding seafood-based formulas more than once or twice a week.)

    DOSING EVERY EIGHT HOURS

    If your cat is consistently having an early nadir and the level is consistently rising 6-8 hours after the shot, the insulin may not be lasting long enough. You might consider shooting more often than every 12 hours. BUT PLEASE BE AWARE: This method is very hard on the caregiver because you need to be available to monitor more often and to shoot every 8 hours. If you can’t make that kind of commitment, don’t try shooting every 8 hours. But if you do decide that your cat’s situation warrants trying this, here’s how it’s done:
    • First, divide the total amount of insulin you are already giving over 24 hours by 3.
    • Then divide your 24 hour schedule into (3) eight hour sections.
    • The first time you attempt this it’s wise to do start during a curve, checking the BG levels every 2 hours.
    • If, by +8, the levels are rising, no longer falling, and to a level above your No-Shot range, you could give another shot.
    • Then wait 8 hours, test to be sure the level is rising, not falling, and is above your No-Shot range and give another shot.
    Often this method is not long term, but allows the levels to stabilize in a few weeks. Make sure you only try this method with the guidance of this forum’s members and your vet.

    These are "general" guidelines which have worked for many cats. However, "Every Cat Is Different". Learn how YOUR cat responds to the combination of food and insulin. Please be aware: There are no specific "dose advisers" on the FDMB. The FDMB is an open board subject to peer review where laypersons with varied amounts of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions. We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications and care for your cat with your veterinarian.


    Sometimes there are special circumstances such as: the presence of ketones, an unusually low pre-shot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines. Please ask for guidance if any of these or other circumstances present themselves or are of concern.
     
    Last edited: May 3, 2020
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