Questions about Dose on ProZinc

Hello wonderful people!

To start, I use the AlphaTrak meter.
This morning my cat, Carlos, was at 152. I rechecked to confirm his number was so low and it was. We recently upped his dose to 2.75 of ProZinc after the 2.5 curve did not show the results we wanted. This morning I lowered his dose to 2.25 because I was worried about a hypo event. Should I have done that? Or should I have kept him at 2.75? I will be home most of the day because I am still a little concerned about him going too low on the 2.5 with such a low preshot number. How do you know when is too low to shoot their normal amount? My vet has asked that I shoot anything above 30. That seems really low to me to shoot and because she has given other questionable advice (like not to test) I question a lot of what she says.
Carlos has been eating Fancy Feast Pate for about 3 months. I have read the ProZinc Dose advice page that this form offers but would still like some advice from others on this page.

Thank you!
-Danielle

 

You need to test more in both cycles.
And if the 65 is from today you'll need to test the rest of the cycle, there's definitely potential for a low BG...
@Nan & Amber (GA) you here?

 

I am not a Prozinc person, so I can't be much help on dosing. Tagging @Panic and @Deb & Wink

 

Deb won't be here for many hours. Panic i don't know. But someone experienced should probably keep an eye out on this thread. Its early to go so low in the cycle

 

Maybe @JanetNJ can help

 

And I agree-- you need to keep testing after the 65 to make sure she hasn't gone lower. That number should be a light green on your spreadsheet-- anything below 68 on an AlphaTrak is a "take action" number.

I cannot believe your vet gave you 30 as a shot cutoff... That is incredibly dangerous advice!!!!

 

She'll probably go lower. Prozinc doesn't peak at +3. Im actually very worried

 

I just checked again and he is at 61. Do you think I should take him to the vet? I am going to check again in another 20 min

 

You need to update your SS so we can see whats happening. Take action means you need to be close, test and have high carb food ready

 

You'll get better advice here for the time being. @Nan & Amber (GA) can you stay?
I'm out dining

 

I updated in the notes section for the 61 number. Thank you for explaining. I have high carb food ready and I am not leaving his side

 

Where are you in the cycle? Have you fed lately? Do you have any HC food?
We don't know how Carlos BG responds to different levels of carbs. 61 is too low
Please give some HC food and retest in 20 minutes.

EDIT - 61 is too low for an Alphatrak

 

Sort of... I'm at work, so might get called away. I will try to keep an eye on things as best I can...

 

Right now we are in the 4+ hour mark. I gave him a little HC food and am giving it just a few more minutes before testing again

 

Give it at least 15mins for the HC to work.

 

Its better than nothing. I'm not nearly experienced enough to advise on this.

@Danidahl you need to update the new numbers in the +4 column
Shift lines and put @ the time in the same space to squeeze more readings in the same column

 

I think @Critter Mom is online and posting right now. Mogs, I know you aren't a prozinc person either, but apart from the dosing questions, can you help keep an eye on the low here?

 

Just re-tested and he is at 71!! Going to give a small amount of more HC food and test again!

 

I need to give my civvie her meds but I'll check back after. Shouldn't be too long.

I'm feeling really unwell so if anyone else can take the lead on this, please say so.

Please note that I won't have eyes on the thread until I post again.


Mogs
.

 

Oh no, I'm sorry Mogs. Feel better soon! Don't worry about this thread, there are several people here already, just take care of yourself.

 

Thank you for your help Mogs! Feel better. I just retested and he is @ 70. I think I have a good understanding of what to do now. I do have one question, how high am I hoping to get him during this HC food/test process? Thank you!

 

I think I'd only relax once he got well above 80, without food influence. I'd still give him a little HC now, he's still only a touch above 68.

 

Thanks Nan. After re-test he is at 83. I fed him a little more HC food and am going to check again in 20 minutes. Really appreciate the help

 

Hi Danielle,

You need to keep Carlos above 68 until the end of the cycle.

1. Test.
2(a). If BG less than 70, give 2 tsps HC food with a drop of honey, wait 20 minutes then go back to step 1.
2(b). If BG between 70 and 80, give 2 tsps HC food, wait 20 minutes then go back to step 1.
2(c). If BG between 80 and 90, give 1-2 tsps LC food, wait 20 minutes then go back to step 1.
2(d). If BG above 90, don't feed. Wait 30 minutes then go back to step 1.

Rinse 'n' repeat until Carlos stays above 90 for two hours without food intervention (better yet if he's over 100 to be on the safe side).



Mogs
.

 

Thank you so much Mogs!!! This is amazing advice, I really appreciate it so much. Feel better!

 

Thank you! I've got a stinking cold that I can't seem to shake off.

Keep posting your test results here so that members with an eye on you two will be able to monitor your progress. If you get stuck, change the title on your thread to let members scanning the board know the help you need.


Mogs
.

 

He is now at 94 around the 5+ mark. I am going to follow Mogs advice and will continue to update on his numbers. Thank you to everyone keeping an eye on this forum. This little guy is my whole world and it means so much that so many people jumped in to help him/me <3

 

@Nan & Amber (GA) -

Is it OK for me to go back to bed now?


Mogs
.

 

Others have jumped in to help us when we've needed it.


Mogs
.

 

Good thing you posted!
Another time, hopefully not, if you get a low neon green put the 911 tag on so we know what to look for. Hope he's feeling better

 

In the middle of a discussion at work (shhhh!), but I think it's wrapping up now.

 

911 is posted here. Dosing advise is usually given in the PZI group, and you're welcome to join in!

 

@Nan & Amber (GA) -

Ta for update. I'd be grateful if you could post to let me know as soon as you're clear. (Struggling.)


Mogs
.

 

OK, I think we're done-- get some rest, Mogs!

 

Don't need to be told twice.

Thanks, Nan.


Mogs
.

 

Just in case it wasn't clear, I was referring to my work meeting , not Carlos' progress. Please do keep updating us with your latest numbers, @Danidahl!

 

At 12:49 (6+) hour mark he is @ 90. I apologize for taking longer to get his readings. He is completely done with me poking him and is summoning the strength of a full grown human. He is normally so easy going about his pokes but I think the constant poking is really starting to frustrate him

 

Oh, poor little guy! Definitely a rough day for him!

He's been over 90 now for about an hour, right? I think you can give him a bit of a break, maybe test once more in an hour if he'll put up with it?

 

Correct, he has been in the 90s for almost a full hour. He keeps trying to take a nap with his little brother so I think letting him sleep for an hour would be something he would enjoy. I will keep an eye on him and update with the next number Thanks Nan

 

Just tested and Carlos is now at 133 and it has been around 2 hours since he was last given anything to eat! Thank you to everyone! I feel like I can finally breathe knowing that we made it past this. Not sure what I would do without this group but forever thankful for all the support

 

Like Mogs said earlier we were ALL helped by someone here once...

 

Hope you feel better soon Mogs

Gill

 

Shot above 30??? Omg at 30 your cat could be in convulsions from being too low!!!! Are you sure he didn't mean 230? With an alpha meter you don't want to see anything under 68!

 

Sorry I missed this tag today. I was busy with my son's online schooling and getting together my own lessons (teacher). I'm glad you were able to handle it so well and had lots of support.

 

Hi Danielle I'm glad everything turned out OK.
I have to tell you that you made me laugh out loud when you said he is summoning
the strength of a full grown human.
That was too funny.
Have a good night

 

@Danidahl I was reading the Prozinc Sticky, did Carlos just earn a reduction
because his BG dropped below 90 today?
@Nan & Amber (GA)
Hey Nan just saw you on did he just earn a reduction?

 

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

Prozinc Sticky

 

What the
Your no-shoot number should be 150!

I would be hesitant to stick to 2.75u ... it is always good to be cautious with lower than normal pre-shots, so reducing today was the right decision. I wonder if 2.5u would be better.

 

I don't "do" prozinc dosing as a rule, but in this case, since Carlos dropped below 68 on an AT2, I think he's earned a reduction under any dosing method, right?

I believe I once had a conversation with Deb where (if I remember correctly), she indicated that the reduction is taken from whatever dose produced the low, which means down 0.25U to 2.0U(prozinc folks, please correct me if I'm wrong-- I could definitely be misremembering ).

 

Oh good, Elizabeth is here to clear this up!!!! I will retreat back into the shadows on this one...

 

@P

Hi Nan that's what the Sticky says, just don't want her to have another day like today with him dropping too low/again

 

@Panic
Hi Elizabeth I was wondering if Carlos earned a reduction today since he dropped
below 90 , I was reading the Prozinc Sticky

 

No come back, we need to figure this out!!

My instinct would be to drop to 2u as well but I thought I saw that you put the lower pre-shot into account and don't base off of it ... perhaps that was for Lantus?? @Deb & Wink help us figure this out? XD

 

N

Now I am really curious

 

My instinct is 2u too, at least for a couple of cycles. And I'm remembering along the same lines as Nan. The dose reduction is taken from whatever dose produced the low.

 

That's what I thought, reduce down to 2 units

 

Janet recommended on the Prozinc forum to keep at 2.75u ... which sounds high. I don't know.

 

errrrgggghhhhh.... Honestly, I feel like the prozinc discussion is outside whatever expertise I might have, but I can say something about lantus:

With Lantus, you always have to take the depot into account. So, if you were dosing at 2.75U for a week and got a low off of a BCS, you would (usually) ignore the BCS and assume that "the depot done it" and reduce off of the 2.75U that built the depot.

My understanding with Prozinc (such as it is) is that, while there's some carryover between shots, it's not nearly as big a factor as the Lantus depot, so you focus more on the shot that produced the low than previous shots.

Plus, there's the fact that @Danidahl had to fight those low numbers for a while...

 

No reduction at all????? Now that I don't get...

 

This would make more sense to me if that is the case honestly.

 

Look what I've created by asking that question lol

 

Chaos.

 

Don't make me laugh, I just didn't want her to have a night like she did today

 

Hello everyone! I am so sorry I just saw these. His pre-shot number was 597 so we shot the 2.75 dose. We did 2.5 dose for over a week and his numbers were still really high. He only went to the 2.75 on Monday, going to take a reading in a little bit to make sure he isnt shooting down but with such a high preshot number I am not super worried about a hypo. I really appreciate your help. Today was horrible and I am exhausted. And I confirmed with my vet twice that they wanted me to shoot for anything over 30 because it went against everything I had previously read. The conversation went from her telling me not to test, me saying I would be testing no matter what, and her saying if I continue to test she wants me to shoot anything over 30 and doesnt want to get panicked voicemails from me and to just shoot as she has prescribed. I am looking into a new vet but for now I am just trying to get his dose right myself (and with the help of all of you wonderful people). I will lower him back to 2.5 in the morning and try it for a few days to see how it goes because I really don't want him to have another day like today. Hope everyone has a good night!!

 

Yes, do look for a new vet. We have seen cats here with symptomatic hypos and seizures at more than 30.

 

Well excuse me.

 

Yeah. Absolutely time for a new vet.

 

@Nan & Amber (GA)
Found the thread (we) were thinking about...I copied a partial note from one of Deb's posts for my personal notes and just dug up the thread I got it from, starting around post #40.
https://www.felinediabetes.com/FDMB/threads/low-amps-but-skyhigh-pmps-what-dose.233172/#post-2605866

 

My recommendation would be to drop the dose to 2U. That is based on Carlos dropping too low on the 2.25U dose this AM. He's bouncing sky high now at PMPS, but that is to be expected after the lows this AM. BLACKS = BOUNCING in almost every instance. RED BG ranges mean the same, a bounce.

You're correct Nan. Reduction needs to be taken based on the current cycle insulin dose for Prozinc.
Yes, the reduction was "earned" since Carlos dropped below 68 on the alphatrak (that is like 50 on a human meter). The exception would be if the member has a LOT of test data and knows how their cat reacts to the different carb levels of food. That is not the case with Dani and her Carlos. She is too new to this "sugardance" to make those kinds of choices to keep the dose higher when her cat dropped so low today.

Personally, I think Carlos is being overdosed, and is dropping too low at night. Need some tests during the PM cycle to show us what is happening then.

Dani, as you can see there are varying opinions and suggestions on what the dose should be for your cat Carlos. This happens sometimes, and ultimately you hold the needle and need to make the decisions on how much insulin to give your cat Carlos.

We really want to try to find an insulin dose that you can give the same amount both AM and PM cycles for several days. Plus, let's see how fast Carlos clears this bounce.

 

I was going to suggest that you need to be testing him at night also.

 

Thank you Deb. I will probably feel more comfortable lowering his dose for a bit, especially after today. Why do you think he is dropping low at night? Do cats drop lower at night than they do during they day? For his dose reduction, do I always take it at .25? Or Should I go lower?

 

Well my vote goes to 2u then

Thanks Deb!!

 

Cats just usually drop lower at night, I can't tell you why
We usually decrease or increase by 0.25 units

 

Many cats are more active at night, and more activity burns up more glucose, so they drop to lower BG levels.
I'm also seeing lots of reds and black BG ranges on the SS, which to me says the dose is too high, and is taking him too low sometime during the cycle. When is the question.

The way to find out the answer to that question, is to do some testing. A good test to get is the "before bed" test, around +2 to +3. And maybe set an alarm to get a test around +5 or +6. Yes, I know, OUCH on your beauty sleep but testing can't be avoided at night, or you only have half the picture of what is going on.

Dose reductions at this particular dose are in 0.25U increments. Only if your cat is more than 1 year since diagnosis, the the guidelines are different. If the nadirs are >200, than larger dose increases are needed.

Dani, would you start a new thread please, and link this one in at the top? When threads get too long, it gets hard to follow them. Plus it makes the database behind the scenes slower to work. Thanks.

 

Hello,

I created a new thread Thank you for the advice @Deb & Wink . Doesnt look like there is a hypo risk today! New thread is linked below if anyone had any additional advice or ideas tho

https://felinediabetes.com/FDMB/threads/dose-advice-for-carlos-continuation-of-past-thread.236940/

 

One word: horrifying.

Ever get the feeling someone's in the wrong line of work?

The treatment approach she advocates could result in panicked calls alright.

Don't walk, RUN!


Mogs
.

 

Thanks Mogs! I felt very similar and am really upset with the vet. She is the third one I have gone to and got really annoyed when I said I was testing and showed her my spread sheet. She said I was taking it too seriously and that I just needed to trust that she knew what she was doing. The only good thing that came from the visit is she wrote me a prescription for ProZinc so that I could move away from the Vetsulin. I just moved to the area right before Carlos got diagnosed and am finding a lot of the vets near me are pretty terrible when it comes to cat diabetes. I got a few recommendations from the fb group for vets that are around an hour away and am hoping one of them ends up working out

 

To which the appropriate reply would be:

"Excuse me, but I take treating my cat with a potentially lethal medication very seriously indeed, and I'd rather trust what my cat's blood glucose is doing, thank you very much (especially when you're telling me it's OK to give insulin to an already hypoglycaemic cat!)."

I wish you every success with your vet hunting, Danielle.


Mogs
.

 

I think i caused chaos. hahahaha i think that low preshot was an anomaly which is why I thought in general she doesn't need a reduction. 2.5 is good though and we can hold it for a few days and see how she does.